Home Forums Discussions Coding and Billing ICD-10 code flexibity expired October 1st

CMS has announced that Medicare ICD-10 flexibility about specificities of the coding expired October 1st. Contractors performing medical review can now deny claims solely for lack of specificity of the ICD-10 code. Has anyone received any rejections yet?

Ironic that you say that. You and I were the only ones who commented on why it would be nice had CMS overlook a claim rejection but let us know it would have been rejected based on this or that. But, then that would mean they could reject less claims.

Government just makes it harder and harder and harder to be a doctor. One day, they will wake up, and there will be no more claims to reject.

Really frustrating that doctors don't have a union. Seems like the AMA would be perfect, but I think they work for the other side.

Thank you so much for that alert. Our Oct 3rd claims should be getting processed now so I'll keep an eye out over the next few days.

How do you stay up to date with these things?
(Please don't say Reading the MLN newsletters). Is ICD10watch.com a good source.

At the risk of being labeled (accurately) as a nerd, there is CMS.gov Email update you can sign up for.

It's not just more specificity. There are 1900 new codes in ICD-10 CM as of 10/1/2016, which have unfortunately not been updated in AC version 8.2.4. Anyone know if AC version 9 ICD-10 codes have been updated? As an example, E78.0 Hypercholesterolemia is no longer a valid code as it now needs an additional digit.

just downloaded 9.2 a couple of days ago and E78.0 shows up as a valid code, damn looks like I'll be getting a lot of denials to correct

Oh another problem if you go into dx's and try to add the expanded code it is not accepted, quick fix needed

Unfortunately, every insurance company and the government will all administer these rules differently.

It is impossible to know how specific to be in many cases, especially if we are coding for symptoms and don't really have a diagnosis.

In reality, we will each build our own library of accepted codes based on our individual experiences with the insurance companies we bill -- it will only take a few rejected claims to figure out which claims get paid.

As I said a long time ago, ICD-10 is not at all about increasing the accuracy of coding (for some not-very-well-defined public purpose that "demanded" ICD-10). It is about jobs for coders, coding teachers, conference centers that host "coding workshops" and revenue for the AMA selling code books.

Real doctors will learn to game this, and very quickly.

I agree that the best way to combat this is to use the least specific to document the specific. i.e. Fever rather than right lower quadrant fever.

But, for those of us who are rich, why not have fun and try using fun codes like falling out of an airplane without a chute or falling off a train onto a passenger. If it gets turned down you can always try to be more specific by falling off a train onto am employee. Especially if it is a workman's comp case.

Bert! We think alike. I have already added a question in my ROS to find the next patient with W22.02XD: V95.43XS: Spacecraft collision injuring occupant, sequela.

We usually do. If you do find one, please let me know. I have a patient who was thrown from a spacecraft when it suddenly veered from a comet. He is looking for a support group. FYI: There is a modifier for involvement of a comet.

I always suspected that there was a human stowaway on Rosetta when it crashed into that comet.

Although, there are many and you see them every time when you are looking for a diagnosis, my favorite is still.

Fell in other hole. There is no ICD-10 code for Fell in hole or at least there wasn't in ICD-9. So you had to document that the patient fell in a hole, NOS (somehow), before you could diagnose him with Fell in other hole.

Now looking it up, it is Fall into hole. There is no fall into other hole. There are a million of these, so don't want to start a thread of funny ICD-10 codes, but there is Fell from a bike after hitting a pot hole. So, would it not be specific enough if you didn't mention the pot hole? Would they read the note? Would the call the family? How would BC/BS know about the pot hole.