Falling from Grace: How to Deal with the End of the Flexibility Period

September 26th, 2016
ICD-10, Preparation, Transition

It’s the end of September already, which means we’re only days away from the end of Medicare’s ICD-10 flexibility period—the year-long grace period in which CMS did not deny claims solely due to lack of code specificity. Beginning next month, though, the gloves are off—and, as a result, denials may increase. If you’ve been using this last year to become an expert on the nuances of the new code set—including how to use your clinical knowledge and documentation to select the most specific code available—then you may not even notice a change. If not, there are still a few things you can do to prepare. Here’s what you should know about the end of the flexibility period (as summarized from the Q&A portion of this CMS doc):

There will be no extension—and no phase-in period.

According to CMS, the grace period will end on October 1, 2016, and there will be no extension or phase-in period, because “providers should already be coding to the highest level of specificity.” The ICD-10 flexibility period was only put into effect so contractors performing medical reviews wouldn’t deny claims based solely on lack of specificity if there was “no evidence of fraud.” But, beginning October 1, providers must choose the most specific codes available—or risk claim denials.

CMS has three pieces of advice to help you prepare:

  1. Don’t use unspecified codes when a more specific one is available. (If you’re wondering how specific your codes should be, there’s no black-and-white answer. You must code to the highest level of specificity you can, while ensuring your documentation supports your coding choices—which brings us to number two.)
  2. Ensure your clinical documentation supports your code selections.
  3. Know that many major insurance carriers never implemented a grace period at all, which means many providers are already successfully using specific codes. In fact, according to a survey cited by CMS, providers have, for the most part, transitioned from ICD-9 to ICD-10 with little issue. (In other words, stay calm and carry on.)

Providers may still use unspecified codes—if the situation warrants it.

According to CMS, providers should report the most specific code available that’s supported by clinical knowledge and documentation. However, there are situations in which unspecified codes “are acceptable, even necessary”—such as “when sufficient clinical information is not known or available about a particular health condition to assign a more specific code.” CMS uses the example of a patient with a diagnosis of pneumonia: if no additional information is available to help the provider or coder determine the specific type of pneumonia the patient has, an unspecified code would be acceptable. To learn more about unspecified codes, check out these resources.

CMS is prepared to handle these changes.

CMS believes that the success of the initial ICD-10 transition proves that the organization is ready to handle new codes and processes. As such, they expect no delays with their enforcement of the post-grace period rules or the 2017 code update. This update includes the deletion of certain codes, the introduction of some new codes, and the revision of some code descriptions. “While this year’s update includes many new codes, the new clinical concepts are minimal,” CMS explained. The Center also notes that similar code updates occurred annually up until a freeze was established to help providers and payers prepare for the ICD-10 transition. As with any update, CMS recommends that providers:

  1. “Determine which codes affect their practices, and
  2. Focus on clinical concepts behind new codes.”

Audits will look just like they did before the ICD-10 transition.

As of October 1, 2016, CMS review contractors may deny claims due to lack of code specificity—and notify providers regarding issues and the steps necessary to correct those issues—in the same way that they did prior to the ICD-10 transition on October 1, 2015. To avoid audits, CMS says, “the provider community should code claims to the degree of specificity supported by the encounter and the medical documentation.”

There are more resources if you have questions.

For more ICD-10 coding resources, visit the Provider Resources section of the CMS ICD-10 website. There, you’ll find a complete list of the 2016 ICD-10-CM codes and code titles. You can also find the updated 2017 ICD-10-CM code set for services you provide on or after October 1, 2016, here. CMS updates the NCDs and LCDs whenever new codes are added. You can learn more about NCD updates on CMS’s ICD-10 website and LCD updates in the searchable Medicare Coverage Database.

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While some experts do expect an increase in denials following the end of the Medicare’s flexibility period, CMS doesn’t seem too concerned. How do you feel? Is your clinic prepared? Have you been coding to the greatest level of a specificity up to this point—or do you plan to up your game now?


New Codes Ahead: What You Need to Know About the 2017 ICD-10 Update

August 18th, 2016
ICD-10, Preparation

After much deliberation, the Centers for Disease Control and Prevention (CDC) released the new 2017 ICD-10-CM codes on June 24, 2016. According to Laurie Johnson, MS, RHIA, CPC-H, FAHIMA—the director of health information management (HIM) consulting services for Panacea Health Solutions, Inc. and author of this ICD10 Monitor article—there are “1,974 additions, 311 deletions, and 425 revisions,” resulting in a total of 71,486 codes. These codes will go into effect on October 1, 2016—and remain in effect through September 30, 2017. Here are the changes to the codes in Chapters 13, 19, and 20—the chapters that are most relevant to physical therapists:

Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue

Johnson reported that CMS added: “bunion, bunionette, pain in joints of the hand, more specificity to temporomandibular joints, cervical disc disorders at specific levels, atypical femoral fractures, and periprosthetic fractures.”   

