Earlier this month, Centers for Medicare and Medicaid Services (CMS) made a surprising announcement that drew a sigh of relief for many medical practices across the country. It was not the total elimination of ICD-10 that some people had been (or perhaps still are) dreaming of, but the new ICD-10 grace period was a compromise of sorts intended to help ease the transition for physicians and help reduce disruptions in payor reimbursement.
CMS has granted a 1 year grace period for ICD-10 billing codes that are sent out on Medicare claims beginning on Oct. 1. During the grace period, claims will not be denied based solely on the specificity of ICD-10 diagnosis code submitted, as long as the code is from an appropriate family of codes. How do you know if the code is in the correct code family? CMS has released a document to help answer many questions about how to best submit ICD-10 codes on claims. The American Medical Association (AMA) was a driving force behind this new flexibility around ICD-10 code submission.
The new grace period doesn’t just stop at ICD-10 codes - it also affects the Physician Quality Reporting System (PQRS) as well. Health care professionals who are eligible to report on PQRS value-based modifiers will not be penalized during the 2015 reporting year for failure to select a specific enough modifier; the code just has to be from the appropriate family. CMS will still apply a negative payment adjustment to any eligible professionals who do not report the required number of PQRS measures this year.
Even with this grace period, the reality is that practices still do have to submit ICD-10 and PQRS codes and they should be submitting them accurately. Practices who have already implemented ICD-10 into their electronic charge capture system may not need that extra buffer, and it will be business as usual when the clock strikes Oct. 1.