It's Time for ICD-10 Changes
The ICD-10 grace period has ended, so avoid using out-of-date and unspecified codes.
Fam Pract Manag. 2016 Nov-Dec;23(6):17-20.
Author disclosure: no relevant financial affiliations disclosed.
If you have seen warnings about a huge, looming ICD-10 code update, don't panic. The update that took effect Oct. 1 was not another new code set, just a sizable list of changes that accumulated during a code freeze enforced during the transition from ICD-9 to ICD-10.
Oct. 1 also marked the end of the Centers for Medicare & Medicaid Services grace period during which non-specific codes were accepted. You now must avoid unspecified codes when possible. You should also expect more stringent auditing of claims that include codes with unspecified laterality and other information that would be commonly known at the time of encounter.
This article highlights changes in codes, guidelines, and payer edits most relevant to family medicine. Make sure your billing system and electronic health record are updated to prevent claim denials and delays.
Current, long-term use of oral hypoglycemic drugs should be reported with code Z79.84. Report Z79.84 secondary to codes for Type 2 diabetes, secondary diabetes, or pre-existing Type 2 diabetes in pregnancy, childbirth, or puerperium. If both oral medications and insulin are used long-term, only the code for insulin use (Z79.4) should be assigned. For use of oral hypoglycemic drugs in gestational diabetes, report code O24.415. Code Z79.84 should not be reported with code O24.415. The new code for reporting prediabetes is R73.03.
A guideline change affects reporting of conditions associated with or due to other conditions, including diabetes. Previously, coding depended on whether the documentation stated or implied a causal relationship between the two conditions. A causal relationship is now assumed, unless otherwise stated, when conditions are linked by the terms “with,” “associated with,” or “due to” in the alphabetic index or tabular list. For example, nephropathy is assumed to be a complication of Type 2 diabetes unless documentation states otherwise.
New guidelines help define the episode of care when selecting the 7th character of an ICD-10 code for injuries. The guidelines explain that 7th character “A” is appropriate for encounters where the patient receives active treatment for a condition that initiates the healing process. By contrast, 7th character “D” is selected for encounters after the patient has completed active treatment of the condition – in other words, when the healing process has been established. Here is one example:
A patient is evaluated and diagnosed with a Colles' fracture of the right distal radius. A splint is applied pending reduction of swelling. Code S52.531A is assigned because
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