AHCA Provides ICD-10 Guidance

Karen Morris and Carl Pucci in Clinical & Quality

AHCA has obtained CMS guidance and educational resources regarding the implementation of ICD-10, which becomes effective today, 10/1/15.

Please see AHCA bulletin below for further details:

AHCA reached out formally via correspondence to the Centers for Medicare & Medicaid Services (CMS) in August, to solicit much needed guidance regarding nursing facility transition from the International Classification of Diseases, Ninth Revision (ICD-9) to the International Classification of Diseases, Tenth Revision (ICD-10).  To date, CMS has provided extensive ICD-10 educational resources.

However, there were several questions specific to SNF services that the CMS resources did not address and we have been working with CMS since that time.  Just last night we received the attached responses.

Starting tomorrow, healthcare providers must submit valid ICD-10 diagnosis codes on claims and required patient assessments, including the SNF Minimum Data Set (MDS), to receive payment.  Key clarification points in yesterday's CMS correspondence include:

  1. The ICD-10 Ombudsman will be available to help answer nursing facility questions and can be reached at ICD10_Ombudsman@cms.hhs.gov.
  2. Minimum Data Set (MDS) assessments with Assessment Reference Dates (ARDs) on or before September 30, 2015 must contain a valid ICD-9 code in Section I if a diagnosis code is necessary.  SNF MDS assessments with ARDs on or after October 1, 2015 must contain a valid ICD-10 code.  CMS will reject MDS assessments if a Section I diagnosis code version does not apply for the ARD entered.

AHCA recommends that SNF clinicians, MDS assessment coordinators, and Billers review the Q&A document before submitting claims and MDS assessments that include October 2015 dates of service.

We will continue to keep an open dialogue with CMS to answer questions as they occur.  Members that submit concerns to the CMS ICD-10 Ombudsman are also encouraged to report such issues to AHCA so that we can quickly identify issue trends and facilitate efforts with CMS as seeking quick resolution of problems.  AHCA has created an ICD-10 Implementation issues mailbox at icd10@ahca.org for this purpose.  NOTE:  When sending such issues to the AHCA mailbox, please do not include any beneficiary personally identifiable information (PII), or personal health information (PHI).  

Please do not hesitate to contact Dianne De La Mare at ddmare@ahca.org or Dan Ciolek at dciolek@ahca.org if you have other specific ICD-10 Implementation questions (other than how to code) that we should be discussing with CMS.


Karen Morris, RN, MS
Director, Clinical & Quality Services
518-462-4800 x15

Carl J. Pucci
Director, Finance & Reimbursement
518-462-4800 x36