COLUMBIA, SC (September 25, 2015)—We are down to the wire on the ICD-10 transition deadline, and health care professionals everywhere are feeling the heat. MiraVista has developed some last minute advice to aid DME suppliers in their final steps:
1. Focus on highest and best use for your resources. If you are staring down a massive data set, don’t work top to bottom. Parse out your data set to focus on active rentals as these orders will create invoices on their own post transition. We have a tool to assist you in that effort, contact us at icd10@miravistallc.com for more information.
2. Scale down where you can. Medicare requires that a valid ICD-10 code be present in order for claims to transmit. If your claim has four ICD-9 codes that need to be mapped, and the product is not diagnosis driven (such as wheelchairs, hospital beds, commodes, walkers, enteral, oxygen, patient lifts etc.), then place your most relevant code in the first position and eliminate the other non-priority codes.
3. Grab that low hanging fruit first. There are two types of ICD-9 codes (1) those that map neatly to one single code in the ICD-10 code set, and (2) those that map to multiple codes in the ICD-10 code set. Prioritize the one-to-one maps first as they are the most straight forward and require no digging in medical records.
4. Leverage the tools available to you. Not sure which codes map to which? The AAPC translator tool is an excellent resource to identify potential matches for your ICD-9 codes. This tool allows you to plug in a single ICD-9 code to identify potential ICD-10 matches.
5. Make sure you have the “right” code. If you are heavy in diagnosis driven products (AFOs, KAFOs, KOs, breast prostheses, glucose monitors, nebulizers, ostomy, PAPs, Group 2 and 3 Support Surfaces, Therapeutic Shoes, Trach supplies, wheelchair seating, etc.) utilize the future LCDs posted to the CMS website. These LCDs will become active on October 1st and can help you match up your diagnosis driven products.
6. Know the rules. CMS has notified the industry that DME claims processing logic will be based on the FROM date of service. Therefore, if your claim has a FROM DOS on or after October 1st, you must utilize ICD-10 codes. For claims with a FROM DOS on or before September 30th, claims should be submitted using ICD-9 codes. A single claim cannot, at any time, contain both ICD-9 and ICD-10 codes. Claims submitted with dual codes will be rejected. When submitting claims with ICD-9 codes (with a qualifying FROM date) the ICD-10 indicator should be ‘9’. When submitting claims with ICD-10 codes (with a qualifying FROM date of service) the ICD-10 indicator should be ‘0’.
7. Prepare your team. Claims that do not contain compliant codes after the ICD-10 deadline will be REJECTED. Suppliers should be checking their front end rejections, which appear in the form of a 277CA report. ICD-10 rejections will appear with Claims Status Category Code (CSCC) A7 (Acknowledgement/Rejection for Invalid Information) and will be accompanied by one or more of the following Claims Status Codes (CSCs) below:
Issue: The ICD-10 code is not a valid ICD-10 code or is not valid for the Date of Service reported.
CSC 254: Primary Diagnosis Code AND
CSC 255: Diagnosis Code
Issue: Diagnosis code must not contain a decimal
CSC 511: Invalid Character and CSC 254: Primary Diagnosis Code OR
CSC 511: Invalid Character and CSC 255: Diagnosis Code
Issue: ICD-10 codes that begin with letter “V”, “W”, “X”, or “Y” are not allowed.
CSC 254: Primary Diagnosis Code AND
CSC 509: E-Code
Issue: Cannot have both ICD-9 and ICD-10 codes on the same claim. If principle diagnosis code is an ICD-9 code the subsequent diagnosis codes must be an ICD-9 code. Likewise if the principle diagnosis code is an ICD-10 code the subsequent diagnosis codes must be an ICD-10 code.
CSC 255: Diagnosis Codes
The deadline is approaching quickly and suppliers should take note that rejected claims will ultimately result in stalled revenue. If you need assistance in your transition contact MiraVista—we have a unique tool that will map the diagnoses for your active rentals and prioritize the listing of your one-to-one matches.
