Looking Beyond the End of the Physician ICD-10-CM Coding Grace Period

Rachael Price | December 2016

Key Points

  • Documentation accuracy is critical in ICD-10-CM coding.
  • Teamwork between coder and physician is essential to the success of ICD-10-CM transition.
  • Providers remain concerned with decreased productivity due to increased ICD-10-CM documentation requirements.
  • With the physician ICD-10-CM grace period ending, audits and claim denials are a concern.
  • Preparation for the ICD-10-CM transition is a start; continued efforts are necessary to ensure further success.

ICD-10-CM Grace Period

The one-year-long grace period for ICD-10-CM implementation ended on October 1, 2016. This provided the healthcare industry a transition period which allowed providers, coders, and billing staff to get familiar with the new code set. Providers will now have to fully comply with the more specific new documentation requirements of ICD-10-CM. The key to a successful transition involves providers improving their documentation. The enforcement of greater specificity in the documentation requires providers to document more precisely and accurately, and it requires coders to choose the ICD- 10-CM diagnosis codes that most closely reflect the complexity and severity of the patient’s condition.

There is concern that these higher documentation and coding standards will be too time consuming for providers and decrease productivity for both the providers and the coders. Additionally, there are concerns about increased claim denials and the negative financial impact this could have for physician practices and healthcare systems. This article will focus on ways that the provider and coder billing staff can continue to improve their ICD-10-CM compliance while reducing the risk of audit and government scrutiny.

Access the full article to read more.

HCCA Compliance Today, December 2016.

About the Author

Rachael Price, Registered Nurse, is a seasoned certified inpatient and outpatient coder and a certified documentation improvement professional with many years of experience in health care. She is a certified hospice coder and experienced doing claims audits for a variety of physician practice specialties.