Hold Vaccine Claims or Submit Them Now? Get a Better Perspective

If your insurer has not said a peep about whether it'll accept the new vaccine administration codes 90460-90461; you should contact the provider relations department directly. That is how Bonnie Palmer with Lawrenceville Pediatrics in Georgia determined which claims she should submit now, and which she should hold onto.

Her local insurers provided her the following advice on submitting claims. If you like to follow her lead and determine which payers are reimbursing for vaccines, get in touch with all of the payers with whom you are contracted and ask them for specific advice on the new codes. That apart, she adds, “I'd recommend that offices only send a few claims to see how they are processing before they send hundreds and find out what they're all denying.

Article Source :- http://www.supercoder.com/coding-newsletters/my-pediatric-coding-alert/practice-perspective-get-to-know-whether-to-hold-vaccine-claims-or-submit-them-now-article

Blue Cross and Blue Shield of Georgia has the new codes loaded into its systems for all claims with dates of service (DOS) on or after January 1 this year – but then the insurer initially asked practices not to submit these claims until February 3 this year. If you billed the just-in codes prior to February 3, the system denied the second or third unit of 90460 or 90461 as a duplicate and you'll have to call the claims department and have the claim reprocessed for proper payment.

The claims systems for Aetna, Humana, Guardian, Taylor Benefit Systems, and Coventry Health Care are all geared to accept the vaccine claims for all DOS on or after January 1, 2011.

The United Health Care Web site indicates that practices shouldn't use the just-in codes until April 1; however Palmer was told by a UHC rep that this information wasn't posted to the website the correct way. The UHC rep advised her that the insurer's system is actually capable of handling the new codes now for all DOS on or after January 1 this year. If you did bill your vaccine services with the old codes based on the wrong information on the UHC website, you will have to rebill all of those claims with the new administration fees and write 'corrected claim' at the top of your claim form.

The New Z Diagnosis Codes Will Replace Routine Health Check Codes

Take a look at these key factors in your physician's documentation.

It's a known fact that when ICD-9 becomes ICD-10 in 2013, you'll not always have a simple crosswalk relationship between old codes and the new ones. Many a time, you will have more choices that may need tweaking the way you document services and a coder reports it.

Here's a common routine child health check vision scenario that will help you discover what you will report post October 1, 2013.

Present way: When a patient comes in for a scheduled preventive wellness exam, you should attach V20.2 (Routine infant or child health check) to an annual visit code (99381-99385 for new patients, or 99391-99395 for established patients).

ICD-10 difference: This year, you will go for Z00.129 (Encounter for routine child health examination without abnormal findings) to reflect the physician's visit. If the physician did face abnormal findings during the visit, you would instead use Z00.121 (Encounter for routine child health examination with abnormal findings).

Physician documentation: The main difference between Z00.129 and Z00.121 is whether the visit showed an abnormal finding during the examination of the patient. The pediatrician must document this. For example, the physician might examine the patient and note, “patient appears severely speech delayed, which leads to the decision to carry our further testing".

Remember: 'Abnormal findings' does not refer to a blood test, biopsy, or a test that went to pathology. Oftentimes, these key abnormal findings would support a separate E/M visit billed with a modifier 25 (Significant, separately identifiable E&M service by the same physician on the same day of the procedure or other service) during the time of a preventive medicine visit.

Tips for coders: Instead of relying on V20.2 as your catch-all annual visit diagnosis, you will need to examine your physician's documentation. To put it in other words, you will be looking at the examination part of the visit and what the pediatrician notes as his findings.

Article Source :-  http://www.supercoder.com/coding-newsletters/my-pediatric-coding-alert/icd-10-new-z-diagnosis-codes-will-replace-routine-health-check-codes-in-2013-article

ICD-10 Will Bring One-To-One Equivalents

As we get ready to embrace ICD-10 Codes, many of you might be dreading the transition. But rest assured. Many a time you'll find simple one-to-one relationships between old and new codes. That is the case for hyperplasia; but even then you need to stay alert. You'll still need to carry over the same coding conventions.

For example, think that your ob-gyn suspects hyperplasia. She detects and documents 'endometrial thickening' during an ultrasound examination. What diagnosis should you use here?

Just because your ob-gyn documents endometrial thickening doesn't mean the patient has endometrial hyperplasia (621.30, Endometrial hyperplasia, unspecified; or 621.31, Simple endometrial hyperplasia without atypia). Many coders commit this mistake.

Remember this pitfall: If you encounter the same scenario in 2013, you shouldn't necessarily report the straight forward hyperplasia equivalents N8500 (Endometrial hyperplasia, unspecified) and N8501 (Simple endometrial hyperplasia without atypia). Take note how these definitions are exactly the same.

Coding tips: Do not be swayed by 'endometrial thickening'. You shouldn't code this as hyperplasia as physicians do not always consider the thickening of the uterus "abnormal;" as a matter of fact, it is just a monthly 'ramp up' for all women. Don't report hyperplasia until the ob-gyn has carried out a biopsy, and you have a pathology report that confirms this condition.

Solution: As you have no code to describe the patient's condition, you should report 793.5 (Nonspecific abnormal findings by ultrasound of genitourinary organs). Endometrial thickening is a finding and not a diagnosis. As such, you should locate the diagnosis code in the signs and symptoms section of ICD-9. If you take a look under 'thickened endometrium', this'll lead you to 793.5.

In the ICD-10 alphabetic index, you will not see 'thickened endometrium' referenced at all so you would usually rely on the choices given by one of the equivalent tables that have been produced (such as the ICD-10 bridge found at a coding resource like Supercoder/) based on the ICD-9 code 793.5.

Word of caution: If you look up 793.5's ICD-10 equivalent, you will find that the National Center for Health Statistics still lists R93.4 (Abnormal findings on diagnostic imaging of urinary organs), which is incorrect because the uterus is not a urinary organ.

Know the Pneumonia Diagnosis Difference

Do you know the difference between 'lobar pneumonia' and 'lobular pneumonia'? When there's no further clarification from the physician, is code 481 (Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia]), which includes lobar pneumonia, organism unspecified, the right code assignment for both "lobar pneumonia" and "multilobar pneumonia?" When should you report 481 versus 485?

