ICD-10 coding, Understand reasons for ICD-10 denials.

All practices should be prepared to give ICD-10 coding their best shot, including reporting the codes to their full specificity, based on the latest guidance from CMS.Remember, to ensure specific documentation is in the note of your EHR, matches the codes entered or is pulled onto your claim.
Family of Codes is a three-character category. In order for this code to be valid, it must be coded to the full number of characters required for that code, including the seventh character, if applicable. Few ICD-10 codes may be reported as their three-character category heading; most require you to include more characters. The lengthiest ICD-10 codes have seven characters.
Review your LCD’s (Local Coverage Determination) and NCD’s (National Coverage Determination).
When Medicare coverage policies require specific codes, you will have to report them or face denial, CMS warns. We have heard it all along, October will be the real “go live” ICD 10 date. Let us hope we all have paid attention to this! If not, redeem and start being specific and stop utilizing non-specified codes.
In certain circumstances, a claim may be denied because the ICD-10 code is not consistent with an applicable policy, such as local coverage determinations (LCDs) or national coverage determinations (NCD). That means that if an NCD or LCD requires the full ICD-10 character set for a code, you must provide it or the claim will reject.
Go to your top NCDs and LCDs and familiarize yourself with the list of payable codes on each.
Recommendation is still to code to the greatest degree of specificity.

 

Understand reasons for ICD-10 denials.
You’ll be able to tell that your claim has been rejected for non-compliance with ICD-10 per a coverage determination by the remittance advice codes (RARCs) that come back with your denial. Some of the RARCs you might see include:
M64 (Missing/incomplete/invalid other diagnosis);
M76 (Missing/incomplete/invalid diagnosis or condition);
MA63 (Missing/incomplete/invalid principal diagnosis);
N115 (This decision was based on a Local Coverage Determination [LCD]…);
N386 (This decision was based on a National Coverage Determination [NCD]…);
N569 (Not covered when performed for the reported diagnosis

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