CMS to Reject More Unspecified Diagnosis Codes

CMS to Reject More Unspecified Diagnosis Codes

A recent technical alert from the Centers for Medicare & Medicaid Services (CMS) outlines additional unspecified diagnosis codes the agency is excluding from both ICD-9 and ICD-10 reporting beginning January 2, 2017.

CMS’ missive states the codes, “will not be accepted in the in the Alleged Cause of Injury, Incident or Illness (Field 15) or in any ICD Diagnosis Code field starting with Field 18. Updates to previously submitted records using these excluded codes, will also be rejected.”

These additions and upcoming changes to the ICD-10 codeset underline the need for clinical documentation improvement and ICD-10 training, experts say, as code and rule freezes are lifted by the healthcare payment agency.  ICD-10-CM will include 1900 new codes and several more changes and deletions. Attention to documentation quality will be paramount.

Impacts Workers’ Comp and Auto

CMS writes that this change supersedes the applicable language in the MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting Liability Insurance (Including Self-Insurance), No Fault Insurance, and Workers’ Compensation User Guide (Version 4.9).

The following ICD-10-CM will be added to the list of excluded diagnosis codes:

  • 999.9 (Other and unspecified complications of medical care, not elsewhere classified)

The following ICD-10-CM will be added to the list of excluded diagnosis codes:

dec-clearance-sale

  • T88.7XXA (Unspecified adverse effect of drug or medicament, initial encounter)
  • T88.7XXD (Unspecified adverse effect of drug or medicament, subsequent encounter)
  • T88.7XXS (Unspecified adverse effect of drug or medicament, sequela)
  • T88.8XXA (Other specified complications of surgical and medical care, not elsewhere classified, initial encounter)
  • T88.8XXD (Other specified complications of surgical and medical care, not elsewhere classified, subsequent encounter)
  • T88.8XXS (Other specified complications of surgical and medical care, not elsewhere classified, sequela)
  • T88.9XXA (Complication of surgical and medical care, unspecified, initial encounter) ·
  • T88.9XXD (Complication of surgical and medical care, unspecified, subsequent encounter)
  • T88.9XXS (Complication of surgical and medical care, unspecified, sequela)

 

Brad Ericson

Brad Ericson

Publisher at AAPC
Brad Ericson, MPC, CPC, COSC, has been publisher for more than nine years. Before AAPC he was at Optum for 13 years and at Aetna Health Plans before that. He has been writing and publishing about healthcare since 1979. He received his Bachelor's in Journalism from Idaho State University and his Master's of Professional Communication degree from Westminster College of Salt Lake City.
Brad Ericson

About Has 196 Posts

Brad Ericson, MPC, CPC, COSC, has been publisher for more than nine years. Before AAPC he was at Optum for 13 years and at Aetna Health Plans before that. He has been writing and publishing about healthcare since 1979. He received his Bachelor's in Journalism from Idaho State University and his Master's of Professional Communication degree from Westminster College of Salt Lake City.

3 Responses to “CMS to Reject More Unspecified Diagnosis Codes”

  1. michelle nurse says:

    Then what are we to use for postop seroma or “fluid collection”?
    Hematoma codes specific to what procedure and what organ system?

  2. Coding Mom says:

    Yes, I agree. We need valid replacement codes for the deleted non specific codes. We only use the non specific because there’s not a valid cpt available.

  3. Maryann Palmeter, CPC, CENTC, CPCO says:

    These codes have nothing to do with CPT, they are ICD-10-CM codes (not PCS). I would have to question a physician who was treating a patient for an adverse reaction to a drug or a complication of medical or surgical care who did not know what the adverse reaction or complication was.

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