The ICD-10 grace period was a time where unspecified ICD-10 codes were permitted as acceptable codes on claims submissions. Therefore, codes could be submitted and not denied when the codes were not selected to the highest level of specificity. This grace period was a joint effort between the Centers for Medicare and Medicaid and the American Medical Association to allow for a smoother transition from the I-9 diagnosis coding to the I-10 diagnosis coding. This grace period extended from October 1st, 2015 to October 1st, 2016. Many third party payers also followed this rule, however, some have not accepted unspecified codes from the beginning of ICD-10 implementation last October.
Beginning October, the use of unspecified codes may trigger denials on your claims. Coding professionals select an unspecified ICD-10 code when the provider’s documentation does not support a more specified code. Therefore, providers are urged to document conditions to the highest specificity possible so that the appropriate diagnosis codes are supported and in turn submitted on the provider’s claims. Thus, coding professionals are urged to query providers for more specific diagnoses.
Providers who do not document to the highest specificity possible may be subject to denials. These denials create a delay in reimbursement besides resulting in costly claim resubmissions and appeals in some cases. If there is a response to the query, the provider can then make an addendum to their documentation to support the highest level of specificity for the diagnosis.
In order to ensure clean claim submission and timely payment from the insurance contractors, it is best to evaluate your ICD-10 code reporting prior to October 1st, 2016 and ensure that documentation supports diagnosis coding to the highest specificity.