Just breathe. Less than one week until the much talked about ICD-10 implementation. If prepared, the doom and gloom might just be another Y2K non-event. Are you prepared?
Let’s look at some last minute reminders about ICD-10-CM codes.
What is implementation date for provider services?
Providers are required to submit ICD-10 claims starting with patients seen/services provided [Date of Service] on October 1, 2015 and beyond. This is regardless of the date the claims are billed out.
*If patient Mrs. Jones is seen for an office visit on Wednesday, September 30th that day’s services will be billed out as ICD-9 diagnosis codes.
*If Mrs. Jones returns for another service on Thursday, October 1st- that day’s services will be billed out as ICD-10 diagnosis codes.
*If Mrs. Jones was admitted to the hospital on September 29th and discharged on October 2nd, the provider services would be billed as follows:
9/29-9/30: ICD-9; 10/1-10/2: ICD-10. Note that ICD-9 and ICD-10 cannot be mixed on the same claim submission. This scenario would require 2 claims.
*Mrs. Jones’ September 30th office visit “kicked out” on edit due to a missing 5th digit ICD-9 code. The claim is corrected and rebilled on October 6th. The 9/30/2015 claim is rebilled using corrected ICD-9 codes.
Who is required to use ICD-10?
All HIPAA Covered Entities are required to use ICD-10-CM for dates of service October 1, 2015. Be aware that workers compensation and liability companies are not covered by HIPAA and therefore, are not required to change. Individual carriers should be researched to determine which code-set they will accept.
Is my software capable of handling ICD-10 codes?
Most medical billing software will require an upgrade to handle the expanded structure of an ICD-10 code. Medisoft’s version 20 is the ICD-10 compliant software known and used by providers because of its combination of affordability, stability, and ease of use. Version 20 includes a mapping tool to aid in transition. Also available are the ICD-10 code names and description setups so that providers can avoid manual entry setup errors.
How will we ever manage almost 68,000 diagnosis codes?
It is true. There are a lot more ICD-10 codes than ICD-9 codes. But just as adding more phone numbers in a phone book or words in a dictionary, adding more codes to a code book does not make locating the code any more difficult. The majority of the additional codes are found in injuries which most providers do not frequent often (Sorry Emergency Room and Orthopedic Surgeons!). In addition, adding laterality(identification of left and right) adds a great deal of codes. Think of all the body systems with a left or right location option. Refer to the “Steps to Correct Coding” in the front of your ICD-10 book for instructions on how to more efficiently use the code book. Providers rarely used all available ICD-9 codes and they won’t use all available ICD-10 codes.
Are there unspecified codes in ICD-10?
ICD-10 still has unspecified codes which have acceptable, even necessary uses. Coding is just an extension of the medical record documentation. Medical records should indicate what is known about the condition of the patient at the time of the encounter (and outline services provided). Unspecified codes should be reported when they most accurately reflect what is known about the patient’s condition at the time of that particular encounter. For example, if it is early in the evaluation of the patient or the patient is being referred to a specialist for diagnosis, the specifics cannot be reported because they are not known.
It would inappropriate to select a specific code that is not supported by the medical record documentation or to conduct medically unnecessary diagnostic testing in order to determine a more specific code.
That being said, lazy coding is not appropriate. If there is sufficient documentation/known factors to more accurately define the condition, unspecified codes should not be chosen. If a high level of service or procedure is being performed that demands a more specific diagnosis code, an unspecified code would not be appropriate.
Those utilizing ICD-10 should know the “unspecified” terminology.
“With unspecified complications”- means the provider acknowledged there were complication in the medical record but he/she failed to specify the complications so that they could be coded.
“With other specified complications”- means that the complications are outlined in the medical record; however, there is no ICD-10 code specifically for that complication. This is a “lump-all” code used to report the leftover-type diseases
“Not otherwise specified (NOS)”- means the medical record does not specify.
To summarize, Non-Specific coding should only be derived from Non-Specific documentation. Documentation should lack specificity only if no other information is known. If the information is known and not documented it is considered incomplete documentation.
How can I not be confused about the 7th character and Placeholder?
Certain ICD-10 categories have applicable 7th Characters, just as a 5th digit was required for certain codes in ICD-9. 7th Characters can be found predominantly in the Obstetrics and Injury chapters, although a few are scattered in other chapters, such as in Glaucoma and Gout.
The issue with 7th characters in ICD-10 is that in ICD-9 when a 5th digit was required there was always a base code with 4 digits assigned. The coder simply added the 5th digit onto the code. In ICD-10, the base code will not always have 6 characters as the base. In fact, the base code might only have 3 character “category” available.
When a 7th character is required, it must be located in the 7th position of the code within the data field. If a code that requires a 7th character is not 6 characters, a placeholder “X” must be used to fill in the empty characters.
Diagnosis: Glaucoma, secondary to other eye disorders, right eye, moderate stage
Secondary Glaucoma requires the use of a 7th character to identify the stage of Glaucoma.
H40.51- Base code is 5 characters
To add the 7th Character in the 7th Position: H40.51_2 the 6th character is missing-it cannot be left blank.
To complete the code a placeholder X must be inserted in the 6th position: H40.51X2.
T66 is the category and the only base code given but still requires a 7th character to identify the encounter to be located in the 7th position of the code.
To add the 7th character in the 7th position: T66._ _ _D the 4th, 5th and 6th characters are missing and cannot be left blank.
To complete the code a placeholder X must be inserted in the 4th, 5th and 6th position: T66.XXXD
October 2015 stands to be an interesting month for providers everywhere as we transition to ICD-10. Hold on and again, breathe! Remember to call on Info Services, Inc. for all your medical billing needs.