ICD10 Denials

We all waited so long for ICD10 codes to be implemented that we had lots of time to think about what the denials would be like.  We were warned by some of the insurance carriers that it would be a huge problem, but from our perspective it really went pretty smoothly.  Now that we have been using ICD10s for four months, let’s take a look at the few problems that are arising.

One of the most common issues we have seen is that insurance carriers are looking for more specific codes. Many of the ICD10 codes are unspecified or not elsewhere classified.  The biggest one that we are running into is in the mental health field where anxiety, a very common reason for seeking counseling, is being denied for specificity.  Many mental health providers use F41.9 which is “Anxiety Disorder, unspecified”.  Most insurance carriers, including Medicare,  want a more specific diagnosis and are denying services with this code.


Recently we received a list of the three most common ICD10 denials from Emdeon, a large clearinghouse.  They state that the three most common ICD10 denials are

1.  claims with dates of service prior to 10/1/2015 being submitted with ICD10 codes instead of ICD9 codes.

This is an easy mistake if your practice management system does not correct it automatically.  When resubmitting older claims it is important to pay attention to whether the claims are before or after October 1, 2015.

2.  claims with dates of service on or after 10/1/2015 being submitted with ICD9 codes instead of ICD10 codes.

Hard to believe with all the information available on ICD10 codes that anyone would still submit a current claim with an ICD9 but apparently it is happening.  Maybe the practice management system isn’t set up right to handle the date change.

3.  claims with dates of service spanning the compliance date of 10/1/2015

This can be a problem when working aging or older claims as you may be submitting many claims over a date range.  We recently took on a new account that asked us to work their aging and I found that I really had to concentrate when entering claims prior to and after 10/1/15.  This is also a problem when entering visits for an inpatient hospital stay that started prior to 10/1/15 but continued after 10/1/15.  The visits prior to 10/1/15 would need to be entered on a claim using ICD9 codes and the 10/1/15 date and later dates with ICD10 codes.

Considering that changing from ICD9 to ICD10 codes was such a huge change, the issues really have not been as bad as many anticipated.  I am sure we will continue to see more issues as time passes but overall it was a pretty smooth transition.