It’s been a busy fall/winter season and hard to believe that it’s December and the year is almost over. Although much of the east is warm right now, winter has set in in the west. We are covered with snow and it’s a winter wonderland. We didn’t even get rid of all the leaves before the snow came.
So it is with ICD-10-CM. Most of us are still working in both code sets, cleaning up our outstanding claims in ICD-9 as we are working new denials in ICD-10. There are several things that we need to be aware of as we work with the new code set.
The guidelines were updated recently, likely after your 2016 ICD-10-CM code books were published. Just as in prior years, the ICD-10-CM Official Guidelines for Coding and Reporting in the front of your book are probably obsolete. In order to be sure that you are using the most current Guidelines, you will want to go to the CDC website (http://www.cdc.gov/nchs/icd/icd10cm.htm). There you will also find some guidance for the Excludes1 note that allows some “conditions to be reported together when appropriate even though they may currently be subject to an Excludes1 note.” Check it out.
Some of the things that have changed in the Guidelines were outlined in a great article by Brad Ericson and can be found at the ICD10 Monitor site (http://www.icd10monitor.com/enews/item/1513-watch-for-hidden-changes-to-2016-cm-guidelines).
The other thing that’s important to know is that the period of leniency that we heard about during the summer in an AMA and CMS joint announcement (https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD-10-guidance.pdf) only pertains to Medicare Part B. It does not apply to commercial payers or to Medicare Advantage plans. To my knowledge, no other payers have granted this type of leniency during this first year. You can find the clarification from CMS at https://www.cms.gov/Medicare/Coding/ICD10/Clarifying-Questions-and-Answers-Related-to-the-July-6-2015-CMS-AMA-Joint-Announcement.pdf.
For those of you in the east, enjoy the weather while it lasts. For those in the west, stay warm. Wishing you and yours a wonder-filled holiday season. Take time to slow down, enjoy the blessings of faith, family, friends, and good food and drink. Before we know it, we’ll be back to work in 2016 and talking about CPT changes and weight loss. After all, the only constant is change.