ICD-10 Talk with Dr. Heidi Jannenga: How Many ICD-10 Codes Do I Really Need to Know?

November 6th, 2015
Codes, ICD-10, ICD-9, Insurance

Overwhelmed by the sheer size of the ICD-10 code set? Not to worry. As Dr. Heidi Jannenga explains in this edition of ICD-10 Talk, rehab therapy practitioners definitely don’t need to know every single code. In fact, they likely will stick to a few key subsets of codes. Which ones, you ask? Watch this video to find out, and stay tuned to ICD10forPT.com for all the latest ICD-10 news.



ICD-10 Talk with Dr. Heidi Jannenga: Am I Choosing the Right ICD-10 Code?

November 2nd, 2015
ICD-10, ICD-9, Insurance, Patient care

So, you’ve got the general gist of this whole ICD-10 thing. But when it comes to coding for specific patient scenario, you’re a bit less confident. How do you know if you’ve really picked the most accurate codes for a particular patient? In this video, Dr. Heidi Jannenga offers a few key pieces of advice for determining whether you’ve landed on the best possible code.



ICD-10 FAQ Part Three

October 23rd, 2015
Codes, ICD-10, ICD-9, Insurance, Transition

We know that lots of good things come in threes—like three-piece suits, the Three Stooges, the three French hens your true love gave to you, and the number of sheets to the wind you might be after happy hour. And now, that list includes our ICD-10 FAQ series. In our first two pieces (here and here), we covered a lot of ground and—hopefully—gave you a good mid-level understanding of ICD-10. This third installment dives into the nuances of using the new code set to help you address some of your trickiest questions. So, let’s get to it:

General Questions

Does my treatment diagnosis have to match the diagnosis the referring physician sent? Sometimes my physicians don’t send codes with their referrals.

Your treatment diagnosis doesn’t necessarily have to match your referring physician’s diagnosis. With ICD-9, therapists typically used only the treatment diagnosis codes, leaving off the “true” diagnosis codes (i.e., medical diagnosis codes), because insurance companies only required treatment diagnosis codes for payment.

As the healthcare system shifts into a pay-for-performance environment—and with the introduction of alternative payment models—providers now must focus more on the complexity of the patient. And as far as claims go, the only way providers can communicate that complexity is through diagnosis codes. So, with ICD-10, it’s critical to include not only the treatment diagnosis codes, but also the codes for the medical diagnosis and comorbidities. This allows you to paint a complete, accurate, and detailed picture of the patient and his or her situation. Remember, though, that the primary code will still be your treatment diagnosis.

Thus, if your referring physician did not send a medical diagnosis, I would suggest reaching out to obtain one, as that will help ensure you code as thoroughly as possible.

When I get scripts with very generic instructions (e.g., “treat the legs”), is it okay for me to use an equally generic code (e.g., R29.9, Unspecified symptoms and signs involving the nervous and musculoskeletal systems)?

When you use generic—or in ICD-10 language, “unspecified”—codes, you risk payers inferring that your services are not medically necessary. So, it’s really up to you as to whether you’re willing to take that risk. We recommend either:

  1. reaching out to the referring physician to get more detail, or
  2. referring the patient to another specialist if, based on your clinical judgment, you believe the patient needs further evaluation that falls outside of your scope of practice.

In the ICD-10 code set, some codes have a dash ( – ) at the end of them. What does this mean?

The dash often is used in the note sections (e.g., Excludes1, Excludes2, and Code also). It indicates that the note applies to all of the codes in that series. That way, the codes don’t have to be listed out individually, which would take up a lot of space. So, to give an example, “T79.A-” would cover every single code that begins with “T79.A.”

Specific Coding Questions

How do I code for “X” patient with “Y” condition?

We’ve received numerous questions about how to code in very specific patient scenarios. However, because ICD-10 places such a strong emphasis on clinical judgment—which requires you, as the therapist, to select the most complete, accurate, and specific code(s) possible based on your assessment of the patient—we cannot provide coding advice for those scenarios. But, if you are able to provide supporting documentation, you can submit specific coding questions to this AHA portal.

What code(s) should I use to indicate decreased range of motion (ROM)?

While there are no codes for decreased ROM specifically, there are plenty of other codes that would apply to patients experiencing this symptom. For example, if a patient presents with decreased ROM in the knee, applicable codes may include those for difficulty walking or gait abnormality (R26.2 or R26.89), knee pain (M25.561 or M25.562), knee stiffness (M25.661 or M25.662), or knee effusion (M25.461 or M25.462).

I’m having trouble finding specific codes for conditions affecting the lumbar region (e.g., lumbar stiffness or decreased ROM in the lumbar spine). What are your suggestions?

While we are not trained coders, we can say that with ICD-10, you are encouraged to first code for the underlying condition causing such spinal symptoms. Here are a few resources that may help with coding spinal conditions:

What codes should I use to indicate muscle weakness in a specific anatomic location? The only muscle weakness code I can find is M62.81.

If the patient is experiencing weakness in one specific area, then the code for generalized muscle weakness (M62.81) likely would not be appropriate, as it indicates the weakness is present throughout the body. To code for weakness in a specific area, use the appropriate atrophy code (you’ll find many of these codes in the M62.5 code family). Additionally, keep in mind that the coding guidelines encourage you to code first for the underlying cause of the weakness, rather than the weakness itself. If you are able to do that, you can include the atrophy codes as secondary.

What ICD-10 code would you recommend for stiffness of the lumbar spine?

Whenever possible, you should first code for the underlying condition that is causing the symptom (which in this case is stiffness). Here is a resource that lists ICD-10 codes for common spinal conditions. As a secondary code, you could use M25.60, Stiffness of unspecified joint, not elsewhere classified (keep in mind that there is not a spine-specific option in that family of codes).

How do I code for impaired balance?

While there is not an ICD-10 code for impaired balance, there are several options that provide a much higher degree of specificity. These include the codes listed in the R26 (Abnormalities of gait and mobility) and R27 (Other lack of coordination) series. To select the code that best describes the patient’s condition, you’ll need to use your clinical judgment. You also may need to reference the coding synonyms provided in resources like this one.

Can I submit M54.5 (Low back pain) as a single, primary code?

Yes, M54.5 is a complete, billable code, and thus, you can use it as the primary. However, because it’s not a very specific code, you should only use it as the patient’s primary diagnosis code if there’s not a more specific code available to accurately describe the patient’s condition. If the patient has a confirmed underlying diagnosis (i.e., the condition actually causing the back pain), then you should code for that first. If not, then make sure you explain those details in your documentation.

