Wiki ICD 10 Unspecified cut-off date

[amyabiller]

Hi Everyone , I have a question ,
WILL MEDICARE START DENYING THE "DATE OF SERVICE" OF 10/1 OR THE "SUBMISSION
DATE" OF 10/1 with unspecified codes on claims ?

 

[danskangel313]

Hi Everyone , I have a question ,
WILL MEDICARE START DENYING THE "DATE OF SERVICE" OF 10/1 OR THE "SUBMISSION
DATE" OF 10/1 with unspecified codes on claims ?

Beginning 10/1/2015, "Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/ practitioner used a valid code from the right family of codes."

The statement recently released by CMS states: "Beginning October 1, 2016, all CMS review contractors are able to use coding specificity as the reason for an audit for a denial of a reviewed claim to the same extent that they did prior to October 1, 2015. Review contractors will notify providers of coding issues they identify during review and of steps needed to correct those issues to the same extent that they did prior to October 1, 2015. The provider community should code claims to the degree of specificity supported by the encounter and the medical documentation."

What this means is that on 10/1/2016, MACs will have the ability to deny any claim going through their system if they deem the service requires a more specific diagnosis code. It really has nothing to do with the DOS; it's the date in which the MACs will be able to deny claims going through solely due to lack of specificity.