Stay Compliant: Coding Updates Effective 10/1/22

As fall approaches, it’s time to review the World Health Organization’s (WHO) list of ICD-10 additions, deletions, and revisions for 2023 – effective October 1, 2022 – and there are a lot of changes:

• 1,468 new codes
• 251 deleted codes
• 35 revised codes
• 36 codes converted to parent

In this blog, we cover changes that are likely to be relevant for urgent care practices, plus, we’ll provide some guidance on documentation when using modifier 25. Keep an eye out for other coding changes in the coming months.

Significant Changes to Diagnosis Codes Related to Head Injuries

Since there are so many ICD-10 codes to address, we’re going to focus on concussion and other traumatic brain injury (TBI) code sets that are adding codes next year. Here’s how we’ll address the code changes in this article:

• Code set identified
• Map to new code
• Map to any additional code(s) based on first new code
• Analysis of the addition

Code set S06.0X- (Concussion)

This established code leads to new code S06.0XA- (Concussion with loss of consciousness status unknown).

Once you get to S06.0XA-, you’ll have to choose from these new seven-character codes:

• S06.0XAA (Concussion with loss of consciousness status unknown, initial encounter)
• S06.0XAD (Concussion with loss of consciousness status unknown, subsequent encounter)
• S06.0XAS (Concussion with loss of consciousness status unknown, sequela)

Impact: Adds loss of consciousness status unknown but confirmed concussion to code set.

Code set S06.1X- (Traumatic cerebral edema)

This established code leads to new code S06.1XA- (Traumatic cerebral edema with loss of consciousness status unknown). Once you get to S06.1XA-, you’ll have to choose from these new seven-character codes:

• S06.1XAA (Traumatic cerebral edema with loss of consciousness status unknown, initial encounter)
• S06.1XAD (Traumatic cerebral edema with loss of consciousness status unknown, subsequent encounter)
• S06.1XAS (Traumatic cerebral edema with loss of consciousness status unknown, sequela)

Impact: Adds loss of consciousness status unknown but confirmed traumatic cerebral edema to code set.

Code set: S06.2X- (Diffuse traumatic brain injury)

This established code leads to new code S06.2XA- (Diffuse traumatic brain injury with loss of consciousness status unknown). Once you get to S06.2XA-, you’ll have to choose from these new seven-character codes:

• S06.2XAA (Diffuse traumatic brain injury with loss of consciousness status unknown, initial encounter)
• S06.2XAD (Diffuse traumatic brain injury with loss of consciousness status unknown, subsequent encounter)
• S06.2XAS (Diffuse traumatic brain injury with loss of consciousness status unknown, sequela)

Impact: Adds loss of consciousness status unknown but confirmed diffuse TBI.

Code set: S06.30- (Unspecified focal traumatic brain injury)

This established code leads you to new code S06.30A- (Unspecified focal traumatic brain injury with loss of consciousness status unknown). Once you get to S06.30A-, you’ll have to choose from these new seven-character codes:

• S06.30AA (Unspecified focal traumatic brain injury with loss of consciousness status unknown, initial encounter)
• S06.30AD (Unspecified focal traumatic brain injury with loss of consciousness status unknown, subsequent encounter)
• S06.30AS (Unspecified focal traumatic brain injury with loss of consciousness status unknown, sequela)

Impact: Adds loss of consciousness status unknown but confirmed unspecified focal TBI.

Code set S06.34- (Traumatic hemorrhage of right cerebrum)

This established code leads you to new code S06.34A- (Traumatic hemorrhage of right cerebrum with loss of consciousness status unknown). Once you get to S06.34A-, you’ll have to choose from these new seven-character codes:

• S06.34AA (Traumatic hemorrhage of right cerebrum with loss of consciousness status unknown, initial encounter)
• S06.34AD (Traumatic hemorrhage of right cerebrum with loss of consciousness status unknown, subsequent encounter)
• S06.34AS (Traumatic hemorrhage of right cerebrum with loss of consciousness status unknown, sequela)

Impact: Adds loss of consciousness status unknown but confirmed traumatic hemorrhage of right cerebrum.

