Stop using disallowed ICD-10 diagnosis codes to identify terminal illness, says CMS.
Way back in 2013 CMS warned the hospice industry that ICD diagnosis codes identifying a hospice beneficiary's terminal illness must be specific. And CMS told hospices that they must follow official coding conventions like all other health-care providers. That's when "Debility" and "Failure to Thrive" went out of style as the terminal illnesses assigned to way too many hospice beneficiaries. MACs started returning to the provider all claims bearing those as primary diagnosis.
This month, CMS gave notice that many more diagnoses are now on the "do not use" list that hospices must avoid using as primary diagnoses to avoid those claims returning to the provider.
Frankly, I don't know why they didn't do this sooner. Hospice must follow all ICD-10 coding conventions. That's always been true. But CMS allowed hospices to ignore that rule for so long, many hospices swapped out primary diagnoses "Debility" and "Failure to Thrive" for other non-specific diagnosis codes – many of which coding conventions exclude from either flying solo or as appearing as primary diagnosis on any claim anywhere.
Now CMS is serious. These two documents from CMS explain it all. One of them even includes the list.
- Processing Hospice Claims – Principal Diagnosis Code Reporting Update: Medicare Claims Processing Manual, Chapter 11, Sections 30.3, 40.2 & 50
- Principal Diagnosis Code Reporting Update for Hospice and Manual Updates to Sections 30.3, 40.2, and 50 of Chapter 11 of the Claims Processing Manual: Processing Hospice Claims
Let me know if you have questions about this. I want you to avoid payment delays and other issues that could arise from not using correct ICD-10 diagnosis codes according to required coding conventions.
Be well.
Beth