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ICD-10 Flexibility to Expire Oct. 1

Claims auditing and quality reporting flexibility during the first year of ICD-10 implementation will expire on Oct. 1, according to updated guidance from the Centers for Medicare & Medicaid Services (CMS).

CMS did not deny physician claims due to incorrect ICD-10 codes for the first 12 months after implementation of the ICD-10 diagnosis and procedure codes, as long as the code the provider listed on the claim belonged to the correct code family. The one-year grace period also applied to the electronic health record incentive, value-based modifier, and Physician Quality Reporting System programs.

Starting Oct. 1, CMS review contractors will be able to use coding specificity as the reason for an audit or a denial of a reviewed claim to the same extent that they did before Oct. 1, 2015.

CMS also clarified that there will be no additional phase-in process and they will not release any additional guidance on ICD-10 flexibility.

If you have questions or concerns, please contact Erin O’Malley, director of policy, at or 202.585.0127.


About the Author

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

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