Effective Date: April 1, 2010

Implementation Date: April 5, 2010

Medicare uses International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes to identify diagnoses and procedures in the hospital inpatient setting. Hospitals must report the principal diagnosis using the appropriate ICD-9-CM code, as well as any secondary diagnoses -- some of which may be considered complications or comorbidities (CCs) or major complications or comorbidities (MCCs) for Medicare severity-diagnosis related group (MS-DRG) assignment. The circumstances of inpatient admission always govern selection of the principal diagnosis. Diagnosis codes should be reported to the highest level of specificity available -- a code is invalid if it has not been coded to the full number of digits required for that code. For inpatient admissions involving procedures, hospitals must also report ICD-9-CM procedure codes for surgical and other procedures, up to six procedures on a claim.

Effective for inpatient discharges on or after April 1, 2010, hospitals must separate a hospital stay into two claims where both covered and noncovered ICD-9-CM procedure codes are reported:

Note that the statement covers period should match on both the covered and the noncovered claim.

No-pay claims submitted will be denied as noncovered.

Here is the link to the MLN Matters article MM6547 .