I thought that the only seventh character options were A, D, and S, but I’ve noticed some codes have additional options (G, K, P, etc.). Is this a different seventh character system?

Yes. Codes for fractures use a whole different set of seventh characters:

  • A: Initial encounter for fracture
  • D: Subsequent encounter for fracture with routine healing
  • G: Subsequent encounter for fracture with delayed healing
  • K: Subsequent encounter for fracture with nonunion
  • P: Subsequent encounter for fracture with malunion
  • S: Sequela

You can learn more about fracture coding in ICD-10 here.  

External Cause Codes

If a patient doesn’t know what caused his or her injury, or if there’s no evidence that a specific event (e.g., a past car accident) resulted in the patient’s current condition, then do I need to use external cause codes?

You cannot code for what you don’t know. So, if you don’t know what caused the patient’s injury—or if there’s no definitive correlation between a known causal event and the patient’s current condition—then don’t code for it. Remember, external cause codes (like those that denote accidents) are optional. Just make sure you accurately record any potentially relevant information within the patient’s documentation.

I heard that S codes (i.e., injury codes) and M codes (i.e., musculoskeletal codes) cannot stand alone. What should I do if I don’t know any of the details necessary to select external cause codes (cause, location, activity, etc.)?

There is no blanket instruction regarding M codes and S codes being unable to stand alone. While you are encouraged to submit external cause codes when possible, they are not required. And if you do not know the details necessary to select those codes, then you shouldn’t submit them (in other words, you cannot—and should not—code for what you don’t know). However, you may see notes at the top of specific code categories instructing you to submit additional diagnosis codes with the codes in those particular sections (e.g., “Code also” or “Code first”).

The official ICD-10 coding guidelines state that external cause status codes, activity codes, and place of occurrence codes are “used only once, at the initial encounter for treatment.” Does that mean you only submit these codes on the claim for your initial evaluation of the patient?

Yes, according to the guidelines, you only need to submit those codes once, and that’s at the patient’s initial encounter (i.e., you initial evaluation). However, we have yet to see what will happen if those codes are submitted on subsequent claims. Different payers may have different rules, and some may enforce them more strictly than others. We don’t anticipate claims being denied for having “extra” codes; that said, if and when ICD-10-related denials start to occur, we’ll keep our Blog readers informed on the most common reasons behind those denials.

The above-cited coding guidelines excerpt seems to conflict with the excerpt that reads, “Assign the external cause code, with the appropriate 7th character (initial encounter, subsequent encounter or sequela) for each encounter for which the injury or condition is being treated.” I’m confused; should I submit external cause codes at every visit or just at the first visit?

Although Chapter 20 of the ICD-10 code set is titled “External Causes of Morbidity,” this chapter actually contains four different types of codes:

  1. place of occurrence codes,
  2. activity codes,
  3. external cause status codes, and
  4. external cause codes.

So, while you should report the main external cause code at every encounter, you only need to report the other types of codes at the initial encounter. Furthermore, “When applicable, place of occurrence, activity, and external cause status codes are sequenced after the main external cause code(s). Regardless of the number of external cause codes assigned, there should be only one place of occurrence code, one activity code, and one external cause status code assigned to an encounter.”

My billing system limits the number of codes I can submit. If I cannot submit all of the external cause codes that apply to a particular patient, how should I choose the one(s) I do submit?

Per the official reporting guidelines, “If the reporting format limits the number of external cause codes that can be used in reporting clinical data, report the code for the cause/intent most related to the principal diagnosis.”

Aftercare Codes

Should I always use an aftercare code for post-op patients?

Per the official ICD-10 coding guidelines (which you can find here), “The aftercare Z codes should not be used for aftercare for conditions such as injuries or poisonings, where 7th characters are provided to identify subsequent care. For example, for aftercare of an injury, assign the acute injury code with the 7th character ‘D’ (subsequent encounter).” Based on those guidelines, if the surgery resulted from an injury that allows for the seventh character, you would use the original acute injury code with the seventh character “D.”

What is the difference between the aftercare codes Z48.89 (Encounter for other specified aftercare) and Z47.89 (Encounter for other orthopedic aftercare)?

Z48.89 applies to all types of surgical aftercare, whereas Z47.89 applies to orthopedic procedures specifically.

Can I submit a post-surgical aftercare code (e.g., Z51.89, Encounter for other specified aftercare) as the patient’s primary diagnosis code?

Your treatment diagnosis should be the one that best supports the medical necessity of your therapy services, and if you submit more than one treatment diagnosis code, you should order them according to significance. The ICD-10 coding guidelines seem to suggest that the order may change based on the specific context of the patient’s situation. The guidelines read: “Z codes may be used as either a first-listed (principal diagnosis code in the inpatient setting) or secondary code, depending on the circumstances of the encounter.” In other words, it’s up to you (and your clinical judgment) to determine which code best represents the main reason the patient needs therapy treatment.

If I am providing post-surgical rehab therapy treatment, and the patient’s original condition (i.e., the one that prompted the surgery) is no longer present, which codes can I submit besides the aftercare code?

If the condition that caused the patient to undergo surgery no longer exists, then you should not code for it. Instead, you can submit any applicable pain/symptom codes relevant to the patient’s treatment. Ultimately, the codes you use, and the order in which you submit them, are up to you and your clinical judgment. Just make sure your documentation clearly supports your coding choices.

Considering the degree of specificity ICD-10 affords, it seems strange that there are not surgical aftercare codes for specific surgeries (e.g., rotator cuff repair or ACL repair). How, then, should I code for these post-op patients?

While there is not an aftercare code for every single surgery, in many cases, the proper way to designate the phase of treatment (i.e., indicate that the patient is receiving aftercare) is to code for the original acute injury and add the appropriate seventh character (which in this case, would be D). So, if, for example, the patient originally strained his or her right rotator cuff, you would indicate that you are providing aftercare by using the code S46.011D, Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder, subsequent encounter. For more information on coding for aftercare, check out this blog post.

Claims

If I submit multiple diagnosis codes on a single claim, which one should I point to on my service lines?

You can submit up to four diagnosis code pointers per service line, which means you can point to up to four diagnoses.

If I have to resubmit a claim for a date of service prior to October 1, 2015 (meaning the claim contains ICD-9 codes), do I need to change the codes to ICD-10?

Because the transition to ICD-10 goes by date of service—not the date of claim submission—you should continue using ICD-9 codes for all claims with dates of service on or before September 30.

