July 15, 2015
New Hospice Diagnosis Reason Codes
New hospice reason codes were implemented with the July 2015 system release to ensure appropriate diagnosis codes are submitted on billing transactions with the types of bill (TOBs) 8XA – 8XE ('X' denotes a 1 (nonhospital based), or a 2 (hospital based)).
Billing transactions (TOBs 8XA – 8XE) receiving one of the following reason codes will be sent directly to the Return to Provider (RTP) file. Therefore, it is important that correct diagnosis codes are submitted in order to avoid untimely submission of Notices of Election (NOEs) and Notices of Termination/Revocation (NOTRs). Timely NOEs (8XA) are submitted and accepted by CGS within five calendar days after the hospice admission. Timely NOTRs (8XB) are submitted and accepted by CGS within five calendar days after the hospice discharge or revocation (unless a final hospice claim has already been submitted).
If NOEs are sent to RTP with one of the reason codes below, causing untimely submission of the NOE, an exception request would not be granted, as this would be considered a billing error. For an exception to be granted, the documentation must show that the late filing of the NOE was beyond the control of the hospice. Billing errors are not considered a valid exception request.
The new reason codes are:
| Reason Code | Description / How to Resolve |
|---|---|
| 19508 | Description: An invalid ICD-9 or ICD-10 diagnosis code is submitted. How to Resolve: Review the diagnosis code(s) entered in the "DIAG CODES" field found on the Fiscal Intermediary Standard System (FISS) Claim Page 03. Ensure that a valid ICD-9 code is entered on billing transactions prior to October 1, 2015. Ensure a valid ICD-10 code is entered on claims with dates of service beginning October 1, 2015. Note: Diagnosis codes should not be entered with the decimal point. |
| 19511 | Description: An ICD-9 diagnosis code is present in the "DIAG CODES" field and the "FROM" date of service is on or after October 1, 2015, the ICD-10 implementation date. How to Resolve: Verify that the "FROM" date of service is correct. Review the diagnosis code(s) entered in the "DIAG CODES" field found on the FISS Claim Page 03. If the "FROM" date of service is on or after October 1, 2015, ICD-10 diagnosis codes should be entered in the "DIAG CODES" field. |
| 19512 | Description: An ICD-10 diagnosis code is present in the "DIAG CODES" field and the "FROM" date of service is prior to October 1, 2015, the ICD-10 implementation date. How to Resolve: Verify that the "FROM" date of service is correct. Review the diagnosis code(s) entered in the "DIAG CODES" field found on the FISS Claim Page 03. If the "FROM" date of service is prior to October 1, 2015, ICD-9 diagnosis codes should be entered in the "DIAG CODES" field. |
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