Wiki CMS No Denials for Lack of Specifity

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BeverPrudh

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In reference to the recent CMS announcement that MACs will not deny Part B claims solely on the basis of use of a non-specific code as long as the code is from the correct family, has anyone seen a statement from CMS as to how they define the code "family"? We have a found a reference to this from the WHO but we are trying to get clarification.

Thanks!
 
Thank you so much for posting this.... "In reference to the recent CMS announcement that MACs will not deny Part B claims solely on the basis of use of a non-specific code as long as the code is from the correct family, has anyone seen a statement from CMS as to how they define the code "family"? We have a found a reference to this from the WHO but we are trying to get clarification." Has anyone been successful on finding out what CMS considers to be a ?valid code? and what is an ?appropriate/correct family?? I've tried researching this and am finding a number of different interpretations.
 
ICD 10 Family of Codes CMS Post

Have not heard of any clarification; supposedly CMS is going to provide clarification but have not heard when.
 
Noridian shared this, after their most recent ICD-10 webinar, with all attendees:


CMS response to ICD-10 ?family of codes?.

CMS will be releasing a FAQ in the near future defining this information. CMS is defining "family" as a code that has the same first three characters for the diagnosis. Example: M02 is Postinfective and reactive arthropathies. All codes under M02 are part of the same code family. However, providers should make every attempt to ensure the ICD-10 codes billed are the most specific and appropriate based on the documentation in the medical records. Example: If the documentation states arthropathy following intestinal bypass of the left hip. Providers should code M02.052 rather than M02.059 for Arthropathy following intestinal bypass, unspecified hip. Please also note that some codes require additional characters, therefore providers must follow the coding guidelines outlined in the coding books. Example: M02.05 for Arthorpathy following intestinal bypass, hip requires a 6th character specifying the anatomic site.
 
Can someone please point me to a link from CMS that includes this announcement?
 
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