Urology Coding Alert

Remember, family matters to CMS.

With the Oct. 1, 2015 ICD-10 implementation date behind you, now is not the time to rest on your laurels. You need to ensure that you have all your ducks in a row, so that you won’t face denials in the coming months.

Check these five pointers to solidify your ICD-10coding skills.

Check 1: Look for Combination Codes

Under ICD-10, you have more combination codes for certain conditions and their associated common symptoms or manifestations, said Sue Bowman, MJ, RHIA, CCS, FAHIMA, senior director of coding policy and compliance for the American Health Information Management Association (AHIMA) in a recent CMS tutorial.

These combination codes eliminate the need for reporting two codes for a condition with a specific manifestation, but you may find it more difficult to “crosswalk” from an ICD-9 code to an ICD-10 combination code. Examples for urology include N30.01 (Acute cystitis with hematuria), N41.3 (Prostatocystitis), and R65.20 (Severe sepsis without septic shock).

Check 2: Understand the Seventh Character

The seventh character in ICD-10 “has a different meaning depending on the section where it is being used,” Bowman noted. “It must always be used in the seventh character position, and when a seventh character applies. Codes that are missing this character are considered invalid.”

In some cases, for instance, you may need to use the seventh character in a code to identify the type of encounter (initial, subsequent, or sequelae), Bowman said. The seventh character may be numeric or alpha (a letter). For urology the seventh character will always be alpha — either A, D, or S representing initial, subsequent, or sequelae, respectively.

Check 3: V Codes Change to Z Codes

“ICD-10 eliminates the use of the [therapy] V codes due to the fact that they provide no clinical information about the patient other than the fact that therapy services are being provided,” noted Kris Mastrangelo, president and CEO of Harmony Healthcare International in a recent company blog posting. “ICD-10 requires much more specificity related to the medical condition resulting in the need for the therapy encounter.”

Under ICD-10, you should report V code services under a new set of codes — Z codes, wrote Karen Kostick, RHT, CCS, CCS-P in a recent Journal of AHIMA article. These codes include “aftercare codes,” which identify specific types of continuing care after the initial treatment of an injury or disease.

Check 4: Beware GEM Shortcomings

CMS, AHIMA, and other industry organizations joined together to develop General Equivalence Mappings (GEMs) to help providers understand how ICD-9 codes relate to the new ICD-10 codes and code categories.

Downside: “Unfortunately, there are no perfect crosswalks to convert from ICD-9 to ICD-10,” Mastrangelo pointed out. “GEMs provide plausible conversions, not equivalent conversions. GEMs do not provide an exact match, and in most cases transition may require the selection of the best alternative code from among all plausible coding options.”

When you’re “forward-mapping” from ICD-9 to ICD-10, expect only about 5 percent of all codes to accurately map one-to-one, according to Mastrangelo.

Resources: You can find a treasure trove of ICD-10 resources at www.roadto10.org, a website that CMS has created specifically for ICD-10 transition-related training, tools, and information.

Check 5: Don’t Fear Code Denials If You Get the Right Code Family

Remember, much to the relief of the healthcare industry, CMS stated that if you can at least list an ICD-10 code from the right “family,” your Medicare administrative contractor (MAC) will pay your claims for the first calendar year following the Oct. 1, 2015 implementation date.

The AMA wanted to delay ICD-10 implementation and CMS was firm about the Oct. 1 implementation date. The two agencies have partnered to provide resources to the healthcare community and make a common understanding for the benefit of practices. “We appreciate that CMS is adopting policies to ease the transition to ICD-10 in response to physicians’ concerns that inadvertent coding errors or system glitches during the transition to ICD-10 may result in audits, claims denials, and penalties under various Medicare reporting programs,” said Steven J. Stack, MD, president of the AMA, in a statement. “We will continue to work with the administration in the weeks and months ahead to make sure the transition is as smooth as possible.”

Resource: To read the CMS/AMA guidance, visit www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD-10-guidance.pdf .