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Compounding Disaster - July 2016 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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ICD-10 Grace Period Is Nearly Over Come October, you can expect to see a resurgence in claim denials. W hen CMS finally rolled out ICD-10 last October after repeated delays, the new code set wasn't nearly as cata- strophic as some had forecast. Rather than a complete meltdown of claims processing, denials were relatively few, usually due to either invalid code selections or valid diagnoses previously covered in ICD-9 that were wrongly considered to not meet medical necessity requirements under ICD-10. Now that we're several months into ICD-10, you may be breathing a sigh of relief, thinking you're over the hump. Not so fast. We're starting to see a resurgence in denials. This uptick is likely because CMS and other carriers are beginning to apply more stringent edits when adjudicating claims. Close enough no longer good enough If you remember, when ICD-10 was first implemented, CMS in collaboration with the American Medical Association offered a 12-month grace period. During this grace period, you could submit claims with a diagnosis that was "close enough," or at least found within the applicable family of codes, and still receive reimbursement. As long as you used a valid code, Medicare review contractors wouldn't deny physician or other claims billed under the Part B physician fee schedule through either an automated medical review or complex medical record review based solely on the speci- Coding & Billing Cristina Bentin, CCS-P, COC, CMA 3 4 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J U l y 2 0 1 6

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