News: ICD-10-CM grace period ends October 1

When ICD-10-CM was launched last year, CMS said it would allow providers billing Part B physician fee schedule codes a one-year grace period to fully ramp up. During the grace period, the agency would not deny physician claims as long as the codes on the claim were from the correct “family of codes” and met medical necessity.

On October 1, that grace period comes to a close.

Now, physicians have less than a month to ensure billing and coding staff are fully trained and able to select the correct ICD-10-CM code—not merely those within the same family of codes. The agency reminded providers of the approaching deadline in an updated FAQ document released in August.

Additionally, in an FAQ from July 2015, CMS defined a family of codes as the ICD-10-CM three-character category. Codes in a given category are clinically related but capture different specific information about a condition.

CDI teams should proactively review the list of 2016 valid codes and the new codes that will come into effect in 2017, so they know when to place a query and the level of specificity required for provider documentation. CDI programs looking to expand into hospital-owned physician practices to help address documentation needs should run an audit of current documentation to identify trends, noting which diagnoses most often come up as unspecified or without needed level of detail. Educating the physicians and helping them obtain that needed level of specificity can help with overall support of CDI efforts in the physician practice setting.

Editor’s note: This article was adapted from the original, which published in Physician Practice Insider. For additional information on outpatient CDI efforts read “Outpatient Efforts: One system's efforts to address physician practice documentation improvement needs.”