Code set S06.35- (Traumatic hemorrhage of left cerebrum)

This established code leads you to new code S06.35A- (Traumatic hemorrhage of left cerebrum with loss of consciousness status unknown). Once you get to S06.35A-, you’ll have to choose from these new seven-character codes:

• S06.35AA (Traumatic hemorrhage of left cerebrum with loss of consciousness status unknown, initial encounter)
• S06.35AD (Traumatic hemorrhage of left cerebrum with loss of consciousness status unknown, subsequent encounter)
• S06.35AS (Traumatic hemorrhage of left cerebrum with loss of consciousness status unknown, sequela)

Impact: Adds loss of consciousness status unknown but confirmed traumatic hemorrhage of left cerebrum.

Code set: S06.36- (Traumatic hemorrhage of cerebrum, unspecified)

This established code leads you to new code S06.36A- (Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness status unknown). Once you get to S06.36A-, you’ll have to choose from these new seven-character codes:

• S06.36AA (Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness status unknown, initial encounter)
• S06.36AD (Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness status unknown, subsequent encounter)
• S06.36AS (Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness status unknown, sequela)

Impact: Adds loss of consciousness status unknown but confirmed traumatic hemorrhage of cerebrum.

Code set: S06.37- (Contusion, laceration, and hemorrhage of cerebellum)

This established code leads you to new code S06.37A- (Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness status unknown). Once you get to S06.37A-, you’ll have to choose from these new seven-character codes:

• S06.37AA (Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness status unknown, initial encounter)
• S06.37AD (Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness status unknown, subsequent encounter)
• S06.37AS (Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness status unknown, sequela)

Impact: Adds loss of consciousness status unknown but confirmed contusion, laceration, or hemorrhage of cerebellum.

Code set: S06.38- (Contusion, laceration, and hemorrhage of brainstem)

This established code leads you to new code leads to new code S06.38A- (Contusion, laceration, and hemorrhage of brainstem with loss of consciousness status unknown). Once you get to S06.38A-, you’ll have to choose from these new seven-character codes:

• S06.38AA (Contusion, laceration, and hemorrhage of brainstem with loss of consciousness status unknown, initial encounter)
• S06.38AD (Contusion, laceration, and hemorrhage of brainstem with loss of consciousness status unknown, subsequent encounter)
• S06.38AS (Contusion, laceration, and hemorrhage of brainstem with loss of consciousness status unknown, sequela)

Impact: Adds loss of consciousness status unknown but confirmed contusion, laceration, or hemorrhage of brainstem.

Code set: S06.5X- (Traumatic subdural hemorrhage)

This established code leads to new code S06.5XA- (Traumatic subdural hemorrhage with loss of consciousness status unknown). Once you get to S06.5XA-, you’ll have to choose from these new seven-character codes:

• S06.5XAA (Traumatic subdural hemorrhage with loss of consciousness status unknown, initial encounter)
• S06.5XAD (Traumatic subdural hemorrhage with loss of consciousness status unknown, subsequent encounter)
• S06.5XAS (Traumatic subdural hemorrhage with loss of consciousness status unknown, sequela)

Impact: Adds loss of consciousness status unknown but confirmed traumatic subdural hemorrhage.

Code set: S06.6X- (Traumatic subarachnoid hemorrhage)

This established code leads to new code S06.6XA- (Traumatic subarachnoid hemorrhage with loss of consciousness status unknown). Once you get to S06.6XA-, you’ll have to choose from these new seven-character codes:

• S06.6XAA (Traumatic subarachnoid hemorrhage with loss of consciousness status unknown, initial encounter)
• S06.6XAD (Traumatic subarachnoid hemorrhage with loss of consciousness status unknown, subsequent encounter)
• S06.6XAS (Traumatic subarachnoid hemorrhage with loss of consciousness status unknown, sequela)

Impact: Adds loss of consciousness status unknown but confirmed traumatic subarachnoid hemorrhage.

Get Ready for More Substance Use, Poisoning Codes

Urgent care coders will want to start looking into updating their coding for patients that report with a consumption or poisoning issue related to substance use.

