Medicare ICD-10 Provisions

A Word of Caution

Per the announcement made on July 6, 2015, CMS and AMA have instituted Medicare ICD-10 provisions to help providers with the transition. However, with the October 1st transition date less than 70 days away, practices would be remiss to rely on these provisions as rationale for stalling their preparation efforts.
While the changes do allow for some additional flexibility, it is important to recognize one rule that has not changed:

ICD-10 codes will be required on all claims beginning October 1, 2015.

In a letter recently sent to Medicare providers, CMS Acting Administrator reiterated this point by saying:

“Starting October 1, Medicare claims with a date of service on or after October 1, 2015 will only be accepted if they contain a valid ICD-10 code.The Medicare claims processing systems will not have the capability to accept ICD-9 codes for dates of service after September 30, 2015 or accept claims that contain both ICD-9 and ICD-10 codes.”


The guidelines, in summary, allow for the following:

  • Medicare claims will not be denied due solely to the specificity of the code, so long as an ICD-10 code from the correct family of codes is used. No ICD-9 codes will be accepted.
  • Similarly, quality-reporting penalties will not be assessed based solely upon code specificity for PQRS, value-based payment modifiers or Meaningful Use.
  • The plan also authorizes advances payments to physicians who are unable to process claims due to ICD-10 issues.
  • An ICD-10 Ombudsman will be available as part of a communication and collaboration center to help address provider issues.

Check out the Medicare ICD-10 FAQs for more information on what will and will not be allowed during the transition period.