ICD-10 Changes

Let's walk back in time, a year ago to be exact. We all went through the conversion to ICD-10 diagnosis codes, and most of us found it easier than expected. Part of this has been because The Center for Medicare and Medicaid Services (CMS) granted quite a bit of flexibility in coding, with the understanding that it would be less flexible in the future. As an aside, decreased flexibility is also something that can happen to a 50-something blog writer.

Unlike my yoga instructor, however, CMS was referring to specificity of coding and the one-year grace period that will end October 1, 2016. After that date, codes must not simply be in the correct family, but at the highest level of specificity appropriate. Rexpert already guides you to the most specific level possible, so the main change will be to take care not to use the "unspecified" codes unless they are warranted.

Let's walk through it here: Mr. Joe Patient comes into your facility and is diagnosed with typhoid fever. On the Charge Entry screen, you enter code A01.0 and the following screen pops up:



You can see the A01.0 family tree in the above screen shot with code A01.0 being the parent and the rest being children. You will want to use one of these child codes (numbered A01.01 through A01.09). Note that the first entry in the table: "no change (this is a header code: invalid for billing)" is Rexpert's gentle and sensitive reminder that Code A01.01 won't make CMS happy: the claim will come back to you, summarily rejected out of hand.

Let's talk about code A01.0 (typhoid fevers). Note that this is the parent code for codes A010.00 through A010.09. You will want to bill under one of the more specific child codes, otherwise your claim will be rejected.  Specificity is key, here. For instance, overuse of code A010.00 (unspecified typhoid) might trigger an audit or review and frankly, we'd rather do five hours of "downward facing dog" poses in yoga class.