Updated on: November 28, 2016

End of Medicare ICD-10 Grace Period Prompts Call for More Education

By
Original story posted on: August 22, 2016
Renewed interest in ICD-10 education has been prompted by the announcement last Thursday from the Centers for Medicare & Medicaid Services (CMS) indicating that the Medicare ICD-10 flexibilities agreement will end and will not be extended beyond Oct. 1, 2016.

CMS also stated that Medicare would not “phase in” the requirement to code to the highest level of specificity. The agency indicated that providers would be required to code “accurately to reflect the clinical documentation in as much specificity as possible.” 

“This announcement from CMS highlights the importance of continuing ICD-10-CM education as well as clinical documentation improvement,” said senior healthcare consultant Laurie Johnson, stressing the importance of continuing education. “This announcement also answers the question about how long the unspecified codes will be accepted. Please note that CMS has stated … that unspecified codes have their role, but the reviewers will be evaluating if the code matches the specificity in the clinical documentation.”  

Yet another developing situation is also making the case for additional ICD-10 education. Last week, ICD10monitor revealed a potential catch-22 in the recently released ICD-10 coding guidelines. The issue involves what facilities are to do when physicians document diagnoses that may be unsupported by the clinical circumstances reflected in the medical record.

There is a section in the guidelines that reads: “the assignment of a diagnosis code is based on the provider’s diagnostic statement that the condition exists. The provider’s statement that the patient has a particular condition is sufficient. Code assignment is not based on clinical criteria used by the provider to establish the diagnosis.”

If the diagnosis is not clinically validated, then both Recovery Auditors (RAs) as well as commercial insurance auditors are going to deny the claim. On the other hand, if the coder or the facility decides not to report the diagnosis, then they are in violation of the coding guidelines, which is also a major problem.

Against the backdrop of these two issues, ICD10monitor is offering providers a four-part, interactive, hands-on ICD-10 workshop series that begins today. The series will be led by two health information management (HIM) authorities in Laurie Johnson and Sandra Brewton. 

Titled Count Down to Ten: Preparing for Massive ICD-10 Code Changes,” the first workshop will be conducted Wednesday, Aug. 24 and will focus on the PCS guidelines and definitions. This will be followed by the following presentations:

Workshop No. 2: Non-Cardiovascular PCS Update and Guidelines
Thursday, Aug. 25, 1:30-2:30 p.m. EST 

Workshop No. 3: Cardiovascular PCS Update
Wednesday, Aug. 31, 1:30-2:30 p.m. EST

Workshop No. 4: ICD-10-CM Code Update
Thursday, Sept. 1, 1:30-2:30 p.m. EST

Johnson is currently the director of HIM consulting at Panacea Healthcare Solutions. Laurie is an American Health Information Management Association (AHIMA)-approved ICD-10-CM/PCS trainer, a past president of the Pennsylvania Health Information Management Association (PHIMA), and a current member of the AHIMA Classification and Clinical Terminology Practice Council; she also has a bachelor of science degree in health records administration and a master of science degree in healthcare information systems from the University of Pittsburgh. Laurie is a member of the ICD10monitor editorial board and is the national correspondent for Talk Ten Tuesdays, a live, weekly Internet radio broadcast.

Brewton is a senior healthcare consultant for Panacea Healthcare Solutions. Previously, she supervised the inpatient coding department of a major university healthcare system.
Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Chuck Buck

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

Related Stories

  • Things Your Mother Never Told You About HCC: Version 23
    The 2019 CMS risk adjustment model is version 23. The Centers for Medicare & Medicaid Services (CMS) released, in April, the latest update to the CMS-hierarchical condition category (HCC) Risk Adjustment Model (V23).  It applies to payment year 2019.  As…
  • Digesting the Medicare Physician Fee Schedule for 2019
    CMS issued the final rule on Nov. 1. The Centers for Medicare & Medicaid Services (CMS) final rule includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (MPFS) on or…
  • “Shock and Awe:” The 2019 MPFS
    CMS released the MPFS on Nov. 1, ending months of turmoil. The Centers for Medicaid & Medicare Services (CMS) released the final rule on the Medicare Physician Fee Schedule (MPFS) and the Quality Payment Program (QPP) on Nov. 1. The…