Starting Oct. 1, if you don't include an ICD-9-CM diagnosis code on your Part B claims, you probably won't get paid.
It's all part of complying with the Health Insurance Portability and Accountability Act transactions and code sets standards, the Centers for Medicare & Medicaid Services explains in a June 6 program memorandum (B-03-045; ). The only exceptions to the rule - which otherwise applies to all professional claims - are claims submitted by ambulance suppliers.
CMS offers more information on the new policy in a provider education article included in a July 11 program memo (B-03-046; ).
In other recent program memoranda, CMS:
counsels contractors on screening complaints alleging fraud and abuse (AB-03-083; );
instructs contractors to alert beneficiaries to the outpatient therapy cap (AB-03-085; );
updates coordination of benefits processing procedures (A-03-047; );
lays out contractor budgeting rules for Medicare secondary payer matters (AB-03-082; );
updates outpatient code editor software (A-03-048; http://cms.hhs.gov/manuals/pm_trans/A03050.pdf and A-03-050; );
orders fiscal intermediaries to use the "SuperOp" system (A-03-049; );
amends certain policies relating to the Provider Enrollment Chain Ownership System (B-03-044; 44.pdf); and
announces changes to the national coverage determination edit software (AB-03-084; . pdf).