HMES face ICD-9 challenge

Sunday, February 2, 2003

February 3, 2003

BALTIMORE - Unless CMS grandfathers existing CMNs - and right now, no one has any information to suggest that they will - HME providers are facing an operational nightmare April 1 when the DMERCs are prepared to start denying all claims that lack a five-digit ICD-9 code.

In the past, suppliers ran into little trouble when using non-current diagnosis codes. But now, to comply with HIPAA, current ICD-9 codes must be filed on every claim. Claims with truncated codes will be denied.

The potential impact to the HME industry was made clear in January when an oversight at Region B installed an edit in the system that kicked out claims, starting Jan. 1, for all claims that lacked the five-digit diagnosis codes. (The April 1 deadline has originally been set for Jan. 1; Region B accidentally launched the edit Jan. 1)

For all claims adjudicated during the first nine days of January, RemitDATA saw the denial rates of its clients rising in a spike. The same could hold true across all DMERC regions April 1 if suppliers fail to submit claims with the right ICD-9 codes.

Even more onerous is the possibility that suppliers will have to get new CMNs, with updated diagnosis codes, for existing patients.

“Nobody from CMS has said they will not require us to go back and obtain new medical necessity info,” said Tim Pontius, president of Yound Medical Equipment and chairman of the Region B Council.