When ICD-10 was implemented on October 1, 2015, the Centers for Medicare & Medicaid Services (CMS) granted a one-year grace period to allow for greater flexibility in the claims auditing and quality reporting process.
The grace period has expired and we have begun to see a number of payers down code charts based on “lack of medical necessity,” which is being determined by the ICD-10 coding.
Therefore, we are recommending that you list diagnoses as accurately as possible, in the order that best explains the “medical necessity” of the evaluation and care you provided.
This will aid in proper reimbursement and increased revenue when used appropriately. Poor documentation has the potential to result in payer down codes.
Noteworthy changes for 2018
There are many noteworthy changes in ICD-10 for FY2018. For discharges and encounters occurring from October 1, 2017 through September 30, 2018, there are 363 new codes, 142 deletions, and 226 revisions.
Chapter 4: Endocrine, Nutritional and Metabolic Diseases (E11.1-E11.11)
New codes have been added to identify Type2 diabetes mellitus (DM) with Ketoacidosis and to specify if the Ketoacidosis is with or without coma. It is up to the provider to specify the type of DM and the condition of the patient (i.e. with or without coma).
Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders
It is now possible to select a specific code to classify the severity of substance abuse as mild, moderate, or severe from the use of various substances including alcohol, nicotine, opioids, and cannabis during each stage of remission. This will better assist in subsequent psychiatric management when needed. In each case the specificity will need to be documented by the provider.
Chapter 9: Diseases of the Circulatory System
New codes for myocardial infarction (MI) Type 2 (I21.A1) and other MI types (I21.A9) were added to clarify which type of MI the patient has experienced. Type 2 MI describes an MI due to demand ischemia. There have also been notes added to the ST-elevation MI codes (I21.0-I21.4) to specify that the condition is a Type 1 MI (related to ischemia from a primary coronary event) as opposed to type 2. The provider should always document the type when known.
Additional new codes in Chapter 9 include:
- Increased options for Pulmonary Hypertension under I27
- Codes for the type of right heart failure including acute (I 50.811), chronic (I50.812), acute on chronic (I50.813), and right heart failure due to left heart failure (I50.814) or unspecified (I50.82) were added as well. Specificity, if known, is a must to gain proper reimbursement. The provider should also document high output heart failure if present (I50.83) and end stage heart failure for patients with advanced forms of the disease that no longer respond to medications (I50.84).
Chapter 15: Pregnancy, Childbirth and the Puerperium
Tubal and Ovarian Pregnancy codes have expanded to specify laterality. Please make note of this when documenting.
- New codes for Maternal care for abnormalities of fetal heart rate or rhythm in the first trimester (O36.831-), second trimester (O36.832-), third trimester (O36.833-), or unspecified trimester (O36839-).
- 17 new Z codes have been added. These are the replacements for the old V codes. The reasons for external reasons for the injury.