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

CIPROMS ICD-10 War Room: The First Denial


CIPROMS recently received our first ICD-10 related denial. An October 1 claim was denied by Mdwise Excel Network, the claims payment system for MDwise Hoosier Alliance, stating that an E-code can’t be primary. However, no E-code was submitted, and the claim contained only a single ICD-10 diagnosis code. A call to the payer revealed the denial was made in error, and they are re-adjudicating.

That claim will be monitored to ensure that it is paid correctly, and the CIPROMS team will continue to monitor all denials and rejections with this and other payers for any ICD-10 related problems.

We also recently discovered an issue with the submission of some paper claims containing ICD-10 codes with six or seven characters. In some cases, the sixth character of the ICD-10 code was erroneously dropped. For example, the correct diagnosis of Z86.010 printed as Z86.01 and the code T75.1xxA printed as T75.1xA.

The operations department painstakingly re-tested all 12 diagnosis slots in all 13 formats using ICD-10 codes with six or seven digits and reported all findings to our practice management system vendor who was responsible for and promptly fixed the error. Once the issue was resolved, any claims that were sent with erroneous diagnoses were re-submitted to payers. The issue did not affect any of the electronic claims formats, which account for the majority of claims submitted by CIPROMS.

Meanwhile, we have now entered more than $17 million in charges for all clients who have submitted October dates of service, and have posted almost $300,000 in payments for October dates of service from most major payers, including Medicare, Medicare Advantage, Medicaid, Anthem, United Healthcare, Cigna, Aetna, Sagamore, and others.

As mentioned previously, we will continue to keep you up to date on our experiences during the ICD-10 implementation. While our updates will begin to slow down now that we are one month into the transition, we will continue to report on all major successes and setbacks, as applicable. If you are a CIPROMS client, someone will contact you directly if we uncover any ICD-10 issues related to your account. Contact your assigned account executive per normal protocol if you have questions about ICD-10.

General questions about ICD-10 or other CIPROMS services can be sent to cipromsmarketing@ciproms.com.

— All rights reserved. For use or reprint in your blog, website, or publication, please contact us at cipromsmarketing@ciproms.com. Photo by tom_bullock via Flickr used with permission under the Creative Commons License. Photo was recolored as sepia, cropped, and words added.


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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