We bill electronically, and it is my understanding that we should be able to submit up to 12 diagnosis codes per claim. However, my billing software only sends the four top codes through to the claim. Why is that?

Because the standard HCFA claim form allows space for only four diagnosis pointers per service line, some billing systems only pull the four most relevant diagnosis codes through to Box 21 on the claim form. Those codes then become the origins for the four diagnosis code pointers that appear in Box 24E. We recommend looking for a billing system that allows you to send up to 12 codes through to Box 21; however, regardless of whether your system limits the number of diagnosis codes you can submit, it’s crucial that you order your codes according to significance, with those codes that most strongly support the medical necessity of your treatment appearing first.

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If ICD-10 is keeping you up at night, this post should help give you the guidance you need to get a few more hours of shut-eye. But, if our third ICD-10 FAQ wasn’t quite the charm, posit your ponderances to us using the form below, and we’ll do our darndest to answer them.


ICD-10 FAQ Take Two

October 23rd, 2015
ICD-10, ICD-9, Insurance, Preparation, Transition

Rob Base and DJ E-Z Rock said, “It takes two to make a thing go right.” If that’s the case, then you can’t get more right than a second helping of our ICD-10 FAQ. (Missed part one? Check it out here.)

General Questions

Will ICD-10 eliminate the need to provide extensive detail within patient documentation?

Absolutely not. While ICD-10 makes it much easier to communicate detailed diagnostic information via codes, the transition to the new code set actually will make detailed documentation even more important. CMS explains why here: “If complete information is not captured in clinical documentation, the result will be incomplete documentation for coding that then can impact revenues through delays, missed revenues, outcome measures that don’t clearly or accurately reflect the quality and complexity of the care that is being delivered.” Furthermore, if you don’t do your own coding (i.e., your practice has a coder), then it’s even more important that you provide all the details necessary for proper code selection within your documentation.

I run a cash-based clinic, so I don’t need to worry about ICD-10, right?

The only exceptions to the ICD-10 transition mandate are HIPAA non-covered entities. So, the only way a therapist would be exempt from the transition is if his or her practice qualified as a non-covered entity. Remember, if your patients submit invoices to their insurance companies for reimbursement, you’ll need to provide the appropriate diagnosis codes. And as of October 1, those codes must be ICD-10.

The Grace Period

What happens if Medicare rejects my claim because my ICD-10 code isn’t a valid code?

As explained in our first FAQ, even with Medicare’s grace period, providers still must submit a valid ICD-10 code from the correct family of codes. However, in the event that you submit an invalid code—and, as a result, receive a claim rejection—you will “have the opportunity to resubmit the claim with a valid ICD-10 code,” this CMS resource explains.

What is a “valid” code?

Often referred to as a “billable” code, a valid code is one that has been built out to the highest possible level of specificity. In other words, you’ve added as many characters as you can to the code—including a seventh character, if the code requires one. (For more on seventh characters, check out this blog post.) For example, the code M70 (Soft tissue disorders related to use, overuse and pressure) would not be a valid code, because additional specificity is possible. However, the code M70.11 (Bursitis, right hand) would be a valid code, because you cannot add any additional characters to that code to make it any more specific.

What constitutes a family of codes?

In ICD-10, “families” of codes are typically indicated by three-character headings. According to CMS, “Codes within a category are clinically related and provide differences in capturing specific information about the condition.” For example, M70 appears at the top of the family of codes for soft tissue disorders related to use, overuse, and pressure. All of the codes that are listed underneath that heading belong to that family of codes.

Because Medicare won’t reject claims solely for lack of coding specificity, does that mean that the current diagnosis coding specificity requirements set forth by National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) will be more flexible in ICD-10? Will I be in compliance with NCD and LCD policy as long as my ICD-10 code is in the correct family of codes?

No. As explained in this CMS document, the grace period announcement “does not change the coding specificity required by the NCDs and LCDs. Coverage policies that currently require a specific diagnosis under ICD-9 will continue to require a specific diagnosis under ICD-10.” That said, the transition won’t affect the expected level of specificity; in other words, you’ll code to the same level of specificity in ICD-10 that you did with ICD-9. There is, however, one very important exception to that statement: laterality. “LCDs and NCDs that contain ICD-10 codes for right side, left side, or bilateral do not allow for unspecified side,” CMS notes.

Does Medicare’s grace period apply to Medicaid?

No. The grace period guidelines only apply to “Medicare fee-for-service claims from physician or other practitioner claims billed under the Medicare Fee-for-Service Part B physician fee schedule,” this resource explains, adding that the grace period “does not apply to claims submitted for beneficiaries with Medicaid coverage, either primary or secondary.”

Will commercial payers observe a similar period of flexibility following the transition?

The official grace period announcement only applies to claims billed under Medicare Part B. Thus, it’s up to each individual private payer to determine whether it will offer a period of flexibility and to define the parameters of that flexibility.

The Seventh Character

Is there any new information on the difference between “A” and “D” with respect to rehab therapy encounters?

This has been such a hot topic of debate that one of the attendees of a recent CMS national provider call brought it up during the Q&A portion of the meeting. Here’s the exact answer the CMS representative provided, as noted in this call transcript: “There is no specific hard set definition of what active treatment is. There are some examples that are given in the official guidelines, such as surgical treatment, emergency department encounter, and that type of situation. So they’re—it’s not an all-exhaustive list. But what I think is probably clearer is that for the subsequent encounters, usually those are where there’s routine healing or a problem with the healing.”

How do I know which seventh character to use for a chronic or recurrent musculoskeletal condition, like those found in chapter 13 (which contains the “M” codes)?

Seventh characters do not apply to the codes listed in chapter 13. Most of the seventh character-eligible codes that rehab therapists will use occur in chapter 19 (a.k.a. the injury chapter).

Coding for Aftercare

I was under the impression that aftercare codes should not be used as primary diagnoses. Is this true in ICD-10?

While you may have been discouraged from using aftercare codes (i.e., “V” codes), as primary diagnosis codes in ICD-9, that is not the case in ICD-10—at least not according to the official ICD-10-CM guidelines for coding and reporting: “Z codes may be used as either a first-listed (principal diagnosis code in the inpatient setting) or secondary code, depending on the circumstances of the encounter,” the guidelines read. Furthermore, regarding R codes such as the one for gait abnormality, the guidelines offer the following explanation: “Codes for signs and symptoms may be reported in addition to a related definitive diagnosis when the sign or symptom is not routinely associated with that diagnosis, such as the various signs and symptoms associated with complex syndromes. The definitive diagnosis code should be sequenced before the symptom code.” So, as with a lot of ICD-10 guidance, the context of the patient’s situation appears to influence the order of the codes.

