Posted Friday, August 6, 2021
Pay attention to the impact of these ICD-10 changes on reimbursement.
Change is the only constant. Nowhere is that more true than in the International Classification of Disease code sets. Where once there were hundreds, now there are thousands. The new level of specificity can be helpful in supporting reimbursement, but it requires detailed knowledge of the options especially as new codes are modified, expanded or deleted.
For 2022, some codes are going away, new codes have been added, and some codes will be more specific. Here are some notable ICD-10 code changes effective as of the October 1 updates, and while this list is not exhaustive, the following is a list of some common conditions encountered in HHAs that you will need to know in order to submit accurate, supportable claims. Note that it is important to check with individual payers to find out which M0090 dates they are using to implement the changes as some commercial and private payers have their own processes that they follow that may be different than CMS dates.
As of October 1, 2021, note the following changes:
These codes are invalid:
- 5 Low back pain. Modifiers have been added to describe the pain
- R05 cough. Modifiers must be used to specify the type of cough
- 3 Feeding difficulties. Modifiers must be used to distinguish among elderly, pediatrics and unspecified
These codes are more specific:
- 9 depression unspecified, will now only be used for a single episode of major depressive disorder
- A depression, unspecified, added
New codes & guidelines for COVID-19:
- Cases of original COVID-19 remain U07.1 for COVID primary, with the manifestations coded as secondary conditions – e.g., U07.1 COVID-19 is the primary condition and chronic respiratory failure (J96.1) is coded as the secondary manifestation
- For cases of U09.0 Post COVID-19 condition or those with a reinfection should now be coded using U09.9 secondary to the residual manifestation, which should be coded as the primary condition – e.g., multisystem inflammatory condition M35.81 is the primary condition and Post COVID-19 U09.9 is coded as the residual condition
What You Need to Do Now
Stay tuned to this blog as we will continue to provide more information about these changes. In the meantime, remember that the most critical impact on the home health agency is to make sure that these code changes are implemented. For example, for clients that had a claim within the first 30 days under codes before the changes, the agency must re-code the claim to the new ICD-10 definition to continue to be paid when you submit claims for the second, 30-day period. Failure to make these changes will result a return to provider (RTP) either in payment delays when claims are returned for correction, or they will result in outright denials. Also, be aware that physicians must issue new orders even if the patient’s diagnosis changes just slightly because choosing the correct sub-classification is the key to reimbursement as ICD-10 becomes more granular. In all cases, the physician’s order must specify the new condition identified by the new code, when applicable.
Confused about ICD-10 code changes? Don’t be shy about needing help, as the very complicated world of reimbursement continues to change. Contact Corridor here or call 1-866-263-3795 and ask for one of our coding experts to help you through the next iteration of ICD-10 code sets.
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