ICD10 and CPT

Some insurance contracts have attachments with CPT® codes listed or refer to CMS codes. How will the change to ICD10 impact reviewing those codes?

re: ICD10 and CPT

I assume you are talking about national or local coverage determinations or policy decisions that list the covered indication (ICD-9 or ICD-10 code) with the procedure performed (CPT® cdoe).

CMS has developed mappings, General Equivalency Mappings, or GEMS to help insurance companies adapt their policies. These GEMS or crosswalks are not meant for coding, but are meant for this purpose.

Read about them here:

https://www.cms.gov/ICD10/11b1_2011_ICD10CM_and_GEMs.asp

re: ICD10 and CPT

The CPT® codes themselves are not going to change for the NCD/LCDs. However, from CMS, each contractor is required to review every policy and reissue new coverage determinations by 10-01-2013 that lists out the new ICD-10 codes. Coders are NOT to use the GEM files to come up with the list of acceptable codes; it is solely the responsibility of each contractor to do so. According to CMS, there is no timeline in place for this to happen, except, of course, before October 2013.