Chapter 19: Injuries, Poisoning, and Certain Other Consequences of External Causes

Apparently, CMS made a “significant number of additions [to] the specific fractures to bones of the skull”—as well as “various fracture types of the foot.” There also are “title revisions to complications involving prosthetic devices; new stenosis of cardiac stent codes, and additions to complication types, including breakdown, displacement, infection, erosion, exposure, pain, fibrosis, thrombosis, and leakage.”

Chapter 20: External Causes of Morbidity

According to Johnson, the CDC also updated several vehicular accident codes and “added contact with paper or sharp objects, overexertion, and…the choking game.” (We don’t even want to know what that last one entails—although it may be scarily self-evident.)

 

For the full list of ICD-10 changes, check out Johnson’s blog post in full here—or, refer to the CMS 2017 ICD-10-CM files here. While Johnson mentioned that the 2017 ICD-10-CM Official Guidelines for Coding and Reporting and General Equivalence Mappings (GEMs) were conspicuously missing from the newly released documents because they were “still pending,” both documents are now available in CMS’s list of files.

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Just like you prepared for the initial launch of ICD-10 back in 2015, it’s time to hit the books again. You’ll want to be sure everyone in your clinic fully understands how these changes impact your practice and processes before CMS’s year-long grace period comes to an end—and these new code changes go into effect—on October 1. If you’re using an EMR, you’ll also want to check with your software vendor to ensure your system will be updated with the new codes so you can receive accurate payment for your services.


Wake Me Up When September Ends: What Happens When the ICD-10 Grace Period is Over?

May 11th, 2016
ICD-10, Preparation

ICD-10 has been in effect for more than six months now—and the Earth is still spinning, the sun is still shining, and the birds are still chirping. So, it would appear that the transition to ICD-10 had way more bark than bite, but appearances can be deceiving. On October 1, 2016, Medicare will terminate its grace period, and some experts are predicting a spike in denial rates after that date. If you’ve been using these last few months to not only get comfortable with the new code set, but also learn how to identify—and use—the most specific code available for each patient, then you have nothing to worry about.

On the other hand, if you’ve been using crosswalking tools to convert ICD-9 codes to ICD-10, and you’ve focused only on the code groups you use most often, then you don’t necessarily need to worry, but you do need to change your ways. “That is why [providers have] done as well as they have so far,” said Mary Jean Sage, president of a billing and coding consulting company called The Sage Associates, in this Healthcare IT News article. “But they need to take the next step and start looking at codes beyond their immediate scope and adding more specificity.” And you’ve got about five months to do it.

According to Deborah Grider—an ICD-10 trainer approved by the American Health Information Management Association (AHIMA)—providers also must take into account the need to document medical necessity: “Without a specific diagnosis code and validation of medical necessity, a claim is not considered valid,” she said. Grider also warns providers not to assume their codes are correct simply because they received payment. Payers may reimburse providers and then retract the payment later if documentation and coding don’t demonstrate medical necessity. This is especially important given the soon-ending grace period, because providers have been knowingly reimbursing despite less-than-optimal coding.

So, how can you ensure your practice is prepared to use the most correct, most specific codes when September ends? Here are four things you can do right now:

1. Train Staff

We still have five more months before the grace period officially ends, which is just enough time to get really good at all things ICD-10. Start by gauging your staff’s current understanding of ICD-10 codes, and then fill in the gaps with as much information and supplemental curriculum as you can. While you’re at it, be sure everyone is familiar with your payers’ policies. That way, you’ll know how each carrier evaluates medical necessity—and what you’ll need to do to demonstrate it.

For more information about ICD-10, check out this guide. There, you’ll find info on the ICD-10 coding structure, the seventh character, surgical aftercare, and preventing code denials.

2. Review Denials

While you certainly don’t want to make receiving denials your goal, you should make it a point to ensure they serve your best interest when they occur. After all, every denial is a learning—and training—opportunity. Instead of getting frustrated—which is a totally normal reaction—try to focus your energy on achieving a more productive end by using denials to further educate yourself and your staff. “Providers need to begin to monitor denials by type and take immediate action to remedy them,” Grider said. A common issue she sees is that billing staff aren’t properly trained on how to determine why a claim was denied. Thus, “Billing staff should be trained on the fundamentals of ICD-10,” Grider said. This will “ensure that they have a good understanding of the importance of specificity and what to look for when a claim is denied.”

