ICD-10 Flexibility Ended October 1st

 In Articles, ICD-10, News, Provider Notes

ICD-10 became a requirement for medical claims one year ago. For the first year, the Centers for Medicare and Medicaid Services (CMS) allowed providers and coders to use diagnosis codes in the correct “family” of codes even though many were not to a high level of specificity. The goal being to allow providers to transition to ICD-10 without a massive denial rate.

The one-year grace period for non-specific codes ended October 1st, 2016. In order to achieve higher specificity, CMS deleted 320 codes and added 1,974 codes. The changes are not phased in but instead are fully effective on claims with date of service 10/01/2016 and newer. Medicare had no issue in updating their systems with new or deleted codes so claims will process without delay. Unspecified codes are still acceptable in particular cases but the most specific diagnosis code for the encounter should be used when appropriate. Cardiovascular, ophthalmology, GI, endocrinology, and spinal surgery are a few of the specialties with the highest volume of changes. Download the list of deleted and new codes here.

Providers can do a few things to help ease the pain of the changes. Within their EMR, providers should review their diagnosis code lists to make sure no deleted codes exist as well as review added codes to see if any are pertinent to their practice. The majority of practice management systems will automatically have the new and deleted codes updated, but programming changes might be required to remove defaults of last encounter codes (MSOC Health clients, this has been done for you).

With the changes, Medicare updated its NCDs and LCDs as well on October 1, 2016 to account for the deleted codes. Palmetto GBA have updated the following policies and providers should review updates found here.

LCD ID Title LCD ID Title
L35048 Nerve Conduction Studies and Electromyogrphay L33449 Swallowing Studies for Dysphagia
L33464 MRI of a Joint L33448 Stress Echocardiography
L33438 Octreotide Acetate for Injectable Suspension (Sandostatin LAR depot) L34415 CT of the Abdomen and Pelvis
L33467 Ophthalmology: Extended Ophthalmoscopy and Fundus Photography L34513 Flow Cytometry
L36109 Minimally Invasive Treatment for Benign Prostatic Hyperplasia Involving Prostatic Urethral Lift (Urolift ®) L33420 Bladder Tumor Markers
L34576 Laparoscopic Sleeve Gastrectomy for Severe Obesity L33418 Assays for Vitamins and Metabolic Function
L36427 Wireless Capsule Endoscopy L33431 HbA1c
L33455 Wireless Gastrointestinal Motility Monitoring Systems L34512 Corneal Pachymetry
L36129 MoIDX: Biomarkers in Cardiovascular Risk Assessment L33423 Cardiac Computed Tomography & Angiography (CCTA)
L35632 MoIDX-CDD: ConfirmMDx Epigenetic Molecular Assay L34412 Cardiac Rehabilitation
L33443 Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control L34413 Cataract Surgery
L33471 Transesophageal Echocardiography (TEE) L33428 Cosmetic and Reconstructive Surgery
L33456 Total Joint Arthroplasty L33422 Brain Natriuretic Peptide (BNP) Level
L33472 Transthoracic Echocardiography (TTE) L33457 Cardiac Radionuclide Imaging
L33452 Virtual Colonoscopy (CT Colonography) L33459 Computerized Axial Tomography (CT), Thorax
L34434 Upper Gastrointestinal Endoscopy & Visualization L33433 Infectious Disease Molecular Diagnostic Testing
L35026 Ritiuximab L33461 Implantable Infusion Pump
L33446 Respiratory Therapy and Oximetry Services L33416 3D Interpretation and Reporting of Imaging Studies
L33447 Special Electroencephalography L33417 Allergy Skin Testing
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