September 24, 2015

Implementation of ICD-10-CM/PCS

Dear Physician,

The compliance date for implementation of ICD-10-CM/PCS is October 1, 2015, for all Health Insurance Portability and Accountability Act-covered entities, which includes suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS).

Physicians are strongly encouraged to engage in an open dialogue with their DMEPOS suppliers to verify the DMEPOS item(s) they are ordering are properly supported by the ICD-10 diagnosis code(s) documented within the medical records. This will ensure your Medicare patients receive the DMEPOS items they need and facilitate DMEPOS supplier claims payment.

Although the Centers for Medicare and Medicaid Services (CMS) has allowed for some additional flexibility in regards to claims auditing for physician services for the first 12 months following implementation, certain DMEPOS policies, especially those based on Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) require ICD-10 guidelines be followed for dates of service on and after October 1, 2015 for appropriate processing and claim reimbursement. This means that for certain DMEPOS items ordered for Medicare beneficiaries, only designated ICD-10 diagnosis codes will be allowable within the claims processing system for proper reimbursement. Not only must the appropriate ICD-10 diagnosis code, with the maximum level of specificity, be provided to the DMEPOS supplier for claim submission; that ICD-10 diagnosis code must be supported and documented appropriately within the patient's medical record.

Sincerely,

Wilfred Mamuya, MD, PhD
Medical Director, DME MAC, Jurisdiction A
NHIC, Corp.
75 Sgt. William B. Terry Drive
Hingham, MA 02043-1518
Wilfred.mamuya@hpe.com 

Stacey V. Brennan, M.D., FAAFP
Medical Director, DME MAC, Jurisdiction B
National Government Services
8115 Knue Rd.
Indianapolis, IN 46250-1936
Stacey.brennan@anthem.com 

Robert D. Hoover, Jr., MD, MPH, FACP
Medical Director, DME MAC, Jurisdiction C
CGS Administrators, LLC
2 Vantage Way
Nashville, TN 37228-1504
Robert.hoover@cgsadmin.com 

Eileen M. Moynihan, MD, FACP, FACR
Medical Director, DME MAC, Jurisdiction D
Noridian Healthcare Solutions
900 42nd Street South
Fargo, ND 58103-2146
Eileen.moynihan@noridian.com