Provider Types Affected Provider Action Needed The IPF Pricer uses the ICD-9-CM code 585 to provide a payment adjustment for claims with a comorbid condition of chronic renal failure, and the IPF Pricer was not updated with the expanded list of ICD-9-CM codes for 585. This article is based on Change Request (CR) 4164 which informs your fiscal intermediary (FI) that the IPF Pricer will have the updated list of ICD-9-CM codes for April 2006. Background The intent of the comorbidity adjustments was to recognize the increased cost associated with comorbid medical conditions by providing additional payments for certain concurrent medical and psychiatric conditions that are expensive to treat. The following are the seventeen (17) comorbidity adjustment categories. Description of Comorbidity
Each comorbidity grouping receives a grouping-specific adjustment, and the comorbidity category “Renal Failure, Chronic” has an adjustment factor of 1.11. IPF may be paid multiple comorbidity adjustments, but only one adjustment is allowed per category. Effective October 1, 2005, the ICD-9-CM diagnosis code for Chronic Renal Failure (585) has been replaced by the four-digit coding numbers listed in the following table. (See Medlearn Matters Article MM4005 at http://www.cms.hhs.gov/MedlearnMattersArticles/downloads/MM4005.pdf Diagnosis Code Description These new ICD-9-CM codes are effective for discharges occurring on or after October 1, 2005, and the IPF Pricer will be updated with the new codes, beginning April 1, 2006. IPFs should resubmit their claims after April 1, 2006 (for discharges occurring between October 1, 2005 and March 31, 2006), if the comorbidity adjustment is applicable. Your FI will accept resubmissions of IPF claims with ICD-9-CM diagnosis codes 585.1 – 585.6 and 585.9 after April 1, 2006, so that the Chronic Renal Failure comorbidity adjustment factor of 1.11 can be applied and the claim can be paid appropriately. In the meantime, all IPF claims will continue to pay. Implementation Additional Information For complete details, please see the official instruction issued to your intermediary regarding this change. That instruction may be viewed at http://www.cms.hhs.gov/Transmittals/ If you have any questions, please contact your intermediary at their toll-free number, which may be found at http://www.cms.hhs.gov/MedlearnProducts/downloads/CallCenterTollNumDirectory.pdf Disclaimer For more information, visit the Medlearn Matters Web page at: http://www.cms.hhs.gov/MedlearnMattersArticles/. Pub. 100-4, Transmittal# 757, CR# 4164 Related CR Release Date: November 18, 2005 Effective Date: October 1, 2005 Posted: 12/02/2005 CPT codes, descriptions, and other data only are copyright 2005 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply. |
on the CMS Web site.) 
on the CMS Web site.
