Pulmonology Coding Alert

CMS has released the finalized list of 2018 diagnosis codes.

Pulmonology coders hoping to benefit from new ICD-10 codes this fall will be pleased to see that CMS has delivered over 300 new diagnosis codes debuting on Oct. 1. CMS published the full listing of codes on June 13, but we’ve reviewed the list to identify the changes most relevant to respiratory care practices.

Find Updates to Notes for These Diagnoses

Although the latest update to ICD-10 does not include any new codes being added to Chapter 10 (Diseases of the respiratory system), it does change some of the notes under codes that offer instructions on how to report these diagnoses properly.

For example, under J09 (Influenza due to certain identified influenza viruses), the manual will now add an Excludes1 note that excludes influenza A/H1N1 (J10.-, Influenza due to other identified influenza virus) from the J09 listing.

What that means: “A type 1 Excludes note is a pure excludes note. It means ‘NOT CODED HERE!’” The Centers for Disease Control says in its 2017 ICD-10-CM Official Guidelines for Coding and Reporting. “An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.”

Note this exception: The ICD-10-CM manual does indicate that in circumstances when the two conditions are unrelated to one another, you can ignore the Excludes1 note. “If it is not clear whether the two conditions involving an Excludes1 note are related or not, query the provider,” the manual says. However, that would be rare when coding influenza due to an identified virus along with a code for the H1N1 virus.

Fortunately, ICD-10 doesn’t just add Excludes1 notes this year — it also deletes them. For example, under both the J45 (Asthma) and J84 (Other interstitial pulmonary diseases) headings, the manual has converted the Excludes1 note for “Lung diseases due to external agents (J60-J70) to an Excludes2 note for 2018.

What’s the difference? “A type 2 Excludes note represents ‘Not included here,’” the Manual indicates. “An Excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.”

Therefore, since the Excludes2 note isn’t quite as restrictive as the Excludes1, it’s a positive that the ICD-10 manual made the switch in this instance. However, coders should take note of any “excludes” notes in the ICD-10 manual, and if you miss one, you could hurt your reimbursement and risk accusations of incorrect coding.

Check out This COPD Adjustment

As of Oct. 1, you’ll also have a new way to report COPD with acute lower respiratory infection (J44.0). Although the code stays the same, the note under it will change from “Use additional code to identify the infection” to “Code also to identify the infection” instead.

What’s the difference? “A “code also” note instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction,” the ICD-10 Manual advises. Instead, the “use additional code” instruction “indicates that a secondary code should be added,” the manual says. In other words, the “use additional code” notation tells use to use a secondary code after the main code, which means that this note does provide sequencing direction.

The only way coders will be able to identify and code the specific infection present with COPD is to refer to the medical documentation, so if your physicians aren’t thorough about including this information, you should sit down with them and explain how vital that data is. “The importance of consistent, complete documentation in the medical record cannot be overemphasized,” advises April Callahan, BA CPC, CPC-I, president and CEO of A&L Medical Coding Consulting, LLC, in Long Beach, Miss. “Without such documentation, accurate coding cannot be achieved.”

The coders should also know how to read a medical record and interpret the information within it. “I teach in a medical billing and coding program, and from day one, I stress the importance of understanding the provider’s documentation to accurately assign an ICD-10 code,” said Susan Stovall, COC, CPC, AAS, medical billing and coding instructor with the Southwest Skill Center in Avondale, Ariz. “As the codes are updated, in my mind it makes my job easier. Once we can get all of the providers to be precise in their documentation, things will get even easier.”

Know Which Proposals Weren’t Adopted

Although several of the ICD-10 additions that stakeholders originally recommended were adopted, some were not. For example, you won’t find expanded mesothelioma codes among the new listings, which the Alliance of Dedicated Cancer Centers had requested.

Resource: To read the complete list of ICD-10-CM changes, visit https://www.cms.gov/Medicare/Coding/ICD10/2018-ICD-10-CM-and-GEMs.html.