Noridian
Electronic Claim Denials: Post ICD-10 Implementation
While ICD-10 was implemented on October 1, 2015, and the vast majority of claims are being submitted appropriately, below in the order of occurrence, are the most common reasons for front-end rejections of DME electronic claims. We have also listed reminders about these billing scenarios and ways to avoid denials.
1. Using an ICD-9 code for a date of service on/after October 1, 2015.
2. Using an ICD-10 code for a date of service prior to October 1, 2015.
3. Submitting both ICD-9 and ICD-10 diagnosis codes on the same claim.
4. Submitting a diagnosis code that does not have the required number of digits.
When should I use an ICD-9 code versus an ICD-10 code?
Claims with a single date of service (D8 qualifier) where the date is prior to October 1, 2015, must contain only ICD-9 diagnosis codes.
Claims with a single date of service (D8 qualifier) where the date is on or after October 1, 2015, must contain only ICD-10 diagnosis codes.
Claims with a date range (RD8 qualifier) where the FROM date is prior to October 1, 2015, must only ICD-9 diagnosis codes.
Claims with a date range (RD8 qualifier) where the FROM date is on or after October 1, 2015, must contain only ICD-10 diagnosis codes.
Can I use ICD-9 and ICD-10 codes on the
same claim?
No. ICD-9 and ICD-10 codes cannot be submitted on the same claim.
Claims requiring an ICD-9 code and claims requiring an ICD-10 code for
the same beneficiary will need to be sent as separate claims.
Diagnosis Codes that Require a Fifth or
More Digits
Below are codes billed in October that denied due to missing digits.
When using diagnosis crosswalk tools, you must still ensure that the code
has the correct number of digits as outlined in the detailed coding guidelines.
Reference your coding manuals or the coding guidelines on the CMS website 
.
E116 Type I diabetes mellitus with other specified complications
I678 Other specified cerebrovascular diseases
I690 Sequelae of nontraumatic subarachnoid hemorrhage
J4590 Asthma
J960 Acute respiratory failure
M199 Osteoarthritis, unspecified site
R131 Dysphagia
R268 Other abnormalities of gait and mobility
S069X9 Unspecified Intracranial injury with loss of consciousness of unspecified duration
S31 Open wound of abdomen, lower back, pelvis and external genitals
Last Updated Oct 26, 2015
https://med.noridianmedicare.com/web/jddme/article-detail/-/view/2230715/electronic-claim-denials-post-icd-10-implementation