Wis. ForwardHealth Online Handbook, Hospice, Topic #830

ForwardHealth requires that all codes indicated on claims and PA (prior authorization) requests, including diagnosis codes,

revenue codes, HCPCS (Healthcare Common Procedure Coding System) codes, HIPPS (Health Insurance Prospective Payment

System) codes, and CPT (Current Procedural Terminology) codes be valid codes. Claims received without valid diagnosis codes,

revenue codes, and HCPCS, HIPPS, or CPT codes will be denied; PA requests received without valid codes will be denied.

Providers should refer to current national coding and billing manuals for information on valid code sets.

Code Validity

In order for a code to be valid, it must reflect the highest number of required characters as indicated by its national coding and

billing manual. If a provider uses a code that is not valid, ForwardHealth will deny the claim.

Code Specificity for Diagnosis

All codes allow a high level of detail for a condition. The level of detail for ICD (International Classification of Diseases) diagnosis

codes is expressed as the level of specificity. In order for a code to be valid, it must reflect the highest level of specificity (contain

the highest number of characters) required by the code set. For some codes, this could be as few as three characters. If a

provider uses an ICD diagnosis code that is not valid (not to the specific number of characters required), ForwardHealth will deny

the claim.