CMS won’t penalize docs transitioning to ICD-10

CMS has agreed to certain measures to ease physicians’ transition to the International Classification of Diseases, Tenth Revision (ICD-10) coding system, which will be fully implemented on October 1, 2015. In conjunction with the American Medical Association (AMA), CMS announced a one-year grace period during which it will not penalize physicians who submit improper codes for billing, provided they have selected the appropriate family of codes, along with other measures intended to educate physicians on ICD-10 billing and claims submissions. Medicare claims processing systems will be unable to accept ICD-9 codes for dates of service after September 30, 2015.


The ICD codes have not been updated in the United States since ICD-9 codes were implemented in 1979. HHS planned to implement ICD-10 in 2013, but extended the deadline for compliance in response to industry pressure and legislative action (see One year ICD-10 delay is now official, August 4, 2014). The AMA and others worried that physicians transitioning to the new coding system would suffer blows to their incomes as a result of penalties imposed for inadvertent coding errors and lobbied CMS for changes. AMA President Steven J. Stack, M.D., referred to the announcement as “a testament to the power of organized medicine and what we can achieve when we band together for the good of our patients and our profession.”

Grace period

CMS has specifically announced that Medicare review contractors will neither deny nor audit practitioner claims billed under the Medicare Part B Physician Fee Schedule “based solely on the specificity of the ICD-10 diagnosis code,” provided the practitioner has used a valid code from the proper family. Medicare clinical quality data review contractors will not impose penalties on physicians or eligible professionals (EPs) subject to the the Physician Quality Reporting System (PQRS), Value-Based Modifier (VBM), or Meaningful Use (MU) program related to the specificity of the ICD-10 code, provided the physician or EP has submitted a valid code from the proper family. Where Part B Medicare administrative contractors (MACs) are unable to process claims due to administrative issues, physicians may submit requests for advance payment to the appropriate MAC.


In addition, CMS announced its intention to appoint an ICD-10 Ombudsman who will be part of a communication and collaboration center “to triage and answer questions about the submission of claims.” The agency announced plans to remind and educate physicians about the transition, including a planned July letter to providers, an MLN Connects National Provider Call on August 27, and its “Road to 10” website, which provides information targeted at small physician practices. The AMA will provide physicians with updates and information at its AMA Wire site.