Posted Wednesday, September 8, 2021
Action Item: Get your claims dates right or payment could be delayed.
On October 1, CMS will implement several new ICD-10 codes, discontinue old ones and add specificity to codes already in use. In an earlier blog, Corridor discussed some of the common code changes that are likely to affect home health agencies. Besides using the right code, claims coders need to know the correct dates that determine the use of the 2022 ICD-10 code sets.
To ensure proper payment, make sure that the ICD-10 code is valid for the service date on your claim. This could affect claims arising from a patient service that began under the 2021 ICD-10 code that ends on September 30, 2021 and continued under the new code that begins on October 1, 2021. In fact, one of the most common problems causing claims denials is failure to update the ICD-10 code during the annual switch. As a general rule, 2022 ICD-10-CM code sets should be used for discharges beginning October 1, 2021.
Here are some examples that can help you decide whether to use the 2021 or 2022 codes on a particular claim:
- If you admit a new patient on August 30 and discharge them on or before September 30, use the old codes.
- If you admit a patient on September 2 and discharge them on October 2, use the new codes.
- For those patients admitted before October 1, codes are used based on the patient’s discharge date, not the claim submission date.
Because claims coding is never straight forward or simple, the date of the claim requiring the 2022 ICD-10-CM code set can vary according to the rules of individual commercial payers. CMS uses the October 1 implementation date, but check with individual payers as some commercial and private payers have their own processes that may be different than CMS.
Putting the 2022 ICD-10-CM Code Set into Practice
Implementing ICD-10-CM code set changes throughout your organization starts with developing a process and having a point person in charge of making sure claims are aligned with new rules.
- Identify cases that have claims with codes that are changing.
- Institute a process for getting new orders for any codes that have changed.
- Put together a team to get updated orders from physicians for claims that must be recertified.
- Assign a team member to follow through on updated orders to avoid payment delays.
- Educate internal coders about the new code sets or coordinate with external partners who do your claims coding to ensure they are implemented throughout the organization.
If you need help integrating the 2022 ICD-10 coding changes into your organization’s claims submission process, you’re not alone. Coding is a specialty, and we have experts on our staff to help you navigate the details. Please contact Corridor at 1-866-263-3795 or by clicking here. Our coding and reimbursement experts can help ensure that your claims won’t be delayed or rejected due to the fine points of dating your submission.
For over 30 years, Corridor has partnered with home-based care providers, delivering powerful solutions to support the unique challenges of caring for patients in the home. Our team of operating executives, clinicians, and nationally renowned industry experts have run provider organizations and resolved the same challenges you face.
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