Podiatry Coding & Billing Alert

Take Heart: You’re Getting Brand New Codes for Bunion & Bunionette in 2017

Think your podiatry practice aced ICD-10 just because you haven’t seen many denials since last October? Think again. CMS is about to play ICD-10 for real.

October 1, 2016 will deliver a one-two punch to healthcare providers 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? The Centers for Medicare & Medicaid Services (CMS) decided to throw us a bone to help us adjust to the new codes. 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 crack down on ICD-10 coding specificity.

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 Podiatry Coding 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.

In Chapter 13 (Diseases of the Musculoskeletal System and Connective Tissue), you’ll see new codes for bunion and bunionette.

Bunion, bunionette separate from hallux valgus in ICD-10 2017

It’s been a tough year for podiatry coders who crave specificity. Since October 1, 2015, you’ve been reporting bunions and bunionettes using the M20.1 series (Hallux valgus [acquired]).

Here’s the problem: 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.

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, CSFAC, of Newport News, VA., “because correct codes simply didn’t exist.”

Come October 1, 2016, you have the following code options to report bunions and bunionettes (MTP enlargements on pinky toes).

• M21.611 (Bunion of right foot)
• M21.612 (Bunion of left foot)
• M21.619 (Bunion of unspecified foot)
• M21.621 (Bunionette of right foot)
• M21.622 (Bunionette of left foot)
• M21.629 (Bunionette of unspecified foot)

Reminder: If you want to avoid denials, avoid “unspecified foot” codes. Somewhat unfairly, ICD-10 gives you lots of opportunities to choose “unspecified” as an option, but many payers have edit systems that kick those codes out, triggering denials.

Here’s why: An “unspecified” code choice essentially says your practice doesn’t know which foot is affected, and many payers won’t shell out reimbursement when they see that lack of specificity.