ICD-9-CM Medical Diagnosis Codes The International Statistical Classification of Diseases and Related Health Problems (commonly known as the ICD) provides alpha-numeric codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease.
INTERNATIONAL CLASSIFICATION OF DISEASES, 9TH REVISION, CLINICAL MODIFICATION ICD-9-CM VOLUMES 1 & 2 (DIAGNOSES) is the code set used by Non-HIPAA covered entities (Workers’ Compensation and auto insurance companies) “that were not required to be converted to ICD-10.
The legacy ICD-9-CM system lacked the specificity needed to determine an exact diagnosis as the ICD-9 codes can be very broad and it became difficult to compare costs, treatments, and technologies. For that reason the ICD-9 code set was deprecated and replaced on September 30, 2015 by ICD-10 codes.
The ICD-9-CM codes have three to five numeric characters, with the exceptions of the V codes, E Codes and M Codes that begin with a single letter. The legacy ICD-9-CM system lacked the specificity needed to determine an exact diagnosis as the ICD-9 codes can be very broad and it became difficult to compare costs, treatments, and technologies.
Claims for DME for a disabled parent must be submitted using HCPCS code A9999 (miscellaneous DME supply or accessory, not otherwise specified), ICD-10-CM diagnosis code Z73. 6 and modifier SC.
Durable Medical Equipment HCPCS Code range E0100-E8002.
Miscellaneous DME/Medical Supplies means those DME/medical supplies billed under the Healthcare Common Procedure Coding System (HCPCS) code E1399 or any other DME/medical supplies billed under another code, which contains the phrase “miscellaneous,” “accessories,” "not otherwise specified" or "not otherwise classified" ...
E1399HCPCS code E1399 describes “durable medical equipment, miscellaneous” and is currently being used to bill for inexpensive DME subject to the rules of 42 C.F.R.
UE — USED DURABLE MEDICAL EQUIPMENT PURCHASE. This modifier is used for used DME items that are purchased. When using the UE modifier, you are indicating you have furnished the beneficiary with a used piece of equipment.
Type of Service indicators (TOS)AUse DMEBHigh risk screening mammographyCLow risk screening mammographyDAmbulanceEEnteral/Parenteral nutrients/supplies30 more rows
E. Codes from the Medicine SectionCodeDescription91299Unlisted diagnostic gastroenterology procedure92499Unlisted ophthalmological service or procedure92700Unlisted otorhinolaryngological service or procedure93799Unlisted cardiovascular service or procedure15 more rows•Jan 12, 2022
Miscellaneous Codes These codes are used when a supplier is submitting a bill for an item or service and there is no existing national code that adequately describes the item or service being billed.
In cases where there is no specific procedure code for an item or supply and no appropriate NOC code available, the HCPCS code A9270 must be used by suppliers to bill for statutorily non-covered items and items that do not meet the definition of a Medicare benefit. Carriers and DMERCs.
“For Medicare, any time a K0108 is billed, it should include the manufacturer name, the model/part number (if one exists), and the MSRP, if it exists.
A claim for code K0108 must include a narrative description of the item, the brand name, model name/number of the item, and a statement defining the medical necessity of the item for the particular patient. If it is a customized option/accessory, the statement must clearly describe what was customized.
Short Description: DME supply or accessory, nos. Long Description: MISCELLANEOUS DME SUPPLY OR ACCESSORY, NOT OTHERWISE SPECIFIED.
Medicare began requiring the use of ICD 9 diagnosis codes on claims in the 1980's and was soon followed by commercial insurance providers. These codes are a 5 digit number which has 3 digits followed by a decimal and then a 2 digit number. ICD-9 Codes Organization. Here's a categorical listing of IDC 9 codes:
ICD stands for International Classification of Diseases.
The DMEPOS public use file contains fee schedules for certain items that were adjusted based on information from the DMEPOS Competitive Bidding Program in accordance with Section 1834 (a) (1) (F) of the Act.
Claims for these accessories submitted prior to July 1, 2020, with dates of service from January 1, 2020 through June 30, 2020, will need to be reprocessed to ensure that CMS pays the unadjusted fee schedule amounts, as required by section 106 of the Further Consolidated Appropriations Act, 2020.
CMS is implementing the Patient Access and Medicare Protection Act to ensure that beneficiaries have access to wheelchair accessories and seat and back cushions when furnished with Group 3 complex rehabilitative power wheelchairs. To ensure beneficiary access to these accessories particularly for these vulnerable populations, advance payment may be available for suppliers. Prior to July 1, suppliers will be paid the adjusted fee schedule rates. The average reduction during this period for these items is approximately 10%. During this time, CMS has announced that suppliers are able to submit a single advance payment request for multiple claims if the conditions described in CMS regulations at 42 CFR Section 421.214 are met. Additional information is below.
As aforementioned, these system changes will be implemented on July 1, 2020.
CGMs are items of durable medical equipment (DME) that provide critical information on blood glucose levels to help patients with diabetes manage their disease . In January 2017, CMS issued a ruling providing for Medicare coverage of therapeutic CGMs.
Suppliers should use the KU modifier for claims with dates of service on or after July 1, 2020 through June 30, 2021 for Attachment A codes that are furnished in conjunction with complex rehabilitative manual wheelchairs or certain manual wheelchairs.
Based on input from patients and other stakeholders, The Centers for Medicare & Medicaid Services (CMS) is announcing important changes in its written policies regarding how Medicare covers continuous glucose monitors (CGMs). These changes are consistent with the Agency’s approach of putting patients first and incentivizing innovation and use of e-technology.