Unspecified ICD-10 Codes: What the End of the Grace Period Means

The grace period is over as of October 1, 2016. What does this mean for providers? Well, CMS is not exactly clear in their 11-page document explaining the changes. Here’s what is clear:

Code as accurately as possible for care you have provided.

It’s important to note that CMS has not issued a firm stance on unspecified codes. The best guidance they offer is “providers should already be coding to the highest level of specificity” (Answer 25) and “avoid unspecified ICD-10 codes whenever documentation supports a more detailed code” (Answer 26).

For example, a patient comes in with a stroke. That’s obvious to you, but the reason why he had a stroke is not. You need to send off for some testing. In this moment, before you have the test results, it is accurate to use an unspecified code for the stroke. Once the results are in, you will be able to code with more specificity.

Alternatively, if you have a patient with a forearm fracture, and the x-ray results clearly show the ulna shaft being broken, go ahead and look up the code S52.2 “Fracture of shaft of ulna.”  From there, you can specify right or left ulna, open or closed fracture, the type, and whether this was an initial or subsequent encounter (MediMobile’s refinement search empowers you to quickly determine the most appropriate code, as seen below). Coding an unspecified code here would put you at risk with CMS.

Refinement search to drill down unspecified ICD-10 codes

If you cannot specify, there needs to be a reason why you cannot.

With the grace period over, as of October 1, 2016, please remember:

Code as accurately as possible for care you have provided.

At MediMobile, we build tools for such coding:

  • Refinement search enables you to sort through thousands of ICD-10 codes using clinical terminology, ensuring both accuracy and speed.
  • Hold a bill in an unconfirmed status for 24 hours, allowing you to update diagnoses as test results come in.
  • A library of custom rules that helps guide physicians to proper codes.

Still need more clarity? Feel free to shoot any questions our way via twitter @medimobile or email us at support@medimobile.com.

 

 

 

By | 2016-09-29T15:36:30+00:00 September 29th, 2016|Uncategorized|0 Comments