Even one-to-one matches can surprise you -- check the index for clearness.
When the conversion of ICD-9 to ICD-10 takes place in 2013, one lesson you'll need to keep in mind is that inclusion lists may vary between the two code sets. That implies that ICD- 9 and ICD-10 codes that seem to be twins might not apply to the same list of diagnoses.
Case in point: ICD-9 2011 code 745.4 (Ventricular septal defect) as well as ICD-10 2011 code Q21.0 (Ventricular septal defect) have the same code definition. Both reference ventricular septal defect (VSD), which includes no less than one hole in the wall separating the ventricles of the heart. In the process of conversion of ICD-9 to ICD-10, you will find that regardless of the similarity in the code definitions, the inclusion lists for these codes are not the same.
ICD-9 coding rules: Code 745.4 has an inclusion note informing you that the code is suitable for Eisenmenger's defect or complex, Gerbode defect, interventricular septal defect, left ventricular-right atrial communication, or Roger's Disease.
ICD-10 changes: The inclusion list under Q21.0 shows only Roger's disease.As you will find differences in which diagnoses come under similar ICD-9 and ICD-10 codes, the fundamental principle of checking both the index and the tabular list will be essential for proper ICD-10 coding.
For instance, if you search for Eisenmenger's defect (which falls under 745.4), you'll find that ICD-10 codes this particular defect to Q21.8 (Other congenital malformations of cardiac septa). And in another instance of what's different, Eisenmenger's complex (which also falls under 745.4) is as an alternative coded to I27.89 (Other specified pulmonary heart diseases) under ICD-10.
Article Source :- http://www.supercoder.com/coding-newsletters/my-cardiology-coding-alert/icd-10-7454-matches-to-q210-to-describe-vsd-107520-article
Documentation: In case the patient has one of the named defects (for instance, those listed in the ICD-9 inclusion list), documentation of that definite name will let you check the index to be assured that you have the most suitable ICD-10 code.
You'll also require documentation to take account of whether the VSD is congenital (existing at or before birth), because of myocardial infarction, or or else acquired (a reaction to environmental influences). In the conversion of ICD-9 to ICD-10, you will experience that ICD-10 directs you away from Q21.0 in case the patient has an acquired septal defect (I51.0, Cardiac septal defect, acquired) or a VSD as a current complication of an acute myocardial infarction (I23.2, Ventricular septal defect as current complication following acute myocardial infarction).
Bonus tip: ICD-9 also has an exclusion list in 745.4, so you know not to use the code for common atrioventricular canal type (coded to 745.69, Other endocardial cushion defects) or single ventricle (coded to 745.3, Common ventricle) defects. In the conversion of ICD-9 to ICD-10, you will see that ICD-10 does not have an excludes list for Q21.0, but those diagnoses still are coded in another place: Q21.2 (Atrioventricular septal defect) is applicable to the common atrioventricular canal and Q20.4 (Double inlet ventricle) is applicable to the single or common ventricle diagnosis.
Showing posts with label ICD-10 codes. Show all posts
Showing posts with label ICD-10 codes. Show all posts
Thursday, November 3, 2011
Thursday, October 20, 2011
Start Small When Preparing for ICD-10 Conversion
Familiarize yourself with the top 30 diagnoses which you think your practice sees and you'll get an edge towards compliance.
If you've studied the ICD-10 book, you know that it would be virtually impossible to remember all of the codes that it has. But preparing for ICD-10 won't need you to even learn the codes by heart.
Switching from ICD-9 to ICD-10 will not require practitioners to or memorize new code sets--in fact, most practitioners perhaps don't know many ICD-9 codes by heart, so they won't be expected to memorize ICD-10 codes either.
What do physicians need to do for the conversion? To prepare for ICD 9 to ICD-10 conversion, doctors will need to look at the codes they use most regularly in their offices and make novel job aids or superbills for those procedures.
Strategy: Use your list of the top diagnoses that your practice sees to find the corresponding ICD-10 codes, and you've got your cheat sheet. Then, make sure that your coders are well-trained, that your claims are necessarily form 5010 compliant, and also that your claim submission system supplier is ready for ICD-10. Besides, in case you have an electronic medical record or you are planning to get one, ensure that it can handle ICD-10. If you're planning to bring in an EMR, you want to convert to ICD-10 first, not bring one in under ICD-9 and then convert.
Physicians should tighten up documentation: As is the case under ICD-9, coders will be unable to bring together ICD-10 codes from a physician's documentation if it isn't detailed and comprehensive, so physicians should take this as an opportunity to enhance their documentation skills. Coders cannot code what's not present in the medical record. Because there are more opportunities for coders to choose from a list, they're going to be coming back to physicians early on to say 'Wait, I need more definition to help me pick A or B.'
Non-Medicare Payers, Too, Are Prepping for ICD-9 to ICD-10 Conversion
CMS has no plans of postponing the implementation of ICD-10 beyond Oct. 1, 2013. However, not all entities are prepared for the ICD-9 to ICD-10 conversion
Starting July 2011, 11 state Medicaid programs are at high risk for not meeting the ICD-10 implementation date, though 21 states are at moderate risk, 15 are at low risk, and four states have not told CMS as to where do stand in the process.
Interestingly, many non-required entities like workers compensation programs and property and casualty insurers are also working towards ICD-9 to ICD-10 conversion. Besides, keep in mind that CMS is very close to determining how to process claims that span the ICD-10 implementation date.
Source URL :- http://www.supercoder.com/coding-newsletters/my-ophthalmology-coding-alert/icd-10-readiness-start-small-when-prepping-for-icd-10-conversion-cms-says-107689-article
If you've studied the ICD-10 book, you know that it would be virtually impossible to remember all of the codes that it has. But preparing for ICD-10 won't need you to even learn the codes by heart.
Switching from ICD-9 to ICD-10 will not require practitioners to or memorize new code sets--in fact, most practitioners perhaps don't know many ICD-9 codes by heart, so they won't be expected to memorize ICD-10 codes either.
What do physicians need to do for the conversion? To prepare for ICD 9 to ICD-10 conversion, doctors will need to look at the codes they use most regularly in their offices and make novel job aids or superbills for those procedures.
Strategy: Use your list of the top diagnoses that your practice sees to find the corresponding ICD-10 codes, and you've got your cheat sheet. Then, make sure that your coders are well-trained, that your claims are necessarily form 5010 compliant, and also that your claim submission system supplier is ready for ICD-10. Besides, in case you have an electronic medical record or you are planning to get one, ensure that it can handle ICD-10. If you're planning to bring in an EMR, you want to convert to ICD-10 first, not bring one in under ICD-9 and then convert.
Physicians should tighten up documentation: As is the case under ICD-9, coders will be unable to bring together ICD-10 codes from a physician's documentation if it isn't detailed and comprehensive, so physicians should take this as an opportunity to enhance their documentation skills. Coders cannot code what's not present in the medical record. Because there are more opportunities for coders to choose from a list, they're going to be coming back to physicians early on to say 'Wait, I need more definition to help me pick A or B.'
Non-Medicare Payers, Too, Are Prepping for ICD-9 to ICD-10 Conversion
CMS has no plans of postponing the implementation of ICD-10 beyond Oct. 1, 2013. However, not all entities are prepared for the ICD-9 to ICD-10 conversion
Starting July 2011, 11 state Medicaid programs are at high risk for not meeting the ICD-10 implementation date, though 21 states are at moderate risk, 15 are at low risk, and four states have not told CMS as to where do stand in the process.
Interestingly, many non-required entities like workers compensation programs and property and casualty insurers are also working towards ICD-9 to ICD-10 conversion. Besides, keep in mind that CMS is very close to determining how to process claims that span the ICD-10 implementation date.
Source URL :- http://www.supercoder.com/coding-newsletters/my-ophthalmology-coding-alert/icd-10-readiness-start-small-when-prepping-for-icd-10-conversion-cms-says-107689-article
Monday, September 19, 2011
ICD-10 Codes: You'll Have One-to-One Hyperplasia Equivalents, But Tread Carefully
Does 'Endometrial thickening' mean you should report these codes? Well, not necessarily.
The switch from ICD-9 to ICD-10 represents one of the most extensive impacts to a healthcare provider's business. So if the very thought of the dramatic increase in codes worries you, rest assured. You'll find simple one-to-one relationships between old and new codes.
That is also the case for hyperplasia; however you need to beware. You'll still need to carry over the same coding conventions.
Say for example your ob-gyn suspects hyperplasia. He traces and documents 'endometrial thickening' during an ultrasound examination; keeping this mind, what diagnosis should you report here?
Many coders all prey to this mistake
Just because your ob-gyn documents endometrial thickening doesn't mean the patient has endometrial hyperplasia. Many coders fall prey to this. (621.30 or 621.31).
