CMS Releases Section 111 Alert Pertaining to No-Fault Claim Records

CMS released an alert on August 14, 2013 relating to the use of ICD-9-CM and ICD-10-CM codes for no-fault claim records. The alert contains a list of ICD-9-CM and ICD-10-CM codes that will effectively be retired for no-fault claims, with each set of codes on a different schedule. PMSI recommends that clients, as well as any entity which manages claim data, take immediate steps to cease using the published codes for no-fault claims to avoid issues with either add or update claim submissions in the future.

No-fault claims submitted to CMS on or after January 6, 2014 that contain one of the specified ICD-9-CM codes will be rejected with an SP disposition code (error), even if there are other valid codes contained within the claim.

For ICD-10-CM rollout, CMS has retired the use of the codes published in the alert effective on January 6, 2014 for those testing ICD-10 directly with CMS, and October 1, 2014 for production claim files. As October 1, 2014 correlates to the start of production files that may contain ICD-10-CM codes, this effectively removes these codes from being utilized in production files.

For PMSI clients, our MedicareConnect system will be updated to flag claims where the discontinued codes are used beginning on the date of retirement. Validation errors relating to the use of these codes will indicate which ICD slot contains retired codes so that the claim can be remedied before submission.

For your convenience, a copy of the alert may be found here.

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