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MIR-2006-12AB, December 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services) |
Processing All Diagnosis Codes Reported on Claims Submitted to Carriers
Provider Types Affected
All physicians and providers submitting claims to carriers
Provider Action Needed
Impact to You
Effective at the earliest, July 1, 2007, the carrier standard system for Medicare will automatically process all diagnosis codes that you submit on your claims.
What You Need to Know
CR4276, the second phase in the implementation of the Negotiated Rulemaking agreement to automatically consider all diagnosis codes reported on claims, includes finalization of the requirements and coding development for the standard system used by Medicare carriers.
What You Need to Do
Make sure that your billing staffs are aware of these changes that allow eight diagnosis codes on Medicare claims, effective at the earliest, July 1, 2007.
Background
While the American National Standards Institute (ANSI) 837P 4010A allows the reporting of up to eight diagnosis codes in the 2300 loop, the Medicare carrier standard system uses only the first four diagnosis codes when processing HIPAA format claims. Carriers have used a manual process to consider the remaining diagnosis codes in the Medicare payment determination.
In CR4276, from which this article is taken, the Centers for Medicare & Medicaid Services (CMS) is requiring that (effective no earlier than July 1, 2007) the Medicare carrier standard system capture and process all diagnosis codes that are reported, up to the maximum of eight, on any claim (both electronic and paper) processed.
Additional Information
You can find more information about the application of all diagnosis codes reported in processing carrier claims by viewing CR4276 at http://www.cms.hhs.gov/Transmittals/downloads/R1095CP.pdf  on the CMS Web site.
If you have any questions, please contact your carrier at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip  on the CMS Web site.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
MLN Matters Number: MM4276
Pub. 100-4, Transmittal# R1095CP, CR# 4276
Related CR Release Date: October 27, 2006
Effective Date: April 1, 2007
Implementation Date: April 2, 2007
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