3. Audit Coding and Documentation

Regardless of whether you’ve received denials to date, now’s a great time to conduct an internal audit to ensure your procedure codes, diagnosis codes, and documentation tell a consistent, complete, specific, and accurate story of medical necessity. To do so, take a random sampling of patient documentation. You then can use the information you gather from your audit to inform your training plan.

4. Establish and Monitor KPIs

To effectively monitor your practice’s coding and claim-payment prowess, Grider suggests monitoring key performance indicators (KPIs), including:

  1. Code frequency
  2. Coder productivity
  3. Volume of questions received
  4. Practitioner productivity
  5. Unspecified code usage
  6. Query increases or decreases
  7. Days from claim submission to payment receipt
  8. Claim denial rate
  9. ICD-10 denial types and reason codes
  10. Payment amount by payer
  11. Clearinghouse and payer edits
  12. System issues

Whichever KPIs you decide to track, be sure to establish benchmarks and goals. Then, monitor your team’s progress toward them, and communicate the results regularly.

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Is your team prepared for the end of September—and the ICD-10 grace period? If not, send us your questions using the form below.

Want this blog post in handy checklist form? Download it here.


4 Tips for Preventing ICD-10 Denials—and Getting Paid

February 1st, 2016
EMR, ICD-10, Insurance, Preparation

For many practices, transitioning to ICD-10 has been no easy feat—especially considering the massive number of codes that are now available. Luckily, though, as a result of all the preparation leading up to the October 2015 go-live date, there haven’t been nearly as many claim denials as there could have been—or may be once Medicare’s grace period comes to end later this year.

So, whether you’ve already faced a denial or you’re wanting to get ahead of the game for when payers start enforcing stricter rules, here are four tips for preventing ICD-10 denials and ensuring you get paid:

1. Check your Codes

Whether you’re using an EMR or still documenting on paper (yikes), the responsibility for submitting the right ICD-10 codes for your patients ultimately falls on you, so take some time to double-check that the codes you should be submitting are the ones that actually are going through. You can do this by performing an internal audit to quality check your documentation against your claims. This is especially important if you’re using an EMR without an intelligent ICD-10 tool. If that’s the case, and you think the software has you covered, think again.

2. Be Specific

The whole point of implementing ICD-10 is to increase diagnostic specificity for patient data. So regardless of what payers are considering acceptable to process payments right now, they’re eventually going to require you to use ICD-10 to its fullest—and most specific—extent.

With that in mind, use this year to practice navigating to not only the right family of codes, but also the most specific codes you can identify that tell the complete story of your patients’ conditions—seventh characters and all. Just be sure that your documentation backs up the level of specificity your codes represent. As this Medical Economics article points out, you don’t want to be left repaying your reimbursement after an audit uncovers that your documentation doesn’t fully support your claim.

3. Do Your Research

The ICD-10 implementation deadline has come and gone, but that doesn’t mean you should stop learning about the coding system or how to navigate tricky coding situations. Rather, your best bet to prevent ICD-10 denials and ensure you’re getting paid is to stay up to date on as much ICD-10 news as you possibly can. Furthermore, you’ll want to keep a pulse on the changing requirements for each individual payer. After all, each insurance provider has its own set of claim specifications. As the above-cited Medical Economics article explains, “Payers may also want specific modifiers added or they may want a specific code used for a procedure.” In other words, you should “know what your payers want before you submit your claims.”

4. Switch to the Right EMR

Your EMR doesn’t need to brew your morning coffee, but it does need to help you stay ICD-10 compliant. Your EMR should do the following:

If your physical therapy software doesn’t do any of the above, then it’s time to replace it with one that does. And fast. ICD-10—as well as every other reporting regulation—only will continue to evolve, in terms of both complexity and intensity. Shouldn’t your practice be evolving with a more comprehensive compliance software, too?

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There you have it: Four tips for preventing ICD-10 denials so you get paid for your services. How has your practice been preventing denials? Fill out the form below and tell us your story.


