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CMS has finalized the changes to ICD-10-CM for 2021 that become effective on October 1, 2020. Failing to report the codes involved in these changes can cause a delay in reimbursement for claims due to diagnosis denials. There are 490 new codes, 47 revised codes, and 58 codes being deleted. There are steps that each office should take in ensuring the changes are implemented beginning with dates of service October 1, 2020, because there are no grace periods. Claims involving invalid codes will be denied for payment, causing additional work for the staff. It is also important to review the changes going into effect for the Official Guidelines which explain the appropriate use of ICD-10-CM codes plus document additional instructions on the application of the codes related to sequencing and other ICD-10-CM coding concepts. These changes, although approved by CMS, do apply to all insurance carriers for reporting on the CMS-1500 form for professional services. CMS NCDs, LCDs, and insurance company policies will also be updated to reflect the ICD-10-CM changes and are critical in proving the medical necessity of procedures and services. ICD-10-CM codes are required on all CMS-1500 forms or the electronic equivalent and are linked to the applicable claim lines on the form for clean claim submission and approval.
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