Updated on: March 17, 2016

CMS ICD-10 Testing Results Revealed, Confusion Persists

Original story posted on: February 26, 2015

Editor’s Note: Diane Kovach, the CMS director of the provider billing group will appear on Talk Ten Tuesdays March 3, 10 am. EST.

Amid the urgings of the American Medical Association (AMA) to have its members write letters to their congressional representatives advocating for a repeal of ICD-10, the Centers for Medicare & Medicaid Services (CMS) yesterday announced the results of its recent ICD-10 end-to-end testing — an initiative that saw approximately 660 providers and billing companies submit nearly 15,000 test claims to Medicare between Jan. 26 and Feb. 3.


According to a fact sheet from CMS, 81 percent of the test claims were accepted; 14,929 test claims were received with 12,149 being accepted. Thirteen percent of submitted claims had administrative errors that were not related to ICD-10.

The announcement was posted yesterday on “The CMS Blog” by CMS Administrator Marilyn Tavenner, who announced last month that she is stepping down from her post. CMS Principal Deputy Administrator Andy Slavitt will become acting administrator when Tavenner, as expected, exits next week.

Beyond reporting the results of the Medicare end-to-end testing, Tavenner said the testing also revealed problems of a different nature — uncertainty about the implementation date of ICD-10, which is still set to become mandatory by Oct. 1, 2015. Hoping to quell rumors, Tavenner wrote that the agency had identified a “point that has caused some confusion.”

Tavenner said that ICD-9 is for services provided before the Oct. 1 deadline, and that ICD-10 is for services provided after Oct. 1, 2015.

“That means ICD-10 can be used only for test purposes before Oct. 1. And only ICD-10 can be used for doctor’s visits and other services that happen on or after Oct. 1,” Tavener said. “ICD-9 cannot be used to bill for services provided on or after Oct. 1. This rule applies no matter when the claim is submitted, so claims submitted after October 2015 for services provided before that date must use ICD-9 codes.”

“This successful week of testing continues to put us on course for successful implementation of this important initiative that better reflects modern practice of medicine by Oct. 1, 2015,” Tavenner added. “Since ICD-10 codes are more specific than ICD-9, doctors can capture much more information, meaning they can better understand important details about the patient’s health than with ICD-9-CM.”

In reporting on the results, Tavenner acknowledged that some claims were rejected and noted that “most didn’t meet the mark because of errors unrelated to ICD-9 or ICD-10.

The reported testing errors are a concern to Stanley Nachimson, who sees warning signs for providers.

“Some 19 percent of claims were rejected (and) only a few for ICD-10 coding errors, but quite a bit for other types of errors,” Nachimson told ICD10monitor. “To me, this shows that provider systems are not completely ready for the transition. It indicates that more providers need to test their systems ahead of time so that any errors, ICD-10 and non-ICD-10 errors, can be found and corrected well before Oct 1.”

On the other hand, Nachimson, on whose watch while a senior technical advisor at CMS, the country implemented 4010, said that from a Medicare perspective, the agency should feel good about the results.

“I think the results, from a Medicare perspective, give them some assurance that they have done a good job, said Nachimson.  “There was only one ICD-10-based Medicare systems error, which can be corrected well in advance of Oct. 1.”  

Read the CMS fact sheet

Program Note

The Centers for Medicare & Medicaid Services (CMS) ICD-10 end-to-end testing results will be discussed at length during an exclusive Talk Ten Tuesdays broadcast this coming Tuesday, March 3, beginning at 10 a.m. EST. Appearing with an update on the testing results will be Diane Kovach, director of CMS’s provider billing group. Register to listen.

Chuck Buck

Chuck Buck is the publisher of ICD10monitor and is the executive producer and program host of Talk Ten Tuesdays.