A patient with lobar pneumonia has pneumonia that impacts a large and continuous area of the lobe of a lung. A patient who's diagnosed with lobular pneumonia, or bronchopneumonia, has an acute inflammation of the walls of his bronchioles, affecting many small areas of his lung tissue rather than the large area affected by lobar pneumonia.

One more distinction between 481 and 485 is the cause. Code 481 is for pneumonia in which the causative agent happens to be pneumococci. Compared to this, code 485, "Bronchopneumonia, organism unspecified" is an unspecified code used in situations where the causative agent isn't mentioned.

Multilobar pneumonia impacts more than one lobe of your patient's lungs and is a more serious illness than lobar pneumonia. Absent any additional details about your patient's pneumonia, you'd list 481 for either lobar or multilobar pneumonia. But then the most spot on code for pneumonia of any type should be determined by the physician, in part based on the casual organism.

You will list 485 (Bronchopneumonia, organism unspecified) when your patient has lobular pneumonia, however you're unable to figure out the causative organism.

Know More about Modifier KK on Your Pet Oncological Claims

You bill the global service for NaF-18 PET scans for bone mets. Are you supposed to add modifier KX to these claims for Medicare?

Well, the answer is no. Since you are reporting the global service, Medicare does not require you to append modifier KX (Requirements specified in the medical policy have been met).

In transmittal 2096, CR 7125, CMS published the guidelines on coding these services (including a helpful chart showing which tracer codes pair with which PET codes).

TC/global: When you report a global or technical only claim with A9580 (Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries) and an NaF PET service to inform the initial treatment strategy or subsequent treatment strategy for bone metastasis, the transmittal instructs carriers to process claims that cover all of the following (apart from A9580).

One of these modifiers:

PI (Positron emission tomography [PET] or PET/ computed tomography [CT] to tell about the initial treatment strategy of tumors ) or

PS (Positron emission tomography [PET] or PET/ computed tomography [CT] to tell about the subsequent treatment strategy of cancerous tumors )

modifier Q0 (Investigational clinical service provided in a clinical research study).

Professional component (PC): When you use modifier 26 (professional component) and modifier KX on your PET oncologic claim to inform the initial treatment strategy or subsequent treatment strategy for bone metastasis, the transmittal instructs carriers to process claims that include all of the same items in the bullet list mentioned.

The difference: Code A9580 belongs only on global and technical claims. Carriers will reject professional claims for A9580 as the assumption is that the facility (the entity providing the technical part of the service) bears the cost of the A9580 agent and should be paid for it.

The presence of modifier KX on the professional claim shows contractors they should process the service as PET NaF-18 rather than PET with FDG.

Use 45990 for Rectal Exam with Anesthesia

In a particular case, the surgeon used a bivalve, suctioned the old blood from where a hemorrhoid had necrosed and fallen off; however the large vessel underneath was continuing to bleed (all done under anesthesia). After this he sutured the bleeding site. If you fail to find a proper CPT code for this, what should you do in this situation?

Well, the procedure described above is a rectal exam under anesthesia (45990, Anorectal exam, surgical, requiring anesthesia [general, spinal, or epidural], diagnostic). According to CCI edits, you shouldn’t report 45990 in conjunction with 45300-45327 (Proctosigmoidoscopy), 46600 (Anoscopy; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]), 57410 (Pelvic examination under anesthesia), and 99170 (Anogenital examination with colposcopic magnification in childhood for suspected trauma).

Physician responsibility: Anorerctal exam is primarily done by placing the patient in left lateral decubitus position. This exam is chiefly done to study anal fissures, anal fistula, anal mass and hemorrhoids. The patient is provided general, spinal or epidural anesthesia and the physician carries out a diagnostic digital rectal exam by inserting a lubricated gloved index finger after relaxation of anal sphincter mainly to examine the perineal area. An ansoscope is inserted into the rectum to visualize the anal canal and distal rectum. Soon after removing the anoscope, a rigid proctosigmoidoscope is inserted to the anus to visualize sigmoid colon and rectal lumen.

Source URL :- http://www.supercoder.com/coding-newsletters/my-part-b-coding-alert/reader-questions-consider-45990-for-rectal-exam-with-anesthesia-article

Know the Difference between Aerosol & Gaseous Ventilation

Not sure about the difference between aerosol and gaseous ventilation? Well, read on and find out the key differences between the two. Both aerosol (78586, 78587) as well as gaseous (78591, 78593, 78594) studies are part of the ventilation code series.

The ICD-9 code depends ( source "http://www.supercoder.com/icd9-codes/")  on whether or not the internist identified a cause.

Aerosol tests include the patient inhaling nebulized (reduced to a fine spray) aerosol agents with radioactive particles. The vital term to look for indicating aerosol is DTPA, the radioactive aerosol the provider has the patient inhale. Often times you would encounter other terms such as Technetium DTPA, particulate, and mist.

Physician's note for gaseous ventilation studies normally refer to the gas used, typically Xenon gas (such as Xenon-133 or Xe 133). One more possibility is Krypton gas (Krypton-81 or Kr 81), even though you may not see this much in practice.

CPT code further differentiates gaseous ventilation studies by whether the patient takes only a single breath or for that matter she does rebreathing and washout without plain oxygen. Rebreathing is inhalation of the gas exhaled earlier. 'Rebreathing' is inhalation of the gas exhaled previously. 'Washout' is the elimination of the radioisotope from the lungs. The xenon gas exams usually consist of three phases:

1. A single breath – the patient takes a single deep inhalation

2. Rebreathing – the patient takes normal breaths while rebreathing a mix of oxygen and xenon

3. Washout -- the patient breathes room air while exhaling the xenon, clearing the lungs of the radioactive gas.

ICD-9 Code for 'Easy Bruising'?

If you are wondering which ICD-9 code to use for 'easy bruising', just read on and find out:

Easy bruising is a symptom of another condition rather than a standalone diagnosis. As such, the ICD-9 code depends on whether or not the internist identified a cause. So if a cause is identified, then code for the specific disease. However, if no cause is pinpointed, then code for the symptoms.

For easy bruising with no identifiable cause, use 782.7 (Spontaneous ecchymoses). An individual may be suffering from other diseases that predispose him to develop bruises even with minimal trauma (like a light rap on the hands), which otherwise will not happen to normal people; therefore, resulting in 'easy bruising. For patients suffering from these conditions, bruises seem to spontaneously appear without any identifiable reason.

