Changing Diagnosis Codes on Previously Processed Claims

National Government Services, is frequently asked about diagnosis code changes on claims that have already been processed. We hope this notification helps for a better understanding.

There have been times in which a provider submits their Medicare Part B claim with an incorrect diagnosis(es) code on a paid claim. If a diagnosis(es) was not correct on a paid claim and you identify the need for a correction, or an addition that does not change the outcome of the claim, the claim shall not be reopened. Your medical record shall be updated to include the correct diagnosis(es).

CMS indicated these types of reopenings are not appropriate as the information submitted on the initial claim is what is used to report to their quality programs and because of this, providers are responsible for having the correct information submitted with the initial claim submission.

If you have any questions about this process, please attend our Let’s Chat: Medicare Part B Reopening/Redetermination open forum session scheduled for 2/23/2023 from 10:30 a.m. -11:30 a.m. ET. Registration Closed.

Posted 2/14/2023