General Question for the Week of September 21, 2015

General Compliance Question of the Week

Question:

What will happen to claims that contain ICD-9-CM codes for services on or after October 1, 2015?

Answer:

According to the Centers for Medicare & Medicaid Services (CMS), depending on the dates of service and bill type, claims that contain ICD-9-CM codes will be handled as follows:

  • Direct data entry institutional claims will be returned to provider (RTP).
  • Paper professional and supplier claims will be returned as unprocessable.
  • Electronic institutional, professional, and supplier claims will be rejected.

Billers whose paper or electronic claims are returned or rejected for an invalid diagnosis code may correct and resubmit those claims. You will receive a letter of explanation or a Remittance Advice that provides information about claim errors. After the claim has been corrected, you must resubmit it as a new claim within the timely filing period. Claims that have been returned as unprocessable may not be appealed.

You may appeal initial claim determinations, including denials, if you are dissatisfied with the claim determination and file a timely appeal request that contains the necessary information needed to process the request.

If a denial is due to a minor error or omission you made in filing a claim, you may request a reopening to correct such clerical errors. A reopening is separate and distinct from the appeals process. After the claim has been corrected, you must resubmit it within the timely filing period.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.