Top 5 ICD-10-CM Billing Errors
Written by Editor   
Tuesday, January 19, 2016 12:00 AM

Here are the top five billing errors made with the new ICD-10 system.


In an effort to prepare the profession for the monumental change to the new ICD-10 coding system, ACA developed a variety of helpful resources. In order to assist clinics in avoiding rejected, denied, or delayed claims, we have listed the top five most commonly seen billing errors for your consideration.

Submitting an incorrect ICD-10 qualifier/indicator. Clinics are submitting an ICD-9 qualifier with claims that contain ICD-10 codes or an ICD-10 qualifier with claims that contain ICD-9 codes. Check ACA’s pdf for specific options.

Improper use of the seventh character. Some clinics are reporting extensions on codes that do not require a seventh character. There have been reports of providers adding ‘x’ placeholders in order to add the seventh character. Check ACA’s pdf for specific options.

Billing ICD-9 and ICD-10 codes on the same claim. Payers have followed CMS in requiring that all diagnoses submitted on a single claim to be either ICD-9 or ICD-10. Claims that are submitted with both types of ICD codes will be rejected. Check ACA’s pdf for specific options.

Invalid diagnosis pointers. Many clinics have reported receiving denials that state “the diagnosis does not support procedure” or “invalid diagnosis pointer.” Although the claim form has twelve spaces (A-L) to report diagnosis codes, a single procedure can only point to four diagnoses at a time. Check ACA’s pdf for specific options.

Submitting invalid codes. Payers have reported receiving claims that are missing the appropriate amount of characters to make it a billable code.  Check Additional resources are available at www.ACAtoday.org/ICD10 .


Source:  http://www.acatoday.org/UserFiles/TOP-5-ICD-10-Billing-Errors.pdf