tci Part B Insider - 2012 Issue 29

Diagnosis Coding: CMS Establishes Additional Safeguards to Prevent You From Reporting 'E' Codes As Primary Diagnoses

Whether you bill electronically or on paper, you'll get an instant denial if your primary dx is an 'E' code. Most practices know that they'll face immediate denials if they report an 'E' code as the primary diagnosis on their electronic claims--but now CMS extends that policy out to paper claims, with a new transmittal reminding Part B practices that there is no workaround to this claims edit.The directive 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...

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