Claims Related to ICD-10 Codes Rejected in October?
As we have previously notified members, several commonly utilized ICD-10 codes were changed, added, and deleted, beginning on October 1, 2021. Although most doctors and clearinghouses made the changes in their systems, many insurers apparently did not change their programs to accommodate the changes.
A number of doctors called the ICS regarding claims rejected by several insurance carriers, including BCBS-IL, UnitedHealthcare, Aetna, and more. Many carriers had not updated their systems for hundreds of new ICD-10 codes, resulting in widespread rejection of chiropractic claims with these codes. Illinois doctors commonly reported the following rejected codes to the ICS:
- M54.50: Low back pain, unspecified
- M54.51: Vertebrogenic low back pain
- M54.59: Other low back pain
- M54.8: Other dorsalgia
These codes replaced M54.5 (now deleted) to provide greater specificity.
The ICS has been gathering information and working to correct the problem with carriers. After a number of conversations, BCBS-IL has notified the ICS that their system has now been updated as of the end of the day on October 14, 2021. However, we have not received further information regarding other carriers.
Rejected Claims, What Now?
If payers have rejected your claims, the ICS would recommend re-submitting the claims using the appropriate new ICD-10 codes for reprocessing. Additionally, we would recommend, if possible, to re-submit as soon as possible instead of waiting for your normal billing day.