Home Health & Hospice Week

If you’re getting weird diagnosis code-related messages with returned claims, you may want to make sure your ICD-10 coding is up to date.

Why? The Centers for Medicare & Medicaid Services implemented new Home Health Grouper edits on April 1, HHH Medicare Administrative Contractor CGS reminds on its website. “With this implementation, CMS finalized the reassignment of 155 additional ICD-10 CM diagnosis codes from their current assigned clinical group to NA when the codes are listed as a principal diagnosis. We remind HHAs that if a claim cannot be assigned a clinical group (NA), the claim will be returned to the provider for correction,” the MAC says.

You may see messages like “Unacceptable primary diagnosis, not reportable as primary” or “Manifestation code not reportable as primary diagnosis” with your returned claim. More details are at www.cgsmedicare.com/hhh/pubs/news/2023/04/cope136984.html.