ICD-9 Billing Reminder
With the exception of claims submitted by ambulance suppliers (specialty type 59), all physician and non-physician specialties must submit a valid ICD-9-CM diagnosis code that is of the highest level of specificity for the date of service. This means if there is a 5-digit diagnosis code, do not submit a 3 or 4-digit (truncated) diagnosis code on the claim.
WPS Medicare will deny paper claims with an ICD-9-CM that is not coded to the highest level of specificity or an invalid ICD-9-CM as unprocessable. The WPS processing system looks at all ICD-9-CM codes submitted on the claim. If any of the ICD-9-CM codes submitted on the claim are invalid or truncated, we will deny the entire claim as unprocessable. You must correct and resubmit these claims.
NOTE: While ambulance suppliers (specialty type 59) are not required to bill ICD-9-CM codes, if ICD-9-CM codes are billed on ambulance claims, they will be subject to ICD-9-CM validity requirements. If the billed ICD-9-CM codes are invalid or not billed to the highest level of specificity, we will return the claim as unprocessable.
The Multi-Carrier System (MCS) Electronic Media Claims (EMC) system subjects every ANSI X12N 837 version 4010A1 to a number of prepass edits. These edits determine whether to accept a file, claim, or batch into the batch cycle. EMC claims with an invalid diagnosis code will reject in prepass editing. You must correct and resubmit these claims.
See the following Websites for information about billing ICD-9s on your claims:
- EMC claims: See the WPS Medicare Website at http://www.wpsmedicare.com/mac/business/cms1500_xwalk.pdf
for information on billing ICD-9-CM codes with electronic claims in the ANSI X12 4010A1 format. - Paper Claims: See the CMS Website at http://www.cms.hhs.gov/manuals/downloads/clm104c26.pdf
for information on billing ICD-9-CM codes on the CMS-1500 form. See item 21 information.
Page Last Updated: Friday, 19-Sep-2008 11:06:05 CDT
