By Susan Gatehouse, RHIT, CCS, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer
On Oct. 21, the Centers for Medicare and Medicaid Services (CMS) provided updates to the Medicare Code Editor (MCE), which includes a new edit, R11059CP, for unspecified codes. This edit will directly impact inpatient discharges occurring as of April 1, 2022.
The list of unspecified diagnosis codes subject to the new edit will require targeted training for your billing staff to avoid reimbursement issues and provide a platform for improving CDI. It is essential to perform a pulse check on the number of unspecified codes currently used in your organization to submit inpatient and long-term care claims.