It doesn’t seem like there are a lot of codes available to represent specific surgeries. Why is that?

While there is not an aftercare code for every single surgery, in many cases, the proper way to designate the phase of treatment (i.e., indicate that the patient is receiving aftercare) is to code for the original acute injury and add the appropriate seventh character (which would be “D”). So, if, for example, the patient who underwent rotator cuff surgery had originally strained his or her right rotator cuff, you would indicate that you are providing aftercare by using the code S46.011D, Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder, subsequent encounter.

Using Multiple Codes

Shouldn’t the primary code be a symptom/complaint code (e.g., difficulty walking), because this code reflects the reason the patient came to therapy?

In some cases, your primary treatment diagnosis code can be a symptom code that reflects what you, as the therapist, are treating. For example, let’s say a patient with Parkinson’s comes to you because he or she is having difficulty walking. In this particular case, you could use a code from the gait abnormalities section (the R26 family of codes) as your primary treatment diagnosis because you, as the therapist, are not treating the Parkinson’s. However, if you are actually providing treatment for an underlying condition, you are encouraged to code for it first, if possible, because it better supports the patient’s medical need for your services. For a more in-depth discussion of coding for medical necessity, check out this blog post.

How should I order my codes?

You should submit the codes in order of significance with respect to medical necessity. For more details on using multiple diagnosis codes, check out this blog post.

Should I include codes for comorbidities?

You should include as many codes as necessary to explain the complexity of the patient’s condition to the fullest extent possible. Remember, though, that you cannot code for what you cannot diagnose (with respect to your scope of practice). For referral patients, we recommend working with your referring physicians to ensure you’ve accounted for as many pertinent diagnoses as possible—and that you’ve selected the most accurate, specific codes possible to represent those diagnoses.

Transitional Logistics

Considering that the transition goes by date of service, will claims for dates of service on or before September 30 be paid if I submit them with ICD-9 codes after October 1?  

Payers theoretically should be equipped to handle claims with pre-October 1 dates of service—and thus, ICD-9 codes—even when those claims are are submitted after October 1. However, we strongly suggest finalizing all notes for dates of service on or before September 30 prior to the transition on October 1. Why? Because there’s no way to know for certain that all payers will truly be ready to handle that distinction. So, just be aware that if you submit pre-October 1 claims after October 1, you may experience delays in payment or have to deal with appeals or claim resubmission for those dates.

How does the transition work for those billing inpatient services?

As CMS explains here, “…for inpatient facility reporting, date of service is defined

as the date of discharge.” So if, for example, a patient is admitted to the hospital on September 27, but he or she isn’t discharged until October 2, you would use ICD-10 codes on the claim. Conversely, if that patient is discharged on September 30, you would use ICD-9 codes on the claim.

How should I handle claims with dates of service that span the transition?

There are different rules for different settings and claim types. To review the requirements for each, check out this MLN Matters document.

Additional Help Resources

What’s the deal with the ICD-10 Ombudsman?

CMS has named an ICD-10 Ombudsman “to be a one-stop shop for you with questions and

concerns and to be your internal advocate inside CMS.” His name is Dr. William Rogers, and he’s a practicing emergency room physician who has been the director of CMS’s Physicians Regulatory Improvement Team since 2002. You can reach him at icd10_ombudsman@cms.hhs.gov.

Where can I go for specific coding questions?

The American Hospital Association (AHA) provides a portal where you can submit specific clinical coding questions here. If you take advantage of this free resource, keep these guidelines in mind:

  • Do not ask the service to code your entire superbill.
  • Do not send an entire patient record and ask for proper coding.
  • Do not simply ask for the appropriate code for a certain disease or procedure.
  • Do not ask about payments, coverage issues, or general equivalence maps (GEMs).
  • You must submit supporting medical records documentation with your question.
  • You must specify whether the question refers to a specific clinical setting (e.g., skilled nursing facility, home health, or a particular provider type/specialty).

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There you have it: a second ICD-10 FAQ to make it outta sight. Don’t see an answer to your questions? Check out part three here.

 


ICD-10: Beyond D-Day

October 1st, 2015
ICD-10, ICD-9, Preparation, Transition

D-Day was the beginning of a major turning point in World War II; for the healthcare industry, ICD-10 represents a major turning point for medical providers. No, the transition to ICD-10 isn’t a military operation—far from it, in fact—but both take a great deal of preparation and coordination to execute. Just like you wouldn’t attack your enemy without trained troops, skilled leaders, and a strategic plan of action, you wouldn’t make the transition to ICD-10 without preparation and coordination.

But despite best efforts, things don’t always go according to plan. Thanks to ICD-10’s increased demand for specificity, it seems there’s no avoiding a dip in productivity come October 1, 2015. As this AHIMA article explains, “Productivity loss, or an increased amount of time to code a patient encounter, due to the transition to ICD-10-CM/PCS is expected to reflect a bell curve, with the peak productivity loss surrounding the go-live date.”

But how will that slow-down actually manifest? According to this article from ICD10Watch, unfamiliarity with the new code set will cause decreased productivity in a few different ways:

  • Taking more time to find the correct code.
  • Spending more time communicating with physicians due to nonspecific referral diagnoses.
  • Claim rejections due to coding errors.
  • Delayed claim reimbursements due to payer unpreparedness.

While some factors are out of your control, the degree of productivity loss your clinic will suffer is mostly up to you. Here’s what you should focus on to combat productivity loss (as adapted from this resource):

  • Practice, practice, practice. If you use an EMR, take advantage of your vendor’s ICD-10 testing tool.
  • Make time for training (you’ll thank me later).
  • If it’s in the budget, consider hiring a coder (or two)—and make sure he or she knows how to code for your speciality.
  • Finalize all notes for dates of service on or before September 30—and submit any outstanding claims.
  • Examine—and refine—your systems and processes to maximize efficiency going into the transition.

