ICD-9-CM Coding common rejection - Tips to use in CMS 1500

Impact on ICD-9-CM Coding

Claims for physicians’ services submitted on or after July 1, 2005, with a truncated ICD- 9-CM diagnosis code for the date of service given will be “returned as unprocessable.”

Important Note: It is imperative to use the most recent version of the ICD-9-CM coding book.

CMS has eliminated the 90-day grace period from October 1 through December 31 for billing discontinued ICD-9-CM codes. Providers will be required to use the new codes.

Fourth or Fifth Digits
Do not add or substitute numbers where they do not already exist in the coding scheme. For example, there are some legitimate three-digit ICD-9-CM codes that do not have a fourth or fifth digit. Physician offices should not add zeroes to these codes. The codes selected should accurately describe a patient’s illness or disease and be listed in the latest ICD-9-CM edition.

Frequently Truncated Codes

Some examples of the most frequently truncated diagnosis codes are:
•    Code 250 (diabetes mellitus) requires five digits. The fourth digit must be 0 through 9; the fifth digit must be 0 through 3.

•    Code 200 (lymphosarcoma and reticulosarcoma) requires five digits. The fourth digit must be 0, 1, 2 or 8; the fifth digit must be 0 through 8.

•    In the case of hypertensive disease, use code 4010 for malignant essential hypertension and code 4011 for benign essential hypertension. There is no fifth digit available for essential hypertension in the current coding system.

Use code 40210 for benign hypertensive heart disease without congestive heart failure and code 40211 for benign hypertensive heart disease with congestive heart failure.

•    Code 185 (malignant neoplasm of prostate). Do not add a zero; 1850 is incorrect.
•    Code 496 (COPD). Do not add a zero; 4960 is incorrect.