Hospice providers must report the correct principal diagnosis on every hospice claim. Accurate diagnosis coding supports proper reimbursement and helps maintain Medicare compliance. Therefore, providers should stay informed about coding updates released by the Centers for Medicare & Medicaid Services (CMS).
Change Request (CR) 13882 introduces an updated list of unacceptable principal diagnosis codes under the hospice benefit. This update affects how hospices submit claims and document patient eligibility.
What Is Included in Change Request (CR) 13882?
Change Request (CR) 13882 updates the list of ICD-10-CM codes that hospice providers cannot report as the principal diagnosis. If a code appears on the unacceptable principal diagnosis list, providers must not use it as the primary diagnosis on hospice claims.
This change helps improve coding accuracy and strengthens compliance with Medicare billing requirements.
Updated Guidance for Hospice Claims
In addition to the diagnosis code list, CR 13882 revises several sections of the Medicare Claims Processing Manual.
The update includes:
- Revised guidance in Chapter 11, Section 30.3 for non-reportable principal diagnosis codes.
- Clarification in Section 40.2 regarding liability for claim denials during a hospice election.
- Updates in Section 50 to include the term “related conditions.”
As a result, the Manual now aligns with current Federal Regulations and the Federal Register.
Why This Update Matters
Hospice organizations should review these changes before submitting claims. Using an unacceptable principal diagnosis code may lead to claim denials or payment delays.
Moreover, correct diagnosis selection supports accurate documentation and reduces compliance risks.
Providers should also educate coding and billing staff about these revisions. Regular training helps maintain billing accuracy and improves claim acceptance rates.
Review the Updated Diagnosis Code List
CMS provides the complete list of unacceptable principal diagnosis codes in Attachment A of Change Request (CR) 13882.
Hospice providers should carefully review this attachment before preparing or submitting hospice claims.
Final Thoughts
The updates in Change Request (CR) 13882 reinforce the importance of accurate hospice diagnosis coding. Every hospice organization should review the revised guidance and update internal billing practices accordingly.
Following these requirements helps reduce claim errors, improve compliance, and support timely Medicare reimbursement.
Resource: CR 13882 (PDF)