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CMS Clarifies ICD-10 Provider Flexibility Guidance

The Centers for Medicare & Medicaid Services (CMS) has further clarified its guidance around flexibility for providers during the transition to the International Classification of Diseases, 10th Edition (ICD-10) diagnosis and procedure codes. Providers currently have a one-year grace period during which Medicare audit contractors (MACs) will not deny physician claims due to incorrect ICD-10 codes, as long as the code the provider lists on the claim belongs to the correct code family. The grace period will apply to similar accuracy issues in the meaningful use, value-based modifier, and Physician Quality Reporting System programs. The update includes greater clarity around what MACs will accept, including examples of what constitutes a code family.

Providers must begin submitting claims to CMS using ICD-10 codes on Oct. 1. America’s Essential Hospitals has compiled a list of resources to help members prepare for a seamless transition to ICD-10, including fact sheets, implementation guides, interactive guides, and more.

If you have any questions or concerns, please contact Beth Feldpush, DrPH, senior vice president of policy and advocacy, at bfeldpush@essentialhospitals.org or 202.585.0111.

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About the Author

Matt Buechner is the policy and advocacy associate for America's Essential Hospitals.

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