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01 Oct


October 1, 2016 officially ends the one-year “grace period” during which “unspecified” ICD-10 Codes can be used on medical insurance claims.


What you need to know

Beginning October 1, 2016 claims submitted with ICD-10 Codes that have a description of “unspecified” will, except in extremely rare circumstances, be denied.


How this can Negatively Affect your Claims and Cash Flow

Our staff manually reviews and our billing system automatically checks each of your claims before they are transmitted for payment. When an “Unspecified” code is identified your claim is held until we can obtain the correct and appropriate ICD-10 code. This may take only a few minutes or can take longer than a day or two. In any case, your claim is not transmitted as quickly as you and we would like and your cash flow will be slowed down.


What you Can Do

If you and your staff are working in an Electronic Medical Records or Practice Management system pay close attention to the narrative description that is displayed when you enter or choose an ICD-10 Code. You may have to click on a button or perform another function for your system to display the description. If the description contains the word “unspecified” you must use a different ICD-10 Code that describes the diagnosis or condition to the highest level of specificity available.


If you are using Super Bills or other paper forms to send your claims to us you should review all of the ICD-10 Codes you are using to ensure that the narrative description does not contain the word “unspecified” and that the codes you are using describe the diagnosis or condition to the highest level of specificity available.


ICD-10 Description Resources

In addition to Electronic Medical Records and Practice Management systems there are a number of other sources for reviewing the narrative descriptions for the ICD-10 Codes you want to use such as Coverage Policy documents and ICD-10 Code Books. The easiest and quickest method we have found is to simply type the alpha/numeric ICD-10 Code that you want to use directly into the internet search engine browser on your computer, tablet or smart phone and you will be able to access multiple web sites that present the narrative description for that code.


How Experics Can Help You

If you have questions about how or what to do, contact your Experics Billing Representative and we will work with you to eliminate your use of Unspecified codes.