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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 or 202.585.0111.


About the Author

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

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