ICD-10 Updates: Remember this snag. If you come face to face with the same situation in 2013, you shouldn't go for the straight forward hyperplasia equivalents N8500 (Endometrial hyperplasia, unspecified) and N8501 (Simple endometrial hyperplasia without atypia). These definitions are exactly the same.
ICD-10 Coding Tips: You should not be carried away by 'endometrial thickening'. Don't code this as hyperplasia because physicians do not always take the thickening of the uterus 'abnormal'; as a matter of fact, it is just a monthly ramp up for all women. You should not report hyperplasia until and unless the ob-gyn has carried out a biopsy and you have at hand a pathology report that corroborates this condition.
Way out: Since you have no code to describe the patient's condition, you should go for 793.5. Since endometrial thickening is a finding and not a diagnosis, you should locate the diagnosis code in the signs and symptoms section of ICD-0. If you look under thickened endometrium, this will take you to 793.5.
You will not see 'thickened endometrium' referenced at all; therefore you'd normally rely on the options given by one of the equivalent tables that have been produced based on the ICD-9 code 793.5.
Watch Out: If you look up the equivalent ICD-10 code for 793.5, you will find that the national Center for Health Statistics still lists R93.4; this is wrong as the uterus is not a urinary organ.
For more ICD-10 guidelines and updates, sign up for a one-stop medical coding guide like SuperCoder. Such a site comes with packed with all the information you need about ICD-10 to make a smooth transition.
The switch from ICD-9 to ICD-10 represents one of the most extensive impacts to a healthcare provider's business. So if the very thought of the dramatic increase in codes worries you, rest assured. You'll find simple one-to-one relationships between old and new codes.
That is also the case for hyperplasia; however you need to beware. You'll still need to carry over the same coding conventions.
Say for example your ob-gyn suspects hyperplasia. He traces and documents 'endometrial thickening' during an ultrasound examination; keeping this mind, what diagnosis should you report here?
Many coders all prey to this mistake
Just because your ob-gyn documents endometrial thickening doesn't mean the patient has endometrial hyperplasia. Many coders fall prey to this. (621.30 or 621.31).
ICD-10 Updates: Remember this snag. If you come face to face with the same situation in 2013, you shouldn't go for the straight forward hyperplasia equivalents N8500 (Endometrial hyperplasia, unspecified) and N8501 (Simple endometrial hyperplasia without atypia). These definitions are exactly the same.
ICD-10 Coding Tips: You should not be carried away by 'endometrial thickening'. Don't code this as hyperplasia because physicians do not always take the thickening of the uterus 'abnormal'; as a matter of fact, it is just a monthly ramp up for all women. You should not report hyperplasia until and unless the ob-gyn has carried out a biopsy and you have at hand a pathology report that corroborates this condition.
Way out: Since you have no code to describe the patient's condition, you should go for 793.5. Since endometrial thickening is a finding and not a diagnosis, you should locate the diagnosis code in the signs and symptoms section of ICD-0. If you look under thickened endometrium, this will take you to 793.5.
You will not see 'thickened endometrium' referenced at all; therefore you'd normally rely on the options given by one of the equivalent tables that have been produced based on the ICD-9 code 793.5.
Watch Out: If you look up the equivalent ICD-10 code for 793.5, you will find that the national Center for Health Statistics still lists R93.4; this is wrong as the uterus is not a urinary organ.
For more ICD-10 guidelines and updates, sign up for a one-stop medical coding guide like SuperCoder. Such a site comes with packed with all the information you need about ICD-10 to make a smooth transition.
Sunday, September 18, 2011
Tips to Help Physicians Switch to ICD-10
Jittery about using ICD-10 codes? Well, here are some tips for physicians that'll help them make a smooth transition to ICD-10.
It's practically not feasible to remember by heart all the codes that the ICD-10 code set contains. However you can take heart as switching to the new code set will not need practitioners to learn new code sets – in fact, most practitioners probably do not know ICD-9 codes by heart.
ICD-10 Tips for Physicians
In order to be all keyed up for ICD-10, physicians will need to take a look at the codes they use very often in their offices and come up with new job aids or superbills for those procedures. You will stand in good stead if you take a good look at the codes that you see most frequently in your practice. You can choose the top 30 diagnoses that they see and concentrate on knowing how to code those properly.
Here's what physicians need to do:
You should use your list of the top diagnoses that your practice sees to find the corresponding ICD-10 codes.
After this, see to it that coders are trained, that your claims are form 5010 compliant and that your claim submission system supplier is ICD-10 ready.
If you have an EMR or you plan to get one, see to it that it can handle ICD-10.
If you are beginning to bring an EMR, you should convert to ICD-10 first, and not bring one under ICD-9 and then convert.
You will not be able to glean ICD-10 codes from a physician's documentation if it is not thorough and detailed. Therefore physicians should take the opportunity to boost their documentation skills.
Note: The Centers for Medicare & Medicaid will very soon determine ways to process claims that span the ICD-10 implementation date.
For more ICD 10 coding tips, sign up for a good coding resource like SuperCoder. Such a site comes with an ICD-10 code lookup tool to help you in your coding.
It's practically not feasible to remember by heart all the codes that the ICD-10 code set contains. However you can take heart as switching to the new code set will not need practitioners to learn new code sets – in fact, most practitioners probably do not know ICD-9 codes by heart.
ICD-10 Tips for Physicians
In order to be all keyed up for ICD-10, physicians will need to take a look at the codes they use very often in their offices and come up with new job aids or superbills for those procedures. You will stand in good stead if you take a good look at the codes that you see most frequently in your practice. You can choose the top 30 diagnoses that they see and concentrate on knowing how to code those properly.
Here's what physicians need to do:
Note: The Centers for Medicare & Medicaid will very soon determine ways to process claims that span the ICD-10 implementation date.
For more ICD 10 coding tips, sign up for a good coding resource like SuperCoder. Such a site comes with an ICD-10 code lookup tool to help you in your coding.
Thursday, September 15, 2011
G47.33 Replaces 327.23 Under ICD-10-CM
When ICD-10 codes go into effect, similar functioning code in the I-10 G Suffix replaces 327.23.
In order to diagnose obstructive sleep apnea (OSA), an otolaryngologist will provide a complete inspection of the nose, mouth, throat, palate and neck, many a time using a fiberoptic scope. Right now, you would code 327.23 for patients suffering from OSA.
Difference in ICD-10 coding: So now under ICD-9-CM code set, when a patient gets diagnosed with obstructive sleep apnea, you will go for 327.23. However after a couple of years, when ICD-10 goes into effect, this code will become G47.33. This change to ICD-10 will not offer any difference. As a matter of fact, G47.33's descriptor is a carbon copy depiction of ICD-9's 327.23.
While diagnosing a sleep disorder such as OSA, a physician may have the patient fill up a questionnaire in order to obtain information on patterns of wake-sleep. That apart, she may also order blood tests to rule out other conditions. If the physician suspects a sleep disorder, the patient would most likely go through a polysomnography to record breathing and brain and muscle during sleep. Treatment will depend on the specific type of disorder, and if there's an underlying cause.
ICD-10 tips: One of the ways an otolaryngologist can lessen this potentially life-threatening condition is with genioglossus advancement. This procedure involves the surgeon creating a small bone window in front of the lower jaw, and then pulls the tendons that fix the front of the tongue to the jaw forward onto a bone fragment. This leads to a larger airway between the back of the tongue and the throat, and results in easier breathing for obstructive sleep apnea patients.
You would code mandibular segmental osteotomy with genioglossus advancement with 21199 when carried out to treat obstructive sleep apnea.
For more ICD-10 updates and ICD-10 guidelines, sign up for a good Medical coding resource.
In order to diagnose obstructive sleep apnea (OSA), an otolaryngologist will provide a complete inspection of the nose, mouth, throat, palate and neck, many a time using a fiberoptic scope. Right now, you would code 327.23 for patients suffering from OSA.
Difference in ICD-10 coding: So now under ICD-9-CM code set, when a patient gets diagnosed with obstructive sleep apnea, you will go for 327.23. However after a couple of years, when ICD-10 goes into effect, this code will become G47.33. This change to ICD-10 will not offer any difference. As a matter of fact, G47.33's descriptor is a carbon copy depiction of ICD-9's 327.23.
While diagnosing a sleep disorder such as OSA, a physician may have the patient fill up a questionnaire in order to obtain information on patterns of wake-sleep. That apart, she may also order blood tests to rule out other conditions. If the physician suspects a sleep disorder, the patient would most likely go through a polysomnography to record breathing and brain and muscle during sleep. Treatment will depend on the specific type of disorder, and if there's an underlying cause.
