# use of unspecified codes



## PLAIDMAN (Feb 12, 2015)

I received a letter from my personal health insurance.....it basically stated that with ICD10, benefits that have been covered....may not be covered in the future if the specificity is not being met.

Is there going to be a "grace period" for use of unspecified codes in ICD10? I know this is a horrible question....but I am being asked to ask it 

Can you direct me to some written info regarding how payors are looking at ICD10?

thx


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## teresabug (Feb 12, 2015)

there is not going to be the opportunity for a provider to be able to even use an unspecified code with ICD-10.


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## PLAIDMAN (Feb 12, 2015)

my docs do not use "typical" flow of Epic
they still dictate....pick generic code....and then coders review transcription and code to specificity

they will have unspecified dictation/dx


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## a.renee86 (Feb 12, 2015)

There will be unspecified codes that they can use. However, they will need to document WHY they are choosing an uspecified code. An example I use with my providers is UTIs, in family practice we aren't going to know where the infection is or what the causal organism is until culture comes back, therefore, we will have to use an unspecified code. The thing is, unspecified codes will be audit triggers, so we need to make sure our providers are documenting to the highest level of specificity they are able, as long as the reason they are using an unspecified code is in their documentation, you should be covered.
Hope this helps,
Amber


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## mitchellde (Feb 12, 2015)

a.renee86 said:


> There will be unspecified codes that they can use. However, they will need to document WHY they are choosing an uspecified code. An example I use with my providers is UTIs, in family practice we aren't going to know where the infection is or what the causal organism is until culture comes back, therefore, we will have to use an unspecified code. The thing is, unspecified codes will be audit triggers, so we need to make sure our providers are documenting to the highest level of specificity they are able, as long as the reason they are using an unspecified code is in their documentation, you should be covered.
> Hope this helps,
> Amber


It is not that unspecified will be unacceptable.  Rather that the payers will be reluctant when the expectation is that the specificity should be known and documented.  Infections are an acceptable exception.  A UTI, like pneumonia and other infections, the provider is allowed to diagnose without the benefit of clinical data. They only need the patient with clear symptomatic presentation indicative of the infection.  So you will not have specificity for some of these infections conditions.  
However, conditions like osteoarthritis or say gout, the provider is expected to be able to be specific to site and type.  If the provider documents OA of lt knee, then they should be queried as to whether it is primary, secondary, or post traumatic .  The coder cannot default this to primary.  So it will not be wise to use unspecified in this case.


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## PLAIDMAN (Feb 12, 2015)

Thank you
this was exactly the type of things I want to tell them.
I will go ahead and take a NO on the grace period thing


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