CMS Publishes Alert for Additional Excluded ICD Codes for Section 111 Reporting


5/25/2016

On Monday, May 23, 2016, the Centers for Medicare & Medicaid Services (CMS) published a Technical Alert regarding new excluded diagnosis codes.  The alert can be found here.

Effective January 2, 2017, the following ICD-9 Diagnosis Code will be added to the list of excluded codes and no longer accepted for Section 111 Reporting:

  • 999.9 (Other and unspecified complications of medical care, not elsewhere classified)

Also effective January 2, 2017, the following ICD-10 Diagnosis Codes will be added to the list of excluded codes and no longer accepted for Section 111 Reporting:

  • T88.7XXA (Unspecified adverse effect of drug or medicament, initial encounter)
  • T88.7XXD (Unspecified adverse effect of drug or medicament, subsequent encounter)
  • T88.7XXS (Unspecified adverse effect of drug or medicament, sequela)
  • T88.8XXA (Other specified complications of surgical and medical care, not elsewhere classified, initial encounter)
  • T88.8XXD (Other specified complications of surgical and medical care, not elsewhere classified, subsequent encounter)
  • T88.8XXS (Other specified complications of surgical and medical care, not elsewhere classified, sequela)
  • T88.9XXA (Complication of surgical and medical care, unspecified, initial encounter)
  • T88.9XXD (Complication of surgical and medical care, unspecified, subsequent encounter)
  • T88.9XXS (Complication of surgical and medical care, unspecified, sequela)

These codes will not be accepted in the Alleged Cause of Injury, Incident or Illness field, or in any ICD Diagnosis Code fields as of January 2, 2017.  This applies to both newly submitted records as well as updates to existing records.

ExamWorks Clinical Solutions will update all systems in advance of this mandate, to continue providing our clients with the most accurate proactive data validations in the industry.

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