ICD-10 tips: One of the ways an otolaryngologist can lessen this potentially life-threatening condition is with genioglossus advancement. This procedure involves the surgeon creating a small bone window in front of the lower jaw, and then pulls the tendons that fix the front of the tongue to the jaw forward onto a bone fragment. This leads to a larger airway between the back of the tongue and the throat, and results in easier breathing for obstructive sleep apnea patients.
You would code mandibular segmental osteotomy with genioglossus advancement with 21199 when carried out to treat obstructive sleep apnea.
For more ICD-10 updates and ICD-10 guidelines, sign up for a good Medical coding resource.
Tuesday, September 13, 2011
ICD-10 Codes: Be Selective while Reporting G89 Category Codes
When ICD-10 goes into effect in a couple of years' time, you need to learn to apply G89 category as it is the key to getting your pain diagnoses right.
Important ICD-10 coding tip: You should be selective in reporting the codes from the G89 category codes. If the definitive diagnosis is established, these codes are never assigned. The only exception happens to be when the reason for the encounter is pain control and not the management of the underlying condition.
You need to combine G89 with site-specific pain codes
You can report the G89 category code along with codes that identify the site of pain; the two codes can be sequenced as per the circumstances.
One-to-one match for several pain codes
The soon to go into effect coding system has a one-to-one match for various pain codes in the current code set. Here are the choices you will have post October 1, 2013.
ICD-9's 338.18 corresponds to G89.18 in ICD-10. Likewise, 338.28 corresponds to G89.28 in ICD-10. In these pairs, there's a change from 'postoperative' to 'postprocedure'. G89.18 covers both postoperative pain NOS as well as postprocedural pain NOS. The inclusion of postprocedure pain acknowledges those circumstances where a procedure, say for instance lumbar puncture or other percutaneous treatment leads to acute or chronic pain.
You should include psychological factors
We know pain is an emotional experience. As such there may be an accompanying psychological component which you should not miss out on. F45.42 which corresponds to 307.89 in ICD-9 is ICD-10 code for the psychological factors. See to it that you have supporting documents for the psychological factors. you have Excludes 1 and Excludes 2 information under G89 and the bottom of the Excludes 2 information urges you to report F45.42 for psychological factors. If you make use of the index and take a look under pain, you'll find psychogenic pain that'll guide you to the code.
Note: You should also use the index and then check the tabular for the right code.
Important ICD-10 coding tip: You should be selective in reporting the codes from the G89 category codes. If the definitive diagnosis is established, these codes are never assigned. The only exception happens to be when the reason for the encounter is pain control and not the management of the underlying condition.
You need to combine G89 with site-specific pain codes
You can report the G89 category code along with codes that identify the site of pain; the two codes can be sequenced as per the circumstances.
One-to-one match for several pain codes
The soon to go into effect coding system has a one-to-one match for various pain codes in the current code set. Here are the choices you will have post October 1, 2013.
ICD-9's 338.18 corresponds to G89.18 in ICD-10. Likewise, 338.28 corresponds to G89.28 in ICD-10. In these pairs, there's a change from 'postoperative' to 'postprocedure'. G89.18 covers both postoperative pain NOS as well as postprocedural pain NOS. The inclusion of postprocedure pain acknowledges those circumstances where a procedure, say for instance lumbar puncture or other percutaneous treatment leads to acute or chronic pain.
You should include psychological factors
We know pain is an emotional experience. As such there may be an accompanying psychological component which you should not miss out on. F45.42 which corresponds to 307.89 in ICD-9 is ICD-10 code for the psychological factors. See to it that you have supporting documents for the psychological factors. you have Excludes 1 and Excludes 2 information under G89 and the bottom of the Excludes 2 information urges you to report F45.42 for psychological factors. If you make use of the index and take a look under pain, you'll find psychogenic pain that'll guide you to the code.
Note: You should also use the index and then check the tabular for the right code.
Medical Billing: Say No to Forms 4010/4010A1 for Electronic Transactions from January 1
In a few months from now, (From January 1, 2012), you will bid goodbye to forms 4010/4010A1 for electronic transactions as you will no longer need fully functional form 5010 to comply with HIPAA electronic transaction standards. You won't be able to submit electronic transactions to Medicare if you do not have your problems worked out by that date.
Gear up now
Version 5010 lays out the technical electronic standards mandated for HIPAA transactions that includes claims, eligibility inquiries, remittance advice and payment data using ICD-10.
The present version (4010/4010A1) doesn't accommodate the ICD-10 code set. That is why CMS will need version 5010 for use by all HIPAA-covered entities as of January 1, 2012.
The agency began accepting 5010 forms from January 1 this year and the agency will require the form as of January 1, 2012. The ICD-10 codes will take effect on October 1, 2013 allowing for 5010 testing and implementation time.
Here are some common 5010 pitfalls you need to stay alert to
Under the new 5010 standards, the place of service address can't be a P.O box, it has to be a street address. The claim will be rejected if it is not a street address. How you fix the problem is up to you. The vendor does not have control of the provider master list.
Upgrade your software now: Now is your chance to research form 5010 problems and see if you need a software upgrade while there is time.
You should correct patient information too: Dig into your claim forms now to see to it that the beneficiary's information is spot on to the letter or you will face lots of denied claims on the just-in HIPAA 5010 forms. This is because CMS will deny claims with a beneficiary's name that does not perfectly match how it is listed on the Medicare ID card. What's more, you need to be sure you include suffixes such as Jr or Sr abbreviations along with the patient's last name. Also, the date of birth you put on the claim form must match with what the Social Security Administration has on file.
The agency will use various new codes on claims once the 5010 form goes into effect. And if you use a clearinghouse, you should discuss with them how they will convey these mistakes to you and how these changes will affect your practice.
Gear up now
Version 5010 lays out the technical electronic standards mandated for HIPAA transactions that includes claims, eligibility inquiries, remittance advice and payment data using ICD-10.
The present version (4010/4010A1) doesn't accommodate the ICD-10 code set. That is why CMS will need version 5010 for use by all HIPAA-covered entities as of January 1, 2012.
The agency began accepting 5010 forms from January 1 this year and the agency will require the form as of January 1, 2012. The ICD-10 codes will take effect on October 1, 2013 allowing for 5010 testing and implementation time.
Here are some common 5010 pitfalls you need to stay alert to
Under the new 5010 standards, the place of service address can't be a P.O box, it has to be a street address. The claim will be rejected if it is not a street address. How you fix the problem is up to you. The vendor does not have control of the provider master list.
Upgrade your software now: Now is your chance to research form 5010 problems and see if you need a software upgrade while there is time.
You should correct patient information too: Dig into your claim forms now to see to it that the beneficiary's information is spot on to the letter or you will face lots of denied claims on the just-in HIPAA 5010 forms. This is because CMS will deny claims with a beneficiary's name that does not perfectly match how it is listed on the Medicare ID card. What's more, you need to be sure you include suffixes such as Jr or Sr abbreviations along with the patient's last name. Also, the date of birth you put on the claim form must match with what the Social Security Administration has on file.
The agency will use various new codes on claims once the 5010 form goes into effect. And if you use a clearinghouse, you should discuss with them how they will convey these mistakes to you and how these changes will affect your practice.
Thursday, August 25, 2011
Medical Billing & Coding: Hardware is a Vital Cog in 5010 & ICD-10 Implementations
From January 1 next year, your practice will have to make the required changes or enhancements to your practice management system, EMR system and/or medical billing and coding. Keeping this in mind, you need to work with your vendors to ensure your healthcare billing and practice management systems are up and running for the conversions to 5010 and ICD-10.
Communication with vendors a vital cog
It's very important that you get in touch with outside vendors to ensure the success of your practice's transition to version 5010 and ICD-10.
One more key to success is to test early and that too often
You should make it a point to test transactions and claim submissions with your vendor, clearing house and payer prior to the 5010 version deadline next year and the ICD-10 deadline in 2013. This step is very important for you to make a smooth transition.
Don't wait too late to test as your task will be tougher if you detect a flaw in your system in the last minute.
How to go about it: Get in touch with your software vendors well ahead of time to ensure that no issues will be there as far as claims submissions using ICD-10 are concerned. First you need to find out whether your vendors are all geared up for the transition to the just-in 5010 format.
Hardware requirements for your practice
Hardware is a vital peg for the 5010 and ICD-10 implementations. As such you need to assess the hardware your practice or vendor use. Find out the present age of your practice's hardware, the dual-processing capability for the two code sets (ICD-9 and ICD-10), storage capacity, processing power, and the like.
Also, you will need to see to it that your system is able to handle alphanumeric codes, seven characters, code descriptions which are long, just-in edits based on age, sex, and more, separate data entry programs for dual processing.