Interested in figuring out how much productivity your clinic actually loses post-transition? You’re going to need to know your productivity levels as they currently stand. You should be tracking this already through key metrics, such as these metrics recommended by ICD10Watch:

  • Time to correctly code a medical claim
  • Time it takes to process a medical claim from patient encounter to healthcare payer
  • How long it takes for healthcare payers to answer coding questions
  • How long medical claims are in accounts receivable
  • Denial rates and how much money is denied
  • Difference between reimbursements and contracted rates

Once you have these figures, you can use them to compare productivity levels as time marches on. If you don’t have these metrics, it’s going to be a lot tougher to track and manage your decrease in productivity, but the war’s not over yet. You won’t have a baseline for your pre-transition productivity, but if you start keeping track now, you’ll at least be able to tell how your clinic is doing in the thick of the transition and, eventually, you’ll have data to demonstrate when your clinic begins to improve.

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ICD-10 is upon us, but if you attack it with all you’ve got, you’ll give your clinic a fighting chance. The transition won’t be easy, but if you keep your wits about you, you’ll come out the other side.


A to Z: What you Need to Know About ICD-10 Aftercare Codes

September 22nd, 2015
Codes, ICD-10, ICD-10 Example, ICD-9

At this point in your ICD-10 journey, it’s likely you’ve noticed that the letters A through Z are no longer reserved for the tiny noodles floating in your favorite childhood soup. In fact, when it comes to ICD-10 coding, you could say that your payments hinge on selecting the correct letter. In ICD-10, letters can indicate a number of things about your patient’s condition, including the category of codes and the phase of treatment. Although this coding logic might not offer you the comfort that alphabet soup once did, these letters of designation do have their place. In terms of ICD-10, Z is just as important as A. But unlike the ABC song, the letter Z doesn’t signify the end. In fact, it signifies the beginning for some rehab therapists—namely, those coding for aftercare. Here’s what you need to know about Z codes—no slurping required:

“Goodbye” to the V57 series

The V57 code series you once knew (and loved) is saying sayonara, as this series isn’t included in the ICD-10-CM code set. If you were to map every one of these V57 codes to a relevant ICD-10 code, you’d end up with one match: Z51.90, Encounter for other specified aftercare. According to the ICD-10 tabular list, this code isn’t able to stand on its own; you also must code for the condition requiring care. Coding for the underlying condition helps prove the medical necessity of your treatment. For more on coding for medical necessity, check out this blog post.

“Hello” to the Seventh Character

If you have the option of submitting a primary diagnosis code that contains a seventh character on your claim, you should take that route rather than selecting one of the aftercare codes. The seventh character indicates phase of treatment, but not all codes require—or allow for—this character. Most of the codes within the musculoskeletal chapter of the tabular list (chapter 13) don’t allow for seventh characters. That’s because most of these conditions result from a healed injury or are chronic in nature—so the phase of treatment is already implied. As for those codes that do require seventh characters (like the ones that appear in chapter 19, also known as the injury chapter): By selecting “D” as the seventh character, you’re indicating that the patient is in the healing and recovery phase of treatment. And if you’ve added a primary diagnosis code with a “D” in the seventh character position, there’s no need to submit an aftercare code, because you’ve already indicated that the patient is in the healing and recovery phase of treatment.

“Maybe” to Z Codes for Surgical Aftercare

Postoperative care aims to bring a patient back to his or her healthy level of function. If you’re specifically providing a patient with surgical aftercare treatment, ICD-10 has a few coding options. To give a couple of examples, you can use Z51.89, Encounter for other specified aftercare, or Z47.1, Aftercare following joint replacement surgery. According to the official ICD-10-CM guidelines for coding and reporting, “Z codes may be used as either a first-listed (principal diagnosis code in the inpatient setting) or secondary code, depending on the circumstances of the encounter.” That said, your clinical judgement and documentation will justify your code selection.

“Sometimes” to Singular Coding

If you’ve selected a Z code as your primary code, it doesn’t necessarily mean you should ditch any additional codes. If there are other codes that apply to your treatment and the patient’s situation, you should include them as well. In some cases, this might mean submitting multiple Z codes to more fully describe the patient’s situation. According to this ICD10 Monitor article, “Aftercare codes should be used in conjunction with other aftercare codes, diagnosis codes and/or other categories of Z-codes to provide better detail on the specifics of the aftercare encounter/visit, unless otherwise directed by the classification.”

One good example of this is in surgical aftercare for a joint replacement. As explained in this WebPT blog post: “If you were treating a patient who had a total knee replacement, you would want to submit Z47.1, Aftercare following joint replacement surgery, as well as ICD-10: Z96.651, Status (post), organ replacement, by artificial or mechanical device or prosthesis of, joint, knee-see presence of knee joint implant.” In this example, the patient received surgery for osteoarthritis relief. It’s assumed the patient is not seeking treatment for osteoarthritis, as he or she has undergone surgery to remedy this condition. Thus, you would use both Z codes to indicate the surgery as well as the joint replaced. For more information on this scenario, check out the blog post.

__________

The use of aftercare codes might not be as cut and dried as you’d like to think. However, that doesn’t mean it needs to be a cause for concern. Just keep in mind that listing Z codes as primary codes should be a last resort. In fact, it may not be appropriate at all. If you have a code that more accurately describes why the patient is seeking therapy, apply that one. While ICD-10 coding might not be as enjoyable as singing your “ABCs” or chowing on some alphabet soup, I hope you’ll still find some satisfaction in knowing how—and when—to apply those oh-so-important letters.


Will ICD-10 Eradicate Paper Superbills?

September 21st, 2015
ICD-10, ICD-9, Transition

To a regular person, the idea of doing away with something called a superbill might sound alluring. I, for one, would love to trash the supersized energy bill I received after running my air conditioner throughout the month of August in Phoenix. For healthcare providers, however, the term “superbill” has a whole different meaning: it’s “a form used by medical practitioners and clinicians so they can quickly complete and submit the procedure(s) and diagnosis(s) for a patient visit for reimbursement,” explains the American Academy of Professional Coders (AAPC).

Many ICD-10 prep resources—including ICD10forPT—have encouraged providers to create ICD-10 versions of their current ICD-9 superbills, an exercise that:

  1. Helps practitioners get comfortable with navigating the ICD-10 code set, and
  2. Produces a helpful ICD-10 resource specific to each individual practice.

