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Watch for Denials If You Take Shortcuts on Form 5010

Say goodbye to form 4010A1 for ICD codes as well, starting in 2012.

Dig into your claim forms now to ensure that the beneficiary’s information is accurate to the letter, or you’ll face scores of denied claims on the new HIPAA 5010 forms.

Why it matters: CMS will deny claims on which the beneficiary’s name doesn’t perfectly match how it’s listed on his Medicare I.D. card when you begin using HIPAA 5010 form — the new Medicare universal claim form starting in 2012.

Include Jr. or Sr. Suffixes

“Whenever there is a name suffix, such as ‘Jr.’ or ‘Sr.’ abbreviations, etc., it must be included with the last name,” said Veronica Harshman of CMS’s Division of Medicare Billing Procedures during an April 28 Open Door Forum regarding the eligibility component of the HIPAA 5010 form.

You can include the suffix either with the patient’s last name or in the suffix field, specified CMS’s Chris Stahlecker during the call.

“The date of birth must also match exactly to what the Social Security Administration has on file,” Harshman said. CMS will use several new error codes on claims once the 5010 form goes into effect. “If you communicate with CMS through a third-party vendor (clearinghouse), it is strongly recommended that you discuss with them how these errors will be communicated to you and how these changes will impact you and your business,” Harshman advised.

Look for Production Systems Next Year

According to the HIPAA 5010 Final Rule, CMS will have a production 5010 system available as of Jan. 1, 2011, Harshman said.

The last day CMS will accept a 4010A1 form will be Dec. 31, 2011. As of Jan. 1, 2012, if you aren’t using the 5010 form, you’ll “lose the ability to receive eligibility data from Medicare,” Harshman said. In…

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Heads Up Coders: 2013 ICD-10 Implementation Date Is Firm

Plus: CMS has proposed freezing the ICD-9 codeset after next year.

If you were hoping that the Oct. 1, 2013 ICD-10 implementation date wasn’t set in stone, you are out of luck. That’s the word from CMS during a June 15 CMS Open Door Forum entitled “ICD-10 Implementation in a 5010 Environment.”

“There will be no delays on this implementation period, and no grace period,” said Pat Brooks, RHIA, with CMS’s Hospital and Ambulatory Policy Group, during the call. “A number of you have contacted us about rumors you’ve heard about postponement of that date or changes to that date, but I can assure you that that is a firm implementation date,” she stressed.

Brooks indicated that the rumor about a potential delay in the implementation date continues to persist throughout the physician community, and recommended that practice managers alert their physicians to the fact that that the rumor is untrue.

The Oct. 1, 2013 date will be in effect for both inpatient and outpatient services. Keep in mind that the ICD-10 implementation will have no impact on CPT and HCPCS coding, Brooks said. You will still continue to bill your CPT and HCPCS procedure codes as before.

You’ll Find Nearly 55,000 Additional Codes

Currently, CMS publishes about 14,000 ICD-9 codes, but there are over 69,000 ICD-10 codes. The additional codes will allow you to provide greater detail in describing diagnoses and procedures, Brooks said.

If you’re wondering which specific codes ICD-10 includes for your specialty, you can check out the entire 2010 ICD-10 codeset, which CMS has posted on its Web site. “Later this year, we’ll be posting the 2011 update,” Brooks said during the call.

@ For more details on CMS’ upcoming plans, subscribe to Part B Insider (Editor: Torrey Kim, CPC).


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Get a Glimpse at ICD-10 Codes for Cough, Back Pain, and More

Wrap your brain around using letters in your diagnosis codes.

If you aren’t curious about how the ICD-9 codes crosswalk to ICD-10, maybe you should be.

“The transition date for ICD-10 codes is Oct 1, 2013,” stressed CMS’s Stewart Streimer…

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Coding Generalized Bronchitis? Prepare for Denials

Relying on the physician’s encounter form could be a big mistake.

Question: I used 491.9 to report a patient’s bronchitis, but the payer denied my claim and requested additional information. What was wrong?

Vermont Subscriber

Answer: Your claim may have…

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Ob-gyn Coding Challenge: Deliver Postpartum V Codes With Care

Bonus: Get exposure to ICD-10 coding equivalents.

Question: A mentally-challenged patient who delivered at home was admitted to the hospital for postpartum care. The patient delivered the placenta at home, and once admitted, she had no complications, but the ob-gyn

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Ob-gyn Coding Challenge: EM End-Result Tells You What ICD Code To Go For

Check out these ICD-10 ob-gyn diagnosis coding equivalents.

Question: A patient presented for an initial OB visit. Another clinic confirmed her pregnancy, but she has never received prenatal care. The patient got her usual initial OB service (i.e. lab orders),

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Pick the Right ICD-9, ICD-10 Code for Postmenopausal Abnormalities

Do N95.0 and N95.2 look foreign? Get your ob-gyn ICD-10 equivalents now.
Spare yourself denial hot flashes by taking this three-part postmenopausal abnormality scenario challenge.
Fill In These Blanks Using Your ICD-9 Book
Question 1: Your ob-gyn sees a post menopausal patient with an inflamed vagina because the tissues are thinning and shrinking. The ob-gyn notes decreased vaginal […]

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A Medical Coder’s ICD-10 Resource Guide

We’ve got the link to a nifty ICD-9 to ICD-10 code translator.
Maybe I’m getting old, but I just can’t believe we’re about to ring in the second decade of the 21st century. It seems like just yesterday I was toasting the new millennium and breathing a sigh of relief that “Y2K” wasn’t the big catastrophe […]

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Pain Management Coding Update: Facet Joint Injection CPT Changes for 2010

Pain management, anesthesia, orthopedic, physiatry & neurology coders get ready for a facet joint codes shift that preps for ICD-10.
The 2010 version of CPT attempts to organize the facet joint injection codes by deleting 64470-64476 and debuting 64490- 64495 in their place, as follows:
• 64490 — Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves […]

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