Podiatry Coding & Billing Alert

Dial into these revisions for last year’s non-pressure ulcer codes.

CMS recently published its list of the new ICD-10 2019 codes, but they won’t go into effect until Oct. 1, 2018.

“This has been a lucky year for podiatry in that there are only a few ICD-10 changes that go into effect, but you still need to take care to use them properly,” says Arnold Beresh, DPM, CPC, CSFAC, in West Bloomfield, Michigan.

Read on to check out how these 280 new codes and 170 revisions may impact your practice’s bottom line.

Tackle Non-Pressure Chronic Ulcer Revisions

Revisions: If you report non-pressure chronic ulcers, you may recall that ICD-10 2018 added 45 new non-pressure chronic ulcer options. Now, with ICD-10 2019, you will see revisions that will add the words “of skin” to descriptors in some codes from category L98.49- (Non-pressure chronic ulcer of skin of other sites). Take a look at the revisions (emphasis added):

• L98.495 (Non-pressure chronic ulcer of skin of other sites with muscle involvement without evidence of necrosis)
• L98.496 (… of skin of other sites with bone involvement without evidence of necrosis)
• L98.498 (… of skin of other sites with other specified severity).

Don’t miss: As you can see by looking at other options in category L98.49-, codes like L98.491 (Non-pressure chronic ulcer of skin of other sites limited to breakdown of skin) already include the words “of skin.” So, these new revisions will help the descriptors of the newer codes stay consistent with the older ones.

When reading the code descriptors for L98.495 and L98.496, you will see the word “necrosis,” and you may wonder what this means. Basically, necrosis refers to how healthy a wound is, explains Jordan Meyers, DPM, partner at Raleigh Foot and Ankle Center and consultant at Treace Medical Concepts, Inc. in Raleigh, North Carolina. Necrosis is a sign that there is likely inadequate perfusion to the wound (vascular issue).

Caution: Watch out for the key descriptor terms “with bone involvement” versus “with muscle involvement.” This distinction helps define the depth of the wound and how much treatment may be involved, according to Meyers. The deeper the wound, the deeper the problem and the higher risk of infection or need for surgery.

Expand Your Cannabis-Related Disorder Options

Additions: ICD-10 2019 will add two new codes to the mental, behavioral, and neurodevelopmental disorders chapter of ICD-10 in category F12- (Cannabis related disorders). They are as follows:

• F12.23 (Cannabis dependence with withdrawal)
• F12.93 (Cannabis use, unspecified with withdrawal).

These new codes will be join the ranks of current codes F12.220 (Cannabis dependence with intoxication, uncomplicated) and F12.250 (Cannabis dependence with psychotic disorder with delusions).

Don’t Miss These Myalgia Additions

Additions: Category M79.1- (Myalgia) will also add four new codes. The additional codes you should watch out for are:

• M79.10 (Myalgia, unspecified site)
• M79.18 (Myalgia, other site).

Myalgia defined: Myalgia is characterized as pain in a muscle or group of muscles.

Mark Down These External Cause Code Changes

T codes are part of Chapter 19, Injury, poisoning and certain other consequences of external causes. Here are some areas to note from the T code additions and changes:

Ecstasy poisoning additions: Watch for options to report ecstasy poisoning under new subcategory T43.64- (Poisoning by ecstasy). Your new choices are as follows:

• T43.641X (Poisoning by ecstasy, accidental (unintentional))
• T43.642X (Poisoning by ecstasy, intentional self-harm)
• T43.643X (Poisoning by ecstasy, assault)
• T43.644X (Poisoning by ecstasy, undetermined).

Don’t miss: Codes in category T43- (Poisoning by, adverse effect of and underdosing of psychotropic drugs, not elsewhere classified) require a seventh character. Your choices are as follows:

• A (Initial encounter)
• D (Subsequent encounter)
• S (Sequela).

Caution: Don’t forget about notes with codes. For example, T74.3 (Psychological abuse, confirmed) has new notes clarifying that the code is appropriate for “Bullying and intimidation, confirmed” and “Intimidation through social media, confirmed.”

Confirmed forced labor/sexual exploitation additions: Check for new code additions specific to confirmed forced labor and forced sexual exploitation. These codes include T74.5- (Forced sexual exploitation, confirmed) through T74.62XS (Child forced labor exploitation, confirmed, sequela). Instructions with codes from category T74- (Adult and child abuse, neglect and other maltreatment, confirmed) tell you to report an additional code, if applicable to identify any associated current injury. You should also report an additional external cause code to identify the perpetrator if known (Y07.-).

Suspected forced labor/sexual exploitation additions: You will also see new codes for suspected forced labor and forced sexual exploitation T76.5- (Forced sexual exploitation, suspected) through T76.62XS (Child forced labor exploitation, suspected, sequela). Instructions »»» with codes from category T76- (Adult and child abuse, neglect and other maltreatment, suspected) tell you if applicable to report an additional code to identify any associated current injury.

Infection and sepsis additions: Notice that codes T81.40- (Infection following a procedure, unspecified) through T81.43XS (Infection following a procedure, organ and space surgical site, sequela) and T81.49XX (Infection following a procedure, other surgical site) added to category T81- (Complications of procedures, not elsewhere classified). And, don’t miss new sepsis code T81.44XX (Sepsis following a procedure).

Adopt These New Z Codes

Z codes are part of Chapter 21, Factors influencing health status and contact with health services. Z codes represent reasons for encounter, and you must report a corresponding procedure code with a Z code if the physician performs the procedure, according to ICD-10 instructions.

ICD-10 2019 will add multiple Z codes you need to be aware of including Z04.81 (Encounter for examination and observation of victim following forced sexual exploitation); Z13.3 (Encounter for screening examination for mental health and behavioral disorders); Z20.821 (Contact with and (suspected) exposure to Zika virus); and Z62.813 (Personal history of forced labor or sexual exploitation in childhood).