Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

A Few Minor ICD-10 Glitches

denied-claim

After two weeks under ICD-10, so far, only minor glitches seem to be surfacing. Of course “minor” glitches can become major ones if not addressed. But here’s what we are hearing so far.

According to Laurie Johnson, MA, FAHIMA, director of health information management (HIM) for Panacea Healthcare Solutions, and Hollie Louie, RN, chair of the HBMA ICD-10 Committee, problems with local coverage determinations (LCDs) have begun to surface among some of the Medicare Administrative Contractors.

In an ICD-10 Monitor live broadcast on Monday, October 12, Louie said that LCDs and even NCDs (national coverage determinations) were only partially loaded and that several MACs have been affected. She did not provide any other details. Johnson provided updates to two specific LCD issues that arose last week involving National Government Services (NGS) and Novitas. In both cases, unspecified ICD-9 codes were previously included in the list of medically necessary diagnoses, but apparently similar unspecified ICD-10 codes had not been included. NGS announced they have begun implementing a fix. No word yet on Novitas’ response.

Johnson advised providers to closely monitor any denials for medical necessity. If you receive medical necessity denials, first check to be sure there were no issues with your claims submission process, like incorrect claims edits or scrubs. Then, she advised, check the LCDs and NCDs. For issues with LCDs, contact your MAC. NCD issues should be addressed to CMS.

Another ICD-10 issue that will continue at least temporarily involves physician orders for lab, radiology, and other services that were written prior to October 1, 2015, and contain ICD-9 codes. The Centers for Medicare and Medicaid Services (CMS) has indicated that new orders do not need to be obtained. Instead, providers of those lab and radiology services have the option to use the General Equivalence Mappings (GEMs) posted on the 2016 ICD-10-CM and GEMs web page to translate the ICD-9-CM codes on the original order into ICD-10-CM diagnosis codes.

Rhonda Buckholtz, AAPC vice president of strategic development, said in that same ICD-10 Monitor broadcast that she had heard of providers who were using incorrect ICD-9 codes that were vague enough that they are getting paid in the past, but now that the codes have been translated to ICD-10, payers are correctly denying them. This issue will be resolved by educating providers on the new code set.

Also, Louie reported that some ICD-10 coding assistance products have been assigning incorrect codes to claims, despite earlier testing. This issue is causing excessive work for coders who now have to check and correct all the work that these products were designed to help with.

Finally, there is still some confusion about the 7th character extension. Review the recent CIPROMS article about Understanding the 7th Character Extensions for more details about this issue.

Visit CMS’s ICD-10-CM/PCS Frequently Asked Questions web page for answers to questions about: Claims processing and billing, Coding, General Equivalence Mappings, Home Health, National Coverage Determinations, Local Coverage Determinations, and more.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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