Your system is very important to be able to process both the soon-to-go ICD-9 code set and the soon-to-come ICD-10 code set concurrently to allow for claims processing, reporting and analysis.
The time required for maintaining both ICD-9 and ICD-10 will depend on your individual practice's requirement.
Source URL :- http://www.supercoder.com/icd-10/icd-10-bridge
You also need to see that your practice or vendor has a hardware that can handle the increased file and database storage you will need when the new code system goes into effect.
Communication with vendors a vital cog
It's very important that you get in touch with outside vendors to ensure the success of your practice's transition to version 5010 and ICD-10.
One more key to success is to test early and that too often
You should make it a point to test transactions and claim submissions with your vendor, clearing house and payer prior to the 5010 version deadline next year and the ICD-10 deadline in 2013. This step is very important for you to make a smooth transition.
Don't wait too late to test as your task will be tougher if you detect a flaw in your system in the last minute.
How to go about it: Get in touch with your software vendors well ahead of time to ensure that no issues will be there as far as claims submissions using ICD-10 are concerned. First you need to find out whether your vendors are all geared up for the transition to the just-in 5010 format.
Hardware requirements for your practice
Hardware is a vital peg for the 5010 and ICD-10 implementations. As such you need to assess the hardware your practice or vendor use. Find out the present age of your practice's hardware, the dual-processing capability for the two code sets (ICD-9 and ICD-10), storage capacity, processing power, and the like.
Also, you will need to see to it that your system is able to handle alphanumeric codes, seven characters, code descriptions which are long, just-in edits based on age, sex, and more, separate data entry programs for dual processing.
Your system is very important to be able to process both the soon-to-go ICD-9 code set and the soon-to-come ICD-10 code set concurrently to allow for claims processing, reporting and analysis.
The time required for maintaining both ICD-9 and ICD-10 will depend on your individual practice's requirement.
Source URL :- http://www.supercoder.com/icd-10/icd-10-bridge
You also need to see that your practice or vendor has a hardware that can handle the increased file and database storage you will need when the new code system goes into effect.
Friday, August 19, 2011
ICD-10 Updates: Report ‘Other’ and ‘Unspecified’ Hyperlipidemia Separately
ICD-10 offers a one-to-one code match with the previous code set for pure hypercholesterolemia, pure hyperglyceridemia, and mixed hyperlipidemia. Read on for a comparative study of how coding for the two code sets will affect you.
When ICD-10 goes into effect on October 1, 2013, there are good chances that high cholesterol will still be a hurdle for your patients. Take a look at how coding for this and similar diagnoses compares between the two code sets (ICD-9 and ICD-10).
ICD-9-CM codes include 272.0, 272.1, 272.2 and 272.4 while soon to go into effect ICD-10-CM codes include E78.0, E78.1, E78.2, E78.4, and E78.5.
ICD-10 coding changes
ICD-10 offers a one-to-one code match with ICD-9 for pure hypercholesterolemia (272.0, E78.0), pure hyperglyceridemia (272.1, E78.1), and mixed hyperlipidemia (272.2, E78.2). However where ICD-9 code offers one code for 'other and unspecified hyperlipidemia" (272.4), ICD-10 offers one code for 'other' E78.4) and a different code for “unspecified" (E78.5).
Don't change your clinicians' documentation from its present form
When it comes to clinicians' documentation you should not change it from its present form. All that you need to do as a coder to capture this already existing information is to format your superbill to capture the difference between 'other' and 'unspecified' hyperlipidemia. By 'others' it means the physician documented the type; however the new code set does not offer a code specific to the documented type. By 'Unspecified' it means that the physician didn't document the type of hyperlipidemia.
Differences between ICD-9 and ICD-10 codes for lipid metabolism disorders
Although the notes with the ICD-9 and ICD-10 codes for lipid metabolism disorders are very similar, there are a few differences though.
Example: Say for instance while 272.1 includes “hypertriglyceridemia, essential," E78.1 includes “elevated fasting triglycerides." Under E78.2, ICD-10 adds 'combined hyperlipidemia NOS', elevated cholesterol with elevated triglycerides NEC and “Hyperlipidemia, group C. Code E78.2 also has an Excludes1 note, asking you to code E78.4 for “familial combined hyperlipidemia" and E78.5 for “cerebrotendinous cholesterosis".
Bear in mind: When the new code system goes into effect on October 1, 2013, you should apply the code set and official guidelines in effect for the date of service (DOS) reported. (You can get more information here www.cdc.gov/nchs/icd/icd10cm.htm#10update.).
When ICD-10 goes into effect on October 1, 2013, there are good chances that high cholesterol will still be a hurdle for your patients. Take a look at how coding for this and similar diagnoses compares between the two code sets (ICD-9 and ICD-10).
ICD-9-CM codes include 272.0, 272.1, 272.2 and 272.4 while soon to go into effect ICD-10-CM codes include E78.0, E78.1, E78.2, E78.4, and E78.5.
ICD-10 coding changes
ICD-10 offers a one-to-one code match with ICD-9 for pure hypercholesterolemia (272.0, E78.0), pure hyperglyceridemia (272.1, E78.1), and mixed hyperlipidemia (272.2, E78.2). However where ICD-9 code offers one code for 'other and unspecified hyperlipidemia" (272.4), ICD-10 offers one code for 'other' E78.4) and a different code for “unspecified" (E78.5).
Don't change your clinicians' documentation from its present form
When it comes to clinicians' documentation you should not change it from its present form. All that you need to do as a coder to capture this already existing information is to format your superbill to capture the difference between 'other' and 'unspecified' hyperlipidemia. By 'others' it means the physician documented the type; however the new code set does not offer a code specific to the documented type. By 'Unspecified' it means that the physician didn't document the type of hyperlipidemia.
Differences between ICD-9 and ICD-10 codes for lipid metabolism disorders
Although the notes with the ICD-9 and ICD-10 codes for lipid metabolism disorders are very similar, there are a few differences though.
Example: Say for instance while 272.1 includes “hypertriglyceridemia, essential," E78.1 includes “elevated fasting triglycerides." Under E78.2, ICD-10 adds 'combined hyperlipidemia NOS', elevated cholesterol with elevated triglycerides NEC and “Hyperlipidemia, group C. Code E78.2 also has an Excludes1 note, asking you to code E78.4 for “familial combined hyperlipidemia" and E78.5 for “cerebrotendinous cholesterosis".
Bear in mind: When the new code system goes into effect on October 1, 2013, you should apply the code set and official guidelines in effect for the date of service (DOS) reported. (You can get more information here www.cdc.gov/nchs/icd/icd10cm.htm#10update.).
Thursday, August 11, 2011
ICD-10 Updates: Combination Code for Coronary Atherosclerosis With Angina Pectoris
In a couple of years' time, when you start using ICD-10 codes, watch out for a combination code that covers more than one diagnosis.
For the uninitiated, atherosclerosis is a type of arteriosclerosis characterized by fatty plague deposits that restricts the blood flow through the arteries. Angina pectoris refers to chest pain or discomfort caused by coronary heart disease.
When you report coronary arteriosclerosis in ICD-10-CM, you will notice some differences from the present ICD-9-CM coding. As already mentioned, when you hop into the ICD-10 bandwagon, you should be ready for a combination code that covers more than one diagnosis:
ICD-10 combines your coding for native coronary atherosclerosis and angina pectoris.
Under ICD-9-CM, you use 414.01, coronary atherosclerosis of native coronary artery
Under ICD-10-CM , you will use I25.10, I25.110, I25.111, I25.118, and I25.119.
So what's different between the two code sets: The main change ICD-10 will bring is that they differ based on 'without' (I25.10) and "with" (I25.11-) angina pectoris.
ICD-10 rules, just like its predecessor ICD-9, indicate you should report an additional code (I25.82) if the patient also suffers from chronic total occlusion of a coronary artery. To add to it, if the patient has coronary atherosclerosis because of lipid rich plague, you should go for I25.83. For codes in the range for ischemic heart diseases (I20- I25), you should go for an additional code to identify presence of hypertension (I10-I15).
Clinicians should know that the presence of angina pectoris will alter your native coronary artery disease coding. While documenting, they should be specific about whether the angina pectoris is unstable, with documented spasm or for that matter another form. Documentation should also point to whether the patient has chronic hypertension, total coronary occlusion, and/or coronary atherosclerosis caused by lipid rich plaque.
Tips for coders: Modify coding tools; bear in mind that ICD-10 offers a combination code for coronary atherosclerosis with angina pectoris.
Source Code :- http://www.supercoder.com
For the uninitiated, atherosclerosis is a type of arteriosclerosis characterized by fatty plague deposits that restricts the blood flow through the arteries. Angina pectoris refers to chest pain or discomfort caused by coronary heart disease.
