Inpatient Facility Coding & Compliance Alert

Question: We sent our Section 1011 payment request to Highmark Medical Services, but it was denied. What's going on?

Answer: As of February 23, a total of 25 states had reached their maximum funding for Section 1011 payment requests for dates of service April 1, 2011 through June 30, 2011. Providers in these states should no longer submit requests for payments or enrollment, according to a CMS representative during a recent Hospital and Hospital Quality Open Door Forum call.

The new Section 1011 Administrative Contractor is Novartis Solutions, which Diversified Service Options (a subsidiary of Blue Cross Blue Shield of Florida) acquired from Highmark in January. You can read the latest on Section 1011 – including the states that can no longer file for payments – by visiting www.novartis-solutions.inc and clicking the Section 1011 tab.

"X" Won't Just Mark a Spot in ICD-10-PCS

Question: I've read articles or heard instructors who use "x" as a way to show that codes need an additional digit. A co-worker says the "x" will have a different meaning in ICD-10-PCS. Can you explain?

Answer: Your co-worker is right: "x" can be a placeholder under ICD-10-CM but won't have that role under ICD-10-PCS. The ICD-10-PCS codes are so detailed that the concept of placeholders doesn't exist. Because of that, an "X" in an ICD-10-PCS code carries particular meaning instead of simply filling a spot.

Explanation: Each ICD-10-PCS code is a seven-digit combination of letters and numbers, with each digit (or character) telling you something about the procedure (body system, root operation, body part, surgical approach, etc.). You'll use categories and cross-reference charts to determine the appropriate letter or number for each digit in the code. An "X" can be one of those characters, and its meaning will depend on its position in the code and section involved.