ICD 10

Bones are typically resistant to bacterial colonization, but events such as trauma, surgery, the presence of foreign bodies, or the placement of prostheses may disrupt bony integrity, or a result of a spread after bacteremia, and lead to the onset of bone infection caused by an infectious organism, or osteomyelitis. In ICD-10-CM, osteomyelitis is differentiated as acute, subacute, or chronic. A subacute infection is differentiated from an acute infection and has its own subcategories.

Acute Osteomyelitis

For inpatient coding, there are times when the diagnosis(es) cannot be established at the time of admit or throughout the course of the admission. In these cases, they are documented in the medical record as “probable,” “suspected,” “likely,” “questionable,” “possible,” or “rule out” conditions. This guideline is true for certain settings such as acute care facilities, short- term facilities, long-term care and psychiatric hospitals. The specific guideline states,

Provider Documentation Guides (PDGs) Are Excellent Training Tools - Part II

PDGs, when properly used, can be tremendous tools to help providers document key pieces of information pertinent to identifying medical necessity for services ordered, performed, and billed. Using PDGs in provider training sessions can improve documentation habits, making proper code selection easier and medical necessity clear. Schedule and execute a quick, 10-minute provider session in the following manner:

Preparation:

The ICD-10-PCS codes set has added new technology codes for fiscal year (FY) 2016, beginning October 1, 2015.  This section was added to identify new technologies not currently in ICD-10-PCS or to classify codes that have been requested through the New Technology Application Process.  This section was added in response to public comments that were received during the ICD-10 Coordination and Maintenance Committee Meetings, specifically in regards to New Technology proposals.

Enough time has passed since the implementation of ICD-10-CM that we are now able to identify some common errors being made in code selection, one of which is the lack of using proper combination codes. Many providers continue to report two codes when ICD-10-CM provides a single combination code. For example, when a patient with diabetes mellitus and polyneuropathy is seen, two codes are being reported to explain the diagnosis fully as:

E11.9 Type 2 diabetes mellitus without complications
G62.9 Polyneuropathy, unspecified

Z-codes are used for the reason of the encounter instead of the V codes, they are found in Chapter 21: Factors influencing health status and contact with health services (Z00-Z99). A corresponding procedure must accompany a Z code if a procedure is preformed.

Note: The chapter specific guidelines provide additional information about the use of Z codes for specified encounters.

We've been using ICD-10-CM for a few weeks now. If you haven't already started getting EOBs from your payers, get proactive and start checking claim status on your own. You may have been coding correctly to begin with, but there can be some hiccups between claim submission and adjudication. For example, we've heard from providers who've told us that their computer software dropped the final character of the ICD-10-CM code when their claims were submitted.

Don't do that!

The 7th character must always be the 7th character in the data field. If a code requires a 7th character and there is only 6 characters, a placeholder "X" must be used to fill in the empty characters.  Without the place holder, the code is considered invalid.

Example:

Incorrect codes:

 S00.00    Unspecified superficial injury of scalp

 S00.00A Unspecified superficial injury of scalp

Below is a Correct or Complete code:

CMS wants to remind you not to change or rewrite your original orders for any service or product due to the change of code sets from ICD-9-CM to ICD-10-CM.

For any type of product or service prior to October 1, 2015, do not change the order, even if it will be a continued service with dates spanning prior and after ICD-10 is in effect. You will simply change your codes from ICD-9 to ICD-10, leaving the original order as is.

The official guidelines for ICD-10-CM define the conventions used in the code set. In section 1.A.6, we learn the following about some common abbreviations in the Tabular List: NEC “Not elsewhere classifiable” This abbreviation in the Tabular List represents “other specified”. When a specific code is not available for a condition the Tabular List includes an NEC entry under a code to identify the code as the “other specified” code. NOS “Not otherwise specified” This abbreviation is the equivalent of unspecified. Section 1.A.9 tells us a little more:

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