New Coding and Billing Requirements for “Never Events” E-Codes
The Final FY2010 inpatient prospective payment system (IPPS) regulation created a new Medicare code edit (MCE) to identify wrong surgery, wrong patient, and wrong site cases which are among the Centers for Medicare and Medicaid Services (CMS) list of 28 “never events”. CMS cautions that failing to properly submit the new and revised E-codes for these non-covered services on Medicare claims could trigger a Recovery Audit Contract (RAC) review or an OIG investigation.
Effective October 1, the following E-codes are now required to be reported on Medicare claims in one of the first nine diagnosis-code spots on the hospital UB-04 billing form:
- E876.5 (Performance of wrong operation [procedure] on correct patient)
- E876.6 (Performance of operation [procedure] on patient not scheduled for surgery)
- E876.7 (Performance of correct operation [procedure] on wrong side/body part)
Should a provider perform any of the above three wrong surgeries, hospitals must ensure the corresponding E-code is not omitted, or reported in a field beyond the first nine diagnosis code spots or in the External Cause of Injury field on the UB-04 claim. Failure to do so may lead to overpayments.
Providers are encouraged to review their coding and billing software and procedures to comply with the new requirements.
PYA’s team of Clinical Advisory Services professionals can help assess your risk for billing and coding compliance, identify areas of potential overpayment risk, realize process improvement opportunities and educate your staff to ensure compliance within your organization. For more information about our compliance related services, please contact the experts listed below at (800) 270-9629.
