On October 1, 2016, CMS is definitively ending an ICD-10 coding “flexibility” policy announced last year that prevents practitioner Medicare Part B physician fee schedule claims from being denied based solely on the specificity of the ICD-10 diagnosis code, as long as the physician/practitioner uses a valid ICD-10 code from the right family. According to a frequently-asked-questions document updated on August 18, 2016, “CMS will not extend ICD-10 flexibilities beyond October 1, 2016,” and CMS will not provide additional flexibility guidance or otherwise continue the phase in of the requirement to code to the highest level of specificity. Effective October 1, 2016, providers must “code to accurately reflect the clinical documentation in as much specificity as possible, as per the required coding guidelines.” CMS observes that many providers are already using specific ICD-10 codes since “[m]any major insurers did not choose to offer coding flexibility.” CMS notes that it has posted additional information on the 2016 ICD-10-CM valid codes and code titles and 2017 coding details on its website.
