CMS Releases NGHP Alert on ICD-10-CM Coding

CMS has released a technical alert for NGHPs dated March 25, 2014 that pertains to the reporting of liability insurance, no-fault insurance, and worker’s compensation claims. This alert provides new and clarified guidance around the usage of ICD-10-CM codes as follows:

  • New Excluded ICD-10-CM Diagnosis Codes
    • ICD-10-CM “Z” diagnosis codes are considered invalid for Section
      111 reporting and must be excluded from use in claim reports.
    • CMS has determined that these ICD-10-CM “Z” codes do not provide enough information related to the cause and nature of an illness, incident, or injury to be adequate for Section 111 reporting usage.
    • ICD-10-CM “Z” codes will not be accepted in either Field 15 (Alleged Cause of Injury, Incident or Illness) or in Fields 18 through 36 (ICD Diagnosis slots 1 through 19) of the Claim Input File Detail Record.
    • The “Z” codes are not listed separately on the exclusion list in the NGHP User Guide, Appendix I.
  • Clarification On The Use of V, W, X and Y Codes
    • ICD-10_CM diagnosis codes beginning with the letters “V,” “W,” “X,” or “Y” may only be used in Field 15, the Alleged Cause of Injury, Incident, or Illness, as long as the code does not appear on the excluded diagnosis code list in the NGHP User Guide – Appendix I.
    • These codes are considered invalid for usage in Fields 18 through 36(ICD Diagnosis slots 1 through 19).

This new alert can be found at the following address:

http://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Non-Group-Health-Plans/Downloads/New-Downloads/Technical-Alert-Liability-Insurance-Including-Self-Insurance-No-Fault-Insurance-and-Workers-Compensation-Excluded-Diagnosis-Codes.pdf

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