An Auditor’s Observations on ICD-10 Audits and Compliance

Written by  Victoria M. Hernandez


We are nearly six months into ICD-10 and more coding reviews and audits are underway, which is a good thing. There are close to 30 times more procedure codes and five times more diagnosis codes in ICD-10-CM/PCS, compared to ICD-9-CM.

In addition, thousands of new and revised codes will continue to emerge, and these reviews and audits will continue to prove valuable in assisting with identifying more patterns, trends, and best practices associated with documentation, correct code capture, productivity, accuracy, training, education, compliance, query practices, data analysis, and many more areas.

With the agreement made between the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) back in March of last year, no physician claims submitted to Medicare now can be denied solely due to the “use of an unspecified or inaccurate subcode.”  Even though this agreement allows for some time for providers to master the more complex ICD-10 code system, healthcare and coding professionals need to be prepared and stay abreast of compliance and regulatory updates.




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Josh Sandberg

Josh Sandberg is the President and CEO of Ortho Spine Partners and sits on several company and industry related Boards. He also is the Creator and Editor of OrthoSpineNews.

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