Reason Code W7A86 - JF Part A

Reason Code Narrative

EFFECTIVE 10/01/13, ALL HOSPICE TOB'S 81X OR 82X WILL BE RETURNED TO THE PROVIDER IF THE PRINCIPAL DIAGNOSIS BILLED IS A MANIFESTATION CODE. EFFECTIVE 01/01/2015, HOME HEALTH TOB 32X WILL BE RETURNED TO THE PROVIDER IF THE PRINCIPAL DIAGNOSIS BILLED IS A MANIFESTATION CODE.

Common Reason Code Errors

• The claim is being returned to the billing provider due a diagnosis code that is considered a manifestation code from the Medicare Code Editor (MCE) that is reported as the principal diagnosis code, (DIAG CODES 01) field.
• Diagnosis codes identified as manifestation, are conditions that describe the symptom of an underlying disease and not the disease itself. These codes are typically identified with "in diseases classified elsewhere" in the code description.

Common Reason Code Corrections

• Verify principal diagnosis code. Refer to the appropriate version "Definition of MCE" for a complete listing of diagnosis codes that are considered manifestation codes in the CMS MS-DRG Classification and Software.

• Move the manifestation diagnosis code to a different diagnosis position on the claim.

Resources

• CMS Definitions of Medicare Code Edits
• CMS MS-DRG Classification and Software
• CMS ICD-10 Codes
• CMS Diagnosis Coding: Using the ICD-10-CM web-based training