An ecchymosis is a bruise which is larger than 1 cm. A bruise less than 1 cm however not less than 3 mm is called a purpura. A bruise less than 3 mm is called a petechiae. Code 782.7 also applies to petechia but not purpura, which has several other codes (287.0-287.9) depending on the etiology.

Bruises resulting from trauma can take place owing to a variety of factors including falls, accidents, and post-surgeries. In general, use codes 920-924 (Contusion with Intact Skin Surface) for bruises secondary to trauma. For instance, for a soccer player who was seen by an intern for bruises in the heel, use 924.20 (Contusion of lower limb and of other and unspecified sites; ankle and foot, not including toe[s]; foot [which is inclusive of the heel]). Remember, for a soccer player who was seen by an interim for bruises in the heel, use 924.20 (Contusion of lower limb and of other and unspecified sites; ankle and foot, not including toe[s]; foot [which is inclusive of the heel]). Remember that as per ICD-9 codes, these codes exclude contusions that are incidental to specific categories of injuries such as crushing injury (925- 929.9), dislocation (830.0-839.9), fracture (800.0-829.1), internal injury (860.0-869.1), intracranial injury (850.0-854.1), nerve injury (950.0-957.9), and open wound (870.0-897.7).

I10 covers Essential Hypertension for ICD-10

When it comes to essential hypertension, both ICD-9 2011 and ICD-10 2011 have coding options for it; however you won't find a one-to-one correspondence between them.

For essential hypertension, ICD-9 2011 has three coding choices:

401.0 -- malignant

401.1 -- benign

401.9 -- unspecified

ICD-10 2011 includes only one code, solving the age-old problem of having to choose the unspecified code when documentation fails to indicate benign or malignant. The ICD-10 code is the letter I followed by the number 10.

I10 -- Essential hypertension (primary).

So what's new: When ICD-10 goes into effect, you'll need to keep an eye on documentation for tobacco exposure. ICD-10 covers an instruction to 'use additional code to identify':

Exposure to environmental tobacco smoke (Z77.22)

History of tobacco use (Z87.891)

Occupational exposure to environmental tobacco smoke (Z57.31)

Tobacco dependence (F17.-)

Tobacco use (Z72.0).

What remains the same: Both the ICD-9 and ICD-10 entries state the codes include 'high blood pressure'; however you have separate codes in both sets for when the cardiologist documents an elevated reading without diagnosing hypertension.

ICD-9: 796.2 -- Elevated blood-pressure reading, without diagnosis of hypertension

ICD-10: R03.0 -- Elevated blood-pressure reading, without diagnosis of hypertension.

Keep in mind: When ICD-10 goes into effect on October 1, 2013, you should apply the codes and official guidelines in effect at that time (or more specifically, always use the codes and guidelines with effect from the relevant date of service). Learn more by signing up for a medical coding guide like Supercoder.com

For Modifier Details, Explore CCI, Fee Schedule

Scenario: In your day to day coding, you may sometimes get denials that appear to be related to bundling issues; however you may not find the two-day code pair in the CCI edits. How can you find out which is the column 2 code so that you can put the modifier on the correct code?

If you cannot find the codes listed in the Correct Coding Initiative (CCI) edit tables, then they are not bundled under that system. See to it that you check both the mutually exclusive and non-mutually exclusive edit tables.

If your code pair is not bundled under correct coding initiative, then you would not need a CCI modifier such as 25 (Significant, separately identifiable E&M service by the same physician on the same day of the procedure or other service), 57 (Decision for surgery), or 59 (Distinct procedural service), to override the edit pair.

You need to tread carefully: Just because a code does not have a bundle in correct coding initiative does not mean a modifier is out of the picture. While you will not need a CCI modifier to override the edit, you might need a payment modifier.

You can get Medicare's other allowed modifiers for any given CPT code in the Medicare Physician Fee Schedule (MPFS)(http://www.supercoder.com/coding-tools/fee-schedules). Columns Y-AC indicate if a modifier such as 50 (Bilateral procedure), and the like, applies. For more on this, sign up for a medical coding guide like Supercoder, which comes with a fee schedule tool to help you in your coding job.

Ensure Your Practice Does Not Lose Money Due to 'No-Shows'

Every practice has the occasional patient who doesn't turn up for an appointment; however if no-shows are becoming common in your practice, it's time to get tough. Here are some expert-details from our experts on ways to ensure your practice does not lose money because of innumerable missed services.

Focus on the patient's insurance

Probably the best way to encourage patients to keep their appointments or call you if they need to cancel is to charge a fee when they don't turn up. However, when, and if, you can charge a no-show fee depends on the insurance your patient has.

In most instances, you should be able to charge patients a fee when they miss an appointment. However check your contracts as you may have a clause forbidding no-show charges or specifying particular cases when you can and cannot bill the patient. For instance, most payers won't allow you to charge a patient who cancelled her appointment more than 24 hours prior to the scheduled appointment.

As of 2007, Medicare allows to bill for no show appointments. But then we still cannot bill Medicaid. You are allowed to bill a Medicare patient a no-show fee as long as you do not distinguish and charge your Medicare patients only. Apply the same no-show policy and fee to all of your patients.

For self-pay patients and those with indemnity insurance, billing for no-shows may be completely legal. But then, you should check first in order to ensure your state law allows this type of billing.

Just because your contract says you can bill for a no-show fee, do not be tempted to bill the payer. Most likely, you will need to bill the patient or you will get a non-covered service denial. For instance, if you bill a missed appointment to Medicare, your claim will be denied citing reason code 204. (This service/equipment/drug is not covered under the patient's present benefit plan).

Explain your policy

For payers that allow you to bill for no-show appointments, the contract will normally require you to give the patient advance notice of your no-show billing policy.

Good practice: Have a financial policy that mentions the fee in writing and include that policy in the paper work you give to every new patient. Have the patient sign two copies of the policy: one that he keeps in addition to one you will keep with his chart.

Include information such as the following in your policy:

The patient needs to inform you that he's not going to show

Whether you will charge a fee

What is the fee if you are going to charge a fee at all

The first time you see a patient, make it a point to sign a 'no show and cancellation form'. It tells them that if they don't show up or cancel within 24 hours of their appointment, they will be charged.

