Home Forums Non-specific codes in ICD-10

Here is an interesting article about coding in ICD-10.
While various carriers have some leeway (apparently this is especially true for Medicaid in various states)... the following exerpts are worthy of note:
"Under ICD-9, Medicare has ALWAYS accepted ?less specific? codes...CMS has reiterated numerous times that their acceptance of unspecified codes will not change as a result of the ICD-10 transition."

"To reiterate for emphasis, ?it is acceptable to report the appropriate ?unspecified? code?. This is the official policy approved by CMS. All HIPAA-covered entities are required to abide by this policy because it is part of the official HIPAA ICD-10 code set standard. We are unaware of any payers that have stated an intention to violate this policy and disallow unspecified codes. Thus, the issue of the level of code specificity required is a non-existent problem."

The article includes references to CMS documents supporting these and other statements.

This runs directly counter to the ICD-10 panic drummed-up by the industry of consultants out there "helping us" through the transition.

http://hitconsultant.net/2015/07/03/why-non-specific-icd-10-codes-are-a-non-issue/

So far --cross fingers-- we are using a mix of unspecified and specified codes from the drop down lists and crosswalks of various "conversion" programs.
No hitch yet.
I suppose with time we will find ut which codes need to be more specific, but no denials yet.

No worries. I am sure the insurance companies start denying various claims for ICD10 specificity in the coming years. It will probably be seemingly random and illogical - they are good at that.

I just don't see how they can really police all that specificity.

If someone comes in with a sprained ankle to an outpatient clinic, there is no way the insurance company will care whether it is right or left. Probably will eventually need to put whether it is initial or subsequent -- but then there is the problem of whether a "subsequent" visit is only for a different clinic or even different doctor in the same clinic.

When it comes to things like URI -- how are they going to care whether it is "sinusitis" or "unspecified upper respiratory infection" -- unless it is paired with a CT scan or something like that.