Changes in Coding2017

Presentedby:CynthiaRobinson,RT,CPC

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Overview of ICD-10

• Over69,000codes(ICD-9hadapproximately17,000)• Codesstartwithan“alpha”character,except“U”• 5-7charactersinacode• “X”placeholders• ChaptersreorganizedfromICD-9• 21chaptersinICD-10,19inICD-9• Alphabeticalindex• Tabularindex• Allowsforfurtherexpansion

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2016- What to Expect

• TheCodefreezeisover!• TherewillbethousandsofnewcodesthatthepracticeswillhavetousestartingonOctober1,2016• TherehavenotbeenanynewchangesinICDsince2012• Thechangesaresignificantforphysicianpractices• 1,943NEWcodes• 305DELETEDcodes• 422REVISEDcodes• Totalof2670changesforthecomingyear!

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Changes, Revisions and Deleted Codes

• Morethan300changesincancercare• Morethan400changesineyecodes• Morethan300Uro/OB-Gyncodechanges• Nearly500changestonewborncodes• Nearly400new,changed,ordeletedinjury,mortalityandfamilyinjurycodes

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New Codes

• Considertheimpactofnewcodesonyourclinicaldocumentation,billingandmedicalpolicies• Thesenewcodesandupdateswillprovidegreaterspecificity• BeforeICD-10,onaverageabout150-200codeswerechangedannuallywithICD-9,andgoingforwardwewillnothaveasmanychangesaswedowith2017• Makesurethatyourbillingservice,yourpracticemanagementsystem,yourEHRandclearinghouseispreparedforthenewchangeseffectiveOctober1,2016.

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• InmanyinstancesanexistingICD-10-CMcodewillbedeletedeffectiveOctober1,2016andcouldbereplacedbymultiple,morespecificcodes.• AlistoftheproposednewICD-10-CMcodesareavailableontheCDC(CentersforDiseaseControlandPrevention)website.• Wewillcontinuetoseeadditions,deletionsandrevisedcodeseachOctoberuntiltheUnitedStatesmovestoICD-11-CM.• Therevisionsincludesimplechanges,suchasasingularwordinthecode.Itcouldbechanging“of”to“dueto”.

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Tips Moving Forward

• Themostimportantthingthatapracticecandoistostopusingunspecifiedcodes,unlesstherearenoothercodesthatdescribethepatient’scondition.• Somecodesthatwereeligibleforreimbursementin2015-2016willnolongerbeallowedin2016-2017.• Reviewlocalandnationalcoveragerulesforcodingchanges.• Ifyouuseavendorforbillingorcoding,makesurethattheyarereadyonOctober1,2016withthenewcodes.

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Non-Specific Codes

• CMSpreviouslyallowedproviderssomeleniencywhenassigningdiagnosesduringthefirstyearofICD-10.• ButthatwillexpireonOctober1,2016• CommercialcarrierswhodidnotadopttheCMSdirective,alreadyrejectclaimsforunspecifiedornon-specificdiagnoses.• Itisabigconcernforproviders,thattheimpactofdiagnosisdrivendenialswilleffectreimbursement.• BetterDocumentation=FewerUnspecifiedcodes

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CPT Changes for 2017

• Over700changesinCPTcodesfor2017• AppendixB—”SummaryofAdditions,Deletions,andRevisions”

• Notethenewcodesthatpertaintoyourspecialty.HighlightchangesinyourCPTbook,especiallythoseforyourspecialty.• Makesureyouknowhowtoapplythenewcodes.• Whatdocumentationyouneedtosupportthenewcodes.• Reviewallchangestoguidelines,notes,orotherinstructions.

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What do I do now?

• Highlightchangesthataffectyourspecialty• Createa“cheatsheet”forcodesthatthedocumentationisdifferentfrom2016.Meetwithyourproviderstoupdatethemonthesechanges.• Reviewallsuperbills,encounterforms,labforms,oranyformsthathaveCPTcodespostedonthem.• Makesureyoursoftwareisupdated.• Trainbillingstaffonchanges.

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Reimbursement by Specialty

• CMSproposestoreduceratesfor“InterventionalRadiology,Pathology,andVascularSurgery”

• CMSproposesarateincreasefor“FamilyMedicine,AllergyandImmunology,Endocrinology,Geriatrics,Hematology/Oncology,InternalMedicine,PediatricsandRheumatology”

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New Modifier• Modifier95• SynchronousTelemedicineServiceRenderedViaaReal-TimeInteractiveAudioadVideoTelecommunicationsSystem.• Thisserviceisdefinedasareal-timeinteractionbetweenaphysician/orotherqualifiedhealthcareproviderandapatientwhoislocatedatadistantsitefromtheprovider.Documentationmustsupportthekeycomponentsoftheserviceprovided.ThismodifiermayonlybeappendedtotheservicesthatarelistedinAppendixP.AppendixPisthelistofCPTcodesforservicesthataretypicallyperformedface-to-facebutmayberenderedviaarealtimeinteractiveaudioandvideotelecommunicationsystem.