But while converting your ICD-9 superbill to ICD-10 is a great way to learn the ICD-10 ropes, it definitely shouldn’t be your only training activity. Furthermore, keep in mind that paper superbills won’t carry nearly as much weight in the post-ICD-9 world. In fact, relying on a superbill to guide your practice’s coding decisions likely will be a losing strategy with ICD-10. Here’s why:

1. Many ICD-9 superbills contain general codes.

In the interest of saving space, most superbills feature a hefty portion of “unspecified” or “not otherwise specified” ICD-9 codes. And while those codes might be enough to generate payment now, they’re just not going to cut it after the big switch. After all, one of the driving forces behind the move to ICD-10 is the global call for greater detail when coding patient diagnoses. For that reason, “ICD-10 requires you to code to the highest possible level of specificity,” explains this blog post. But mapping one general code to another defeats the purpose of the transition—and, more importantly, puts your practice at risk for denied payments.

2. Crosswalking tools often map ICD-9 codes to non-specific ICD-10 equivalents.

For the superbill conversion strategy to work well in practice, you’d need to find a single ICD-10 code to sub in for each ICD-9 code. And I hate to be the bearer of bad news, but you don’t have a snowball’s chance in the Sonoran Desert of doing that—at least not in a way that would meet the aforementioned specificity standard. In fact, in many cases, the quest to find a one-to-one match for a fairly specific ICD-9 code will actually lead to a less-specific ICD-10 code. The AAPC offers the following example to illustrate this point: CMS’s crosswalk maps the ICD-9 code 845.00, Sprained/strained ankle, unspecified, to both S93.409A, Sprain of unspecified ligament of unspecified ankle, initial encounter, and S93.409D, Sprain of unspecified ligament of unspecified ankle, subsequent encounter. “However, this is incomplete because it does not include a code for a strained ankle,” the article points out.  

3. More coding specificity means more codes.

Superbills are meant to be quick resources, and the ones currently in use probably don’t have enough room to accommodate all relevant ICD-10 codes. That’s because, as this ICD10forPT article states, “…for each ICD-9 code, there could be dozens—sometimes even hundreds—of possible ICD-10 equivalents.” And there’s no way to know which one to use until you have a real, live patient in front of you, because you’ll need to have a complete picture of the patient’s situation in order to select the code that most accurately represents his or her specific diagnosis. So, while your incumbent superbill might fit nicely on one page, your ICD-10 version could explode to nearly ten pages—or even more. As Gayl Kirkpatrick, a solution sales executive for 3M HIS Consulting Services, tells Government Health IT in this article, “We took a two-page superbill in ICD-9 and translated that into ICD-10…It became a 48-page superbill.”

4. Paper is so last-millenium.

The transition to ICD-10 represents a huge step forward for the entire US healthcare industry. This is the code set of the future (of the present, actually—after all, we’re the last major country in the world to take the ICD-10 plunge). It’s not just about us; it’s about collecting and analyzing data to raise the bar for patient care on a global scale. And to do that, we have to move away from the paper systems of old and embrace the technology that will usher us into a new age of health care. Who needs a printed list of codes when they have innovative, intuitive coding tools at their fingertips—tools that allow them to approach coding in a wholly patient-centric way? When you think about it that way, paper just can’t compete.

 

While paper superbills probably won’t disappear as fast as popsicles at an Arizona summer picnic, they will become less useful—and less reliable—come October 1. Looking for a better way to streamline diagnosis code selection? Click here to see a solution that puts paper superbills to shame.    


The Best Darn ICD-10 FAQ for PTs

September 14th, 2015
CMS-1500, Codes, ICD-10, ICD-10 Delay, ICD-10 Example, ICD-9, Preparation, Transition

If you’re a HIPAA-covered medical professional, ICD-10 is a huge deal for you—like, deflategate huge. Along with all the controversy—including delays and grace periods—ICD-10 also has caused a lot of confusion. Over the course of the months leading up to the October 1 transition, we’ve received thousands of questions regarding the new code set. After sifting through your coding queries, we’d bet good money that thousands more folks have questions, but they’re afraid to ask. That’s why we gathered our very best answers to your most-frequently-asked questions and created this hefty, Costco-sized collection:

The Seventh Character Craze

What is the seventh character?

The seventh character didn’t exist in ICD-9, so it’s caused a great deal of confusion. Basically, it’s a mechanism for applying greater specificity to a diagnosis, particularly with regard to the episode of care. As its name would suggest, the seventh character should always be the seventh digit of a code. As this blog post details, there are three seventh characters related to the episode of care:

  • A (initial encounter) describes the entire period in which a patient is receiving active treatment for the injury, poisoning, or other consequences of an external cause.
  • D (subsequent encounter) describes any encounter after the active phase of treatment, which is when the patient is receiving routine care for the injury during the period of healing or recovery.
  • S (sequela) indicates a complication or condition that arises as a direct result of an injury.

How do I know when to use the seventh character?

You don’t always need to attach a seventh character to your diagnosis code. Seventh characters are required for codes in certain ICD-10-CM categories—primarily Chapter 19 (Injury, poisoning and certain other consequences of external causes) and Chapter 15 (Pregnancy, childbirth and the puerperium). You’ll know when to use it because there will be instructions specifying seventh character use within any code book or tabular list you reference. Don’t see instructions? Then “leave the seventh position blank,” explains this blog post. “Adding a seventh character to a code that does not require one will make the entire code invalid.”

What’s the difference between A (initial) and D (subsequent)?

We’ve seen multiple interpretations of what distinguishes an “initial encounter” from a “subsequent encounter.” Based on everything we’ve reviewed, this is the best answer we’ve found: “The 7th character for ‘initial encounter’ is not limited solely to the very first encounter for a new condition. This 7th character can be used for multiple encounters as long as the patient continues to receive active treatment for the condition.” This resource goes on to say: “The key to assignment of the 7th character for initial encounter is whether the patient is still receiving active treatment for that condition.”

So, it appears that the words “initial” and “subsequent” have less to do with how many practitioners the patient has already seen or how many visits the patient has logged at your office, and more to do with the patient’s treatment phase (i.e., “A” for active treatment and “D” for recovery/healing). That would mean the “A” designation wouldn’t be limited to the patient’s first visit, even though the label “initial encounter” makes it seem like a one-time descriptor.

What about sequela (S)?

According to Code It Right Online, “‘sequela’ in ICD-10-CM, is a chronic or residual condition that is a complication of an acute condition that occurs after the acute phase of a disease, illness or injury. It can also be caused indirectly by the treatment for the disease or condition.” There’s no time limit on when you can use sequela; “the residual condition may come directly after the disease or condition, or years later.” Simply put, this less frequently-used character is reserved for complications or conditions directly resulting from an injury.

