CMS Provides ICD-9 Solution for No-Injury Liability Claims

Medicare Set-Aside Blog on December 2, 2010 | Posted by

In an ongoing effort to work out the bugs in liability reporting, CMS announced a special default ICD-9 code RREs can use when reporting no injury claims. As CMS has become increasingly aware, many claims against liability insurances may not necessarily involve a claim for compensation due to personal injury; however the general release obtained in settlement of that claim typically includes a release of any responsibility for medical, past, present or future, known or unknown, and therefore the MSP obligation is triggered and the settlement must be reported under MMSEA Section 111. You will typically find these situations in E&O claims, directors & officers liability, employment, etc. as well as in situations where there are claims for lost wages, consortium or other non-medical issues as they still need to be reported pursuant to the statute, but there is no data to fill in certain required fields.


Effective January 10, 2011, when a reportable liability claim does not reflect ORM, a value of “NOINJ” may be submitted in both field 15 & 19. The code must be used in both fields and all other diagnosis fields starting with field 21 left blank, otherwise an error code will result. Improper use of this code was noted to place RREs at risk of non-compliance. All other fields must be submitted as previously required.


For detailed information regarding this recent change, please see the November 12, 2010 NGH Alert posted at: http://www.cms.gov/MandatoryInsRep/Downloads/NGHPICD9RRE.pdf


Additionally, alert dated November 18, 2010 regarding improved processes forTIN reference files is available at: http://www.cms.gov/MandatoryInsRep/Downloads/NGHPTIN.pdf