The Top 4 Coding Predictions You Need to Know in 2016

January 20th, 2016
ICD-10, Preparation

Well, folks, it’s probably safe to say that the transition to ICD-10 was a lot of bark and only a little bite. Roughly four months after the October 1 implementation deadline, most clinics are doing fine—but that doesn’t mean you’re done worrying about the coding change’s effect on your practice. In fact, 2016 brings with it several new coding challenges, both big and small. To help you prepare, we’ve put together a list of our top four coding predictions for the new year:

  1. According to the ICD-10 Monitor, 2016 will bring on more coding assessments, reviews, and audits. At this point, you’ve processed enough claims to start evaluating—and, hopefully, validating—your ICD-10 processes. If you uncover weaknesses, you’ll need to adjust your current best practices and metrics tracking processes—or establish new ones. What used to be “business as usual” for your clinic during the reign of ICD-9 may not be possible in the ICD-10 world. Not sure how to perform an ICD-10 assessment? Check out this how-to article from ICD-10 Monitor.
  1. Thanks to the above audit forecast, the experts at H.I.M. ON CALL, a health information and coding solutions company, believe we may experience nationwide auditor shortages. So, if you need to hire one, do so as soon as possible. You may even need to upgrade your technology to manage all those audits in a timely manner. Furthermore, these experts predict those audits will reveal accuracy rates 32% lower than pre-switch rates. If you find yourself facing a large drop in claims accuracy, it’s time to hit the books for a refresher course on ICD-10.
  1. Expect a comprehensive code update when the coding freeze thaws this fall. To help ensure a successful implementation, the US has held off on adding any new ICD-10-CM (and PCS) codes for the past four years. But that all changes on October 1, 2016—exactly one year after the mandatory transition to ICD-10. This update likely will be massive, so you should prepare for it in the same way you prepared for the transition itself. CMS may release more information as we get closer to update time, but for now, just know that you should expect new subcategories and tons of indexing changes.
  1. Big data isn’t just for big clinics. Thanks to ICD-10’s increased specificity, we have more—and better—data than ever before, and as this coding expert explains, we can “expect to see requests for detailed data increasingly utilized in smaller organizations.” We believe the push for data is a good thing, but it also can place a burden on coders who already have full plates—especially at smaller clinics where everyone wears multiple hats. So, make sure you provide your staff with the software training they need to meet new data demands.

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Like a high school graduate taking a gap year before entering college, the one year grace period from CMS allows you time to get a firm grip on ICD-10 and optimize your processes. But we’re already more than a quarter of the way through it, so there’s no time to waste. With these coding predictions in mind, you can start facing these coding challenges head-on—and make 2016 your best year yet.


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.


Direct Access and ICD-10: What You Need to Know

September 23rd, 2015
ICD-10, ICD-10 Example, Patient care, Preparation

The transition to ICD-10 is causing many providers to change how they run their practices. But if you have a cash-pay clinic or find yourself working mostly with direct access patients, you may be wondering how the heck ICD-10 will affect you.

Here’s the deal: while you may not deal with payers often, you’ll still need to take them into consideration, especially if your clinic submits bills to your patients’ insurances on their behalf. And even if you don’t, there’s a good chance your patients submit bills to their insurances directly, so you should still have a firm grasp on how to code in ICD-10. Here are some tips:

1. Ask specific questions.

Because you don’t have a referral diagnosis, coming up with the medical—and treatment—diagnosis is totally on you (even if you had one, you’d still want to be sure the referral diagnosis was as specific as possible). To begin, throw on your best reporter hat and ask yourself these questions:

Who

Who is this patient? Is he or she new to your practice?

What

For what reason am I seeing this patient? What happened to this patient to cause his or her present condition?

Where

If you are treating a patient who has suffered an injury, consider where the injury occurred. (In addition to adding an external cause code to designate the place of occurrence, be sure to select a diagnosis code that accounts for the anatomic site of the injury in the most specific way possible.)

When

When did the injury occur? Is the patient in the active phase of treatment, or is he or she healing or recovering from the injury or condition (i.e., can you apply a seventh character, and if so, have you selected the appropriate option)?

Why

Why is the patient seeking rehab therapy? Think in terms of causation: rather than simply coding for knee pain, for example, try to account for what actually caused the knee pain (i.e., the underlying condition).

The answers to these questions will help you navigate the code index or tabular list, but coding correctly will take a bit more effort.

2. Learn the alphabet.

Forget the ABCs; you’re going to want to know the ADSs. These three letters are ICD-10’s seventh characters, which are exactly what they sound like: the seventh character of a code. They hold a special place in the new code set—and they could make or break your claims. So, make sure you know how and when to use them:

A – Initial encounter

The patient is receiving active treatment for his or her injury or condition.

D – Subsequent encounter

The active phase of treatment for the patient’s injury or condition has ended, and the patient is now in the healing or recovery phase of treatment.

