betsy-nicoletteMedical coding expert, Betsy Nicoletti, M.S., CPC, is leading a three-part ICD-10 webinar series as part of our free, month-long ICD-10 Boot Camp. Here she addresses questions we’ve received about the new coding system, in parts one and two of the three-part series.

Question: Can we begin reporting ICD-10 codes before October 1st?
Answer: No.

If we have an outstanding encounter from 9/30/15 that we complete on 10/1/15 or thereafter, do we use ICD-9 codes for that date of service – or since we’re submitting after the ICD-10 date, do we code it with ICD-10 codes?
Use an ICD-9 code for dates of service 9/30/15 or before. The date submission doesn’t affect it.

When are we supposed to use initial codes “A?”ICD-10 Boot Camp Free Webinar Series
Begin using all ICD-10 codes and extenders for date of services 10/1/15 and later. “A” is one of the 7th character extenders needed for trauma — it isn’t needed everywhere.

How are the first alpha digits organized?
The ICD-10 chapters are organized in the same way as ICD-9, and assigned A-Z, not using U.

Is there any reasoning/patterns behind the first alpha character?
The chapters are in the same order as ICD-9. The letters were assigned from A-Z, not using U.

The ICD-10 code for plantar fascial fibromatosis is m72.2 – why does the book not prompt for laterality?
The reasoning is hard to decipher in coding; some codes have laterality and some don’t. This one doesn’t.

Bilateral ICD-10 coding: Do you recommend using the bilateral diagnosis codes or use individual right and left diagnosis codes?
If there is a bilateral code, use it. If no bilateral code, and the patient has the condition on both sides, use two codes.

Are the A, D, S codes for trauma/injury only?
They are used with fracture codes in the musculoskeletal section, and with injury/adverse effects codes in the S/T chapters and with external cause codes.

Where can I purchase an ICD-10 book specializing in podiatry?
I don’t know of any. Check with your specialty society.

We see renal failure patients for their devices … if secondary to diabetes, hypertension, etc. which dx do we list first?
Look in your book under category code N18. There is a code first note there that will answer your question.

If ear wax was removed in both ears, would you use modifier 50 or 25?
This is a CPT question: Look in the appendix of your CPT book. Modifier 50 on procedure code.

E927.9 overexertion has been eliminated. What is the reasoning and what is the replacement?
There is no code for over exertion in ICD-10. I do not know why.

If we have been seeing a patient for wound care, would we use A or D on October 1st?
Wound care codes are in the skin section and do not require a 7th character extender. Free Demo - Award Winning MediTouch EHR and Billing Software

Are there changes in ICD 9 in Nephrology?
Look at the GU section, Chapter 14, beginning with the letter N.

To diagnose onychomycosis with Medicare, you have to include pain in limb. The ICD-10 code for pain has laterality and if you have fungus on both feet do you use the two laterality codes or can you use the unspecified pain code?
Use the pain code twice, one for the right and one for the left. Don’t use the unspecified code.

If a patient comes in for a colon surgery and then ends up with an incisional hernia, would we code the diverticulitis with the S and the incisional hernia with the A?
Neither of these are trauma codes and they do not require a 7th character extender.

If a patient is seen monthly for opioid dependence would you need to use an extender with each visit?
This is also not a trauma code and does not require a 7th character extender.

For patients following up in their 10 or 90 day global period, do we use the same diagnosis as the first visit and only change the A code?
Yes. It is a 7th character extender.

If an internist sees a pregnant woman with HTN, is the normal IUP coded first, and HTN second?
Use hypertension first, and pregnancy incidental state second. The OB doctor would code supervision of high risk pregnancy.

The vaccine ICD-10 code is the same for all vaccines. Do we enter multiples of the Z23 and link each CPT to their own, or do we only put in one Z23 ICD-10 code and link each CPT to that same code?
Yes, one diagnosis code for all immunizations. List the CPT code.

What is the ICD-10 coding for Medicare flu shot and Prevnar?
The coding is Z23 for all vaccines

If a patient had a flu shot, Prevnar and PPD, how do you bill for three shots and an office visit?
That’s really a CPT code and not a diagnosis related code. You’d bill the office visit with a 25 modifier, you’d bill for the administration of the flu shot, if you had bought the flu vaccine, you’d bill for that – same with the Prevnar.

You mentioned Workers Comp claims, but what about auto accident insurances? Will they be changing to ICD-10?
They are not HIPAA covered entities and are not required. It will vary.

I’m confused with Excludes1 and 2. Can you please re-explain the difference?
From the General Guidelines:

Excludes Notes – The ICD-10-CM has two types of excludes notes. Each type of note has a different definition for use but they are all similar in that they indicate that codes excluded from each other are independent of each other.

a. Excludes1 
A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE!” An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.

b. Excludes2 
A type 2 Excludes note represents “Not included here”. An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.

How many ICD-10 codes can be billed per encounter? The same four as before?
The 5010 allows for 12 ICD-10 codes.

If a patient is seen at the office and referred to the hospital by the doctor, will it be a particular ICD-10 to indicate the patient was referred to the hospital that same day for a particular condition?

Is it true that for any office visit that is related to a MVA or WC claim we need to use E Codes on every visit to describe the injury?
This is payer driven. You’ll need to ask the individual payer.

In regards to reproductive endocrinology, as far as ultrasounds go: If there are polyps or cysts, will we need to be specific as far as making sure the coding includes the LT (left) RT (right) ovary?
This will also be payer/reimbursement driven.

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