When you report coronary arteriosclerosis in ICD-10-CM, you will notice some differences from the present ICD-9-CM coding. As already mentioned, when you hop into the ICD-10 bandwagon, you should be ready for a combination code that covers more than one diagnosis:
ICD-10 combines your coding for native coronary atherosclerosis and angina pectoris.
Under ICD-9-CM, you use 414.01, coronary atherosclerosis of native coronary artery
Under ICD-10-CM , you will use I25.10, I25.110, I25.111, I25.118, and I25.119.
So what's different between the two code sets: The main change ICD-10 will bring is that they differ based on 'without' (I25.10) and "with" (I25.11-) angina pectoris.
ICD-10 rules, just like its predecessor ICD-9, indicate you should report an additional code (I25.82) if the patient also suffers from chronic total occlusion of a coronary artery. To add to it, if the patient has coronary atherosclerosis because of lipid rich plague, you should go for I25.83. For codes in the range for ischemic heart diseases (I20- I25), you should go for an additional code to identify presence of hypertension (I10-I15).
Clinicians should know that the presence of angina pectoris will alter your native coronary artery disease coding. While documenting, they should be specific about whether the angina pectoris is unstable, with documented spasm or for that matter another form. Documentation should also point to whether the patient has chronic hypertension, total coronary occlusion, and/or coronary atherosclerosis caused by lipid rich plaque.
Tips for coders: Modify coding tools; bear in mind that ICD-10 offers a combination code for coronary atherosclerosis with angina pectoris.
Source Code :- http://www.supercoder.com
Wednesday, August 3, 2011
Under ICD-10-CM, Obstructive Sleep Apnea Gets a New Code - G47.33
As the October 1, 2013 ICD-10 deadline approaches, it's very important that you have a sound ICD-10 coding know how. If you are an otolaryngology coder, here are some ICD-10 guidelines that'll stand you in good stead.
Obstructive sleep apnea: Snoring, restless sleep, etc are manifestations of sleep-disordered breathing. The main disorders that may need surgical intervention are snoring and obstructive sleep apnea (OSA). In obstructive sleep apnea, pauses in breathing (more than 10 seconds at a time) take place because the airway becomes narrowed, blocked or floppy. This disorder may differ in severity and is normally associated with other physiologic problems.
Ways to diagnose OSA? An otolaryngologist will provide a thorough examination of the nose, mouth, throat, palate, and neck, many a time using a fiberoptic scope. Under ICD-9-CM code set, if the patient was diagnosed with obstructive sleep apnea, you would go for 327.23 (obstructive sleep apnea –adult – pediatric).
Transition from ICD-9 to ICD-10 codes : However, after the transition to ICD-10 on October 1, 2013, you would not report 327.23 for OSA as 327.23 becomes G47.33. This change will offer no difference; as a matter of fact, the descriptor of the new code is a carbon copy depiction of the previous code set's 327.23.
Documentation: While diagnosing a sleep disorder like obstructive sleep apnea, a physician may have the patient fill out a questionnaire to get information on wake-sleep patterns. Blood tests may also be ordered to rule out other conditions. If the physician suspects a sleep disorder, the patient would most probably undergo a polysomnography to record breathing and brain and muscle during sleep. Depending on the specific type of disorder, treatment will be provided.
Obstructive sleep apnea: Snoring, restless sleep, etc are manifestations of sleep-disordered breathing. The main disorders that may need surgical intervention are snoring and obstructive sleep apnea (OSA). In obstructive sleep apnea, pauses in breathing (more than 10 seconds at a time) take place because the airway becomes narrowed, blocked or floppy. This disorder may differ in severity and is normally associated with other physiologic problems.
Ways to diagnose OSA? An otolaryngologist will provide a thorough examination of the nose, mouth, throat, palate, and neck, many a time using a fiberoptic scope. Under ICD-9-CM code set, if the patient was diagnosed with obstructive sleep apnea, you would go for 327.23 (obstructive sleep apnea –adult – pediatric).
Transition from ICD-9 to ICD-10 codes : However, after the transition to ICD-10 on October 1, 2013, you would not report 327.23 for OSA as 327.23 becomes G47.33. This change will offer no difference; as a matter of fact, the descriptor of the new code is a carbon copy depiction of the previous code set's 327.23.
Documentation: While diagnosing a sleep disorder like obstructive sleep apnea, a physician may have the patient fill out a questionnaire to get information on wake-sleep patterns. Blood tests may also be ordered to rule out other conditions. If the physician suspects a sleep disorder, the patient would most probably undergo a polysomnography to record breathing and brain and muscle during sleep. Depending on the specific type of disorder, treatment will be provided.
Monday, July 25, 2011
ICD-10 Preparation: Not Planning to Transition to ICD-10 as of Oct. 1, 2013? You Might Be Liable to Face Millions in Fines, CMS Reps Say
Plus: CMS officials are considering how to handle dates of service that span the pre- and post-ICD-10 implementation dates.
If you think the ICD-10 codes won't apply to your Medicare claims as of Oct. 1, 2013, CMS has news for you—not only will your claims be denied if you continue to submit ICD-9 codes to Medicare after that date, but you could face fines. CMS representatives shed light on this and several other issues during the agency's May 18 "ICD-10 National Provider Teleconference," and we've broken down the five FAQs that best apply to Part B practices.
Question 1: How will CMS handle claims that span from before Oct. 1, 2013 through dates after Oct. 1, 2013? Should the practitioner use ICD-9 or ICD-10 codes for these claims?
Answer: CMS is mulling how to handle this situation, but hasn't yet arrived at a firm decision. "We are getting very close to finalizing our decision for all claim types, including professional claims, supplier claims, and the various types of institutional claims," said CMS's Sarah Shirey-Losso during the call. "Some claims will continue to use the discharge date, some will use the ‘from' date, and some may be required to be split," she said.
Stay tuned: CMS is currently working on a final decision, which the agency will issue in a "Change Request" document this summer.
Date of service issue: If, however, you submit a claim for a single date of service, you'll submit ICD-9 codes for dates of service through Sept. 30, 2013, and ICD-10 codes for dates of service Oct. 1, 2013 and thereafter. For instance: If you send in a claim on Oct. 15, 2013, but the date of service is Sept. 1, 2013, you'll still use ICD-9 codes.
Question 2: Will workers' compensation insurers still use ICD-9, even after the rest of the industry transitions to ICD-10 after Oct. 1, 2013?
Answer: The answer to that is unclear, but CMS has heard murmurs that workers' comp. insurers will switch over to ICD-10.
"We've heard anecdotally that even though they're not required to transition to ICD-10, that many of them are planning to, just because it's more practical to do so and they see that it's the way the rest of the industry is going," said CMS's Denise Buenning, MsM, during the call.
Article Source :- http://www.supercoder.com/coding-newsletters/my-part-b-coding-alert/icd-10-preparation-not-planning-to-transition-to-icd-10-as-of-oct-1-2013-you-might-be-liable-to-face-millions-in-fines-cms-reps-say-106761-article
If you think the ICD-10 codes won't apply to your Medicare claims as of Oct. 1, 2013, CMS has news for you—not only will your claims be denied if you continue to submit ICD-9 codes to Medicare after that date, but you could face fines. CMS representatives shed light on this and several other issues during the agency's May 18 "ICD-10 National Provider Teleconference," and we've broken down the five FAQs that best apply to Part B practices.
Question 1: How will CMS handle claims that span from before Oct. 1, 2013 through dates after Oct. 1, 2013? Should the practitioner use ICD-9 or ICD-10 codes for these claims?
Answer: CMS is mulling how to handle this situation, but hasn't yet arrived at a firm decision. "We are getting very close to finalizing our decision for all claim types, including professional claims, supplier claims, and the various types of institutional claims," said CMS's Sarah Shirey-Losso during the call. "Some claims will continue to use the discharge date, some will use the ‘from' date, and some may be required to be split," she said.
Stay tuned: CMS is currently working on a final decision, which the agency will issue in a "Change Request" document this summer.
Date of service issue: If, however, you submit a claim for a single date of service, you'll submit ICD-9 codes for dates of service through Sept. 30, 2013, and ICD-10 codes for dates of service Oct. 1, 2013 and thereafter. For instance: If you send in a claim on Oct. 15, 2013, but the date of service is Sept. 1, 2013, you'll still use ICD-9 codes.
Question 2: Will workers' compensation insurers still use ICD-9, even after the rest of the industry transitions to ICD-10 after Oct. 1, 2013?
Answer: The answer to that is unclear, but CMS has heard murmurs that workers' comp. insurers will switch over to ICD-10.
