The one-year grace period for ICD-10 will end on Oct. 1, the Centers for Medicare and Medicaid Services announced in an update to its FAQ guidelines for the diagnostic code set.
ICD-10 went live on Oct. 1, 2015, and at the time CMS said it would not deny claims as long as physicians used codes in the correct “family” related to the treatment. However, with the grace period ending, physicians will now be held to using the correct degree of specificity in their coded claims.
“ICD-10 flexibilities were solely for the purpose of contractors performing medical review so that they would not deny claims solely for the specificity of the ICD-10 code as long as there is no evidence of fraud,” CMS said.
ICD-10, which contains more than 70,000 diagnostic codes, replaced ICD-9, which relied on just 11,000 codes. The grace period had only applied to claims submitted to Medicare and Medicaid, and while many commercial insurers offered similar flexibility, the majority did not.
For more information about ICD-10 and a list of resources, view the ICD-10 Update: Physician Resource in the NewsCenter.