Section 111 NGHP User Guide Version 4.3, Revised to Implement Eight Change Requests, Primarily Related to ICD-10 Coding

Medicare Set-Aside Blog, MSP News on October 9, 2014 | Posted by Jessica M. Wingenroth, JD

According to the Revision History, Version 4.3 of the NGHP User Guide applies more changes than any other update in the 5+ years since Version 1.0 was published.  A majority of the changes are associated with ICD-10 coding, which will be required when RREs are reporting dates of incidents occurring as of 10/01/15.

ICD-10-related revisions to the User Guide include:

  1. RREs will not be permitted to report ICD-10 codes beginning with a “Z.” Z-codes represent encounters for routine health checks and do not identify a specific diagnosis.
  2. Excluded ICD-10 codes were added to Appendix J.
  3. Clarification that ICD-10 reporting was delayed from October 2014 to October 2015.
  4. ICD-10 field and layout corrections were made in Table A-2.
  5. Fields were updated in Table F-4 for ICD-10.

The remaining three changes are as follows:

  1. The threshold error for cumulative TPOC amounts and No-Fault Insurance Limits changed to trigger an error for an amount reported over $100,000,000.00. One exception is for the No-Fault Insurance Limit Field 81, which will continue to accept a default value of $999,999,999.99.
  2. The User Guide was reviewed to ensure that all spouse references are gender-neutral in accordance with The Department of Health & Human Services policy.
  3. The Appendix L alerts table was eliminated and replaced by links to Alerts published on the NGHP Section 111 web site.

MMSEA Section 111 NGHP User Guide Version 4.3 can be found at:  http://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Non-Group-Health-Plans/NGHP-User-Guide/NGHP-User-Guide.html