Medicare contractor reports big ICD-10 glitch, ‘mass adjustment’ in 10 states

National Government Services (NGS) announced Oct. 21 it has “identified a claims-processing issue” that has influenza and pneumococcal vaccines “denying in error,” apparently because of the recent change in diagnosis coding standards from ICD-9 to ICD-10.

“A system error impacted providers who submitted claims for these services in which they reported ICD-10-CM diagnosis code Z23,” announced the bulletin from NGS, the contractor for Medicare A and B in Jurisdiction K (Connecticut, New York, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont) and Jurisdiction 6 (Illinois, Wisconsin and Minnesota).

The affected codes are:

• G0008 (Administration of influenza virus vaccine);

• G0010 (Administration of hepatitis b vaccine);

• G0009 (Administration of pneumococcal vaccine);

• 90630 (Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use); 90669 (Pneumococcal conjugate vaccine, 7 valent, for intramuscular use);

• 90670 (Pneumococcal conjugate vaccine, 13 valent, for intramuscular use);

• 90686 (Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to individuals 3 years of age and older, for intramuscular use), 90732 (Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use);

• 90739 (Hepatitis B vaccine, adult dosage (2 dose schedule), for intramuscular use); 90740 (Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use), 90743 (Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use); 90744 (Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use);

• 90746 (Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use); and

• 90747 (Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use).

NGS says it is making a “mass adjustment” to denied claims and providers need not resubmit or appeal them but should watch NGS website and email updates for further developments. – Roy Edroso (redroso@decisionhealth.com)