CMS clears ICD-9 confusion

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Sunday, April 20, 2003

April 21, 2003

BALTIMORE - CMS issued a Program Memorandum Friday that further clarifies how HME providers should file claims using ICD-9 codes.

CMS has instructed the DMERCs to not deny claims when the diagnosis code on a claim does not match the diagnosis on the order or CMN so long as:

- there’s sufficient evidence in the patient’s medical record to justify use of the code.

- the diagnosis on the claim justifies coverage for the item or service.

- the diagnosis code on the claim is valid and to the highest level of specificity.

CMS has also instructed the DMERCs to keep from asking suppliers for new CMNs “in those cases where ICD-9-CM codes were updated unless normal business practices would require a new order or CMN.”

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