"We've heard anecdotally that even though they're not required to transition to ICD-10, that many of them are planning to, just because it's more practical to do so and they see that it's the way the rest of the industry is going," said CMS's Denise Buenning, MsM, during the call.
Article Source :- http://www.supercoder.com/coding-newsletters/my-part-b-coding-alert/icd-10-preparation-not-planning-to-transition-to-icd-10-as-of-oct-1-2013-you-might-be-liable-to-face-millions-in-fines-cms-reps-say-106761-article
Tuesday, July 19, 2011
5010 Version: Don't List Your Practice's Place of Service as A P.O Box
If you do so, your claims will be denied straightaway.
As we approach the transition deadline for ICD-10 code set and version 5010, there are many out there who are still figuring out how to take the plunge. CMS, as we all are aware, will want you to be using form 5010 from January 1 next year. You need to start double-checking your system's provider information and claim forms to see to it that address fields are 5010-form ready.
One important thing you need to keep in mind while making the transition is staying away from confusions created by your P.O box.
As we approach the transition deadline for ICD-10 code set and version 5010, there are many out there who are still figuring out how to take the plunge. CMS, as we all are aware, will want you to be using form 5010 from January 1 next year. You need to start double-checking your system's provider information and claim forms to see to it that address fields are 5010-form ready.
One important thing you need to keep in mind while making the transition is staying away from confusions created by your P.O box.
And those practices that maintain lockboxes with P.O box addresses, however who do not have the ability to fill in two different fields will either have to give up their lockboxes so the claim won't be denied; or use the lockbox address and face claim denials. They will alternatively have to get a software update or upgrade so they can have two fields for the separate addresses. For More Information :- http://www.supercoder.com
ICD-10 Prep: Get to Know How Eye Infection, Strep Diagnoses Will Change in 2013
Hint: Your diagnosis coding will depend on which eye was infected once ICD-10 hits.
When ICD-9 becomes ICD-10 in 2013, you'll have to be prepared for changes across the board when it comes to diagnosis coding. Often, you'll have more options that may require tweaking the way you document services and a coder reports it. Check out the following examples of how ICD-10 will change your coding options when the calendar turns to Oct. 1, 2013.
Nail Down These Upcoming Eye Infection Coding Changes
Conjunctivitis is an eye infection that can affect patients of all ages, and your practice is probably familiar with the signs and symptoms of this condition. But, like all other conditions, conjunctivitis will fall under new codes under ICD-10.
You currently have several coding options for conjunctivitis, depending on the type of condition that the physician treats. The following is a sampling of ICD-9 codes that most practices use:
When ICD-9 becomes ICD-10 in 2013, you'll have to be prepared for changes across the board when it comes to diagnosis coding. Often, you'll have more options that may require tweaking the way you document services and a coder reports it. Check out the following examples of how ICD-10 will change your coding options when the calendar turns to Oct. 1, 2013.
Nail Down These Upcoming Eye Infection Coding Changes
Conjunctivitis is an eye infection that can affect patients of all ages, and your practice is probably familiar with the signs and symptoms of this condition. But, like all other conditions, conjunctivitis will fall under new codes under ICD-10.
You currently have several coding options for conjunctivitis, depending on the type of condition that the physician treats. The following is a sampling of ICD-9 codes that most practices use:
ICD-10 Changes: Under ICD-10, you'll have to not only denote the specific type of conjunctivitis by using the accurate diagnosis code, but you'll also have to indicate which eye was affected. The following is a sampling of ICD-10 codes that will affect pediatricians under the new coding system.
The "x" designations above show where you'll input an additional digit to denote the affected eye. As shown in the H10.10-H10.13 range above, you will have options for the left eye, right eye, bilateral, or unspecified in most categories under ICD-10.
Article Source :- http://www.supercoder.com/coding-newsletters/my-part-b-coding-alert/icd-10-prep-get-to-know-how-eye-infection-strep-diagnoses-will-change-in-2013-article
Tuesday, June 28, 2011
ICD-10 Preparation: Not Planning to Transition to ICD-10 as of Oct. 1, 2013? You Might Be Liable to Face Millions in Fines, CMS Reps Say
Plus: CMS officials are considering how to handle dates of service that span the pre- and post-ICD-10 implementation dates.
If you think the ICD-10 codes won't apply to your Medicare claims as of Oct. 1, 2013, CMS has news for you--not only will your claims be denied if you continue to submit ICD-9 codes to Medicare after that date, but you could face fines. CMS representatives shed light on this and several other issues during the agency's May 18 "ICD-10 National Provider Teleconference," and we've broken down the five FAQs that best apply to Part B practices.
Question 1: How will CMS handle claims that span from before Oct. 1, 2013 through dates after Oct. 1, 2013? Should the practitioner use ICD-9 or ICD-10 codes for these claims?
Answer: CMS is mulling how to handle this situation, but hasn't yet arrived at a firm decision. "We are getting very close to finalizing our decision for all claim types, including professional claims, supplier claims, and the various types of institutional claims," said CMS's Sarah Shirey-Losso during the call. "Some claims will continue to use the discharge date, some will use the ‘from' date, and some may be required to be split," she said.
Stay tuned: CMS is currently working on a final decision, which the agency will issue in a "Change Request" document this summer.
Date of service issue: If, however, you submit a claim for a single date of service, you'll submit ICD-9 codes for dates of service through Sept. 30, 2013, and ICD-10 codes for dates of service Oct. 1, 2013 and thereafter. For instance: If you send in a claim on Oct. 15, 2013, but the date of service is Sept. 1, 2013, you'll still use ICD-9 codes.
Question 2: Will workers' compensation insurers still use ICD-9, even after the rest of the industry transitions to ICD-10 after Oct. 1, 2013?
Answer: The answer to that is unclear, but CMS has heard murmurs that workers' comp. insurers will switch over to ICD-10.
"We've heard anecdotally that even though they're not required to transition to ICD-10, that many of them are planning to, just because it's more practical to do so and they see that it's the way the rest of the industry is going," said CMS's Denise Buenning, MsM, during the call.
What about Medicaid? You can rest assured that Medicaid insurers will be transitioning to ICD-10 as of the Oct. 1, 2013 date, Buenning said. CMS is working with Medicaid administrators to ensure that they are compliant by the implementation date, she noted.
Article Source :- http://www.supercoder.com/coding-newsletters/my-part-b-coding-alert/icd-10-preparation-not-planning-to-transition-to-icd-10-as-of-oct-1-2013-you-might-be-liable-to-face-millions-in-fines-cms-reps-say-106761-article
If you think the ICD-10 codes won't apply to your Medicare claims as of Oct. 1, 2013, CMS has news for you--not only will your claims be denied if you continue to submit ICD-9 codes to Medicare after that date, but you could face fines. CMS representatives shed light on this and several other issues during the agency's May 18 "ICD-10 National Provider Teleconference," and we've broken down the five FAQs that best apply to Part B practices.
Question 1: How will CMS handle claims that span from before Oct. 1, 2013 through dates after Oct. 1, 2013? Should the practitioner use ICD-9 or ICD-10 codes for these claims?
Answer: CMS is mulling how to handle this situation, but hasn't yet arrived at a firm decision. "We are getting very close to finalizing our decision for all claim types, including professional claims, supplier claims, and the various types of institutional claims," said CMS's Sarah Shirey-Losso during the call. "Some claims will continue to use the discharge date, some will use the ‘from' date, and some may be required to be split," she said.
Stay tuned: CMS is currently working on a final decision, which the agency will issue in a "Change Request" document this summer.
Date of service issue: If, however, you submit a claim for a single date of service, you'll submit ICD-9 codes for dates of service through Sept. 30, 2013, and ICD-10 codes for dates of service Oct. 1, 2013 and thereafter. For instance: If you send in a claim on Oct. 15, 2013, but the date of service is Sept. 1, 2013, you'll still use ICD-9 codes.
Question 2: Will workers' compensation insurers still use ICD-9, even after the rest of the industry transitions to ICD-10 after Oct. 1, 2013?
Answer: The answer to that is unclear, but CMS has heard murmurs that workers' comp. insurers will switch over to ICD-10.
"We've heard anecdotally that even though they're not required to transition to ICD-10, that many of them are planning to, just because it's more practical to do so and they see that it's the way the rest of the industry is going," said CMS's Denise Buenning, MsM, during the call.
What about Medicaid? You can rest assured that Medicaid insurers will be transitioning to ICD-10 as of the Oct. 1, 2013 date, Buenning said. CMS is working with Medicaid administrators to ensure that they are compliant by the implementation date, she noted.
