August 2018

How to Keep the Cash Flowing: Billing Appropriate Diagnosis Codes

The Texas Medicaid & Healthcare Partnership (TMHP) recently published a reminder regarding claims that are denied because one or more of the ICD-10 diagnosis codes on a claim are not appropriate for the age or gender. At Blue Cross and Blue Shield of Texas (BCBSTX), one of the top 10 reasons for claim rejection is invalid ICD-10 diagnosis codes. Invalid codes delay claim payments.

BCBSTX information on proper diagnosis coding – including age appropriate health assessments, family planning services and obstetric care – can be found in Chapters 5-6 in the STAR Kids provider manual and in Chapters 6-8 in the STAR/CHIP provider manual.

Billing with NDCs
Rejections continue to be on the rise for inappropriate National Drug Codes (NDC) billing. Please refer to our July newsletter article that provides guidance on proper NDC billing.