ED Coding and Reimbursement Alert

Check out these new ED-related 2017 ICD-10 updates for emergency medicine

The freeze on new ICD-10 codes has been lifted, and, as expected, there are a significant number of changes to ICD-10 for 2017. Overall, you’ll find 1,943 new codes, 422 revisions and 305 deletions. In addition to the end of the ICD-10 allowance that allows for flexibility in diagnosis reporting, (e.g., the claim being accepted as long as the code is in the correct family) being aware of all of the available codes will be essential in proper reporting of diagnoses, says Sarah Todt, RN, CPMA, CPC, CEDC, director, provider education & audit for LogixHealth, a national ED coding and billing company in Bedford, MA.

Key New Diagnosis Codes Describe Substance Abuse, Diabetes and More

Todt reminds coders of these new ICD-10 codes for common ED presentations:

• One of the most talked about diseases in the news, Zika, has a new specified code of A92.5 (Zika virus disease). Previously, this disease had to be reported as “Other specified mosquito-borne viral fevers.” Providers are encouraged to continue to report symptoms for unconfirmed cases.
• Alcohol and substance abuse and dependence codes have been further defined. The diagnoses for abuse include “use disorder, mild” while dependence includes “use disorder moderate and severe.” For example, F10.10 (Alcohol abuse, uncomplicated) includes alcohol use disorder, mild whereas F14.20 (Cocaine dependence, uncomplicated) includes “Cocaine use disorder, moderate” and “Cocaine use disorder, severe.” Additional descriptors of tobacco use, such as “disorder mild, moderate and severe,” have been added to F17.200 (Nicotine dependence, unspecified, uncomplicated).
• Diabetes mellitus has expanded the “Use Additional” instructions to identify the method of control. Previously you only had a single code to indicate “insulin use” and that language has been modified to “Code to identify control using: insulin” for Z79.4. An additional code, Z79.84, has been added to show control using oral agents: “Code to identify control using: oral antidiabetic drug or hypoglycemic drug.”
• Several new codes have been added or modified related to neurological conditions, including several that will supplement the cerebral infarction diagnosis to indicate stroke score. Code R29.7_ (National Institutes of Health Stroke Scale [NIHSS] score) with 5th or 6th digits would be used to indicate the specific stroke score. For example, a NIHSS score of 32 would be reported with R29.732. These diagnoses cannot be used alone; they must be preceded by codes that define the type of cerebral infarction (I63-.) Additional specificity has been added to coma score codes. Diagnosis reporting for R40.24_ Glascow coma scale, total score, has been modified to include a 7th digit to indicate when the scoring was made: either in the field [EMT or ambulance], at arrival to the emergency department, at hospital admission, 24 hours or more after hospital admission or unspecified. For example, R40.2422 would be used for Glascow coma scale total score of 9-12 at arrival to the emergency department.
• Injuries have some additional codes for new specificity as well. Laterality has been added to S03.0_ (Jaw dislocation) and S03.4_ (Jaw sprain) codes. These new 5th digits include “1” for right, “2” for left, “3” for bilateral and “0” for unspecified. The cause of injury codes have new specific codes related to physical activities. Overexertion and strenuous or repetitive movements have additional specificity such as X50.0_ (Lifting heavy objects), X50.1_ (Prolonged kneeling) and X50.3_ (Repetitive movements). A 7th digit is required to illustrate the episode of care for all injury codes.

Be Aware of New Specificity

As always, providers should report diagnoses to the highest level of specificity. With the lifting of the flexibility allowance for 2016, it will be more important than ever to document diagnoses appropriately, warns Todt.