Oncology & Hematology Coding Alert

Testing reveals 81% success rate; most errors unrelated to ICD-10-CM. 

You can now be certain to start implementing ICD-10-CM in October this year. In a recent Congressional hearing, it was finalized that there won’t be any further push back for the transition to ICD-10-CM. This means it is now time continue to move forward in planning and prepare for ICD-10-CM transition to occur. 

The American Medical Association (AMA) was among 100 medical groups that wrote to the Centers for Medicare & Medicaid Services (CMS) on March 4 seeking responses to ICD-10-CM issues that they believe have not been appropriately addressed. The groups have expressed strong concerns about the transition in the 7-page letter to Acting CMS Administrator Andrew Slavitt.

Chief among the issues were the results of CMS’s end-to-end testing periods, which revealed claim acceptance rates in the 76 to 89 percent range. This range clashes significantly with the current standard Medicare acceptance rate of 95 to 98 percent, the letter stated. Because only a small number of practices participated in the testing, the groups worry that when all Medicare practices start submitting claims, that percentage rate will extrapolate out to the community at large, triggering massive denials.

“The likelihood that Medicare will reject nearly one in five of the millions of claims that go through our complex health care system each day represents an intolerable and unnecessary disruption to physician practices,” said AMA President Robert M. Wah, MD in a March 4 statement. “Robust contingency plans must be ready on day one of the ICD-10-CM switchover to save precious health care dollars and reduce unnecessary administrative tasks that take valuable time and resources away from patient care.”

Testing update: The most recent CMS end-to-end testing period (Jan. 26 to Feb. 3) resulted in an 81-percent success rate, the agency said. The remaining claims were rejected for three main reasons, as follows, according to the most recent statistics released by CMS:

• Invalid submission of ICD-9-CM codes (seen in 3 percent of rejected claims)

• Invalid submission of ICD-10-CM codes (as demonstrated by another three percent of claims that didn’t pass through the system)

• Errors unrelated to ICD-10-CM, such as using an incorrect NPI, an invalid date, the wrong place of service or an incorrect HCPCS code (seen in 13 percent of rejected claims).

What does this mean for you? The results of the testing demonstrate that most errors are unrelated to ICD-10-CM. You should not only prepare to adopt the ICD-10-CM coding, but also try streamlining processes for ICD-10-CM submissions in your practice. Keep an eye on detail and capture all of them with precision. 

Wait Until Oct. 1 to Use ICD-10-CM

The date of service errors led CMS to discover that some providers are confused about when they can submit claims with ICD-10-CM codes in both the testing arena and the real, “non-testing” world, said CMS Administrator Marilyn Tavenner in a Feb. 25 blog post on the topic.

“ICD-10-CM can be used only for test purposes before October 1,” said Tavenner, who has now left her CMS post last month. “Only ICD-10-CM can be used for doctor’s visits and other services that happen on or after October 1. ICD-9-CM cannot be used to bill for services provided on or after October 1. This rule applies no matter when the claim is submitted, so claims submitted after October 1, 2015, for services provided before that date must use ICD-9-CM codes.”

Overall, the testing results indicate that the majority of health care providers are poised to succeed under the ICD-10-CM system — and those who aren’t should step up their training to be ready in time for the Oct. 1, 2015 deadline.

To read Tavenner’s statistics on the end-to-end testing, visit blog.cms.gov/2015/02/25/successful-icd-10-testing-shows-industry-ready-to-take-next-step-to-modernize-health-care.

Editor’s note: Watch for future issues of Oncology Coding Alert for more on this topic as the ICD-10-CM implementation date draws nearer.