Medicare Compliance & Reimbursement

Brace for more than 4,000 new & revised codes in 2017.

Part B Providers: Think you’ve aced ICD-10 just because you haven’t seen many denials since last October? Think again. CMS is about to get serious about ICD-10.

October 1, 2016 will deliver you a one-two punch as the “grace period” ends and thousands of new ICD-10 codes take effect.

What was CMS’s ICD-10 “grace period” all about?

Remember last summer when we were all wigging out about the upcoming ICD-10 implementation? Back then, CMS decided to throw us a bone. Since implementation on October 1, 2015, the agency has prohibited carriers from denying claims with improper ICD-10 coding, as long as the codes were sort-of-correct.

If the incorrect code is in the same “family” as the correct code, Medicare carriers have been paying the claim. By “family,” CMS means the first three characters in the category.

Why should I worry now?

If your ICD-10 denials are low and your coding confidence is high, you could have a false sense of security. Experts predict that denial rates will increase for claims submitted on or after October 1, 2016, as the Medicare contractors pay ICD-10 for real.

Pshaw, says CMS. You’ve probably been coding correctly anyway. “Many major insurers did not offer coding flexibility, so many providers are already using specific codes,” CMS spokesperson Jibril O. Boykin tells Medicare Compliance & Reimbursement Alert.

Why are there so many new codes for 2017?

In the years leading up to ICD-10 implementation, CMS froze new code updates to make the transition from ICD-9 to ICD-10 easier for providers. Lots of updates piled up during the freeze, and on October 1, 2016 they all come gushing out.

Some of the code changes delete a non-specific code and replace it with a series of several, more specific codes.

Example: ICD-10 2017 deletes K52.2 (Allergic and dietetic gastronenteritis and colitis) and replaces it with a series of codes that describe conditions such as food protein-induced enterocolitis syndrome (K52.21), and various kinds of irritable bowel syndrome (K58.-).

Other changes correct ICD-10 2016 coding that didn’t make much medical sense to clinicians and coders.

Example: Changing the way ICD-10 handles hallux valgus, bunions, and bunionettes has been “one of the major things that the American Podiatric Medical Association (APMA) has advocated for,” says Arnold Beresh, DPM, CPC, of Newport News, VA, “because correct codes simply didn’t exist.”

Since October 1, 2015, we’ve been reporting bunions and bunionettes using the M20.1- series (Hallux valgus [acquired]). But a “hallux valgus” and a bunion are not the same thing. A bunion is an enlargement of bone or tissue around the big toe’s metatarsophalangeal (MTP) joint. Hallux valgus is an angled displacement that causes the big toe to ride over or under other toes. A person can have a bunion without having a hallux valgus.

Come October 1, 2017, we’ll have new ICD-10 codes in the M21.6-- series to report bunions and bunionettes (MTP enlargements on pinky toes).

Here’s the lowdown on more ICD-10 2017 code changes that specialty coders at The Coding Institute are watching.

Listen Up: New Codes for Hearing Loss & Tinnitus

New H90.A-- series codes will force otolaryngologists to document hearing diagnoses more specifically and give coders new options for specificity.

“In the 2016 edition of ICD-10, there are only options for unilateral conductive, sensorineural, or mixed conductive hearing loss with unrestricted hearing on the contralateral side,” explains Barbara J. Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO, vice president at Stark Coding & Consulting, LLC, in Shrewsbury, N.J. “Unlisted hearing loss codes have been needed to define hearing loss on both sides. With this change in 2017, there will be codes for patients with hearing loss on both sides.”

New tinnitus codes in the H93.A- series will force physicians to diagnose tinnitus with more detail, delineating between regular ringing and buzzing from pulsing,” Cobuzzi says. “Once again, this will require more documentation.”

Look Out for Eye Care Codes

Ophthalmology and optometry practices should prep staff for 123 new ICD-10 codes, says Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, a nationally known ICD-10 instructor and a speaker at AAPC’s upcoming regional conference in Atlantic City.

Many of the new codes add laterality to eye diagnoses that don’t have laterality in the ICD-10 codes we’re using now, Buckholtz says.

Example: Current ICD-10 codes for diabetic retinopathy lack a way to report laterality. Many code changes add seventh characters that allow the codes to express which eye is affected. Look out for changes in the following code series.

• E08.3-- (Diabetes mellitus due to underlying condition with ophthalmic complications)
• E09.3-- (Drug or chemical induced diabetes mellitus with ophthalmic complications­)
• E10.3-- (Type 1 diabetes mellitus with ophthalmic complications)
• E11.3-- (Type 2 diabetes mellitus with ophthalmic complications)

Eye care providers will also see a dramatic expansion within the age-related macular degeneration (AMD) diagnosis codes. Currently, there are two to choose from, depending on whether the patient suffers from nonexudative (dry) or exudative (wet) AMD.

Codes H35.31 and H35.32 will go away on October 1, 2016. The new codes — which will specify not only which eye is affected, but which stage — add two characters on to the old five-character codes.