tci Medicare Compliance & Reimbursement - 2012 Issue 18

Denial Management: Not So Fast: Put the Brakes on E Codes as Primary Dx

New CMS directive says claims with E codes as primary diagnoses unprocessable.If you're submitting paper claims to Medicare with E codes in the primary diagnosis slot, don't expect a favorable response from the Centers for Medicare & Medicaid Services. The agency has released a new directive that tells MACs to return as unprocessable claims submitted on the Form CMS-1500 where an ICD-9-CM 'E' code (external causes of injury and poisoning) is reported as the first/principal diagnosis on the claim. Although this policy was already in place for electronic claims, the new announcement brings the policy for handling CMS-1500...

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