U.S. Centers for Medicare and Medicaid Services Advises on New Excluded ICD-9-CM Diagnosis Codes for No-Fault Claim Records

Aug 20, 2013


To ensure claims under the Medicare Secondary Payer Mandatory Reporting Provisions in Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 are not improperly denied as of January 6, 2014, the Centers for Medicare & Medicaid Services (“CMS”) advised that it will no longer allow certain diagnosis codes to be posted within Non-Group Health Plan No-Fault Medicare Secondary Payer records if they are not related to a No-Fault claim.

In an alert sent on August 15, 2013, CMS advised that, as of January 6, 2014, these ICD-9-CM Diagnosis Codes will not be accepted when submitting a No-Fault Claim Input File Detail Record (Plan Insurance Type, Field 51, is equal to ‘D’). 

To view the alert and list of codes, click here.

CMS also advised that, beginning October 1, 2014, it will adopt the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for diagnosis coding in accordance with mandatory Health Insurance Portability and Accountability Act (HIPAA) administrative simplification requirements.


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