Avoid E Codes as First Dx, or Face Claims Rejection
When submitting claims to Medicare, be certain that you aren’t listing an ICD-9-CM E code as the first diagnosis, or your claims will be returned to you. E codes describe external causes of injury or poisoning. ICD-9-CM prohibits E codes from being reported as principal diagnoses.
The Centers for Medicare & Medicaid Services (CMS) instructs contractors in Transmittal 2515 to return claims submitted on Form CMS-1500 when an ICD-9-CM E code is reported as the first diagnosis of the claim in Item 21, effective Jan. 1, 2013. This instruction will bring the policy for handling Form CMS-1500 paper claims into alignment with the policy for handling claims initially submitted in electronic format. The new edit will also apply to ICD-10-CM codes V00-Y99 when they become effective on Oct. 1, 2014.
Refer to MLN Matters® MM7700 for handling CMS claims reported with an E code as the first diagnosis code in Item 21.