May 2004 Newsletter

ICD Grace Period Gone

By: Janet Browning, Quality Assurance

CMS - Elimination of 90-day Grace Period for Billing Discontinued ICD-9-CM Codes for 2005

Medicare has traditionally allowed a 90-day grace period after the annual October 1 implementation of an updated version of ICD-9-CM Diagnosis Codes. During this 90-day grace period providers could use either the previous or the new diagnosis codes. For claims received on or after January 1, the updated diagnosis codes were required.

Due to HIPAA standards, which require the use of national code sets that are valid at the time that the service is provided, CMS can no longer allow the 90-day grace period. Effective for dates of service on and after October 1, 2004, Carriers and DMERCs will no longer be able to accept discontinued codes for dates of service October 1, 2004 through December 31, 2004.

Quadax will be updating our edits to edit electronic claims against the new 2005 codes, effective with dates of service October 1, 2004 and after. As of this month, only CMS has announced the elimination of this grace period. We are monitoring other payers to see if they will also be following these guidelines.

Providers can view the new, revised, and discontinued ICD-9-CM diagnosis codes on CMS' web site . CMS updates this site annually after the updated diagnosis codes are published in the Federal Register, which usually occurs by May 1 of each year.

Other articles this quarter by Janet Browning: HCPCS Grace Period Gone, Claims' Supporting Doc.