June 01, 2016
Area(s) of Interest: Payor Issues and Reimbursement Practice Management
CPR’s “Coding Corner” focuses on coding, compliance and documentation issues relating specifically to physician billing. This month’s tip comes from Barbara Aubry; Renee Dustman, executive editor at AAPC; and G. John Verhovshek, the managing editor for AAPC, a training and credentialing association for the business side of health care.
ICD-10 has received minimal updates since 2012. Changes effective October 1, 2016, mark the return of regular, annual updates for the diagnosis code set.
To date, there are 1,900 proposed revisions to the ICD-10-CM code set, for use beginning October 1. Of that number, there are 313 deletions and 351 revised codes. The codes are posted on the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics website.
Some nonspecific codes are deleted and replaced by more specific designations. For instance:
- Delete: N830 Follicular cyst of ovary
- Add: N8300 Follicular cyst of ovary, unspecified side
- Add: N8301 Follicular cyst of right ovary
- Add: N8302 Follicular cyst of left ovary
A code for Zika virus (A92.5) has been added, and there are 299 revisions and improvements to the diabetes mellitus codes.
Among the many proposed updates in the Tabular List, a large chunk occurs in categories H54 Blindness and low vision and O00 Ectopic pregnancy.
The American Congress of Obstetricians and Gynecologists’ (ACOG) request for new codes to capture multiple gestational pregnancies with co-existing ectopic and intrauterine pregnancies has been approved for the October 2016 addenda. According to ACOG, new codes are necessary to recognize the increased incidence of ectopic pregnancy occurrence with the use of assisted reproductive technologies. At the meeting in March, ACOG requested to amend their proposal to include laterality. “Laterality is important to track since patients who have had ectopic pregnancies in the past are more likely to have subsequent ectopic pregnancies,” ACOG said.
Prepare for new codes
Probably the most important step clinicians can take to prepare for ICD-10 updates is to document, with precision, the patient’s diagnoses. Providers and coders must be vigilant to avoid using “unspecified” codes, unless there is no other option. In addition, be sure to review the Local Coverage Determination (LCD) and National Coverage Determination (NCD) medical necessity policies for coding changes. CMS and its Medicare administrative contractors will be responsible for updating their policies in advance of the effective date of October 1. If you use a vendor, whether for billing or coding, check to be sure your vendor can guarantee their product will be ready with the latest codes by October 1.
Presently, there are 75,625 ICD-10-PCS (procedure) codes for fiscal year 2017. Of that number, 3,651 are new and 487 are revised. The list of proposed new and revised codes for ICD-10-PCS is available on the CMS.gov website.
Of the new codes, 3,549 (97 percent) are in the cardiovascular system section. The changes relate to unique device values, the addition of bifurcation as a qualifier, congenital cardiac procedures and placement of an intravascular neurostimulator. Revised code titles now specify the number of vessels rather than the number of coronary artery sites, and also specify the descending thoracic aorta.
Additional new codes include expansion of body part detail in the removal and revision of lower joints, and add unicondylar knee replacement.
The current list is not final. The work group meets again in July, which may result in more code changes. The CDC and CMS decided to release the proposed list early to help providers and vendors prepare for the update. The final rule containing all finalized codes to be implemented October 1 will be released August 1, 2016.