Wiki Icd 10 and non-specific codes

[kwrenn]

Good morning Has anybody heard what the deadline is for the use of non-specific ICD-10 codes for providers? I had heard there was talk of payers cracking down on the use of the non-specific codes (i.e. hypertension)?!! Thank you!

 

[mhstrauss]

Good morning Has anybody heard what the deadline is for the use of non-specific ICD-10 codes for providers? I had heard there was talk of payers cracking down on the use of the non-specific codes (i.e. hypertension)?!! Thank you!

There was a general 1 year "grace period" from Medicare, and any other payers that followed suit. This will end 9/30/16.

 

[melissa.reed22]

We're being told by a billing company that when the grace period ends both unspecified and other specified codes will all be denied with possible penalties for using them. I can't find anything to support that. Does anyone know anything about this?

 

[CodingKing]

. Does anyone know anything about this?

I know ideas have been thrown around inside carriers such as reductions when using unspecified but I have not seen anything specific. I think many carriers are waiting to see what Medicare does. Most will probably copy it.

 

[mitchellde]

No there is nothing that supports this. It is just rumor mixed with a small amount of fact. Unspecified codes will generally be denied. However if you can support that there was no way for the provider to be more specific then you will appeal with solid rationale. Such as pneumonia unspecified is a good diagnosis code. Since the provider is allowed to diagnose the infection without diagnostic feedback it will be possible to state that the patient has pneumonia but know know the specific type. This is not true of something like osteoarthritis where it is expected that the provider know the type.

 

[kwrenn]

Thank you!