If your practice calls patients to remind them of their appointments, think about mentioning the no-show fee during those reminder calls as well. You can even post the information about your fees in the registration area and in the waiting room.

Fix your fee: Your no-show policy should tell exactly what fee you'll charge for a missed appointment. Many practices set one fee for an office visit and another, higher fee for procedures. The going rate around here is $50 charge for office visits and $100 if they had a procedure scheduled.

One way to bring down your no-show rate, particularly for procedures, is to collect a deposit when the patient schedules the appointment.

Think about discharge for repeat offenders

Medical Coding: Most practices allow patients one or two freebies, which means that they excuse the first missed appointment and don't charge a fee. However, you should send a letter to the patient, reminding him of your practice's policy on no shows.

Source Code :- http://www.supercoder.com/

Once you have sent a letter reminding the patient of the policy, you should think about charging a fee for additional missed appointments. After that, if the patient starts to consistently schedule no-show, you have the right to discharge him as a patient after a few offenses.

People send reminder letters for the first two no-show appointments. The third one gets a $50 fee since that is to cover that appointment time. During the fourth no show, the patient is discharged from the practice.

Key: When a patient does miss an appointment without notifying the office beforehand, you should note it in the patient's file. This will provide you an accurate count of how many times a patient has been a no-show. Spot on documentation can help with any legal issues that crop up if you end up discharging a patient from your practice.

FAQS to Help You Choose the Right Code

Do you know how to bill your claim when a patient presents to your office for a capsule study and the capsule gets lodged in his stomach?

If you have a good sense of what anatomy the capsule study evaluates, it could save you from a possible coding disaster. It is not enough that you know the two CPTs (91110 and 91111) to use for this study.

Here are some answers to frequently asked questions (FAQs) which will help you in choosing the right code:

How would you code a repeat procedure with 91110?

Now and then, your gastroenterologist would use a capsule study to image the intraluminal esophagus all the way through the ileum and reaching the colon. Here, you should report 91110 (Gastrointestinal tract imaging, intraluminal [example, capsule endoscopy], esophagus through ileum, with physician interpretation and report).

For instance: Patient comes in for a capsule endoscopy; however the capsule gets stuck and visuals can't be seen past the stomach. The gastroenterologist ends up repeating the procedure to see if she can see the small and large intestine.

Report it: Initially you would code 91110 and then add modifier 53 (Discontinued procedure) to indicate that the doctor repeated the procedure. If the physician makes up his mind not to repeat the procedure, you should go for modifier 52 (Reduced Services) to mirror that the capsule imaged the patient's anatomy until it became lodged in the food.

Medical coding tip: If you think about repeating a capsule study owing to technical problems, it's a good idea to pre-authorize payment for the second study with the carrier. You may be required to provide records of the incomplete study.

According to CPT 91110's descriptor, the evaluation is from the esophagus to the ileum. The only time this won't be true is when the gastroenterologist places the pill cam endoscopically for the study. Once again in this case, you should use modifier 52 to 91110.

What does 'SB' (small bowel) and 'ESO' mean on PillCam Labels?

Imagine that the gastroenterologist limits her study to the patient's esophagus only – without going further down the stomach, duodenum, jejunum and ileum. Here, you should go for the other capsule study code: 91111 (Gastrointestinal tract imaging, intraluminal [example., capsule endoscopy], esophagus with physician interpretation and report).

Notice that the physician would use two different types of wireless capsules when performing 91110 and 91111, respectively. PillCam SB is designed specifically to visualize the esophagus, stomach, duodenum, jejunum, and ileum. It has one camera and a battery that can last up to eight hours. In contrast, PillCam ESO covers the esophagus. It has cameras at both ends of the capsules and takes very rapid images; however the battery lasts only for a short while.

Tread cautiously: Do not dare to report 91110 and 91111 together as the work required in 91111 is already included in 91110, according to CCI edits. As some payers consider PillCam ESO “investigational, and will not cover the procedure, you would be safe checking your payer's policies first prior to submitting your claim.

Where PC and TC matter

In many areas, hospital endoscopy suites purchase the capsules, and hospitals own the equipment used to view the capsule video. If the physician provides only the professional portion of the procedure ( i.e interpretation and report of the results) , you should use modifier 26 (PC) to the CPT Codes. Do not worry about adding any modifiers if the physician purchases the capsule and owns the computer video equipment. In that case the physician provides both the PC and TC of the procedure.

Advice: Ensure you maintain proper clinical and billing records in case the payer elects to audit claims.

Just-In Preventive Service Fee Waivers for Medicare Patients

If you code for a rural health clinic (RHC), be extra careful in assuring proper reimbursement for Medicare preventive services. The CMS has identified a claims processing issue that impacts rural health clinics (RHCs) submitting claims for preventive health care services on or after January 1 this year.

PPACA waives the coinsurance and deductible for the initial preventive physical examination (IPPE), the Annual Wellness Visit (AWV), and other Medicare-covered preventive services recommended by the US Preventive Services Task Force (USPSTF) with a grade of “A" or “B," with effect from January 1, 2011. However, Medicare contractors will not implement the system changes required to correctly process claims for these RHC services until April 4 this year.

According to a National Institutes of Health (NIH) listserv and the Rural Health Clinics Center on the CMS website, as additional revenue lines are not payable separately, contractors have been instructed to move the associated charges to the non-covered field and to override reason code 31577. This'll allow claims to continue processing and not delay payments.

Providers who submit claims between January 1, 2011 and April 3, 2011 shouldn't resubmit affected claims.

You do not need to resubmit as the contractors will mass adjust the claims in any case. Resubmission would be unnecessary work on the RHC's part.

Process: In order to ensure the charges are reflected as covered, contractors will mass adjust the affected claims within 30 days post the claims processing instruction in Transmittal 2122, Change Request (CR) 7208 are implemented on April 4 this year. Comprehensive HCPCS Level II coding is required; but in order to ensure that coinsurance and deductibles aren't applied to these preventive services when submitted by RHCs on a 71X type of claim with dates of service on or after January 1, 2011.

