Top Five ICD-10 Coding Questions

KMC University Librarymembers are busy making great use of our 24/7 email HelpDesk, free for Library members only! Unsurprisingly, most of our questions over the past week or two have been about ICD-10 coding. Since quite a few of you are unclear on the same hot topics, here’s a peek at the top five questions we’re seeing most – and their answers!

Q: Are all ICD-10 codes 7 characters in length?

A: Nope. ICD-10 codes can be up to 7 characters in length, but most of the ICD-10 codes you’ll use most frequently will be fewer than 7 characters. The details: like ICD-9, ICD-10 codes are required to be coded up to the highest level of specificity possible, or the code will be considered invalid. But because of the additional code length, it’ll take both practice and ongoing training for you to become completely familiar with the ICD-10 code set. In order to learn how to get it right, you should read the complete definitions of the codes and – this is important – refrain from adding additional letters or numbers to the end of codes in an unnecessary effort to create a 7-character code. The bottom line: for chiropractic coding, only the codes in the External Causes of Injury and Poisoning chapter of your code book will require placement of a 7th character.

Q: Is there a way to code right and left side for ICD-10 codes pertaining to the spine?

A: So much has been made of ICD-10’s laterality that this is a common misunderstanding. The spine is not considered to have a left side and a right side, so coding for laterality will pertain primarily to extremity codes. Oh, and just as a reminder: when your patient presents with a bilateral extremity condition, you’ll need to code for the right and left sides separately, since in most cases, bilateral codes aren’t available in most categories of chiropractic diagnosis.

Q: Does Box 14 (Date of Current Illness/Injury) need to be updated on established patients to 10/1/2015 for all visits on or after 10/1/2015?

A: No. The ICD-9 to ICD-10 transition doesn’t affect existing patient treatment plans, so Box 14 should stay exactly as it currently is until the original treatment plan has been completed and a new presentation of symptoms/condition/incident is being addressed. The only thing that changed when ICD-10 was implemented on 10/1 is the diagnosis used for documenting and reporting to third-party payers.

Q: Is there a minimum number of ICD-10 diagnoses required to include on a claim form?

A: There’s no minimum. Rather, your diagnosis must adequately support the services being rendered. For example, if you perform a spinal manipulation of three to four regions of the spine (98941), an extremity adjustment (98943), and e-stim (G0283), there must be a diagnosis to appropriately support each of these services rendered. As a reminder, the diagnosis and services rendered must also support medical necessity, be consistent with standard coding and payer guidelines, and be a direct reflection of the patient documentation.

Q: How are the A, D, and S used as 7th characters?

A: To date, there’s been no official guideline issued for these characters. But current recommendations for the use of the 7th character are:

• A: To be appended as the 7th character during the active/corrective phase of care
• D: To be appended as the 7th character once the patient transitions to maintenance/prevention
• S:  Late effect. To code for a late effect injury. This is not likely to be a commonly used 7th character.

Important: some payers, including Blue Cross Blue Shield, ChiroCare, and Medicare in Minnesota, as well as Workers’ Comp and PI payers eleswhere, have different guidelines for the use (or nonuse) of these 7th characters in the months to come. The AMA, ACA and/or CMS may also further clarify use of these 7th characters. Please carefully review your payers’ policies on this to ensure correct claims processing.

Next Steps:

1. KMC University Library members: keep using your free access to our 24/7 email HelpDesk with your ICD-10 and other questions. Not a Library member? Over 100 trainings and tools, live webinars, and so much more! Find out how to get in on the goodness here.
2. Need more help? Don’t forget Library membership includes a 30 minute 1:1 live consult, half-priced at just $69.
3. Where does your practice stand on compliance? You are required to have complete and updated HIPAA and OIG compliance policies and manuals in place, and to have trained all existing employees and new employees on them annually. Click the link below to schedule a no-cost, no-obligation consultation to find out whats best for your practice and to learn more about Discovery Consultations with a KMC University Certified Specialist.

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