January 2007
Provider Types Affected
All physicians and providers submitting claims to carriers
Provider Action Needed
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.
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.
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, 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 website.
If you have any questions, please contact your state's Provider Contact Center.
MLN Matters MM4276