Updated on: November 28, 2016

Developing Story: Fix to First ICD-10 Glitch Reported

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Original story posted on: October 9, 2015

Efforts to fix what has been identified as the first significant issue to emerge under ICD-10 — medical necessity — appear to be underway with Medicare Administrative Contractor (MAC) NGS reporting that it will update its local coverage determination (LCD).

The LCD issue surfaced earlier this week, when Laurie Johnson, MS, FAHIMA, reported on Tuesday’s edition of ICD10monitor’s “War Room” broadcast that some policies that contained a non-specific code in ICD-9-CM did not include a corresponding code for ICD-10.

 

NGS, in a posting on an American Health Information Management Association (AHIMA) listserv, said it would update the LCD L33627 to include I73.9, which is the non-specific code for peripheral vascular disease; it will be applied retroactively to Oct. 1, 2105.

“We will add ICD-10-CM code 173.9 to the referenced LCD for peripheral arterial examinations (CPT® codes 93922-93931),” the posting read. “It should be considered as a covered ICD-10-CM code retroactive to 10/01/2015. The revised LCD will be viewable in the Medicare Coverage Database next Friday, Oct. 16, 2015.”

In a related development, another medical necessity issue has been reported with a Novitas LCD policy.   The policy number is L35125 (Wound Care). The issue with this policy is that the ICD-10-CM unspecified stage of pressure ulcer codes have been omitted from the policy.   

According to Johnson, this policy oversight will increase appeals, delay reimbursement, and create additional rework. The patients may be affected as they may not be able to afford the cost of the care out-of-pocket.

 “The process of reporting these issues is important to resolve ICD-10 issues”, added Johnson, director of health information management (HIM) for Panacea Healthcare Solutions. This issue (LCDs) will have a big impact on registration, patients, physicians, and payers. It will also impact the revenue cycle (due to) slow reimbursement.”

 

 

Chuck Buck

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

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