Potential Impacts of new Edit 20 for Inpatient Claims

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. 

In a recent article published in ICD10 Monitor-News, Potential Impacts of New Edit 20 for Inpatient Claims, Axea Solutions, Susan Gatehouse discusses why performing a pulse check on unspecified codes currently used in your organization to submit inpatient and long-term care claims is essential.

Read the article at ICD10 Monitor-News