It is the time of year again that can cause mass chaos in medical practices, hospitals, and medical billing offices-the dreaded updates to ICD-10 guidelines and codes. Every year, the new guidelines become effective October 1 and are valid thru September 30. Staying on top of these changes and updates will in turn benefit all aspects of the billing cycle from educating providers to ensuring reimbursement is not affected. There have been updates/additions to the codes as well as changes to some of the guidelines. Below is a list of a few of the changes and a short description of the change.

  1. More Specificity-Guideline I.A.15- In the Alphabetic Index, in the Tabular List as an instructional note, or when it is seen in a code title the words “with” and “in” now should be understood to mean “associated with” or “due to”.
  2. Documentation by Others-Guideline I.B.14- With the exception to a few codes such as Body Mass Index, depth of non-pressure chronic ulcers, pressure ulcer stage, coma scale, and NIH stroke scale codes, code assignment is based on the documentation by the patient’s provider. The reason for the exception to the above mentioned codes is because other qualified healthcare professionals other than the patient’s provider are normally documenting these problems (nurse to document BMI, EMT to document the coma scale). Nevertheless, the associated diagnosis (obesity, stroke, ulcer) must be recorded by the patient’s provider because it is a medical diagnosis. On the other hand, the guideline also states when it comes to social causes, for instance those found in categories Z55-Z65, code choice can be determined on the medical documentation from the clinicians providing care to the patient even though the clinician is not the patient’s provider. The reason for the exception to this rule is because this information denotes social information as opposed to an actual medical diagnosis. Reminder that codes Z55-Z65 should be reported only as a secondary diagnosis.
  3. Hurricane Victims-Guideline I.B.19- This is a new ICD-10 code for injuries sustained due to a hurricane. The guidelines stipulate, this external cause code (X37.0) is intended to be used secondary to any appropriate codes for the injuries sustained due to the hurricane.
  4. Sepsis Coding I.1.5(b)- This new guideline expands the coding for Sepsis to now first report a code from T81.40-T81.43 for infections following a procedure or O86.00-O86.03 for infection of obstetric surgical.

These are just a few of the new updates to ICD-10, please refer to ICD-10 CM 2019 for a full listing of the changes with complete descriptions of the changes. Don’t forget to make sure the codes that are being selected are being done within the established/new guidelines and the encounter is coded per the medical documentation to the highest specificity.

With changes being made at what seems to be the drop of a hat, Medorizon continues to stay on top of all coding changes/updates to maintain low payer denials and continue to receive maximum reimbursement for all clients.

Source: https://aapcperfect.s3.amazonaws.com/hbm/Nov2018_Non-Member/index.html