When the physician provides one more preventive services that meets the specified criteria (say for instance a USPSTF grade A or B) as part of an RHC visit, charges for these services must be deducted from the total charge for purposes of calculating beneficiary copayments and deductibles. For instance, if the total charge for the visit is $150, and $50 of that is for a qualified preventive service, the beneficiary copayment and deductible is based on $100 of the total charge. If no other RHC service takes place along with the preventive service, no copayment or deductible apply.

Information: Take a look at Transmittal 2122 for the official instruction. Attachment A covers a list of CPT codes that are termed as preventive services under Medicare as well as Level II HCPCS codes for the IPPE and AWV. One can even visit the RHC Center on CMS's Website.

TMJ Diagnosis: Be specific to succeed

In a particular situation, our provider included two diagnoses in the documentation for a temporomandibular joint injection: TMJ pain and face pain. The Medicare Local Coverage Determination (LCD) does not allow either diagnosis: How and what can we report here?

Well, many conditions can be characterized as temporomandibular disorder; as such don't think your provider can only document general diagnoses such as TMJ pain (524.62) or face pain (784.0).

Key factors: The more specific your physician can be with her diagnosis, the better. Here are some examples for diagnoses you might report for present conditions:

848.1 (Jaw sprain) for strain

830.0 (Closed dislocation of jaw) if the TMU or facial pain is owing to recent TMJ dislocation

524.69 (Temporomandibular joint disorders other specified temporomandibular joint disorders) if arthritis causes TMJ cartilage damage

524.63 (Temporomandibular joint disorders articular disc disorder [reducing or non-reducing]) if TMJ disc erosion or misalignment is the reason for the pain.

Here's how: As found in CMS guidelines, many procedures, services, or appliances used to treat TMJ fall within the Medicare program's statutory exclusion at 1862(a)(12), which prohibits compensation for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth...." Owing to this, a catch-all diagnosis of TMJ is not enough. Your provider must figure out and document the real condition or symptom for claims purposes.

ICD-9 787.22 for Dysphagia in Oropharyngeal Phase

While coding for your pulmonology practice, you may encounter various coding confusions such as this:

Scenario: Our pulmonogist diagnosed a patient with nasopharyngeal carcinoma status post radiation and chemo with subsequent dysphagia and nasopharyngeal stenosis. As such can I code the dysphagia as oropharyngeal phase when the note does not specifically mention the condition as such?

Well, if the pulmonologist does not specify the type of dysphagia the patient has in her notes, you should go for dysphagia unspecified or 787.20. ICD-9 787.22 (pharyngeal walls,"Dysphagia; oropharyngeal phase) represents ‘impaired structure/ physiology of tongue base and pharyngeal walls," according to the American Speech-Language-Hearing Association (ASHA). On the other hand, 787.21 (… oral phase) describes “impaired structure/physiology of palate, tongue, lips, cheeks", while 787.23 (… pharyngeal phase) represents “impaired structure/ physiology of pharynx and larynx."

ICD-9 787.22 has more specificity of the affected swallowing disorder phase. For example, a patient with oral dysphagia has difficulty in the voluntary transfer of food from the mouth to the pharyx. In the pharyngeal dysphagia, the patient has difficulty in reflexive transfer of food from pharynx to initiate involuntary esophageal phase of swallowing while protecting airway from misdirection of food. In this situation, the patient normally undergoes testing to identify the affected phase. If the test reveals difficulty with preparation of the bolus, premature loss over back of tongue, some penetration into upper laryngeal vestibule and residue in pyriforms with risk of aspiration, the physician or speech language pathologist would diagnose oropharyngeal dysphagia (787.22).

G0105 Is Matchless For No-Finding Service

My gastroenterologist carried out a colonoscopy on a patient with a V16.0 diagnosis. The patient is 50 years old and does not have coverage for screening colonoscopy because of his age. However his insurance considers V16.0 a medical diagnosis and could have paid for the service. The colonoscopy showed no findings. As such, why did the insurance deny my claim when I billed V16.0 with 45378?

Well, you should have determined the advantages of the procedure and verified the payment prior to performing it on the patient. Colonoscopy procedures in patients minus active symptoms don't qualify as an emergency and the best way to ensure that the physician is paid for the service is to get phone verification of benefits. What's more, regulation does not require insurance coverage for high-risk screening colonoscopy.

Even though some insurance would accept G0105 Colorectal cancer screening; colonoscopy on individual at high risk) in place of 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]) to qualify for screening benefits, you should not bill it unless the insurance company representative instructed it during the verification process. Commercial carriers for non-Medicare patients normally do not recognize G0105, which is a CMS code.

Intent: G0105 is a CMS HCPCS code that applies for screening of a patient that has a high-risk for colorectal neoplasia. Examples would be universal ulcerative colitis (556.6) or a history of malignant neoplasm of the lower gastrointestinal tract (V10.0). When the service reveals no findings, you should report this HCPCS code(Source "").

No modifier would be proper to use on 45378 if you insist on using this code. Nevertheless, you could try sending all notes with your claim. If the patient was referred for the procedure, you might want to ask the referring physician if she would write a letter validating medical necessity.

Physician's Intent to Treat Obstruction? Choose 94640

Coding scenario: An established patient with emphysema presents the office complaining of shortness of breath. The pulmonologist provides inhalation treatment and at the same time educates the patient on using the nebulizer at home, and provides an expanded problem-focused examination and medical decision making of low complexity. What code should we use in this situation?

Well, you should consider two CPTs to report this service. In the first instance, you would bill 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [example with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device]) to cover the wide-ranging service the physician provided.

Here's why: The best option is 94640 as the physician's primary intent was to treat the obstruction. If you report 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device), you would risk a denial.

For the office visit, you should report 99213 (Office or other outpatient visit for the evaluation and management of an established patient …) based on your documentation of an expanded problem-focused exam with low complexity decision-making. You might need to add modifier 25 to 99213 to indicate that theE/M service was significant and separately identifiable from 94640.

Coding tip: Even though technically not required, it may help to link separate diagnosis codes to the E/M and the nebulizer treatment. For example, you could link 786.05 (Shortness of breath) to 99213, and link the emphysema code (492.8, Other emphysema) to 94640.

Coding 96372 with 90471

During an office visit, our nurse administered a B12 injection and a flu shot to an established patient. Can we code for both injections apart from the office visit?

