2017 ICD-10 Updates to National Coverage Determinations Issue

CMS is aware that changes to the claims processing systems to implement the 2017 ICD-10 updates for several of the CMS National Coverage Determinations (NCDs) has not occurred and will not be implemented until early January, 2017. Updates will then be phased in over the first quarter of 2017. Claims for dates of service on or after 10/1/2016 with 2017 ICD-10 diagnoses codes associated with the NCD edits may be subject to medical necessity denials during this period. Also, some NCD services will be rejected rather than denied for medical necessity if claim is submitted with a diagnosis that was end-dated 9/30/16. At this time there is no immediate resolution for this issue and no provider action is necessary. MACs are awaiting CMS direction and Palmetto GBA continues communication with CMS regarding this issue. Providers should  monitor their medical necessity denials carefully.