CMS Offers Physicians and Providers Help Prepping for ICD-10

By Kelly A. Briganti, Editorial Director, G2 Intelligence

With the transition to ICD-10 looming, the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association issued a joint press release highlighting various educational resources for providers to help them prepare for the new codes for medical diagnoses and inpatient hospital procedures.

“As we work to modernize our nation’s health care infrastructure, the coming implementation of ICD-10 will set the stage for better identification of illness and earlier warning signs of epidemics, such as Ebola or flu pandemics,” said CMS Acting Administrator Andy Slavitt, in a press release. CMS also explained in its release that the ICD-10 codes are a much-needed update for diagnosis codes that are over 35 years old and ICD-10 should improve emergency response to “disease outbreaks and adverse drug events, as well as support innovative payment models that drive quality of care.”

Among the resources CMS has provided to help physicians adjust to ICD-10:

  • “Road to 10” – a web-based resource for small physician practices that includes a quick start guide, an interactive case study tool that quizzes providers on coding specific clinical scenarios—with new scenarios added weekly, specialty-specific tools, webcasts, videos and assistance in building an action plan for the transition.
  • Training videos.
  • Frequently Asked Questions regarding the transition.

CMS also plans to establish an ICD-10 Ombudsman to assist providers in the transition as well as a communication and collaboration center to monitor implementation. The agency promised guidance explaining how to submit issues and concerns to the Ombudsman.

Pathologists and laboratories will be happy to hear that CMS will give the industry time to adjust to the new codes. The Frequently Asked Questions state that for the first 12 months after implementation, claims won’t be denied solely based on ICD-10 specificity if a code in the correct family is used. Nor will penalties be issued with regard to quality reporting due specifically to ICD-10 specificity if an ICD-10 from the “correct family of codes” is used.

AMA President Steven J. Stack praised CMS for its response to provider concerns that “inadvertent coding errors or system glitches during the transition to ICD-10 may result in audits, claims denials, and penalties under various Medicare reporting programs” and committed to working with CMS to help ease the transition to ICD-10. The AMA provides resources for ICD-10 adoption on its website AMA Wire.


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