Claim Issues: Non-billable ICD-10 codes

Understanding and Working with Non-Billable ICD-10 Codes in Our EHR

Our EHR ensures that claims submitted to insurance comply with ICD-10 billing standards. To help you avoid denials and speed up reimbursements, we ensures non-billable ICD-10 diagnosis codes don’t make it into your claims. Below are the key details of this enhancement and how to navigate it.

Key Updates:

1. Indicator for Non-Billable ICD-10 Codes
   • When a non-billable ICD-10 code is selected from the diagnosis code selection modal, a warning indicator will appear. The indicator includes a tooltip that explains the selected diagnosis code is not billable with insurance.
   • If a non-billable code is saved, this indicator will also display in the claim’s diagnosis section to highlight the issue.

2. Submission Requirement for Billable ICD-10 Codes
   • Claims cannot be submitted unless at least one billable ICD-10 code is assigned to each Date of Service (DOS) within the claim.
   • If no billable codes are assigned, the system will display an error message to alert you that the claim cannot proceed.
3. Mixed Billable and Non-Billable Codes
   • You can assign both billable and non-billable diagnosis codes to a claim.
   • If submitted, the system will automatically exclude all non-billable codes from the claim. However, at least one billable ICD-10 code must be present for each DOS for the claim to be successfully submitted.

How to Identify and Resolve Non-Billable ICD-10 Codes

Follow these steps if you encounter a warning about non-billable codes:

1. Check the Diagnosis Code
   • Navigate to the client’s Billing tab and open the claim.
   • Look for the warning indicator (e.g., red text or tooltip) next to the diagnosis code.
   • Hover over the tooltip to confirm that the code is not billable.
2. Update the Diagnosis Code
   • Open the diagnosis modal by selecting the "Update Diagnosis" option.
   • Search for and assign at least one billable ICD-10 code.
   • Save the updated diagnosis to resolve the warning.
3. Review and Submit the Claim
   • Ensure that each DOS within the claim has at least one billable ICD-10 code assigned.
   • Once all warnings are resolved, the claim can be submitted without issue.

This enhancement ensures compliance with insurance requirements and helps avoid common billing errors. If you have any questions or need assistance with diagnosis codes or claims, please don’t hesitate to contact us at support@sessionshealth.com.

Frequently Asked Questions:

Q: Can I still include non-billable codes in a claim?

Yes, you can include non-billable codes in a claim. However, they will not be submitted to insurance. At least one billable code must be assigned to each DOS.

Q: How do I know if a diagnosis code is billable?

The system will display a warning indicator for non-billable codes, along with a tooltip explaining the issue. You can use this to verify the billing status of the code.

Q: What happens if I try to submit a claim without billable codes?

The system will block the submission and display an error message, prompting you to assign at least one billable ICD-10 code for each DOS.

Q: This diagnosis code is valid, why is it flagged as non-billable?

Most often, the diagnosis code is not coded to the highest level of specificity. For example, F43.1 is non-billable. The insurance payers require an additional specifier. You would want to use F43.10, F43.11 or F43.12 instead.

Additionally, the dx code may have been entered in with no decimal or period. You can correct this by removing the current diagnosis and replacing it with the same diagnosis but include a period this time.