Well, it all depends on the circumstances. First report the proper code for the flu vaccine (example 90658, “Influenza virus vaccine, split virus, when administered to individuals three years of age and older, for intramuscular use) depending on the type of vaccine administered as well as the proper code for the administration of the vaccine like 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; 1 vaccine [single or combination vaccine/toxoid]). If the administration involved physician counseling with a patient 18 years of age or younger, you'll report 90460 for the administration; for a Medicare patient, the administration code is G0008 (Administration of influenza virus vaccine).

For the B12 injection, report the administration with 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular). Include J3420 (Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg) for the vitamin B-12 itself.

In the end, if the office visit was significant and separately identifiable from the two injections, you may add the proper office visit code from 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient …). In this case, make it a point to append modifier 25 (Significant, separately identifiable E&M service by the same physician on the same day of the procedure or other service) to the office visit code.

There are exceptions: If the patient gets the B12 shots as part of a scheduled administration plan which otherwise involves no E&M of the patient, go for the flu shot and the B-12 injection, but not the office visit.

Which Anesthesia Code and Modifier to Use For Cancelled Procedure?

Scenario: There was a patient scheduled for a colonoscopy with biopsy; he experienced an episode of syncope in the pre-op area while the nurse was placing an IV. The physician called off the procedure; as such, which anesthesia code and modifier should I use to describe this?

Solution: Begin by checking whether your payers have definite guidelines for reporting cancelled cases. If the physician cancels the procedure after the patient is prepared for surgery but before induction starts, the payer may ask you to report 01999 (Unlisted anesthesia procedure[s]) with modifier 53 (Discontinued procedure). Other payers might call for the proper anesthesia code for the intended procedure in addition to modifier 53.

Remember: The entire definition for modifier 53 indicates not to report it for elective cancellation of a procedure before induction. But then some insurance companies may request the modifier despite that direction.

You need to include reports and additional notes in box 19 or the electronic equivalent (such as “cancelled before induction, but after preparation").

After the induction, if the physician cancelled the procedure, surgical procedure code 45380 (Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple) crosses to 00810 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum).

Heads up: If the service took place in an outpatient hospital or ambulatory surgical center, some payers need modifier 73 (Discontinued outpatient procedure prior to anesthesia administration) or modifier 74 (Discontinued outpatient procedure after anesthesia administration).

Bear in mind: You should point to the reason for the cancellation of the surgery by reporting diagnosis codes V64.1 (Surgical or other procedure not carried out because of contraindication) and 780.2 (Syncope and collapse). Depending on when the physician cancelled the case, you may also report the diagnosis for the colonoscopy.

Article Source :- http://www.supercoder.com/coding-newsletters/my-anesthesia-coding-alert/reader-questions-remember-modifier-53-case-details-for-cancelled-procedure-article

Sinusitis Options Have a One-To-One Match with Icd-10 Codes

When ICD-10 goes into effect in 2013, you may sometimes have a simple one-to-one relationship between old and new ones, meaning that only the coder needs to twist the way he or she report it.

Take a look at these common sinusitis diagnoses and find out what you will report after October 1, 2013.

At present: When your physician treats a patient for sinusitis, you should report the proper sinusitis code for sinus membrane lining inflammation. Report 461.x for acute sinusitis. For chronic sinusitis – frequent or persistent infections lasting more than three months – assign 473.x.

For both acute and chronic conditions, you will choose the fourth digit code based on where the sinusitis occurs. For instance, for ethmoidal chronic sinusitis, you should use 473.2 (Chronic sinusitis; ethmoidal). Your otolaryngologist will most likely prescribe a decongestant, pain reliever or antibiotics to treat sinusitis.

Good tidings: These sinusitis options have a one-to-one match with the soon-to-come ICD-10 codes. For acute sinusitis diagnoses, you will look at the J01.-0 codes. For example, 461.0 (Acute maximllary sinusitis) translates to J01.00 (Acute maxillary sinusitis, unspecified). Code 461.1 (Acute frontal sinusitis) maps directly to J01.10 (Acute frontal sinusitis). See how the definitions are mostly identical. Just like ICD-9 , the fourth digit changes to specify location.

For chronic sinusitis diagnoses, you will look to the J32 – code. For example, in the above instance, 473.2 maps direction to J32.2 (Chronic ethmoidal sinusitis). Again, this is a direct one-to-one ratio with identical definitions. Like ICD-9 code, the fourth digit changes to specify location.

Physician documentation: Presently, the physician should pinpoint the location of the sinusitis. This won't change in year 2013.

Tips for coders: You will scrap the 461.x and 473.x options and turn to J01.-0 and J32.- in your ICD-10 manual. Except for the change in code number and the addition of a letter, you should treat these claims the same as before.

Five Strategies to Ease Your Sports Exam Coding

Getting calls all year-round from parents requesting sports physicals for their children might be a common feature for your pediatric practice. Even though the physical may be fairly simple to carry out, it is not always straightforward to code.

If you are clueless about how to code a sports exam, think about these choices that will put your CPT coding on the right track while dodging non-payment issues.

Perform less and code office visit

When a pediatrician provides a true sports exam, CPT offers no direct match. Pediatricians may provide a shortened well-care visit, in which they assess the risks, perform an exam, and order vaccine and labs.

Encourage full well check

In order to avoid V70.3 non-coverage issues, try to schedule patients for preventive medicine services rather than for sports physicals. Sometimes parents misinterpret the sports physical as the child or adolescent's complete annual physical examination. Having the patient come in for the annual ensures she gets the full service.

Consider forms policy

For patients who have received a recent preventive medicine service, think about using that information to complete a sports form. Few pediatric practices have a set fee the patient pays for this service such as a $20 forms fee.

Some practices will include completion of forms at the time of an E/M visit; however charge if the forms are brought in at another time. There's additional office overhead involved if the chart must be pulled and reviewed, the form completed, mailed, or faxed, and the chart refiled.

Drawback: For liability reasons, your physician may not want to issue a form without checking the patient to see if his status has changed.

Charge parent

When a parent insists or the school calls for an abbreviated exam on a patient who has not had a well check in the previous half of the year, you might want to put into practice a financial plan. Physicals required for sports are normally the patient's responsibility. Insurers normally do not cover the service.

