Reimbursement

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Wednesday, April 30, 2003

Minding your ICD-9 p's & q's
With Jane Bunch

Q: Since CMS updated the ICD-9 codes, I have had both assigned and nonassigned claims denied by DMERCs for improper diagnosis codes. What should I do and how can I avoid this in the future?

A: When a claim is denied for an improper diagnosis code, the supplier should take one of two simple actions depending on whether the denied claim is assigned or unassigned.

On an assigned claim, the supplier should make the necessary coding corrections and simply resubmit. On unassigned, the supplier can choose to either resubmit with the necessary corrections or send the claim in on appeal.

If a supplier knows a diagnosis code on a CMN is not carried out to the correct specificity level, the supplier does NOT have to get a revised CMN. The supplier should simply transmit the claim inserting the correct code.

The anxiety level among suppliers regarding the changes to ICD-9 codes is largely unnecessary. Not all diagnosis codes have changed, although what has changed is the specificity level of many codes. An ICD-9 code has three, four or five digits. If a three-digit code has four-digit codes that further describe it, then the three-digit code is unacceptable.

The majority of DME software programs currently on the market will insert the correct diagnosis code for the supplier; however, suppliers are urged to purchase annually an updated version of the ICD-9 code book, which highlights the proper, updated diagnosis codes in addition to giving a thorough definition of the code and its use.

An updated list of ICD-9 codes that changed for FY 2003 can be found on the CMS Web site at www.cms.hhs.gov/medlearn/icd9code.asp.

— Jane W. Bunch is CEO of Jane’s Billing & Consultation Services at (678) 445-1221.

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