EM Coding Alert

Question: Have there been any changes in how you should report an ICD-10 code for the Zika virus? Notes indicate that one of our physicians recently treated an established patient with a confirmed Zika diagnosis; notes indicate a level-two office E/M service.

Florida Subscriber

Answer: Since October 1, there has been a new ICD-10 code on the books for Zika: A92.5 (Zika virus disease).

Remember: You’ll use this code for all E/M services the physician provides after October 1, 2016, when ICD-10 2017 took effect. If the date of service for your claim is on or after October 1, you should report 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making) for the E/M with A92.5 describing the visit.

If you are coding for a service dated before Oct. 1, 2016, however, you should not report A92.5. Before the new code came along, coders reported most instances of Zika with A92.8 (Other specified mosquito-borne viral fevers).

Remember:  ICD-10 2017’s final list of new, updated, and deleted codes for 2017 were effective October 1, 2016 — not January 1, 2017. So if they haven’t already, practices need to get up to speed immediately on all the ICD-10 revisions, additions, and deletions relevant to their specialties.

And with that turn of the calendar came increased ICD-10 scrutiny from the Feds. Keep in mind that through September 2016, for auditing purposes, Medicare was only checking for ICD-10 accuracy to the point of the code family (the first three characters).

That level of understanding disappeared on October, 2016, however.

Now, practices are “responsible for the accuracy of the specific diagnosis within the family to the highest character available,” says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison.

Check it out: To see a complete list of the 2017 ICD-10 code additions, deletions, and revisions, see www.cdc.gov/nchs/icd/icd10cm.htm.