Medicare claims processing systems will not accept ICD-9 codes for dates of services after September 30, 2015 and will not accept claims that include both ICD-9 and ICD-10 codes. However, CMS and the American Medical Association (AMA) agreed to a one-year grace period in which Medicare claims will not be denied based on which diagnosis code was selected, as long as an ICD-10 code from an appropriate family of codes is submitted; the family of codes is considered the same as the ICD-10 three-character category. For example, if a patient has a diagnosis of G43.711 (Chronic migraine without aura, intractable, with status migrainosus) under ICD-10, use of the valid codes G43.701 (Chronic migraine without aura) or G43.719 (Chronic migraine without aura, intractable without status migrainosus) would likely not prompt an audit during the 12-month grace period.

Steps to Take If You’re Not Prepared

As the deadline approaches, some clinicians may be scrambling to transition based on their practice and patient population. The AMA recommends the following advice for healthcare professionals who have not yet taken action:


Continue Reading

  1. Call your vendors immediately: ask about any updates needed immediately and how to address issues after October 1.
  2. Get your staff trained quickly: CMS and the AMA offer a variety of resources, some of which are specialty-specific.
  3. Focus on your top 10-15 diagnosis codes: Rhonda Buckholtz, vice president of ICD-10 education and training for the American Academy of Professional Coders, recommends creating a practice management report to determining the top diagnoses with ICD-10.
  4. Acknowledgement reports: watch acknowledgement reports closely after claims are submitted to spot issues immediately.
  5. Establish cash reserves: if possible, have cash reserves on hand or look into lines of credit should payment get interrupted and you need them.