CMS appoints ICD-10 ombudsman

The director of the CMS Physicians Regulatory Issues Team, William Rogers, MD, will act as ICD-10 point person
By Susan Morse
08:58 AM
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William Rogers, MD, director of the Physicians Regulatory Issues Team at the Centers for Medicare and Medicaid Services, will act as ICD-10 ombudsman to the federal agency, acting CMS administrator Andy Slavitt announced Thursday.

Rogers, a practicing physician at Georgetown University Hospital, will help address concerns from healthcare professionals after the new diagnostic code library goes live on Oct. 1. He will work out of an ICD-10 coordination center in Baltimore that will be set up at the end of September, Slavitt said. Rogers can be reached at ICD10_ombudsman@CMS.HHS.gov.

Implementation of ICD-10 is only 34 days away, Slavitt reminded providers, physicians and coders during a "Countdown to ICD-10" forum held Thursday by the Centers for Medicare and Medicaid Services.

"While we've seen it coming for awhile, it's almost here," said Slavitt.

Starting Oct. 1, CMS will not accept ICD-9 codes for dates of service after September 30.

[Related: Industry eyes calendar as ICD-10 countdown begins.]

While CMS has said it will not deny claims as long as the right code family is used, the agency will not send back a message if the wrong code is used.

As for the potential backlog and its effect on claim reimbursement, CMS said there should be no delay in the standard turnaround time of 14 days for electronic, and 29 for paper records.

"While we encourage coding to correct specificity, flexibility covers the 12 months after implementation," said Chief of Staff Mandy Cohen.

CMS will not audit claims if the valid code is from the right family of codes, which is a three character category, she said. Also, Medicare will not subject physicians or other eligible professionals to the Physician Quality Reporting System, Value Based Modifier, or Meaningful Use penalties, as long as the right code family is used.

ICD-10-PCS Procedure Coding System, a subset of ICD-10 codes, will be used only for hospital claims for inpatient hospital procedures. ICD-10-PCS will not be used on physician claims, even those for inpatient visits, CMS said.

Current Procedural Terminology and Healthcare Common Procedure Coding System codes will continue to be used for physician and outpatient services including physician visits to inpatients.

[See also: ICD-10 hops Congressional hurdle.]

Several officials such as Sue Bowman from the American Health Information Management Association and Nelly Leon-Chisen from the American Hospital Association, offered the following transition steps on Thursday's call:

  • If claim is submitted after Oct. 1 for date of service in September, use ICD-9 codes;
  • No claim can obtain both ICD-9 and 10 codes;
  • There is no dual code reporting;
  • Determination of which code set to use is driven by date of service, not billing date;
  • The date of service is the date of discharge;
  • Claims for dates of service on and after October 1, 2015 must be coded in ICD-10;
  • Claims for dates of service prior to October 1, must be coded in ICD-9;
  • Any claims for dates of service after October 1, that contain ICD-9 codes will be rejected;
  • The process for determining the correct code is same as ICD-9: Look up the diagnostic term in Alphabetic Index, then verify the code number in Tabular List;
  • To be valid, ICD-10-CM diagnosis codes must be coded to the full number of characters required for that code;
  • While documentation supporting accurate and specific codes will result in higher-quality data, nonspecific codes are still available for use when documentation doesn't support a higher level of specificity;
  • When sufficient clinical information isn't known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate "unspecified" code;
  • It would be inappropriate to select a specific code that is not supported by the medical record documentation or conduct medically unnecessary diagnostic testing to determine a more specific code.

Twitter: @SusanMorseHFN