Andrea Stark’s last minute ICD-10 advice

Andrea Stark
reimbursement consultant, MiraVista

We are down to the wire on the ICD-10 transition deadline, and healthcare professionals everywhere are feeling the heat. MiraVista has developed some last minute advice to aid DME suppliers in their final steps:

1.      Focus on the highest and best use for your resources. If you are staring down a massive data set, don’t work top to bottom. Parse out your data set to focus on active rentals, as these orders will create invoices on their own post-transition.

2.      Scale down where you can. Medicare requires that a valid ICD-10 code be present for claims to transmit. If your claim has four ICD-9 codes that need to be mapped, and the product is not diagnosis-driven (such as wheelchairs, hospital beds, commodes, walkers, enteral, oxygen, patient lifts, etc.), then place your most relevant code in the first position and eliminate the other non-priority codes.

3.      Grab that low hanging fruit first. There are two types of ICD-9 codes: (1) those that map neatly to one single code in the ICD-10 code set, and (2) those that map to multiple codes in the ICD-10 code set. Prioritize the one-to-one maps first, as they are the most straightforward and require no digging in medical records.

4.      Leverage the tools available to you. Not sure which codes map to which? The AAPC translator tool is an excellent resource to identify potential matches for your ICD-9 codes. This tool allows you to plug in a single ICD-9 code to identify potential ICD-10 matches.

5.      Make sure you have the “right” code.  If you are heavy in diagnosis-driven products (AFOs, KAFOs, KOs, breast prostheses, glucose monitors, nebulizers, ostomy, PAPs, Group 2 and 3 support surfaces, therapeutic shoes, trach supplies, wheelchair seating, etc.) utilize the future LCDs posted to the CMS website. These LCDs will become active on Oct. 1st and can help you match up your diagnosis driven products.

6.      Know the rules. CMS has notified the industry that DME claims processing logic will be based on the from date of service. Therefore, if your claim has a from DOS on or after Oct. 1st, you must utilize ICD-10 codes. For claims with a from DOS on or before Sept. 30th, claims should be submitted using ICD-9 codes. A single claim cannot, at any time, contain both ICD-9 and ICD-10 codes. Claims submitted with dual codes will be rejected. When submitting claims with ICD-9 codes (with a qualifying from date) the ICD-10 indicator should be 9. When submitting claims with ICD-10 codes (with a qualifying from date of service) the ICD-10 indicator should be 0.

7.      Prepare your team. Claims that do not contain compliant codes after the ICD-10 deadline will be rejected. Suppliers should be checking their front-end rejections, which appear in the form of a 277CA report. ICD-10 rejections will appear with claims status category code (CSCC) A7 (Acknowledgement/ Rejection for Invalid Information) and will be accompanied by one or more of the following claims status codes (CSCs) below:

·         Issue:  The ICD-10 code is not a valid ICD-10 code or is not valid for the date of service reported.

o   CSC 254: Primary diagnosis code and

o   CSC 255: Diagnosis code

·         Issue: Diagnosis code must not contain a decimal

o    CSC 511: Invalid character and CSC 254: Primary diagnosis code  OR

o   CSC 511: Invalid character and CSC 255: Diagnosis code

·         Issue: ICD-10 codes that begin with letter “V”, “W”, “X”, or “Y” are not allowed.

o   CSC 254: Primary diagnosis code and

o   CSC 509: E-Code

·         Issue: Cannot have both ICD-9 and ICD-10 codes on the same claim. If principle diagnosis code is an ICD-9 code the subsequent diagnosis codes must be an ICD-9 code. Likewise, if the principle diagnosis code is an ICD-10 code the subsequent diagnosis codes must be an ICD-10 code.

o   CSC 255: Diagnosis codes

The deadline is approaching quickly and suppliers should take note that rejected claims will ultimately result in stalled revenue. If you need assistance in your transition contact our office.

Andrea Stark is a reimbursement consultant with MiraVista.