For further insight on sequelae, check out this example from the AAPC: “A patient suffers a low back injury that heals on its own. The patient isn’t seeking intervention for the initial injury, but for the pain that persists long after. The chronic pain is sequela of the injury. Such a visit may be reported as G89.21 Chronic pain due to trauma and S39.002S Unspecified injury of muscle, fascia and tendon of lower back, sequela.” One caveat to this example: Don’t fall back on an unspecified code. Instead, ask the patient as many questions as possible to get to the root cause of the original injury.

How do I format a code that requires a seventh character?

As this post explains, “If you add a seventh character to a code with fewer than six characters, you must fill each empty slot with a placeholder ‘X.’” For example:

  1. You choose S44.11, Injury of median nerve at upper arm level, right arm, for your patient.
  2. You look at the instructions for the S44 code category and determine that you must add a seventh character to this code.
  3. Because the patient is receiving routine care for the injury in the healing and recovery phase, you determine that D is the appropriate seventh character.
  4. S44.11 is only five characters long, so you add an X in the sixth position.
  5. You then add your seventh character of D, making the final diagnosis code: S44.11XD, Injury of median nerve at upper arm level, right arm, subsequent encounter.

Do I need to change the seventh character every time a patient returns for another visit?

Nope. You would only change the seventh character if the patient progressed to a different phase of treatment (i.e., the patient moved from the active treatment phase to the recovery/healing phase).

External Cause Codes

Do I have to use external cause codes?

As explained in this blog post, there’s no national requirement mandating any provider—PTs included—to submit external cause codes. However, providers are encouraged to do so when possible. Most of the PT-relevant codes that allow for external cause codes are located in Chapter 19 of the tabular list (which you can access here). Furthermore, some state and regional payers may require the use of external cause codes, so check with each one individually.

What are external cause codes? And how do I use them?

Found in Chapter 20, external cause codes help give context to a particular diagnosis code, and contrary to the name, external cause codes can indicate more than cause. To appropriately apply accurate external cause codes, you’ll also have to consider the place of occurrence, activity, etc. We recommend asking yourself the following questions regarding the patient’s injury: How did the injury or condition happen? Where did it happen? What was the patient doing when it happened? Was it intentional or unintentional?

When do I use external cause codes?

If it’s possible to submit external cause codes for a particular category or section of codes, you will see instructions to do so within the tabular list. Also, bear in mind that you can never submit an external cause code by itself; it always must have a corresponding principal diagnosis code. Here’s a quick clip to show you how to use external cause codes.

What if I don’t know what caused a patient’s injury or condition?

External cause codes are not mandatory (at least not nationally). Remember: you cannot code for what you don’t know. So, if you don’t know the details necessary to select external cause codes—like what caused the onset of the injury, the activity the patient was engaged in at the time of the injury, or where the patient was when the injury occurred—then don’t submit any such codes.

The Great Switch

Should I start using ICD-10 codes now?

Short answer: No.

Long answer: Nooooooooooooo.

Payers will deny claims that contain ICD-10 codes prior to October 1, just like they’ll deny claims that contain ICD-9 codes after September 30.

What do I do about patients with visits spanning the transition date?

We’ve written an entire blog post on what to do prior to September 30 and after October 1, including specific to-dos for that 48-hour transition window. You can check it out here.

Do I need to complete a progress note, evaluation, or re-evaluation to switch to ICD-10 codes?

No. Instead, when it comes time to add ICD-10 codes for the patients who previously had ICD-9, you’ll simply update the diagnoses in the patients’ charts as they come in for appointments on or after October 1.

Will I need to mass-update my patient notes come October 1?

No, there’s no need for a sweeping code change for all your patient notes. You’ll simply update codes within patients’ charts as they come in for their visits.

What about the ICD-10 grace period?

There’s a lot of confusion regarding CMS’s “grace period.” According to CMS, “Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family.” That means ICD-10 absolutely is happening on October 1. You’ll still receive denials from your commercial payers if you code inaccurately. And, for Medicare claims, you still have to code using valid codes from the accurate code family. For all of the details on what this grace period means for providers, check out this blog post.

The Resources

Where can I get an ICD-10 code book?

You can access the entire code set free of charge here. However, you may find a PT-specific ICD-10 code book useful for educational purposes, as it likely will provide guidance around coding strategy and processes. You can purchase it here.

Where can I find the tabular list?

You can download the tabular list here.

Is there an ICD-10 cheat sheet for physical therapists?

We have a wealth of educational resources that you can download here. However, we wouldn’t recommend using a “cheat sheet.” As most providers know, certain CPT codes are only payable when used in conjunction with certain ICD-9 codes. Thus, you may be tempted to quickly crosswalk those ICD-9 codes and tack up a new reimbursement cheat sheet—or worse, download the first cheat sheet you find online. Don’t. The rules aren’t the same, and crosswalks typically yield unspecified ICD-10 equivalents. As this ICD-10 for PT article explains, “One of the main battle cries of the new code set is increased specificity, and the transition to ICD-10 represents a giant step away from the use of unspecified codes (unless one of those codes truly represents the most accurate description of a patient’s condition). Thus, if you submit an unspecified code when a more specific code is, in fact, available, you could put yourself at risk for claim denial.”

Do you have any ICD-10 information specific to hand therapy?

We recommend checking out this ASHT page.

Do you have any ICD-10 information specific to pelvic health?

We recommend checking out this resource.

Claims, Claims, Claims

How do I handle billing for services provided before and after October 1?

We recommend that practitioners finalize notes and get claims submitted for all dates of service prior to September 30 before October 1 hits. That way, you’re able to start with as clean of a slate as possible come October 1. For additional info on dual coding, check out this post.

Are the 1500 forms going to change? How many ICD-10 codes will be allowed on the 1500 form, and how should I order them?

HCFA 1500 forms were updated in 2013 to accommodate ICD-10, so you shouldn’t have any problems there. You can list up to 12 ICD-10 codes. Keep in mind, though, that only the first four can be linked to CPT codes. Thus, it’s imperative that you arrange the ICD-10 codes in order of importance, with the codes that best justify the medical necessity of your services appearing at the top.

How will ICD-10 affect CPT codes (e.g., 97001, 97110, and 97140)?

ICD-10 does have a set of procedure codes, but anyone who currently uses CPT codes to designate procedures will continue to do so. So, if you’re using CPT codes, ICD-10 will not change that. You can continue using CPT codes as you do now, even after October 1.

Compliance

How does ICD-10 work with therapy cap exception codes?

There haven’t been therapy cap exceptions for a while now. In 2014, Medicare introduced a two-tier exceptions process. In the first tier, which is the Automatic Exceptions tier, therapists affix the KX modifier to necessary services provided above the cap amount. To learn more about the therapy cap, check out this guide.

