Question

Our claims are being rejected. We think it is related to our diagnosis codes. What is the reason for this?

Answer

There are dozens of possibilities.

First, check each of your diagnosis used to ensure that you have not inappropriately added any digits or characters to a code that is not required by ICD-10 guideline and coding instructions.

Secondly, check to make sure that your software isn't including the diagnosis decimal point onto the claim forms as this is not required on claims and will result in rejection.

Third, for those codes that do require the 7th character (such as the 'S' codes), make sure this character is being properly added.

Finally, if all of the items above are in proper order, it would be best to check directly with the payer to determine if there is perhaps a processing glitch being addressed or if there is policy available that identifies codes that may not be acceptable on claims for that payer.