We are now 86 days away from the implementation of ICD-10! Are you ready? If not, you do not have much time to waste. I do not think another pause is in our future, but you never know!! CMS and AMA Announcement

ICD-10 training is imperative for MDS Coordinators, Business Office Managers, and Therapy Staff. Have you started training yet? CMS ICD10 Provider Resources

At Functional Pathways, we are ramping up and getting ready to train all of our therapists and managers. Training begins July 20th and continues through the end of July. Beginning on August 1st, we are requiring all FP therapists to begin dual coding (ICD-9 and ICD-10) in our software systems. Giving therapists time to become comfortable with coding ICD-10 will ease anxiety come mid-September and especially October 1st.

Mid-September you ask? Well, even though ICD-10 is mandatory beginning on October 1st, therapy Certifications and Re-Certifications can span over several weeks/couple of months. Per the CMS Guidelines, any certification period that spans from September to October will require special coding: September claims will require ICD-9, October claims will require ICD-10. So if you have a resident who begins therapy September 15th and will be on therapy through October 14th, then both ICD-9 and ICD-10 codes will need to be recorded by the Therapist so the Business Office can appropriately bill each month.

What happens if you use the wrong ICD-10 codes? Will your claim be denied? These very questions were included in CMS Frequently Asked Questions. CMS stated that, “For twelve months after ICD-10 implementation, Medicare review contractors (MACs, RACs, ZPICs, SMRCs) will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family.” I raised an eyebrow when I read, “solely on the specificity of the ICD-10 diagnosis code.” When I continued to read the answer, I understood why I raised an eyebrow; CMS also said that, “it is possible a claim could be chosen for review for reasons other than the specificity of the ICD-10 code and the claim would continue to be reviewed for these reasons.”

Gina Tomcsik
Director of Compliance