Article Source :- http://www.supercoder.com/coding-newsletters/my-part-b-coding-alert/icd-10-preparation-not-planning-to-transition-to-icd-10-as-of-oct-1-2013-you-might-be-liable-to-face-millions-in-fines-cms-reps-say-106761-article
Friday, April 15, 2011
How Lyme disease, ear pain diagnosis will change in 2013
Suggestion: Your diagnosis coding will depend on which ear was affected once ICD-10 hits. Since CMS has reiterated that it'll not push back the deadlines for the conversion to ICD-10, you will need to have your ICD-10 coding skills ready by October 1, 2013. Here are some examples of how ICD-10 will change your coding choices for two common conditions. Lyme disease Dx will need thorough documentation of attributable conditions
Right now, if a patient is confirmed to have Lyme disease, you report code 088.81 (Lyme disease). ICD-10 changes: With effect from October 1, 2013, you will find that the Lyme disease diagnosis codes have been expanded to include symptoms due to confirmed cases of Lyme disease, as below:
A69.20 (Lyme disease, unspecified)
A69.21 (Meningitis due to Lyme disease)
A69.22 (Other neurologic disorders in Lyme disease)
A69.23 (Arthritis due to Lyme disease)
A69.29 (Other conditions associated with Lyme disease) Documentation: Your doctor will need to clearly note whether the patient has Lyme disease alone (A69.20) or Lyme disease with other contributing factors (A69.21- A69.22). For example, you cannot use A69.21 unless the documentation includes confirmation that the patient ails from meningitis as well as Lyme disease, and that the two conditions are related. You shouldn't report the Lyme disease diagnosis code unless your practice gets confirmation from a lab test indicating that the patient tested positive for a Lyme disease. If you do not have a positive lab test confirming strep throat, you should simply use the diagnosis codes for the symptoms. As such, your documentation must include a copy of the laboratory report confirming that the patient had Lyme disease before you select your diagnosis code. ICD-10 coding tips: teach your practitioners about the just-in ICD-10 codes and let them know that documentation must indicate which specific Lyme disease diagnosis the patient has. Otalgia will need identification of affected ear To put it simply, otalgia refers to an ear ache. Part B practices often report otalgia diagnoses when patients complain of ear pain however no more definitive diagnosis is found. Presently, the ICD-9 manual offers just one code for unspecified otalgia: 388.70 (Otalgia, unspecified). ICD-10 coding changes: From October 1, 2013, you will be dealing with a series of four codes that describe otalgia, organized according to the location of the diagnosis, as here: Documentation: Doctors should already include the affected ear in their documentation. All you require to do as a coder to capture this already present information is to format your superbill to see to it that physicians document the additional anatomical information. Tips: You can arrange your superbill in a way that ensures that the physician documents all information applicable for you to submit the most proper code. For example, you can print it like this: H92.0x (x=1 for right ear, x=2 for left ear, x=3 for bilateral, and x=9 for unspecified ear) Or you can simply list "H92.0x" and have the doctor circle "left ear," "right ear," or "bilateral" on the form.
Article Source :- http://www.supercoder.com/coding-newsletters/my-part-b-coding-alert/icd-10-preparation-get-to-know-how-lyme-disease-ear-pain-diagnoses-will-change-in-2013-article
Article Source :- http://www.supercoder.com/coding-newsletters/my-part-b-coding-alert/icd-10-preparation-get-to-know-how-lyme-disease-ear-pain-diagnoses-will-change-in-2013-article
Tuesday, March 15, 2011
Coding and Compliance Pitfalls: Stay Away From These Deadly Myths
Here are some common myths in the medical industry that you and your staff need to stay clear from.
Myth one: You need to bill the same amount to everyone
The fact is, you cannot bill your Medicare patients more than you do all your other patients. If your practice maintains various fee schedules (Source "http://www.supercoder.com/coding-tools/fee-schedules"), the government payers should be the lowest-priced among the group.
But then as long as you're following a contract or have consistent non-discriminatory billing policies in writing, billing may differ within your practice. But then, practically speaking, you should keep your billing policies consistent to stay away from accusations or discrimination.
Myth two: You have to send three bills before you write something off
Well, you have to make a reasonable attempt at gathering the co-pay, deductible, and when applicable, the balance of the bill; however that does not necessarily mean sending three bills.
Waiving deductibles and copayments regularly can violate several federal laws and regulations, including the Federal False Claims Act, anti-kickback statutes, and compliance guidelines for individual and small group physician practices. In the Federal False Claims Act, the OIG identifies three criteria that can end up in a violation: The waivers are routine, the waiver is given without regard to the individual's financial hardship, and the provider fails to pass on to the payer its proportional share of the discount.
Be careful: OIG regulations are not your only concern as far as collecting copays is concerned. Take a look at your payer contracts as well. Many contracts require that copays are collected during the time of service. A provider can lose participating status if they fail to toe the guidelines.
One reason you may be able to write off a patient's copay, deductible or balance is if the patient meets the criteria of financial hardship. In order for your practice to accept financial hardship as terms for a debt-off, the patient needs to be able to prove he's unable to pay. In case you cannot establish financial hardship, CMS requires that you make a reasonable endeavor to collect money from a patient. This might comprise sending three bills, followed by two phone calls, and a final notice. That cycle is at your practice's discretion. If you cannot collect it ultimately, be sure to document your efforts.
Myth three: You can bill only a single diagnosis code per claim
Well, you should bill as many diagnosis codes as you need to establish medical necessity for the services you are billing. Some payers' computer systems used to be able to read only one diagnosis code per line. However, now you should always be able to report all relevant diagnoses for each visit, and link the proper diagnoses to each service on each line.
This will become important when ICD-10 codes go into effect in 2013 at which point diagnosis coding will expand considerably.
Myth Four: E/M codes are assigned only by the level of medical decision-making (MDM).
Medical decision-making (MDM) is only one of three important components, depending on the category of the code. However you should always think about the nature of the patient's presenting problem when figuring out which code is most accurate.
Myth Five: If you are a Medicaid provider, you have to accept all Medicaid patients partly state-funded and state-designed, it's hard to give a general rule. Many states will allow some flexibility allowing you to limit new admits to your patient mix.
Some states may allow you to limit the number of Medicaid patients that you see. Most Medicaids recognize that you can go broke minus the ability to keep a viable patient mix.
Check with your state: If you are not clear regarding whether your state allows limitation of Medicaid patients, get in touch with your state's Department of Health and Human Services rather than contacting your payer.
Myth six: Medicare HMOs have to toe the same rules as Medicare
Medicare HMOs have a set of guidelines that they must follow; what's more, they've to cover everything Medicare would cover. However, they can also opt to cover other things, and they can require referrals, authorizations, and other things that Medicare would not need.
Myth seven: Secondary insurance always pays what Medicare does not
Well, secondary insurance is more likely to pick up what Medicare does not pay. However, secondary insurance does not have to pay for everything that Medicare does not. Oftentimes, secondary payers will only pay up to a certain amount and if Medicare has already shelled out that amount, they will not pay any more. Supplemental insurance will only pay Medicare's copays and deductibles, not everything else Medicare does not reimburse.
The fact is, you cannot bill your Medicare patients more than you do all your other patients. If your practice maintains various fee schedules (Source "http://www.supercoder.com/coding-tools/fee-schedules"), the government payers should be the lowest-priced among the group.
But then as long as you're following a contract or have consistent non-discriminatory billing policies in writing, billing may differ within your practice. But then, practically speaking, you should keep your billing policies consistent to stay away from accusations or discrimination.
Myth two: You have to send three bills before you write something off
Well, you have to make a reasonable attempt at gathering the co-pay, deductible, and when applicable, the balance of the bill; however that does not necessarily mean sending three bills.
Waiving deductibles and copayments regularly can violate several federal laws and regulations, including the Federal False Claims Act, anti-kickback statutes, and compliance guidelines for individual and small group physician practices. In the Federal False Claims Act, the OIG identifies three criteria that can end up in a violation: The waivers are routine, the waiver is given without regard to the individual's financial hardship, and the provider fails to pass on to the payer its proportional share of the discount.
Be careful: OIG regulations are not your only concern as far as collecting copays is concerned. Take a look at your payer contracts as well. Many contracts require that copays are collected during the time of service. A provider can lose participating status if they fail to toe the guidelines.
One reason you may be able to write off a patient's copay, deductible or balance is if the patient meets the criteria of financial hardship. In order for your practice to accept financial hardship as terms for a debt-off, the patient needs to be able to prove he's unable to pay. In case you cannot establish financial hardship, CMS requires that you make a reasonable endeavor to collect money from a patient. This might comprise sending three bills, followed by two phone calls, and a final notice. That cycle is at your practice's discretion. If you cannot collect it ultimately, be sure to document your efforts.
