IMPORTANT! READ CAREFULLY TO ENSURE THAT YOUR CLAIMS MEET THE NEW DIAGNOSIS CODING REQUIREMENTS

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1 Invalid Hospice Diagnosis Codes, Effective October 1, 2014 To: NHPCO Members From: NHPCO Regulatory Team Date: October 2, 2014 IMPORTANT! READ CAREFULLY TO ENSURE THAT YOUR CLAIMS MEET THE NEW DIAGNOSIS CODING REQUIREMENTS Summary at a Glance When CMS issued CR8877 to implement the FY2015 Hospice Wage Index Final Rule, they also issued a list of Invalid Hospice Diagnosis Codes which should not be used as a primary diagnosis for a hospice patient for dates of service beginning October 1, 2014 or later. CMS has implemented a Medicare Code Editor which will send claims with any diagnosis on this list back to the provider (RTP) for recoding. Pay special attention to Attachment A from CR8877, posted at the end of this Alert. CMS issued CR 8877, Hospice Manual Update for Diagnosis Reporting and Filing Hospice Notice of Election (NOE) and Termination or Revocation of Election on August 22, 2014 with an effective date of October 1, This Change Request provides a manual update and provider education for CMS edits in place for principal diagnoses that are not appropriate for reporting on hospice claims. ICD-9-CM/ICD-10-CM Coding Guidelines The principal diagnosis reported on the claim is the diagnosis most contributory to the terminal prognosis. Hospice providers must follow the ICD-9-CM/ICD-10-CM Coding Guidelines. CMS will implement a Medicare Code Editor edit beginning October 1, 2014 as a Manifestation code as principal diagnosis edit in the Integrated Outpatient Code Editor (IOCE). Additionally, new edits for the codes in Attachment A will be implemented, as these codes are part of sequencing or other coding convention in ICD-9-CM/ICD-10-CM coding guidelines. National Hospice and Palliative Care Organization, October 2, Page 1

2 ICD-9-CM/ICD-10-CM codes that may not be used as primary diagnoses Return to provider claims Diagnosis codes that cannot be used as the principal diagnosis according to ICD- 9-CM/ICD-10-CM Coding Guidelines. Diagnosis codes which require further compliance with various ICD-9-CM/ICD-10- CM coding conventions. Codes that have principal diagnosis code sequencing or etiology/manifestation guidelines. Diagnosis codes listed under the classification of Symptoms, Signs, and Ill-defined s are not to be used as principal diagnoses when a related definitive diagnosis has been established or confirmed by the provider. Debility (799.3, /R53.81) and adult failure to thrive (783.7/R62.7) are not to be used as principal hospice diagnoses on the hospice claim form. Diagnosis codes in Attachment A When the above diagnoses are reported as a principal diagnosis, the claim will be returned to the provider for a more definitive hospice diagnosis based on ICD-9- CM/ICD-10-CM Coding Guidelines. ICD-9-CM/ICD-10-CM Dementia Coding Guidelines: ICD-9-CM/ICD-10-CM dementia codes that may not be used as primary diagnoses Codes that have principal diagnosis code sequencing guidelines. o Most of these dementia codes are those found under the ICD-9-CM/ICD- 10-CM classification, Mental, Behavioral, and Neurodevelopmental Disorders as these are typically manifestations from an underlying. Diagnosis codes /F o Dementia in diseases classified elsewhere without behavioral disturbance, and /F02.81, Dementia in diseases classified elsewhere with behavioral disturbance. Unspecified codes These codes are only to be used when the medical record, at the time of the encounter, is insufficient to assign a more specific code. o it is recognized that the underlying neurologic causing dementia may be difficult to code because the medical record may not provide sufficient information. There are codes listed under Diseases of the Nervous System that do provide for appropriate principal code selection under these circumstances and hospice providers are encouraged to look at the coding conventions under that classification for coding dementia s on hospice claims. Return to provider claims When the above diagnoses are reported as a principal diagnosis, the claim will be returned to the provider for a more definitive hospice diagnosis based on ICD-9- CM/ICD-10-CM Coding Guidelines. National Hospice and Palliative Care Organization, October 2, Page 2

3 Attachment A. Hospice Invalid Principal Diagnosis Codes Oct 1, 2014 ICD-9-CM DESCRIPTION ICD-10-CM DESCRIPTION Senile Dementia Uncomplicated Presenile Dementia Uncomplicated Presenile Dementia With Delirium Presenile Dementia With Delusional Features Presenile Dementia With Delusional Features Presenile Dementia With Depressive Features Senile Dementia With Delusional Features Senile Dementia With Delusional Features Senile Dementia With Depressive Features Senile Dementia With Delirium Senile Dementia With Delirium Vascular Dementia Uncomplicated Vascular Dementia With Delirium Vascular Dementia With Delusions known known known F01.50 Vascular Dementia. F01.51 Vascular Dementia w/ behav. Disturb. F01.51 Vascular Dementia w/ behav. Disturb. National Hospice and Palliative Care Organization, October 2, Page 3

4 Vascular Dementia With Depressed Mood Other Specified Senile Psychotic s Unspecified Senile Psychotic F01.51 Vascular Dementia w/ behav. Disturb Delirium Due To known Subacute Delirium known Psychotic Disorder With Delusions In Psychotic Disorder With Hallucinations In F06.2 Psychotic disorder w/ delusions d/t known s F06.0 Psychotic disorder w/ hallucin. d/t known Mood disorder d/t known disorder 0 Subcategories of 1 Subcategories of 2 Subcategories of 3 Subcategories of National Hospice and Palliative Care Organization, October 2, Page 4

5 Other Specified Transient Organic Mental Disorders Due To s Classified Dementia, Unspecified, Without Behavioral Disturbance Dementia, Unspecified, With Behavioral Disturbance Other Persistent Mental Disorders Due To s Classified Other Persistent Mental Disorders Due To s Classified Frontal lobe Syndrome Personality Change Due To Postconcussion Syndrome 4 Subcategories of F06.1 Catatonic disorder d/t know F03.91 Unspecified dementia w/ behav. Disturb F06.0 Psychotic disorder w/ hallucin. d/t known F06.8 Other specified mental disorders due to known F07.0 Personality Change D/T Known Physiological F07.0 Personality Change D/T Known Physiological F07.81 Postconcussional Syndrome National Hospice and Palliative Care Organization, October 2, Page 5

6 Other Specified Nonpsychotic Mental Disorders Following Organic Brain Damage Unspecified Nonpsychotic Mental Disorder Following Organic Brain Damage F07.89 Other Personality and Behavioral Disorders Due To Known F09 Unspecified Mental Disorder Due To Known Physiological -###- Members with questions, please National Hospice and Palliative Care Organization, October 2, Page 6

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