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Telemedicine Requirements

• Mustbefurnishedviaaninteractivetelecommunicationssystem.• Servicemustbeprovidedbyaphysicianorotherqualifiedhealthcareprofessional.• Mustbefurnishedtoaneligibletelehealthindividual.• Thepatientreceivingtheservicemustbelocatedinatelehealthoriginatingsite.

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Telemedicine Place of Service

•CMShasaddedanewplaceofservice(POS)code-02- tousewhenaserviceisprovidedthroughatelehealthcommunication.•02-Placeofserviceinan“Unassigned”Placeofservice.

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Moderate Sedation• AppendixGhasbeenremovedfromtheCPTcodeset.ThisappendixwasasummaryofCPTcodesthatincludedModerate(conscious)sedation.

• Thesymbolfor“moderatesedation”,thebull’seyehasbeenremoved.

• 441codesnolongerincludemoderatesedation.Largestchangesinthe2017CPTbook.

• Therearenewcodes99151-99157

• Refertothecode99151fordescription,totalintraservicetime,patient’sage,andcodestouse. 16

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Moderate Sedation Codes99141-99150weredeleted.● 99151 Moderatesedationservicesprovidedbythesamephysicianorotherqualifiedhealthcareprofessionalperformingthediagnosticortherapeuticservicethatthesedationsupports,requiringthepresenceofanindependenttrainedobservertoassistinthemonitoringofthepatient’slevelofconsciousnessandphysiologicalstatus;initial15minutesofintraservice time,patientyoungerthan5yearsofage

● 99152initial15minutesofintraservice time,patientage5yearsorolder

+● 99153eachadditional15minutesintraservice time(Listseparatelyinadditiontocodeforprimary

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E & M Changes

• HealthandBehavior/Assessment/Intervention

• Codes96160and96161arenew,andtheyreplacethecode99420• 96160 Administrationofpatientfocusedhealthriskassessmentinstrumentwithscoringanddocumentation• 96161 Administrationofcaregiver-focusedhealthriskassessmentforthebenefitofthepatient,withscoringanddocumentation

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Musculoskeletal Codes

• Code22851hasbeendeletedfor2017.Replacethiscodewithoneofthenewcodes.• Threenewadd-oncodesforbiomechanicaldeviceinsertion.Theyare22853,22854,and22859.• Fournewcodesdescribetheinsertionofaninterlaminar/interspinous stablization device.Therearetwoprimarycodesandtwoadd-oncodesforadditionallevels.Theyare22867and22869andtheadd-oncodesare+22868and+22870

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Bunionectomy Codes

• Deletedcodes28290,28293,and28294• Revisionstocodes28292and28296

▲ 28292Correction,halluxvalgus(bunion)(bunionectomy),withsesamoidectomyor orwithout,whenperformed;Keller,McBridewithresectionofproximalphalanxbase,orMayotypeprocedurewhenperformed,anymethod• Therevisionsremovereferencestonamesandaddspecificsaboutwhatisperformedduringtheprocedure.

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Laryngoscopy Codes• Changesinclude“fiberoptic”beingremovedfromthecodesandtheadditionofnewcodes.

• NewCodes:

● 31572Laryngoscopy,flexible;withablationordestructionoflesion(s)withlaser,unilateral

● 31573Laryngoscopy,flexible;withtherapeuticinjection(s)(eg,chemodenervation agentorcorticosteroid,injectedpercutaneous,transoral,orviaendoscopechannel),unilateral

● 31574Laryngoscopy,flexible;withinjection(s)foraugmentation(eg,percutaneous,transoral),unilateral

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Respiratory Codes

▲ 31575Laryngoscopy,flexible fiberoptic;diagnostic

▲ 31576withbiopsy(ies)

▲ 31577withremovalofforeignbody(s)

▲ 31578withremovaloflesion(s),non-laser22

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Cardiovascular Codes

•Codes35450,35452,35458,and35460foropentransluminalangioplastyhavebeendeleted.

•Codes35471,35472,35475,and35476forpercutaneoustransluminalangioplastyhavebeendeleted.

•Codes36147,36148forintroductionofacatheterforACshuntcreatedfordialysisweredeleted.

• Codes36870and75791havebeendeleted.23

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Cardiovascular Codes

• Therearenewcodesforvisceral,aortic,brachiocephalicandvenousballoonangioplastythatbundleopenandpercutaneousprocedurestogether.Thenewcodesincluderadiologicalsupervisionandinterpretation,soyouwouldnolongercodetheradiologycodes.

• TheserelatedRadiologycodeshavebeendeleted.

