Harmony Healthcare Blog

ICD 9 Coding

Posted by The Harmony Team on Wed, Jun 23, 2010


Edited by Kris Mastrangelo

ICD 9 CODING Q: Where can I find a list of commonly used PT ICD-9 codes that have been deleted as of January 1? A: ICD 9 code changes take effect October 1 of each year. CMS publishes these changes on its Website at www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/07_summarytables.asp Keep in mind that several Medicare contractors’ local coverage decisions (LCD), as well as Aetna’s therapy policies, contain a list of ICD 9 CM codes that support medical necessity for all outpatient therapy services. To be considered for reimbursement, at least one of the ICD 9 CM codes contained in the LCD or Aetna policy must be present on the claim form to support the medical necessity of all services provided during that billing period. If the claim submitted does not contain an ICD 9 CM code that is in the LCD or Aetna policy, the entire claim will be rejected or denied. Several other Medicare contractors’ LCDs link ICD 9 CM codes to CPT codes. For each CPT code to be considered for reimbursement, at least one of the ICD 9CM codes listed under each CPT code in the LCD must be presented on the claim form. If an individual CPT code submitted on a claim form for payment does not have an ICD 9 CM code on the claim form to support its medical necessity, the individual line item will be rejected or denied. Contact your fiscal intermediary’s provider inquiry department to obtain clarification about why it considers this specific ICD 9 code to be nonpayable for skilled therapy services.

Source: Outpatient Rehab Reimbursement and Regulations, Oct. 2007

 

Tags: Medicare Coverage Criteria, ICD 9 Coding

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