Dx Codes Eligible for Co-morbidity Pay Revised

Two ICD-9-CM diagnosis codes are no longer eligible for a co-morbidity payment adjustment under the End-Stage Renal Disease Prospective Payment System (ESRD PPS). In fact, they never really were eligible.

Diagnosis codes 484.6 Pneumonia in aspergillosis and 484.7 Pneumonia in other system mycoses have been removed from the bacterial pneumonia co-morbidity category, effective Jan. 1, because they didn’t belong in the ESRD PPS in the first place. These codes were incorrectly listed under the acute co-morbidity category in Attachment 8 of Change Request (CR) 7064, released Aug. 20, 2010.

Contractors are not required to identify and adjust claims with these codes, but ESRD facilities are expected to identify claims receiving payment adjustments for these codes and adjust claims accordingly within the filing period.

Source: MLN Matters article MM7284

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