By Mandeara Frye, RHIA, CPC, CPMA, CASCC, Director of Coding
Each October, the new ICD-10-CM diagnosis codes go into effect. It’s
important to make sure your ASC is prepared for these changes. In this
blog post, I'll share some steps to help ensure your transition is
as successful as possible. I'll also be taking a look at some important
changes for this year that may impact your ASC.
4 Steps for a Successful ICD-10 Transition
1. Update your software. If your practice management system isn’t automatically updated with
new codes each year, coordinate with your vendor to come up with a plan
of action. Having the new diagnosis codes available on October 1 will
help avoid billing delays since new codes may come up as invalid. ICD-10-CM
data sets are available to the public from
CMS.
2. Review the guideline changes. It’s important to understand the
ICD-10-CM guidelines since these drive how the codes are used. Changes to the guidelines will
appear in bold text to aid in identifying the differences. Not everyone
wants or has the time to read 100-plus pages of guidelines, so we’ll
break down some important changes below.
3. Review the code changes. Make sure your coders are prepared for the changes and know what new codes
to look for and their appropriate usage. It’s also a good idea to
make sure your providers are informed of the new codes as well since they
may need to alter their dictation to meet new requirements.
4. Watch the date of service (DOS). Code changes go into effect based on DOS, not coded/billed date, so it’s
imperative to make sure the appropriate code is used. No new codes for
fiscal year 2022 should be used for any claim prior to date of service
Oct. 1, 2021.
Important Guideline Changes
1. Laterality
“When laterality is not documented by the patient’s provider,
code assignment for the affected side may be based on medical record documentation
from other clinicians. If there is conflicting medical record documentation
regarding the affected side, the patient’s attending provider should
be queried for clarification. Codes for “unspecified” side
should rarely be used, such as when the documentation in the record is
insufficient to determine the affected side and it is not possible to
obtain clarification.”
What this means for ASC coding: If laterality is missing from the operative report, it can be taken from
other clinical records such as an intraoperative record that is signed
by a clinician. It’s important to only take this from clinical records.
Coding information should never be based on non-clinical documents such
as a consent or scheduling form. Any documentation used must be signed
by a clinician.
2. Use of Sign/Symptom/Unspecified Codes
“As stated in the introductory section of these official coding guidelines,
a joint effort between the healthcare provider and the coder is essential
to achieve complete and accurate documentation, code assignment, and reporting
of diagnoses and procedures. The importance of consistent, complete documentation
in the medical record cannot be overemphasized. Without such documentation
accurate coding cannot be achieved. The entire record should be reviewed
to determine the specific reason for the encounter and the conditions
treated.”
What this means for ASC coding: Physician documentation remains critical to the coding process. Physicians
should document the reason(s) the patient is having a procedure performed
in the op report. There are often multiple conditions listed in a history
and physical (H&P) report that may or may not be applicable to the
current surgical encounter. If a coder requires clarification to avoid
using a code that may not meet medical necessity, it would be appropriate
for the coder to request the H&P or query the physician.
Important Diagnosis Code Changes
New Codes:
-
C56.3 Malignant neoplasm of bilateral ovaries (previously only left, right, unspecified existed)
-
C79.63 Secondary malignant neoplasm of bilateral ovaries (previously only left, right, unspecified existed)
- G44.86 Cervicogenic headache
- K22.81 Esophageal polyp
- K22.82 Esophagogastric junction polyp
-
K22.89 Other specified disease of esophagus (previously codes as K22.8, 5th character added)
-
K31.A—Gastric intestinal metaplasia (code to appropriate 6th character)
-
L24.A- Irritant contact dermatitis due to friction or contact with body fluids (code to appropriate 5th character)
-
L24.B- Irritant contact dermatitis related to stoma or fistula (code to appropriate 5th character)
-
M54.A- Non-radiographic axial spondyloarthritis (code to appropriate 5th character)
- M54.50 Low back pain, unspecified
- M54.51 Vertebrogenic low back pain
- M54.59 Other low back pain
The low back pain diagnosis changes are of particular importance for any
ASCs that are performing pain management procedures. Surgeons must be
aware of how these revisions affect their documentation since they will
need to more precisely specify the type of low back pain treated to avoid
an unspecified diagnosis.
The importance of physician documentation cannot be overstressed. Make
physicians aware of the diagnosis code changes so they can make appropriate
changes to their documentation. There are several mentions in the guidelines
about coding to the highest level of specificity documented in the medical
record. While there are times when an unspecified diagnosis is accurate
and appropriate, physicians should always strive to document to the highest
level of specificity that is known at the time of the encounter.