Emergency Department (ED) ICD-10 Updates Post the Grace Period

October 1, 2016 marks the end of the one year grace period for post payment reviews related to ICD-10 specificity. That means your ICD-10 coding needs to be accurate enough to stand up to CMS scrutiny.

Widespread use of unspecified codes could cause claim rejections and post payment reviews.  Exactly what will the Centers for Medicare & Medicaid Services (CMS) and other commercial payers will deny is still unknown. But coding with specificity and not relying on unspecified codes could help safeguard your claims. Here are some ED-relevant codes with examples to prevent future denials.

Chest Pain

Chest pain includes more specific locality and type.

Examples of specific codes:

  • 1 (Chest pain on breathing)
  • 2 (Precordial pain)
  • 81 (Pleurodynia)
  • 82 (Intercostal pain)
  • 89 (Other chest pain [anterior chest-wall pain NOS])

Specific Example:

Diagnosis: Precordial chest pain à Code as: Precordial pain (R07.1)

Respiratory Infection

Coding for respiratory infections in ICD-10 requires significant detail. This diagnostic specificity (such as the infectious organism) is often unavailable in the ED place of service. Document as much specific detail as possible, including upper or lower, acute or chronic, and exact type if known.

Examples of specific codes:

  • 8 (Other specified diseases of upper respiratory tract)
  • J00 (Acute nasopharyngitis)

Specific Example:

Diagnosis: Common Cold à Code as: Acute nasopharyngitis (J00)

Asthma

Classifications for asthma in ICD-10 are based on severity (mild, moderate or severe), and subcategories also differentiate between intermittent or persistent asthma as well as acute exacerbation, status asthmaticus or uncomplicated asthma.

Severity Subcategory Other Descriptors
Mild Intermittent Acute Exacerbation
Moderate Persistent Status Asthmaticus
Severe Unspecified

Examples of specific codes:

  • 909 (Unspecified asthma, uncomplicated (asthma not otherwise specified)
  • 22 (Mild intermittent asthma with status asthmaticus)

Specific Example:

Diagnosis: Mild persistent asthma with exact à Code as: Mild persistent asthma w/ acute exacerbation (J45.31)

For more on ICD-10 Updates for the Emergency Department and other specialties, you may check our upcoming and pre-recorded sessions.

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