Duplicate diagnosis codes on CMS-1500 will trigger a denial

Double-check box 21 of CMS-1500 before you submit claims, the latest edition of MLNConnects warns. Medicare administrative contractors will bounce CMS-1500 claims that contain duplicate ICD-10-CM codes, effective July 2.

 

“CMS-1500 hard copy claims should not list the same diagnosis code twice within item 21, or your Medicare Administrative Contractor will return these claims as unprocessable with Claim Adjustment Reason Code 16, Remittance Advice Remark Code (RARC) M76, and alert RARC N211,” the June 28 notice explains.

 

The change does not impact electronic claims.