ICD-10 October 2016 Updates

On October 1, 2016, there will be two updates for ICD-10:

This article provides more details about the updates, including links to the full change lists. Now, let’s take a look at some specific examples of deleted codes, added/new codes, and code description updates—as well as some ICD-9 to ICD-10 crosswalk changes.

Examples

Deleted Code Examples

With this update, more than 300 ICD-10 codes have been deleted from the code set. The following examples come from Chapter 19: Injuries, Poisoning, and Certain Other Consequences of External Causes. Because these codes have been deleted from the ICD-10 library, they will no longer be available within WebPT for dates of service on or after October 1, 2016:

  • T84.040  Periprosthetic fracture around internal prosthetic right hip joint
  • T84.041  Periprosthetic fracture around internal prosthetic left hip joint
  • T84.042  Periprosthetic fracture around internal prosthetic right knee joint
  • T84.043  Periprosthetic fracture around internal prosthetic left knee joint
  • T84.048  Periprosthetic fracture around other internal prosthetic joint)
  • T84.049  Periprosthetic fracture around unspecified internal prosthetic joint

So, if you used any of these codes in the documentation for existing patients—and then continued to see those patients on or after October 1, 2016—then you would need to select new diagnosis codes for those dates of service occurring after the new code set went into effect.

Added Code Examples

With this update, nearly 2,000 ICD-10 codes have been added to the code set. Let’s return to our previous examples of deleted codes: if you had entered one of the above-listed codes for periprosthetic fracture for an existing patient—and that patient returned to your clinic on or after October 1, 2016—then you would need to enter a new code. Luckily, as part of the update, a new family of codes for this injury will be available: M97, Periprosthetic fracture around the internal prosthetic joint. As shown below, these codes will appear within WebPT’s ICD-10 code picker once the updated code set goes into effect:

I one of these replacement codes accurately reflects the patient’s condition, you could use it as a replacement for the deleted code.

Updated Code Description Examples

This ICD-10 update includes more than 400 updated code descriptions. The following examples come from Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue.

M96.83

Original description: Postprocedural hemorrhage and hematoma of a musculoskeletal structure following a procedure

Revised description: Postprocedural hemorrhage of a musculoskeletal structure following a procedure

M96.830

Original description: Postprocedural hemorrhage and hematoma of a musculoskeletal structure following a musculoskeletal system procedure

Revised description: Postprocedural hemorrhage of a musculoskeletal structure following a musculoskeletal system procedure

M96.831

Original description: Postprocedural hemorrhage and hematoma of a musculoskeletal structure following other procedure

Revised description: Postprocedural hemorrhage of a musculoskeletal structure following other procedure

Please note that the ICD-10 code is the same; only the description has changed. WebPT will automatically update all affected descriptions for the appropriate dates of service. Please double-check the descriptions for your codes to ensure they still accurately reflect the patient’s condition.

Updates to the ICD-9 to ICD-10 Crosswalk Tool

This ICD-10 update also has crosswalking implications. In WebPT, you can search for ICD-10 equivalents of ICD-9 codes using the following process:

  1. Type an ICD-9 code into the search field.
  2. Check the box next to “Search By ICD-9.”
  3. Click the Search button.
  4. Here’s an example showing how the crosswalk functionality will work differently following the ICD-10 update:

ICD-10 Grace Period Ends

When ICD-10 first went into effect on October 1, 2015, Medicare announced that it would have a one-year “grace period” ending with dates of service falling on or after September 30, 2016. During this introductory period, CMS offered providers some flexibility with coding. Specifically, CMS indicated that as long as the provider selected a code from the correct family of codes, that code would be accepted—regardless of whether it was the most accurate, most specific code. In ICD-10, the first three characters of any code typically denote the code family. The remaining characters allow the provider (or coder) to account for additional clinical details relevant to the patient’s condition.

Impact on Providers

Codes on claims with dates of service on or after October 1, 2016, will be subject to a higher level of scrutiny than those on claims with dates of service on or before September 30, 2016. This could potentially lead to more ICD-10-related denials.

Example

Consider the following table of codes:

All of the codes above fall within the same family, which is M54: Dorsalgia. The additional characters placed after “M54” provide more specific information about the patient’s condition.

So, under “grace period” rules, if a patient presented with a condition falling under the M54 umbrella, the provider could select any of the codes beginning with “M54” and still receive reimbursement. Once the grace period ends, however, providers could be held accountable (i.e., receive claim denials) for incorrect or nonspecific codes. Thus, providers must ensure the codes they select to represent the patient’s condition in the most accurate, most specific way possible.

Strategies for Post-Grace Period Success

When it comes to ensuring you have selected a complete, billable code, WebPT has always had you covered. And while we will continue to alert you when you have not selected a valid code, we now recommend that you pay even closer attention to the codes you are selecting to ensure they accurately describe the patient you are treating. Furthermore, we suggest that, prior to October 1, 2016, you finalize all documentation with dates of service on or before September 30, 2016. This will help ensure a smoother transition to the updated code set and coding guidelines.

Want to take your preparations a step further? Great! We recommend making time to train staff, review claim denials, audit coding, and documentation practices, and establish and monitor relevant KPIs. For more in-depth advice on how to tackle those tasks, check out this article.