ICD-10 clarification from CMS

Here is the link to the CMS FAQ document about specificity and ICD-10.  They clarified that when they said “family” they meant “category” because ICD-10 doesn’t use the term family in coding. (I theorized that if the code was in a page or two of the right code it would be okay, but that’s not what they meant, was it?)  Just a reminder, we use diagnosis coding for two reasons on a claim form.  The first is to establish the medical necessity to get a claim paid.  The second is to tell the payer how sick the patient is, and the acuity of our entire population of patients.  This is important for risk based contracts and ACOs. Even an unspecified code establishes the medical necessity for an office visit, but that doesn’t mean you should use it.  You should report the condition you are treating specifically.  And, if the service you are performing has a Medicare LCD or NCD, or a private payer coverage policy, you will need a specific, covered indication.

As for private payers, who knows?

ICD-10: AMA and CMS come to terms

CMS and the AMA have agreed to offer physician practices a grace period on code specificity of ICD-10 for the first year.  The link to the announcement from the AMA is below, and you’ll notice it mentions “family” of codes.  ICD-10 is divided into categories and subcategories.  I’m not sure how the CMS Contractors will interpret “family.”

If I see any clarification or wise words from other consultants, I’ll add them here.


CMS resources on CCM

Two links I thought you might find helpful.



We appreciate the detail from CMS on chronic care management.