CMS will deny unspecified ICD-10 codes on October 1, 2016.

CMS Grace Period for unspecified ICD-10 codes comes to an end on October 1, 2016.

When use of the ICD-10 codes began just one year ago, we all greeted it’s arrival holding our collective breath. As it turned out, it really wasn’t all that bad. CMS did their homework, as did vendors and professional organizations in making crosswalks and look-up tables available that eased the transition. Part of the reason that the transition was only mildly painful was that CMS provided a one-year grace period on the use of unspecified ICD-10 codes. That grace period expires on October 1, 2016.

This means that if you are not reporting diagnoses to the highest level of specificity (ex: left vs right vs bilateral), your claims may be more closely examined and/or rejected. We are encouraging providers to review their frequently used codes to determine if they are still using unspecified codes and to begin editing their patient records accordingly.

You can find more information from CMS’s guidance by clicking here and reviewing Question 7.

Although we would like to be able to tell you exactly what codes to use, we are not coding experts and instead direct you to your professional association and/or carrier for further clarification.

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