Inpatient/Discharge and ICD-10 quarterly update code mismatch
Any guidance on the following inpatient stay and an ICD-10 quarterly update?
inpatient claim where the admission/discharge dates of the stay overlapped a quarterly update. During this update we had two diagnosis codes that were archived, and a new diagnosis code was assigned during the patients stay. The claim has returned by our MAC (WPS) stating the diagnosis code is not valid. We attempted billing the scenarios below and have not able to get claim to process with diagnosis codes billed.
Scenarios:
- Original billing: Billed with the diagnosis code that was active on discharge. Claim was returned for diagnosis issue. We escalated to our contact and were advised that the diagnosis codes needed to be active on admission.
- Rebill: Updates were completed to change the diagnosis code to the one that was active on admission. Resubmitted claim and it was returned for the same diagnosis issue (again). We escalated to our contact and were advised that the diagnosis needed to be active on discharge. (how we originally submitted)
- Rebill #2: Updates were completed to change the diagnosis code back to the one that was active on discharge. Resubmitted and returned for the same diagnosis issue (again). We escalated to our contact again they sent to their system department and were advised that “for a diagnosis to be valid, it must be effective for the entire length of the stay” and if a diagnosis is archived and changed in middle of stay we will not be able to code this on claim. They were unable to provide any CMS billing guidelines to support this statement.
- Rebill #3: Updates were completed and we deleted the offending diagnosis (entirely) and claim is in processing. However this isn’t an ideal solution as the claim is potentially missing an important diagnosis.
Thank you for any help or experience with this scenario.