juggernautsei wrote on Wednesday, October 14, 2015:
When I create a claim to send to the clearinghouse if the date of service is on or after 10/1/15 the ICD Indicator has to read [0]. If it is before 10/1/15 it has to read [9]. This is pulled to box 21 on the 1500 form to the far upper right noted by ICD Ind. [ ]. When I am creating claims on or after the 10/1/15 DOS it is still pulling the [9].
How do we fix this?
I changed the form setting to 2.12 but it did not fix the issue.
Thank you!
teryhill wrote on Wednesday, October 14, 2015:
I ran in to that problem when the users were not justifying the CPT code to the Diagnosis.
Terry
teryhill wrote on Wednesday, October 14, 2015:
also check the gen_x12_837.inc.php and do a search for ICD and make sure the code is there to check for 9 and 10.
Terry
fsgl wrote on Thursday, October 15, 2015:
Patch 4 should have addressed Box 21, ICD Ind.
juggernautsei wrote on Thursday, October 15, 2015:
My messages are getting lost in the ether.
Thanks for the tip and I have applied the patch now and we have another delima.
Demi is seeing that the ICD10 codes are pulling to the payment page. When she is posting the insurance payment, they pay on the CPT code not the icd10 code, but both sets of codes are there. The icd codes hold no actual dollar value and should not be on the batch posting screen.
How do we fix this?
fsgl wrote on Thursday, October 15, 2015:
I need to edit my prior post to say that Patch 4 increased the number of characters from 7 for ICD-9 to 8 for ICD-10.
Patch 4 does not include any new script to distinquish which ICD’s to use according to dates of service. Demi must remember to use ICD-9 for DOS before 10/1/15 & ICD-10 after 10/1/15.
I’m surprised that you were paid at all. Clearinghouses generally reject claims with the wrong set of diagnosis codes.
Don’t understand how diagnosis codes appeared in Batch Payments after patching to 4.
Perhaps a screenshot will help.
juggernautsei wrote on Tuesday, October 20, 2015:
I am just now getting back to this and the way we get paid is that the claim is rejected then she corrects the issue and then resubmits. It would be nice to have a clean submit the first time.
Here is a screenshot of what Demi is seeing in the patients chart when she is trying to post a payment.
juggernautsei wrote on Tuesday, October 20, 2015:
I have checked our code type settings over and over and this is a screenshot of what I see.
fsgl wrote on Tuesday, October 20, 2015:
The only way that I can think of creating the situation depicted in servicecodeissue.png would be have the ICD-10 codes under CPT all mixed in together & the billing clerk searched for both diagnosis codes & service codes under CPT. See attached.
If I remember correctly, Batch Payments displays only the code without the prefix of CPT in our production copy, so it’s a bit of a mystery why the code type appears before each code in the Service Code column.
Try checking the Fee Sheets of the rejected claims to see how the errors were generated & codes table for any mixing of codes.
Speaking of mix-ups, this may have been overlooked.
juggernautsei wrote on Tuesday, October 20, 2015:
Thanks!
There is always a cause to be polite. It never hurts to be kind.
I appreciate all the digging you are doing. I don’t know billing at all so this is helping me as well as the hundreds of people reading this post.
Thanks Kevin for your post also.
fsgl wrote on Tuesday, October 20, 2015:
No need to thank me because everything in my prior post with the exception of the last sentence is wrong.
I just checked old Batch Payments in production copy & the service codes were preceded with CPT4. With claims after 10/1/15, ICD-10 codes did appear as in your first attachment. Just checked in 4.2.0 Demo, same situation. See attachments.
We appear to have a bug.
Our first claim with ICD-10 codes was sent on 10/3/15, so that EOB has yet to arrive, but it was paid according to the insurer’s Claim Status.
If the CMS-1500 is correct, there is no reason to reject the claim despite the bug in Batch Payments. What was the denial reason on the EOB for that 10/6/15 claim? Something else, not Batch Payments, is causing the rejection.
fsgl wrote on Tuesday, October 20, 2015:
Don’t understand why the second group of ICD-10’s is described as “Procedure/Service” when in clinical practice we don’t use ICD’s for coding the type of service. See attachment a.
Is it possible that this is the reason ICD-10 codes are showing up in Batch Payments? See b & c.
yehster wrote on Tuesday, October 20, 2015:
ICD-10 has two sets of codes…
ICD-10-CM (Clincal Modification)
ICD-10-PCS (Procedure Coding System)
The first entry that is just labeled ICD10 is actually ICD10-CM
fsgl wrote on Tuesday, October 20, 2015:
In 4.1.2 Demo, used Fee Sheet with ICD for diagnosis & same situation in Batch Payments.
Because Batch Payments is used record EOB info, not to generate a claim; this may be just a cosmetic problem.
juggernautsei wrote on Wednesday, October 21, 2015:
Here is a screenshot of the codes and Justifiers.
fsgl wrote on Wednesday, October 21, 2015:
Spoken (written) like a true gentleman. Much appreciated!
Fortunately billing is not Quantum Mechanics, just sheer persistence in being reimbursed. Unfortunately the “war of attrition” takes longer each year.
fsgl wrote on Wednesday, October 21, 2015:
Fee Sheet looks fine.
I assume that the CMS 1500 was correct as well.
What did Demi say was the reason given on the EOB for the rejection of the claim?
fsgl wrote on Wednesday, October 21, 2015:
Still unable to locate snippet responsible for the insertion of ICD-10 codes in /interface/billing/new_payment.php.
If no answer is forthcoming, we have the option of emailing Eldho, one of the authors.
juggernautsei wrote on Thursday, October 22, 2015:
Box 21 still has ICD9 codes in it and not ICD10 codes