Best practice: If you expect the insurer will not cover the sports physical, have the parent sign an advance beneficiary notice (ABN). Ensure the parent understands she will have to pay if the insurer does not cover the sports exam, and notify her of the price.

Tool: You can use a private payer version of Medicare's form to educate the parent and ensure she is aware of her choices and responsibilities.

Check state scope of practice laws

Once you decide on the best strategy for your practice, confirm that your state allows you to use that technique. For instance, certain states publish guidelines indicating that a physical done within the last 12 months is enough and the patient does not require an updated form, whereas other states need children to bring in new forms for each individual sport they intend to play.

For More Info :- http://www.supercoder.com/

Clear Modifier 52, 53Ambiguity for Incomplete Scope

This year (2011), see to it that you stay away from frequency trap.

Think of a situation where your general surgeon carries out a procedure on a patient who is scheduled and prepared for a total colonoscopy. During the procedure, the physician finds out that owing to unforseen circumstance, he cannot advance the colonoscope beyond the splenic flexure. How should you go about this situation?

Here's what you need to do

You should use the colonoscopy code 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]) with the proper modifier -- but then which modifier?

Disparate instructions lead to a lot of confusion

For the incomplete colonoscopy scenario, previous editions of CPT instructed you to use modifier 52 (reduced services) to 45378. On the other hand, the Center for Medicare and Medicaid (CMS) instructed you to go for modifier 53 (Discontinued procedure).

Rationale: The agency advised that you use modifier 53 in order to overcome a frequency edit trap. If after coding 45378-52, you had to go back and do a colonoscopy that you coded 45378, you would not get the payments because of the frequency edits.

Here's what you should know

CPT 2011 changes the text note so that it now instructs providers to report an incomplete colonoscopy with modifier 53 and the proper documentation.

Gear Up With K Codes for Gerd In 2013

When coding for a motility manometric study that discovers esophageal reflux, you would most probably opt for 530.81 (Diseases of esophagus; other specified disorders of esophagus; esophageal reflux) to describe a diagnosis for the test claim.

As we all know, ICD-9 becomes ICD-10 in a couple of years' time (2013). When that happens, you will have to shift to coding either K21.0 (Gastro-esophageal reflux disease with esophagitis) or K21.9 (Gastro-esophageal reflux disease with no esophagitis) for the diagnosis.

ICD difference: When ICD-10 goes into effect on October 1, 2013, 530.81 will expand into two codes K21.0 and K21.9. The ICD-10 code specifically defines gastro-esophageal reflux disease (GERD) and indicates the presence or nonpresence of esophagitis.

Physician documentation: Notice the difference between K21.0 and K21.9, which depends on whether the test revealed that the patient has esophagitis. You should be on the lookout for any mention of this in the notes of your physician.

But then, remember that esophagitis is a visible or histologic finding that cannot be concluded without an endoscopic exam. You might be able to select other appropriate codes from ICD-10 for patients that have had endoscopy.

Tips for medical coders: In ICD-9 codes, GERD is coded 530.81, but in ICD-10 more details are called for. The user needs more information such as whether the GERD is with or without esophagitis.

96446 Joins CCI Edits 17.0 along With Many Others

Last month saw new CPT codes and CCI physician edits from CMS for those codes. The latest CCI edits have 19,822 new edit pairs which have been added while 9,778 have been terminated, for a net gain of 10,044 new edit pairs.

The main CCI edits you want to be sure to watch for are those related to new code 96446.

Note where 96446 falls (Col. 1/Col. 2) for non-mutually exclusive (NME edits)

The 96446 NME edits are largely what you'd expect based on other chemotherapy code edits – bundles with E/M, anesthesia, venipuncture and other vascular procedures, for instance. You want to be sure to watch which is the column 1 code and which is the column 2 code for these bundles.

For example: CCI places E/M codes 99217-99239 in the column 1 position and 96446 in the column 2 position. On the contrary, CCI places 96446 in the column 1 position and E/M codes 99201-99215 in the column 2 position.

Remember that if you report both codes in an NME edit pair without a modifier, Medicare (as well as payers who adopt these edits) will deny the column 2 code and pay you only for the column 1 code.

79200 edit reminds you to check ME edits as well

CCI Edit also created an ME edit for 96446. ME procedures cannot reasonably be performed at the same anatomic site or patient encounter. The edit places 96446 in column 1 and in column 2 is 79200. This edit also has a modifier indicator of 1; as such you may override the edit with a modifier when clinically appropriate, such as in the case of distinct separately identifiable encounters.

Modifier 62: Ease Your Multi-Provider Coding Confusion

When you come face-to-face with multi-provider situation, the last thing you would want is to mess up your coding by assigning the wrong modifier(s). As such, you really need to know how to assign the proper modifiers.

Here's a scenario: A 70-year-old female patient who presents with COPD and coronary artery disease, status post myocardial infarction (CAD s/p MI) has a 28 mm of inner diameter thoracic aortic aneurysm. Imaging studies indicate the aneurysm to be descending. The cardiologist teams up with a thoracic surgeon and decides to perform an open operative repair with graft replacement of the diseased segment.

The key in a multi-provider scenario is to treat each physician's work as a separate activity. But then, deciding when to report a case as co-surgery, assistant surgery -- or something else -- has more to it than meets the eye. Here are some expert advice:

Modifier 62, 81, 82

In this situation, a modifier is at hand; but then, more importantly you should be able to tell what role each modifier plays so that your procedure codes blend well together. Take a look at these common modifiers used in multi-provider situations:

Modifier 62 (Two surgeons). Use this modifier to each surgeon's procedure when the physicians perform distinct, separate portions of the same procedure. Also called co-surgery, modifier 62 applies when the skill of two surgeons (normally of different skills) is called for in the management of a special surgical procedure.

Opt between modifier 80 (Assistant surgeon), modifier 81 (minimum assistant surgeon), and modifier 82 (Assistant surgeon [when qualified resident surgeon not available]) when one surgeon aids the other with multiple portions of the case rather than completing his work independently. What to look for? Ensure your physician indicates in his documentation that he is working with an assistant surgeon, what the assistant surgeon did, and why he or she was used during the case.

When you report a nonphysician practitioner's (NPP's) involvement to Medicare, attach modifier AS (Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery).

But remember that not all payers recognize modifier AS. You should verify the proper way to report the NPP's service before completing your claim.

