Hospice Coding: Strike Nearly 40 Dx Codes off Your List for Hospice Claims

Why This Topic Matters

Hospice claims can be delayed or returned if the principal diagnosis does not align with the CMS edit rules described in the article, affecting reimbursement flow and administrative workload. The guidance is important for providers updating workflows, training staff, and ensuring claim data reflects the patient’s terminal prognosis and related conditions.

Article Sections

1. CMS hospice claim edits and principal diagnosis guidance

   Introduces the hospice claim edit update and the general reporting issue it addresses. Summarizes the CMS and MAC implementation context and the types of diagnoses affected.

2. Affected diagnosis categories and CMS instruction

   Describes the diagnosis categories discussed in the transmittal and the general reporting expectations for hospice claims. Includes CMS clarification about principal versus secondary diagnosis reporting.

3. NAHC preparation steps for hospices

   Outlines recommended administrative and workflow preparation steps for hospice organizations. Focuses on staff training, documentation review, and intake process readiness.

4. Reporting coexisting and related diagnoses

   Covers CMS and NAHC reminders about including additional diagnoses related to the terminal illness and related conditions on the hospice claim.