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Cardiovascular Codes

● 36456Partialexchangetransfusion,blood,plasmaorcrystalloidnecessitatingtheskillofaphysicianorotherqualifiedhealthcareprofessional,newborn

● 36473Endovenous ablationtherapyofincompetentvein,extremity,inclusiveofallimagingguidanceandmonitoring,percutaneous,mechanochemical;firstveintreated

+● 36474subsequentvein(s)treatedinasingleextremity,eachthroughseparateaccesssites(Listseparatelyinadditiontocodeforprimaryprocedure)

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Cardiovascular CodesNewCodes● 37246Transluminalballoonangioplasty(exceptlowerextremityartery(ies)forocclusivedisease,intracranial,coronary,pulmonary,ordialysiscircuit),openorpercutaneous,includingallimagingandradiologicalsupervisionandinterpretationnecessarytoperformtheangioplastywithinthesameartery;initialartery+● 37247eachadditionalartery(Listseparatelyinadditiontocodeforprimaryprocedure)

● 37248Transluminalballoonangioplasty(exceptdialysiscircuit),openorpercutaneous,includingallimagingandradiologicalsupervisionandinterpretationnecessarytoperformtheangioplastywithinthesamevein;initialvein

+● 37249eachadditionalvein(Listseparatelyinadditiontocodeforprimaryprocedure)

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Digestive System Codes

• NewCodes

● 43284Laparoscopy,surgical,esophagealsphincteraugmentationprocedure,placementofsphincteraugmentationdevice(ie,magneticband),includingcruroplasty whenperformed

● 43285Removalofesophagealsphincteraugmentationdevice

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Radiology Codes

•DeletedCodes:75791,75962,75964,75966,75968,75978

NewCodes:● 76706Ultrasound,abdominalaorta,realtimewithimagedocumentation,screeningstudyforabdominalaorticaneurysm(AAA)

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Radiology/Mammogram Codes

•Mammogramcodes77051,77052,77055,77056,and77057weredeleted.

• NewCodes:● 77065Diagnosticmammography,includingcomputer-aideddetection(CAD)whenperformed;unilateral

● 77066bilateral

● 77067Screeningmammography,bilateral(2-viewstudyofeachbreast),includingcomputer-aideddetection(CAD)whenperformed

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Lab Changes

• DrugScreeningcodes80300-80304havebeendeleted.

• Thenewdrugscreentestcodesfor2017are80305-80307andwillbebasedonthemethodthatisusedfortestinganditwillthenbereportedwithoneunitofservice.

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Flu Vaccines

• Fluvaccinecodeswillnowbecodedbydosage,notage.

• Thischangeaffectscodes90655-90661.

• Example:90655,“administeredtochildren6-35monthsofage”hasbeenremovedfromthedescription,andinsteadsays“0.25mldosage”.

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Psychotherapy

• Psychotherapycodes90832-90834,and90836-90838havebeenrevised.Theynolongersay“and/orfamilymember”.Thishasbeenremoved.• 90846Familypsychotherapy(withoutthepatientpresent),50minutes• 90847Familypsychotherapy(withpatientpresent),50minutes• 50minuteshavebeenaddedtothesecodes

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Physical Therapy Codes•Deletionof97001,97002

•Newevaluationcodes:97161,97162,97163Thesecodesarenowcodedastocomplexity,low,moderate,or

highandarestructuredlikethepresentE&Mcodes.Documentationforthesecodesconsistof:History,Exam,ClinicalPresentationandClinicaldecisionmaking.

•Newreevaluationcode:97164

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Occupational Therapy Codes•Deletionof97003,97004

•Newevaluationcodes:97165,97166,97167Thesecodesarenowcodedastocomplexity,low,

moderate,orhighandarestructuredlikethepresentE&Mcodes.Documentationforthesecodesconsistof:History,Exam,ClinicalPresentationandClinicaldecisionmaking.

•Newreevaluationcode:97168

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Ophthalmic Changes

• Changesinthedescriptionoffluoresceinangiographycode92235andindocyanine-greenangiographycode92240.• Thesecodeshavechangedthattheyapplywhethertheserviceisunilateralorbilateral.

• NewCode:• 92242Fluoresceinangiographyandindocyanine-greenangiographyperformedatthesamepatientencounterwithinterpretationandreport,unilateralorbilateral.

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Wound Care

• 97602Thiscodehasbeenrevisedtoincludelarvaltherapy.Thisisotherwisereferredtoasmaggottherapy.

• 97602Removalofdevitalizedtissuefromwounds,non-selectivedebridementwithoutanesthesia(example:wet-to-moistdressings,enzymatic,abrasion,larvaltherapy)includingtopicalapplications,woundassessment,andinstructionsforongoingcare,persession.

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Claim Denials

• LackofDocumentationisthe#1reasonforClaimsDenials• Providerscanfixthatbydocumentingthefollowing:

• Historyofillnessfromonsettodecisionforthesurgery• Priorcoursesoftreatmentandresults• Currentsymptomsandfunctionallimitations• Physicalexamdetailingobjectivefindingssupportinghistoryofillness• Resultsofanyspecialtests

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Resources• AmericanAcademyofProfessionalCoders• ICD-10-CMbook• CPTBook• AmericanAcademyofPediatrics• Intelicode• CMS-(CentersforMedicareandMedicaidServices)• CDC-(CenterforDiseaseControlandPrevention)

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