The End: of ICD-10 Flexibility
On October 1, 2016 flexibility in ICD-10 Diagnostic Coding expired. Those of you using electronic remittance may have already seen some denials coming back. CMS’ one-year grace period to use unspecified codes is finished. Non-specific codes, like the codes used when converting ICD-9 to ICD-10, are no longer supported.
- CD-10-CM was developed by the Centers for Disease Control and Prevention for use in all United States of America health care treatment settings.
- ICD-10-PCS was developed by CMS for use in the U.S. for inpatient hospital settings ONLY.
Providers should be coding to reflect as much specificity as possible, New terminology aligns with the DSM-5, and also new Diagnosis that were added to Chapter 5 of ICD-10-CM 2017. The new updates require you to produce codes with more precision and specificity. ICD-10-CM Diagnoses Codes: 3–7 digits Digit 1 is alpha Digit 2 is numeric Digits 3–7 are alpha or numeric (alpha digits are not case sensitive)
For example if you code F43, ICD-10-CM F43 is a non-specific code, that is, there are codes below or above this code that have a greater level of detail. Here is an example of a new code that is specific: ICD-10-CM F42.9 is NEW 2017 ICD-10-CM code that became effective on October 1, 2016.
This code diagnosis is A disorder characterized by the presence of persistent and recurrent irrational thoughts (obsessions), resulting in marked anxiety and repetitive excessive behaviors (compulsions) as a way to try to decrease that anxiety.
Or you may want F43.1 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. This is stress related to Post trauma.
F43.0 is billable but below that you have the choices of F43.1, or F43.10, -F43.12 the more digits after the decimal the more detail you are giving about your approach and the symptoms.
Diagnostic coding can have up to 7 characters. The first character, in our case “F” is the section of the the manual (Mental Health) the second character a number 0-9 describes the specific disorder; for example orders with onset in childhood or adolescence will always start with F followed by a 9, anxiety disorders will always be an F followed by a 4 and so on. But these are not specific enough.
Lets use this example, substance abuse will always fall under F10-F19 the second character will always be “1” the third character then gets more specific with the type of substance such as F14 “4” signifies cocaine use. Then we have the decimal followed by even more description. F14.1 is cocaine abuse, but more specifics will show the symptom/ approach such as F14.1 cocaine use F14.10 is mild
→ mild F14.10
→ amphetamine, cocaine, or other stimulant intoxication F14.12
→ without perceptual disturbances F14.129
As you see each character after the decimal shows more and more specific information about the diagnosis and treatment of the patient.
There have also been disorders changed and added for social and eating disorders; Some disorders used to fall into a physical category but have since been regrouped as falling under a mental disorder after being recognized as the mental disorder being the primary diagnosis at the visit. Diagnosis such as Excoriation or PMS type mental disorders have changed to Mental Health categories. The following is a table of some of the new changes:
We follow up on all claims until they are paid, and if there are issues with coding we try to contact you to get more specific diagnosis before they are submitted thus lowering you chance of a denied claims. Michelle Husted. If you are in need of billing for maximum reimbursement contact us here at Denmaar Psychiatric Billing 1-888-595-5101
Providers: Have you been hearing talk about peer-to-peer payments and how they can be used for patient payments?
Want to know if this is really a viable way to have patient's make co-payments?...