Myth three: You can bill only a single diagnosis code per claim
Well, you should bill as many diagnosis codes as you need to establish medical necessity for the services you are billing. Some payers' computer systems used to be able to read only one diagnosis code per line. However, now you should always be able to report all relevant diagnoses for each visit, and link the proper diagnoses to each service on each line.
This will become important when ICD-10 codes go into effect in 2013 at which point diagnosis coding will expand considerably.
Myth Four: E/M codes are assigned only by the level of medical decision-making (MDM).
Medical decision-making (MDM) is only one of three important components, depending on the category of the code. However you should always think about the nature of the patient's presenting problem when figuring out which code is most accurate.
Myth Five: If you are a Medicaid provider, you have to accept all Medicaid patients partly state-funded and state-designed, it's hard to give a general rule. Many states will allow some flexibility allowing you to limit new admits to your patient mix.
Some states may allow you to limit the number of Medicaid patients that you see. Most Medicaids recognize that you can go broke minus the ability to keep a viable patient mix.
Check with your state: If you are not clear regarding whether your state allows limitation of Medicaid patients, get in touch with your state's Department of Health and Human Services rather than contacting your payer.
Myth six: Medicare HMOs have to toe the same rules as Medicare
Medicare HMOs have a set of guidelines that they must follow; what's more, they've to cover everything Medicare would cover. However, they can also opt to cover other things, and they can require referrals, authorizations, and other things that Medicare would not need.
Myth seven: Secondary insurance always pays what Medicare does not
Well, secondary insurance is more likely to pick up what Medicare does not pay. However, secondary insurance does not have to pay for everything that Medicare does not. Oftentimes, secondary payers will only pay up to a certain amount and if Medicare has already shelled out that amount, they will not pay any more. Supplemental insurance will only pay Medicare's copays and deductibles, not everything else Medicare does not reimburse.
Eye Infection, Strep Diagnoses Post ICD-10
When ICD-10 goes into effect, you will have to gear up for changes across the board as far as diagnosis coding is concerned. Many a time, you will have more choices that may need changing the way you document services and a coder reports it. Take a look at the following examples of how ICD-10 will alter your coding choices after October 1, 2013.
Get on top of upcoming eye infection coding changes
Conjunctivitis is an eye infection that can affect patients of all ages. And most likely your practice is familiar with the signs and symptoms of this condition. However, like all other conditions, conjunctivitis will come under new codes after ICD-10 goes into effect.
Presently, there are several coding options for conjunctivitis, depending on the type of condition that the doctor treats. Under ICD-10, you will not only have to denote the specific type of conjunctivitis by using the most proper diagnosis code, but you'll also have to point out which eye was affected.
Documentation: Already, your doctors should be including the affected eye in their documentation. As a coder, all you need to do to capture this already present information is to format your superbill to capture the additional anatomical information.
Medical coder tips: On your superbill, after ‘conjunctivitis, list the available choices to prompt the doctor to enter this information. A condensed system could include:
Conjunctivitis is an eye infection that can affect patients of all ages. And most likely your practice is familiar with the signs and symptoms of this condition. However, like all other conditions, conjunctivitis will come under new codes after ICD-10 goes into effect.
Presently, there are several coding options for conjunctivitis, depending on the type of condition that the doctor treats. Under ICD-10, you will not only have to denote the specific type of conjunctivitis by using the most proper diagnosis code, but you'll also have to point out which eye was affected.
Documentation: Already, your doctors should be including the affected eye in their documentation. As a coder, all you need to do to capture this already present information is to format your superbill to capture the additional anatomical information.
Medical coder tips: On your superbill, after ‘conjunctivitis, list the available choices to prompt the doctor to enter this information. A condensed system could include:
H10.3x, Unspecified acute conjunctivitis (x=0 for unspecified eye, 1 for right eye, 2 for left eye, and 3 for bilateral)
H10.40x (x=1 for right eye, 2 for left eye, 3 for bilateral, and 9 for unspecified eye)
Key: Remember that the "x" digits in the H10.3x and H10.40x examples above do not translate exactly from one conjunctivitis condition to the other. For H10.3x, a "0" for the final digit refers to an unspecified eye, whereas for H10.40x, a "9" for the final digit refers to an unspecified eye. As such, physician training will be imperative for this condition, and the coder should screen all conjunctivitis diagnoses right away post ICD-10 implementation prior to sending out claims to the insurer.
Strep throat coding changes should be minimal
Probably, primary care practices see patients with symptoms of strep throat every day, and this common illness is marked by pain and redness in the throat, potential fever, and sometimes flushed cheeks (scarlet fever).
While using the ICD-9-CM code set, you use 034.0 (Streptococcal sore throat) if the patient suffers from streptococcal sore throat. The ICD-9 manual also points you to this code if the patient suffers from streptococcal tonsillitis.
ICD-10 changes: With effect from October 1, 2013, you will not have a simple catch-all code for streptococcal throat infections. In its place, ICD-10 codes (Source "http://www.supercoder.com/icd-10/")will differentiate between the following two types of conditions:
Key: Remember that the "x" digits in the H10.3x and H10.40x examples above do not translate exactly from one conjunctivitis condition to the other. For H10.3x, a "0" for the final digit refers to an unspecified eye, whereas for H10.40x, a "9" for the final digit refers to an unspecified eye. As such, physician training will be imperative for this condition, and the coder should screen all conjunctivitis diagnoses right away post ICD-10 implementation prior to sending out claims to the insurer.
Strep throat coding changes should be minimal
Probably, primary care practices see patients with symptoms of strep throat every day, and this common illness is marked by pain and redness in the throat, potential fever, and sometimes flushed cheeks (scarlet fever).
While using the ICD-9-CM code set, you use 034.0 (Streptococcal sore throat) if the patient suffers from streptococcal sore throat. The ICD-9 manual also points you to this code if the patient suffers from streptococcal tonsillitis.
ICD-10 changes: With effect from October 1, 2013, you will not have a simple catch-all code for streptococcal throat infections. In its place, ICD-10 codes (Source "http://www.supercoder.com/icd-10/")will differentiate between the following two types of conditions:
J02.0 (Streptococcal pharyngitis)
J03.00 (Acute streptococcal tonsillitis, unspecified)
J03.01 (Acute recurrent streptococcal tonsillitis)
Documentation: You shouldn't report the strep] throat diagnosis code unless your practice gets confirmation from a lab test (either rapid strep or throat culture) indicating that the patient tested positive for a streptococcal throat infection. If you do not have a positive lab test confirming strep throat, you should just report the diagnosis codes for the symptoms (sore throat, fever, scarlet fever, etc.)
As such, your documentation must include a copy of the laboratory report confirming that the patient had strep throat prior to selecting your diagnosis code.
Key: Your doctor will require to clearly note which type of throat condition the patient has. Contrary to previous years, when one code covered both streptococcal pharyngitis and streptococcal tonsillitis, that will not be the case post ICD-10. As such, it'll be important for your documentation to include a notation of whether the patient's streptococcal infection affected the pharynx or the tonsils.
What's more, if the patient suffers from streptococcal tonsillitis, you'll have to further delineate whether he's experiencing an acute or recurrent condition. If you use J03.01 (recurrent), your documentation will have to confirm that the patient has suffered from the condition in the past.
Medical coder tips: See to it that you print both new strep throat codes on your superbills before ICD-10 goes into effect. You should also let your practitioners know that they'll need to differentiate between streptococcal pharyngitis versus streptococcal tonsillitis.
Documentation: You shouldn't report the strep] throat diagnosis code unless your practice gets confirmation from a lab test (either rapid strep or throat culture) indicating that the patient tested positive for a streptococcal throat infection. If you do not have a positive lab test confirming strep throat, you should just report the diagnosis codes for the symptoms (sore throat, fever, scarlet fever, etc.)
As such, your documentation must include a copy of the laboratory report confirming that the patient had strep throat prior to selecting your diagnosis code.
Key: Your doctor will require to clearly note which type of throat condition the patient has. Contrary to previous years, when one code covered both streptococcal pharyngitis and streptococcal tonsillitis, that will not be the case post ICD-10. As such, it'll be important for your documentation to include a notation of whether the patient's streptococcal infection affected the pharynx or the tonsils.
What's more, if the patient suffers from streptococcal tonsillitis, you'll have to further delineate whether he's experiencing an acute or recurrent condition. If you use J03.01 (recurrent), your documentation will have to confirm that the patient has suffered from the condition in the past.
Medical coder tips: See to it that you print both new strep throat codes on your superbills before ICD-10 goes into effect. You should also let your practitioners know that they'll need to differentiate between streptococcal pharyngitis versus streptococcal tonsillitis.
Sunday, February 20, 2011
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.
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.
Thursday, February 3, 2011
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.
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.
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