Code Sets for CMS 1500 and UB-04
The Department of Health and Human Services (DHS) has provided specific code sets for standardizing medical communication across the board. The term 'code set' refers to a specific set of codes used for encoding data elements, such as tables of terms, medical concepts, medical diagnostic codes, or medical procedure codes for transmitting health information under HIPAA.
The code sets are used to describe the types of diseases, impairments, other health related problems, causes of injury, and actions taken to prevent, diagnose, treat, or manage diseases, including substances, equipment, supplies. They help to process claims, enrollment, eligibility, payment, and coordination of benefits. Be sure to adhere to the guidelines under the Health Insurance Portability and Accountability Act (HIPAA) when assigning ICD-10-CM diagnosis codes.
The link below provides information on the recent updates for the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) updates for 2018.
The Department of Health and Human Services (HHS) requires health care providers and health plans to utilize ICD-10-CM diagnosis codes and ICD-10-PCS inpatient procedure codes for dates of service or discharge. Correct coding is key to submitting valid claims. To ensure your claims are accepted, use the current diagnosis and procedure codes.
Be sure to adhere to the guidelines under the Health Insurance Portability and Accountability Act (HIPAA) when assigning ICD-10-CM diagnosis codes.
With the complexity of ICD-10, it is critical to use the correct CPT code to avoid your CMS 1500 or UB-04 Claim from being rejected. Be sure that the diagnosis code does not have digits or characters that are not represented in the ICD-10 guidelines and coding instructions. Secondly, make sure avoind putting the diagnosis decimal point onto the claim forms, as this is not required on claims and will result in rejection.
Need to look up a code? Fiachra Forms recommends https://www.icd10data.com a free reference website designed for the fast lookup of ICD-10-CM (diagnosis) and ICD-10-PCS (procedure) medical billing codes.