S – Sequela

This one’s reserved for complications or conditions directly resulting from an injury. A commonly used example of a sequela is a scar that results from a burn.

Keep in mind that not all codes have seventh characters. This character position is only 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). If you’re still confused about how and when to use the seventh character—and trust me, you’re not alone—check out this blog post.

3. Use your noodle.

To code successfully using ICD-10, you must code for medical necessity—and that all comes down to clinical judgement. ICD-10 demands that providers select the codes that best fit the patient’s condition—not just the codes that will get paid—so your knowledge and experience will play a crucial role in coding. An EMR can assist you in this process, but it can’t replace you (after all, you are the musculoskeletal expert—not your technology).

And don’t forget about your documentation. Defensible documentation may be a jargony term, but it also is a key piece of the ICD-10 pie—even if your patients come to you directly. There’s no excuse for not creating thorough and specific documentation that supports your diagnosis and plan of care. By the same token, if you determine the patient’s condition is outside your scope of practice, then refer out.

4. Hit the books.

Not sure you have the right resources to help you make the transition successfully? Consider obtaining a quality, PT-specific coding book that offers guidance around coding strategy and processes. Not only would it be useful for educational purposes, but it also would help you put together a list of your clinic’s most-frequently-used ICD-10 codes. But with so many coding books out there, which one should you purchase? We suggest Instacode: ICD-10 Coding for Physical Therapy. And if you’re a WebPT Member, you’re in luck. You can purchase the book through the WebPT Marketplace at a discounted rate.

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Even if you haven’t previously considered how ICD-10 will affect your direct access or cash pay clinic, we’re here to make sure the transition to the new code set doesn’t induce hives or hyperventilation. Eager to learn more about these tips—or WebPT’s ICD-10 tool? Join us for our free, one-hour ICD-10 Crash Course webinar from 9:00 AM to 10:00 AM Pacific time on September 24, 2015.

 


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 Coding Practice for OTs: Down Syndrome

August 31st, 2015
ICD-10, ICD-10 Example, Preparation, Transition

Are you an ICD-10 coding expert? Do you feel prepared to take on the complexities that are an inevitable—yet, crucial—component of the new code set? No? Well, not to worry. ICD-10 is certainly complex, and you should take this transition seriously. Still, you shouldn’t let fear (and frustration) get the best of you. With that in mind, what can you do to make the transition smoother? Practice, practice, and well, more practice. Speaking of practice, here’s an occupational therapy coding example from compliance expert Rick Gawenda. Walking through this example should help you fine-tune your coding skills. Here’s the situation:

The Patient

The patient is a 7-year-old female with Down syndrome (meiotic). Her parents have been referred to occupational therapy, because she’s having problems with her posture and walking. She appears to be suffering from muscle weakness. How would you code for this?

The Codes

Primary Code

  • Q90.0, Down syndrome. More specifically, this code indicates the patient’s diagnosis of Trisomy 21, nonmosaicism (meiotic nondisjunction).

Additional Codes

With ICD-10, you should indicate the reason for outpatient therapy whenever possible. In this case, you would use the following codes:

  • R26.2 for the difficulty walking or R26.89 for other abnormalities of gait and mobility
  • M62.81 for generalized muscle weakness
  • R29.3 for abnormal posture

The Description Synonyms

You’ll have to use your clinical judgement to determine whether you’d code R26.2 (difficulty walking) or R26.89 (other abnormalities of gait and mobility). During your evaluation, you likely will find that one code is more appropriate than the other. One way to determine which code you should select: review each code’s description synonyms. Here are the description synonyms in this situation:

Difficulty walking. The description synonyms for R26.2 are:

  • Difficulty walking
  • Walking disability

Other abnormalities of gait and mobility. The description synonyms for R26.89 are:

  • Cautious gait
  • Gait disorder due to weakness
  • Gait disorder, painful gait
  • Gait disorder, weakness
  • Gait disorder, postural instability
  • Gait disorder, multifactorial
  • Toe walking and toe-walking gait
  • Limping/limping child

The Summary

When all’s said and done, coding to the highest level of specificity requires you to change your mindset. When you account for additional information pertaining to each patient’s condition, you’re able to determine which codes accurately explain the scenario. Feeling better about the transition after reviewing this example? Want to see more examples like this one? Watch WebPT’s free ICD-10 bootcamp webinar. In it, we provide step-by-step guidance on how to code for this example—and ones that are even more complex. With our help, you’ll be ready well before October 1.