HIMSS News

CMS Releases Notice to Address ICD-10 Problems

On November 20th, the Centers for Medicare and Medicaid Services (CMS) issued a notice that clarifies actions that they have taken since October 1st to address isolated problems processing ICD-10 codes for certain national or local coverage decisions and policies.

According to CMS, there has been very few issues stemming from local and national determinations.  CMS said it will reprocess claims that produced errors at no cost to providers. Such claims will be automatically processed and updated in CMS' system.

CMS has created some short-term remedies to the national coverage determination errors such as: refining coding and updating claims processing instructions.  More long term updates will be in place by January 4, 2016.

Meanwhile, CMS said that some errors resulting from local coverage determinations occurred because some Medicare Administrative Contractors (MAC) needed to update certain criteria. The agency said it delayed processing those claims until the contractors' updates were in place.

After October 1, some MACs also needed to add allowable ICD-10 diagnosis codes for certain local coverage decisions. Affected claims with dates of service on and after October 1, 2015 were generally suspended until the fixes were implemented, CMS said. Questions about specific Local Coverage Determinations should be directed to the appropriate MAC. As of October 1, health care claims must include ICD-10 codes for medical diagnoses and inpatient hospital procedures.