Medicare Compliance & Reimbursement

Question: Our claim scrubber is kicking out claims for removing foreign bodies from ears and for fractures, stating that a date of injury is required in order to bill these. I have not found anything in the ICD-10-CM manual or on our local Medicare website that states this is required; it is only requested as additional information if we were able to capture it. How should we handle this?

AAPC Forum Participant

Answer: There is no guideline that a date of injury is mandatory, but you need to include it when your scrubber tool requires the information (unless you can find a way to override this in your tool). Many insurance companies require the date of the injury to process claims for patients who are hurt. Check the patient’s medical record or consult with a physician to determine the date of the injury.

Important: Keep in mind that there is a chance that the Centers for Medicare & Medicaid Services (CMS) may not pay for some injuries, depending on how the injury happened. If a nose is fractured during a car accident, Medicare will be secondary to motor vehicle insurance. If a patient’s neck is cut severely, requiring a plastic closure from a slip and fall on ice on the steps of someone’s front yard, their homeowners insurance should be responsible for the care of the wound as the primary insurance, and Medicare would be secondary. If a foreign body gets in someone’s ear at work, workers’ compensation would be primary to Medicare’s secondary coverage.