When the industry transitioned from ICD-9 to ICD-10 in October 2015, the payers, led by CMS, decided to observe a "grace period." This grace period essentially lessened some of the burden of coding to the highest level of specificity in ICD-10. The intent of the grace period was to allow providers the time to improve their documentation to support the level of specificity available with ICD-10 codes, and to adjust to the new code set. The grace period is scheduled to end September 30, 2016.
Effective October 1, 2016 claims will be required to have diagnosis codes with the highest level of specificity, making payer procedure/test requirements enforced more stringently as defined in the respective policies, such as LCD/NCD.
For example, an injection of Hyaluronan aka Hyalgan or Supartz is only covered by WPS Medicare for eight (8) diagnosis codes from the family of M17. There are eleven (11) total codes in this family. From October 1, 2015 thru September 30, 2016, any code from the M17 family would be covered for this drug. October 1, 2016 and on only the specified codes from this family will be payable. So, osteoarthritis of knee, unspecified (M17.9) most probably will result in a rejection.
With more than 1,900 ICD-10 code changes for 2017, the bar has been raised to capture a clear clinical picture through specified codes. It is important that you assess whether or not your clinical documentation is ready.
If you are looking to contract with a vendor for your data integrity and compliance needs, MSMS Practice Solutions partner, The Rybar Group, offers multiple options from which to choose and a discount for MSMS members.