Part B Insider (Multispecialty) Coding Alert

Published on Fri Feb 27, 2015 PDF

Biggest denial reason had nothing to do with diagnosis coding.

It appears that ICD-10 really will be implemented this year, with a recent Congressional hearing confirming that the government doesn’t plan to push back the new diagnosis coding system any further than it already has been—and with those plans full steam ahead, CMS revealed that its recent end-to-end testing period returned positive results.

The agency processed 14,929 test claims during the Jan. 26 to Feb. 3 testing period, from 661 participating providers. An overwhelming majority of claims—81 percent—were accepted through the system, and the remaining claims were rejected for three main reasons, as follows, according to the most recent statistics released by CMS:

• Invalid submission of ICD-9 codes (seen in three percent of rejected claims)
• Invalid submission of ICD-10 codes (as demonstrated by another three percent of claims that didn’t pass through the system)
• Errors unrelated to ICD-10, such as using an incorrect NPI, an invalid date, the wrong place of service or an incorrect HCPCS code (seen in 13 percent of rejected claims)

Wait Until Oct. 1 to Use ICD-10

The date of service errors led CMS to discover that some providers are confused about when they can submit claims with ICD-10 codes in both the testing arena and the real, “non-testing” world, said CMS Administrator Marilyn Tavenner in a Feb. 25 blog post on the topic. 

“ICD-10 can be used only for test purposes before October 1,” said Tavenner, who will be leaving her CMS post at the end of this month. “Only ICD-10 can be used for doctor’s visits and other services that happen on or after October 1. ICD-9 cannot be used to bill for services provided on or after October 1. This rule applies no matter when the claim is submitted, so claims submitted after October 1, 2015, for services provided before that date must use ICD-9 codes.”

Overall, the testing results indicate that the majority of health care providers are poised to succeed under the ICD-10 system—and those who aren’t should step up their training to be ready in time for the Oct. 1 deadline.

To read Tavenner’s statistics on the end-to-end testing, visit http://blog.cms.gov/2015/02/25/successful-icd-10-testing-shows-industry-ready-to-take-next-step-to-modernize-health-care.