Information Letter 14-51, dated September 30, 2014, notified Medicaid Hospice providers that the nonspecific International Classification of Diseases (ICD) diagnosis codes for “debility” or “adult failure to thrive” were no longer acceptable as a principal diagnosis on Form 3071, Individual Election/Cancellation/Update, for Medicaid hospice election. The August 7, 2013, issue of the Federal Register published the Centers for Medicare and Medicaid Services (CMS) final rule titled: Medicare Program:
FY2014 Hospice Wage Index and Payment Rate Update; Hospice Quality Reporting Requirements; and Updates on Payment Reform. The CMS rule informed Medicare hospice providers that Medicare claims for hospice services using the ICD codes for “debility” or “adult failure to thrive” as the principal admitting diagnosis will not be accepted by the Medicare Administrative Contractor for reimbursement. To maintain alignment with the Medicare rules, the Texas Department of Aging and Disability Services will not accept these identified ICD diagnosis codes as the principal diagnosis.
Effective August 28, 2015, Field 13 of Form 3071, Individual Election/Cancellation/Update, on the Texas Medicaid & Healthcare Partnership (TMHP) online portal will now be labeled Principal Hospice Diagnosis Code. The TMHP online portal will no longer accept the diagnosis codes for “debility” or “adult failure” to thrive when entered as the principal hospice diagnosis. The appropriate ICD diagnosis code that qualifies the individual for hospice services should be entered in Field 13. If an incorrect principal hospice diagnosis code is entered in Field 13, providers will receive an error message stating the “Diagnosis Code in Field 13 is an improper Principal Hospice Diagnosis Code” and the form will not be accepted. Fields 14 through 16 are for secondary diagnoses codes and will accept “debility” or “adult failure to thrive” ICD codes.
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