ICD-10 Flexibility Ended October 1st
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|