Home Health & Hospice Week

The requirement to use longer diagnosis codes where applicable has softened a bit, but the diagnosis for durable medical equipment suppliers remains gloomy.

Suppliers still must make sure every claim they submit for new and longstanding patients has four- or five-digit ICD-9 codes where those codes exist, according to a clarification issued by the DME regional carriers in their spring bulletins. But the DMERCs explain that suppliers won't need to obtain new or revised certificates of medical necessity for existing patients.

As of April 1, the DMERCs will implement new edits to ensure suppliers use the longest ICD-9 code available. The DMERCs will return as unprocessable claims received on or after Jan. 1 and processed starting April 1 if they lack the most specific codes. Suppliers will have to correct and resubmit those claims.

Every line on an electronic claim must reference a valid diagnosis code. Paper claims don't need diagnosis codes, but the DMERCs will apply the edits to every claim that has them.

ICD-9 codes are updated and deleted every October, but suppliers will have a grace period every year until Dec. 31 to start using the new codes.

So how can suppliers figure out the correct ICD-9 code to submit with each claim? The DMERCs offer a list of possible sources, including the codes on a physician's written order or CMN; the narrative diagnosis on a written order; information from other written forms or verbal statements from physicians and other professionals; information from the beneficiary; and coding books and resources.

Any diagnosis code must be supported by the information in the patient's medical record, the DMERCs point out.

Suppliers are forbidden from entering any diagnosis information on CMNs, but they won't have to worry about CMNs the DMERC systems already have accepted in the past.

"It's a relief that we will not be expected to obtain revised CMNs and detailed orders for any code changes," says Paula Koenig with the Association for Indiana Home Medical Equipment Services. "That would have been a nightmare!"

But it remains unclear how suppliers must document the use on claims of ICD-9 codes that don't match the codes on existing CMNs, she says. "Can we document a verbal confirmation, or should we get something signed by the doctor to assure we do not have difficulties in an audit situation?" asks Koenig, executive vice president with Indianapolis-based Wheelchairs & More.

She also says April 1 is too soon for suppliers to implement changes that the DMERCs are just getting around to clarifying.