General Surgery Coding Alert
Keep Medical Necessity Accurate With New Dx Codes
You’ll need to start using these codes Oct. 1, 2022 Don’t get overwhelmed with more than 1500 new and revised ICD-10-CM 2023 codes going into effect later this year — we’re here to help you sort it out. Read on as we highlight the relevant changes that could impact pay for your surgery practice beginning Oct. 1. Take Steps to Keep Clean Claims and Appropriate Pay Medicare and many other payers use ICD-10-CM to process claims, relying on diagnosis codes to demonstrate medical necessity for your surgeons’ services. Also, Medicare quality reporting programs rely on appropriate diagnosis coding to evaluate appropriate procedures — so missing the boat now could impact your bottom line later. As you prepare to implement the new ICD-10-CM changes on October 1, there are a few things you need to address, says Robin Peterson, CPC, CPMA, manager of professional coding services, Pinnacle Integrated Coding Solutions, LLC in Centennial, Colorado. First, review current documentation for each of the expanded categories. As your providers are currently documenting, would the verbiage support the level of specificity required to report the new codes? If not, meet with your providers to explain the new codes and increase their awareness of what the documentation requries. “You will also address the detail that is needed to support the highest level of specificity,” Peterson adds. “Also remember, the current EHR templates providers are using may require updates. And lastly, any internal billing or charge systems will need to make the new codes available as of Oct. 1, 2022.” Abdominal Endometriosis Gets Hundreds of New Codes Surgeons may perform laparoscopic or other surgeries for endometriosis that has spread to various abdominal organs. ICD-10-CM 2023 expands the existing nine N80.- (Endometriosis) codes by adding more than 130 new codes. The changes add significant specificity to your diagnosis choices based on anatomic site and tissue depth. Convert to parent: Starting Oct. 1, the following will become parent codes instead of stand-alone codes: “To avoid invalid ‘truncated’ codes, you’ll need to stop reporting what will be a ‘parent code’ without the additional 5th and possibly 6th character required to identify the most specific diagnosis for endometriosis of these anatomic sites,” says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, revenue cycle director for Clinical Health Network for Transformation in Houston, Texas. ICD-10-CM does not convert the following codes to “parent,” and they remain unchanged for 2023: New 4-character codes: Adding more specific anatomic sites where endometriosis may occur, ICD-10-CM creates the following new code families you’ll need to use, effective Oct. 1: Table: Look at the Clip and Save Endometriosis Dx table following this article for a breakdown of the new codes. Vascular Surgeons Welcome New Aneurysm Code Specificity ICD-10-CM currently provides the following four-character codes for aortic aneurysm based on region and with or without rupture: Beginning Oct. 1, you’ll need to report those codes with a 5th character that provides more detail about the anatomic site of the aneurysm. If you have no further information than what’s described by the current codes, you’ll need to add a “0” as the 5th character to indicate “unspecified.” For each of the thoracic codes, the 5th character adds the following anatomic information: For the abdominal aortic aneurysm codes look at these 5th digit additions: For thoracoabdominal aortic aneurysm codes, new 5th digit options include the following: Don’t Miss External Causes “Cycle” Codes When your surgeon performs a procedure for a patient due to an injury, you should remember to report the appropriate “V” code. ICD-10-CM guideline I.C.20.a.1. tells you that “an external cause code may be used with any code in the range of A00.0-T88.9, Z00-Z99, classification that represents a health condition due to an external cause.” If your surgeon ever treats injuries related to motorcycle accidents, you should be familiar with upcoming changes. ICD-10-CM currently lists the following code families for external causes of morbidity related to motorcycle incidents: The 4th and 5th characters added more specificity, such as whether the injury occurred to the driver, passenger, or unspecified rider, and seventh characters indicated the encounter. Beginning Oct. 1, ICD-10-CM deletes “motorcycle” codes and extends the families with new codes that distinguish between “electric (assisted) bicycle” or “other motorcycle.” For example: ICD-10-CM deletes V23.0XXA (Motorcycle driver injured in collision with car, pick-up truck or van in nontraffic accident, initial encounter). Beginning Oct. 1 you’ll need to specify the type of motorcycle and choose one of the following new codes: Remember: Before using an external cause code, make sure you don’t report it as the primary diagnosis, according to Jeri L Jordan, CPC, billing manager at Hampton Roads Foot and Ankle in Williamsburg, Virginia.
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