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Use of unspecified codes now may result in denied or downcoded claims

ICD-10 Reporting Flexibility Ended  Oct. 1: New Guidance 

CMS has updated its guidance on ICD-10 claims auditing and quality reporting flexibility, affirming that the flexibility ended as planned on October 1. As part of a one-year transition period immediately following ICD-10 implementation, the agency provided flexibility in the claims auditing and quality reporting process for 12 months after ICD-10 went live on Octobert 1, 2015.

For example, up to this point Medicare review contractors have not been denying claims based solely on the specificity of the ICD-10 diagnosis code, provided the practitioner used a valid code from the correct family of codes.  In preparation for the end of the flexibility period, practices should review their use of unspecified ICD-10 codes and avoid use whenever the clinical documentation supports a more detailed diagnosis code.  Use of unspecified codes will likely result in denied or downcoded claims for dates of service October 1, 2016 and after.