Earlier this month, the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) jointly announced efforts to ready the physician community for the transition to ICD-10.  Part of this effort includes CMS’ claim processing flexibility and guidance that will prevent Medicare part B claims from being denied due to lack of specificity as well as eliminating potential penalties associated with its various quality reporting initiatives.  Though not the most desirable of arrangements, this agreement should clear an unabated path to October 1,2015 and the implementation of the new ICD-10 code set.  As part of the ICD-10 project, we here at NYP should be reminded as to what this announcement means.

• This announcement is only applicable to claims being submitted by physicians and other providers for professional services.
• Hospital based encounters and their associated (technical) claims are not affected by this announcement.  Clinical documentation activities performed by our physicians and other providers will continue to require the most specific representation of care provided to our patients.  This has been the case prior to ICD-10 and will continue to be the case after the implementation of ICD-10 on October 1.
• There is no indication that commercial insurance carriers to which physicians and other providers may be submitting professional claims will follow CMS’ lead in relaxing its own and respective medical policies and coverage guidelines.

The NYP ICD-10 Project PMO, in conjunction with its various workgroups and in cooperation with the Cornell and Columbia Faculty Practice Organizations will continue to work to ensure consistent understanding of this announcement as well as all other impacts to affected parties.  Questions can be directed to ICD-10Help@nyp.org.