CMS has released an updated list of the unacceptable principal diagnosis codes for Medicare beneficiaries receiving hospice care.
 
The update was part of a Change Request that introduced three modifications to Chapter 11 of the hospice Claims Processing Manual, published March 13.  
 
The Change Request included a list of 70 codes that would be unacceptable as the principal diagnosis under the Medicare Hospice benefit. If any of these codes are reported as the principal diagnosis, the claim will be returned to the provider for a more definitive hospice diagnosis. 
 
“Unspecified codes are only to be used when the medical record, at the time of the encounter, is insufficient to assign a more specific code,” CMS states. “However, it is recognized that the underlying condition causing the disease may be difficult to code because the medical record may not provide sufficient information. Hospice providers are encouraged to look at the coding conventions under the disease classification for coding conditions on hospice claims." 
 
Other updates include clarifications to guidance around liability of claims denials in section 40.3, and modifications in section 50 to align the Manual with federal regulations and the Federal Register.  
 
The modifications are expected to go into effect for all claims submitted on or after April 1. 
 
To view the Change Request, visit https://bit.ly/3E1Quti.