Stay away from the modifier 51 trap

When you are coding for multiple procedures during the same operative session, it is easy to fall into the lure of using modifier 51 (Multiple procedures). However you could end up in the gutters if you are not careful enough.

Here's why: Modifier 51 tells you that a surgeon was present carrying out multiple procedures. If a surgeon is not present physically for multiple procedures in a surgical case, it is not proper to indicate that he was busy using modifier 51.

Two surgeons require two echo claims

In the given scenario, both surgeons should bill 33880. (Then, you'd use 441.2 (Thoracic aneurysm without mention of rupture) with 33880 to describe the condition. Finally, you should use modifier 62 to 33880 to show that two surgeons performed the repair.

Catch: You do not use modifier 62 if the physicians are not reporting the same CPT code(source"http://www.supercoder.com/cpt-codes"). If each doctor can represent his work with a separate CPT code, leave out modifier 62. Ensure both surgeons send a claim with the same code and modifier declared or you would end up throwing away about $4,000 in reimbursements (56.62 RVUs multiplied by 2011 conversion factor of 33.9764; $1,923.74 for each surgeon).

2011 Conversion Factor Will Stand at $33.9764

Recently, President Obama may have locked in a zero percent adjustment to your Medicare Part B payments, however that does not mean your ortho practice should be calculating your fees using last year's rates. As a matter of fact, the 2011 conversion factor is slightly lower this year than what you were collecting last year, according to an 'Emergency update' to the 2011 Fee Schedule that CMS issued on Dec. 30.

However the good news is that your payments should not drop.

Your 2011 conversion factor will stand at $33.9764, a net reduction of 7.86 percent from the 2010 conversion factor of 36.8729.

The Medicare and Medicaid Extenders Act of 2010, which was signed into law on December 15, established a payment update for 2011 of zero percent. In order to cover the cost of the legislation, Medicare has to modify provisions in the proposed 2011 Medicare Physician Fee Schedule final rule, which altered some of the RVUs, as well as the conversion factor. But then as the conversion factor went down, most of the RVUs went up, ensuring that you should not notice any payment woes over the changes.

Article source :- http://isupercoder.blogspot.in/2011/02/2011-conversion-factor-will-stand-at.html

For example, the RVUs for outpatient E/M code 99212 will change from the 2010 rate of 1.08 to a higher rate of 1.22 this year. Multiplied by the conversion factors for their respective years, the payment for 99212 this year will still be higher than it was last year, despite this year's low conversion factor (2010 payment was around $39.82 compared to the 2011 payment of approximately $41.45).

Count Post-Op Brace Fitting and Education Separate?

Is it feasible that my physician bill for a fitting and education of a brace during the postoperative period for an anterior cruciate ligament (ACL) surgery? I found 97760, but can I use this separately or is it considered a part of the ACL surgery's global period?

Answer: The CCI edits do not bundle 97760 (Orthotic[s] management and training [including assessent and fitting when not otherwise reported], upper extremity[s], lower extremity[s] and/or trunk, each 15 minutes) into any of the ACL repair codes, for instance, 27407 (Repair, primary, torn ligament and/or capsule, knee; cruciate). However, this does not automatically mean you can report 97760 in the situation outlined in the question above.

As per the December 2005 CPT Assistant, 97760 includes the provider's time associated with determining the proper orthotic design in relation to the patient's skin integrity, sensibility and healing of tissues with or without surgical repair.(for example static versus dynamic, pre-fabricated versus custom designed, choice of materials such as thermoplastic, pulleys, and elastic tendon). The code also includes the fitting of the orthotic, training in use, care and wearing time of the orthotic, and brief instructions in exercises that are to be carried out while the orthotic is in place."

When settling on whether to report 97760, examine your physician's documentation to ensure he has noted each of these decision-making processes. Most national and local Medicare coverage determinations note that physical therapists report this code most often and this service should take no longer than 30 minutes. As a result, you might run into frequency edits if you attempt to report more than two units of 97760.

Article  Source :- http://www.supercoder.com/coding-newsletters/my-orthopedic-coding-alert/you-be-the-coder-97760-count-post-op-brace-fitting-and-education-separate-article 

Post ICD-10, Osteoarthritis Will Require Heightened Documentation

In 2013, as we all know, ICD-9 will become ICD-10. After this, you'll not always have a simple one-to-one relationship between old codes and the new ones. often, you will have more options that may need tweaking the way your doctor documents a service and a coder reports it.

Read on for some common osteoarthrosis diagnoses that will help you find out what you will report post October 1, 2013.

Normally a patient with osteoarthritis might start with his primary care physician, who then refers him to a rheumatologist. The rheumatologist has been tending to the patient with conservative measures such as NSAIDS (nonsteroidal anti-inflammatory drugs). Owing to increasing symptoms, now poorly controlled by the use of NSAIDS, the rheumatologist requests an orthopedic consultation. He diagnoses osteoarthrosis(715.xx-716. xx) and these codes specify location, primary, or secondary.

ICD-10 difference: For these codes, you should look at the following:

M15 (Polyosteoarthritis)

M16 (Osteoarthritis of hip)

M17 (Osteorthritis of knee)

M18 (Osteoarthritis of first carpometacarpal joint)

M19 (Other and unspecified osteoarthritis).

Just like ICD-9 codes, these codes are broken down into location, primary and secondary. However they also sometimes specify unilateral, bilateral and post-traumatic indications.

Documentation: In order to submit the most detailed diagnosis, the orthopedic physician will need to maintain osteoarthrosis documentation but expand it to unilateral, bilateral, and/or post-traumatic specification. Some important terms are "oestoarthritis," "arthritis," "athrosis," "DJD," "arhtorpathy," "post traumatic arthritis," and "traumatic arthritis."

Tips for coders: See how codes M19.01--M19.93 entail unspecified locations. Now ICD-10 code(http://www.supercoder.com/coding-newsletters/icd-10-coding-alert)
  does not group unspecified locations alongside the specific locations for each type (as in, the familiar .9 code in most ICD-9 codes categories). You'll find them at the end of the code grouping (M19.90--"M19.93) for each specific type but in an unspecified location.

That apart, traumatic osteoarthritis is now more appropriately indexed and described as post-traumatic osteoarthritis, the true condition.