One Year Grace Time Period for ICD-10 Coding to End Soon

Nobody requires going to medical school to know that persons have 2 ears.

Although, if physicians treat a sufferer with suppurative, or pus-discharging, otitis media, they do not have to mention left ear, right ear, or both — at least right now — when they select an ICD-10 coding diagnostic code for the bill. They also do not have to mention whether it is a chronic or acute issue, or accompanied or not by a spontaneously ruptured ear drum. They can go with ICD-10 coding or code H66.40 — unspecified suppurative otitis media, unspecified ear — as an all-purpose code.

Come on the day of October 1, though, physicians who treat otitis media had better select a code that is particular on matters like which ear and the like, assuming they document clear details like that. Otherwise, a third-party payer such as Medicare might bounce back the claim for having the inaccurate diagnostic code.

The October 1 embarks the end of a one year grace time period that the Centers for Medicare and Medicaid Services (CMS) developed for the latest diagnostic codes called ICD-10 coding. CMS will no longer admit unspecified ICD-10 coding on Medicare fee-for-service (FFS) claims when a particular one is warranted by the medical record. Various huge health insurers that followed Medicare's lead on coding leniency are hoped to get harder as well.

The IDC-10 coding, which debuted on the day of October 1, 2015, permits clinicians to more precisely explain sicknesses and conditions than they could before. Utilizing ICD-9, a hand surgeon operating on a broken wrist, for instance, could mention which of the 8 wrist bones was broken, and either it was a closed or open fracture. That was it. ICD-10 coding go further, distinguishing between the right and left wrist. They also demonstrate either the fracture was displaced or non-displaced, either the healing was routine or delayed/postponed on a follow-up visit, and either there was fracture malunion or nonunion. For the scaphoid and hamate bones of the wrist, the codes zoom in on the location of fracture.

Other the physicians, either they toil in primary care, endocrinology, or oncology; can point to how the ICD-10 coding have fine-tuned their diagnoses. This larger specificity, although, makes the latest code set tougher to work with. After all, there are almost 5 times as many ICD-10 coding as there are ICD-9 coding, and the new codes run to a maximum of 7 characters in contrast with 5 for their predecessors.