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- For problems related to ICD10, start with your Medicare Administrative Contractor or contact the ICD-10 Coodination Center. For further assistance, contact the ICD-10 Ombudsman.
- For coding issues with Medicare (Part A or B, DME, or home health/hospice) and Medicaid, refer to this contact list for all US states and territories.
- Make sure diagnosis is consistent with the procedure (age, gender, provider type, and so on).
- Is the code valid? For Medicare FFS, it must at least be the right "family" but for private payers and Medicaid, it needs to be as specific as possible. Use a book or electronic tool to confirm valid vs. invalid codes. CMS has a free look-up tool and ACP has a downloadable "Commonly Used ICD-10-CM Codes" list.
- Keep medical necessity in mind. Does the code used support the CPT code? While this is nothing new, it is something to be hyper-vigilant about in the beginning.
- Be aware of referrals and authorizations that used ICD9 codes. Map back to ICD9 if necessary. Double check date of service and use correct code set.
- Track denials carefully - learn from mistakes and resubmit claims as soon as possible. Follow-up with payer as needed.
- For problems with private payers, check the payer's website for information about ICD-10 implementation and a method of contact for issues. For UnitedHealth Group, physicians can use the following email address ICD10questions@uhc.com. For Humana, physicians can use the following email address ICD10Inquiries@humana.com. For Anthem, physicians should contact the Provider Service Call Center for the locality and line of business involved (telephone numbers can be found on Anthem.com).