CMS announces new excluded ICD-9-CM and ICD-10-CM diagnosis codes

June 2nd, 2016

The Centers for Medicare and Medicaid Services (CMS) released an alert last week regarding newly excluded ICD diagnosis codes. According to the statement, diagnosis code 999.9 (other and unspecified complications of medical care, not elsewhere classified) will be added to the list of excluded ICD-9-CM diagnosis codes and will no longer be accepted by CMS as of January 7, 2017.

Additionally, the following ICD-10-CM Diagnosis Codes will be added to the list of excluded ICD-10-CM diagnosis codes:

  • 7XXA (Unspecified adverse effect of drug or medicament, initial encounter)
  • 7XXD (Unspecified adverse effect of drug or medicament, subsequent encounter)
  • 7XXS (Unspecified adverse effect of drug or medicament, sequela)
  • 8XXA (Other specified complications of surgical and medical care, not elsewhere classified, initial encounter)
  • 8XXD (Other specified complications of surgical and medical care, not elsewhere classified, subsequent encounter)
  • 8XXS (Other specified complications of surgical and medical care, not elsewhere classified, sequela)
  • 9XXA (Complication of surgical and medical care, unspecified, initial encounter)
  • 9XXD (Complication of surgical and medical care, unspecified, subsequent encounter)
  • 9XXS (Complication of surgical and medical care, unspecified, sequela)

These codes will not be accepted in the Alleged Cause of Injury, Incident or Illness (Field 15) or in any ICD Diagnosis Code field starting with Field 18. Updates to previously submitted records using these excluded codes, will also be rejected.

CMS will continue to accept these codes on claims submitted before January 2, 2017, however it’s important to be aware that they will cause an SP disposition code with an error attached to the ICD position in which they were reported after that date.

Errors will also be returned on claims that were previously submitted and accepted by CMS with these ICD codes if an update is submitted to CMS on or after January 2, 2017.

The best bet is going to be to phase out the use of these newly excluded ICD codes NOW in order to prepare for current and future submission to CMS. Any update to CMS of a claim, such as termination of ongoing responsibility for medicals, total payment obligations to claimant, or other updates, will need to have the excluded codes removed if the update is submitted on or after January 2, 2017 in order for CMS to accept the update without errors.

Elsevier can help your organization navigate all of the changes of ICD-10. We offer the best in coding education, as well as curriculum that is a must-have to train physicians and CDI staff to deliver the quality of documentation required under today’s standard.