How does ICD-10 affect the KX modifier?

It doesn’t. You will continue using the KX modifier to denote automatic exceptions in the same way you currently use this modifier.

Will ICD-10 affect G-codes?

ICD-10 will not affect functional limitation reporting (a.k.a. G-code reporting). The current rules will still apply after October 1.

Documentation

How do I handle direct access patients in ICD-10?

We’ve received tons of questions about how to choose the most accurate diagnosis codes for non-referral patients. For advice at every stage of the entire code selection process, check out this blog post.

Keep in mind, though, that this advice isn’t purely for direct access patients. Just because you receive a diagnosis code from a referring provider doesn’t mean you can accept that code blindly, plug it into your documentation and your claim forms, and expect to get paid. You should use the physician diagnosis to inform you on the patient’s situation, but then use your own clinical judgment and skills as a medical professional to diagnose the patient based on what you’re actually going to treat. To learn more about selecting diagnosis codes that help justify treatment, check out this blog post.

What’s the difference between medical diagnosis and treatment diagnosis?

The treatment diagnosis is the one that represents the injury or condition that you, as the therapist, are treating. The medical diagnosis is typically the one that comes with a referral patient’s script. Usually, the treatment and medical diagnoses match. If they don’t, it’s a good idea to get the physician to sign off on the treatment diagnosis before you bill.

Are there V codes in ICD-10?

ICD-9’s V codes will become Z codes in ICD-10, but as explained in this blog post, “A simple mapping of the V57 series of codes found in ICD-9-CM over to ICD-10-CM is not possible, as codes that duplicate the V57 series currently are not included in ICD-10-CM classification.” Furthermore, because V57.1 does not provide specific, detailed information about the patient’s diagnosis—and thus, does not justify the medical necessity of the treatment—using a similar code in ICD-10 could lead to claim denials. Instead, you should select whatever code explains the patient’s diagnosis in the most specific way possible. For more on the importance of coding for medical necessity, check out this blog post.

How do I code for surgical aftercare?

As explained in this resource, the aftercare Z codes should not be used for aftercare of injuries/fractures where seventh characters are provided to identify subsequent care. That said, you won’t always be providing aftercare for injuries—especially in cases involving surgical aftercare. For that reason, ICD-10 contains a few options for coding for surgical aftercare. A couple examples: Z51.89, Encounter for other specified aftercare, and Z47.1, Aftercare following joint replacement surgery. Please note that when you use aftercare codes, you also should code for any underlying conditions/effects. Codes for bone, muscle, and joint conditions that are chronic or recurrent—or that result from a healed injury—are typically found in chapter 13. Also, if you’re coding for joint replacement aftercare, you should include a code indicating which joint was replaced (e.g., V43.65, Joint replaced, knee).

What if I don’t have enough information to select a more specific code?

Select the most specific code you can based on the information you have. In some cases, you may need to contact a referring provider for additional information. But if you’ve exhausted all options and still can’t obtain the information necessary to select a more specific code, just make sure you clearly document the reasons behind your code selection within your documentation.

What if a more specific ICD-10 code does not exist?

ICD-10 requires you to code as specifically as possible, but there may be instances in which codes for your specific diagnosis do not exist, and you’ll have to use an unspecified or generalized code. You can’t code for what you don’t know; just make sure you communicate all the details in your documentation. To learn more about when to use unspecified codes, check out this blog post.

Do I remove codes as my patient improves?

If the patient’s primary diagnosis changes, and you need to update the plan of care, then you should update the diagnosis code. However, if the patient is simply making progress, you can document his or her progress as normal.

How many ICD-10 codes do I have to add for each patient?

There is no minimum or maximum number of codes you can record (though not all will necessarily flow through to your billing, and obviously, you will need to enter at least one). Just make sure you order the diagnosis codes you do submit in order of importance, with the primary diagnosis at the top.

Can’t I just use the ICD-10 code I receive from the referring physician?

Because clinical judgment is such a crucial part of selecting the appropriate diagnosis code, the therapist may need to get involved with code selection to ensure that:

  1. The selected code is the most specific one available to describe the patient’s condition, and
  2. The code justifies the medical necessity of the services provided.

In some cases, the codes sent by referring physicians may meet that criteria, but ultimately, it’s your clinic’s responsibility to code correctly. After all, it’s your clinic—not the physician’s—that will end up suffering the consequences for inaccurate coding. Don’t just take the physician’s word as gospel. Your physicians don’t have the depth of neuromuscular knowledge and expertise that you do. You are best equipped to make the most specific diagnosis possible, and that is exactly what ICD-10 requires.

How do I code for multiple body parts?

For single conditions involving multiple sites, such as osteoarthritis, there often is a “multiple sites” code available. If no “multiple sites” code is available, you should report multiple codes to indicate all of the different sites involved. For a patient seeking treatment for multiple conditions involving multiple body parts, you would create separate cases just as you do with ICD-9.

If a patient is experiencing the same condition on both sides (i.e., right and left), how do I code for that? I noticed some ICD-10 codes don’t have “bilateral” options.

In some categories and families of codes, there is no “bilateral” option for denoting laterality. In those cases, you would need to submit separate codes for both the left and the right sides. This is for data-tracking purposes (e.g., tracking the total number of “left” and total number of “right”).

If a patient has multiple diagnosis codes, which one should be the primary diagnosis?

Your primary diagnosis code should be the one that most closely aligns with the reason the patient is seeking your services. From there, you should order the codes according to importance and significance regarding medical necessity.

Whew! That was a lot of information, right? Hopefully, it helped ease your mind. But remember these are the answers to only your most burning questions. Need more ICD-10 advice? We’ve got your back. Check out these posts—and tons more—on the WebPT Blog:


ICD-10 Talk with Dr. Heidi Jannenga: Why ICD-10?

September 14th, 2015
ICD-10, ICD-9

Our previous ICD-10 Talk video covered the basics of ICD-10 and explained the features that distinguish it from its predecessor, ICD-9. In this second video of our ICD-10 Talk Series, Dr. Heidi Jannenga tells us why the US needs to make the transition to ICD-10. Additionally, she provides clarification around a common point of confusion: is it date of service or date of claim submission that dictates whether a provider should use ICD-9 codes or ICD-10? Check out the video now to find out, and stay tuned to ICD-10forPT.com for more great videos and other educational materials as we get closer to transition time.