ICD-10 2023 has a bevy of new codes aimed at making your claims for patients with various substance use issues more detailed. With these codes, you will be able to paint a more accurate picture of exactly what the patient’s issues are. This should, in turn, lead to better patient outcomes and more directed care.

Take a look at these new ICD-10 codes, set to take effect Oct. 1, 2022.

Several Substances Get More Substantive Dx Codes

When ICD-10 2023 takes effect, there will be new (but similar) additions to each of these current code sets:

• F10.9- (Alcohol use, unspecified)
• F11.9- (Opioid use, unspecified)
• F12.9- (Cannabis use, unspecified)
• F13.9- (Sedative, hypnotic or anxiolytic-related use, unspecified)
• F14.9- (Cocaine use, unspecified)
• F15.9- (Other stimulant use, unspecified)
• F16.9- (Hallucinogen use, unspecified)
• F18.9- (Inhalant use, unspecified)
• F19.9- (Other psychoactive substance use, unspecified)

New codes: In ICD-10 2023, coders can add these codes to the above diagnosis sets:

• F10.90 (Alcohol use, unspecified, uncomplicated)
• F10.91 (Alcohol use, unspecified, in remission)
• F11.91 (Opioid use, unspecified, in remission)
• F12.91 (Cannabis use, unspecified, in remission)
• F13.91 (Sedative, hypnotic or anxiolytic use, unspecified, in remission)
• F14.91 (Cocaine use, unspecified, in remission)
• F15.91 (Other stimulant use, unspecified, in remission)
• F16.91 (Hallucinogen use, unspecified, in remission)
• F18.91 (Inhalant use, unspecified, in remission)
• F19.91 (Other psychoactive substance use, unspecified, in remission)

Get Ready for Codes Representing This Poisoning Type

The ICD-10 code set T43.6- (Poisoning by, adverse effect of and underdosing of psychostimulants) will devote a new section solely to methamphetamine use. The new codes you’ll have for this condition in ICD-10 2023 are:

• T43.65 (Poisoning by, adverse effect of and underdosing of methamphetamines)
• T43.651 (Poisoning by methamphetamines accidental (unintentional))
• T43.651A (Poisoning by methamphetamines accidental (unintentional), initial encounter)
• T43.652 (Poisoning by methamphetamines intentional self-harm)
• T43.652A (Poisoning by methamphetamines intentional self-harm, initial encounter)
• T43.653 (Poisoning by methamphetamines, assault)
• T43.653A (Poisoning by methamphetamines, assault, initial encounter)
• T43.654 (Poisoning by methamphetamines, undetermined)
• T43.654A (Poisoning by methamphetamines, undetermined, initial encounter)
• T43.655 (Adverse effect of methamphetamines)
• T43.655A (Adverse effect of methamphetamines, initial encounter)
• T43.656 (Underdosing of methamphetamines)
• T43.656A (Underdosing of methamphetamines, initial encounter)

Impact: This will make coding for these methamphetamine-use conditions more specific. Previously, you would have had to code these conditions with T43.691- (Poisoning by other psychostimulants, accidental (unintentional)) through T43.696- (Underdosing of other psychostimulants).

This V Code Group Grows … a Lot

There are also a staggering number of new V codes in the External Causes of Morbidity (V00-Y99) code set.

There are far too many codes to list, but they mostly concern some type of accident on a two-wheeled motorized vehicle that is not a motorized scooter (e.g., motorcycle, electric bike). The new codes, which will number in the hundreds, will be bookended by V20.01 (Electric (assisted) bicycle driver injured in collision with pedestrian or animal in nontraffic accident) and V29.9XXA (Rider (driver) (passenger) of other motorcycle injured in unspecified traffic accident, initial encounter).

No scooter codes: Of note, of the dozens of new codes in this family, none describe injuries from electric or motorized scooters. Widespread use of these scooters has dramatically increased injuries presenting to the urgent care, especially as many tourists use them for the first time when traveling.

Do this: Resist the temptation of using these new codes that specify bicycle or motorcycle in the descriptor for scooter-related injuries. Contact your payer if you need more information on how to report V codes for motorized scooter accident victims.

Other diagnoses in the V code additions for 2023 include:

• V22.01 (Electric (assisted) bicycle driver injured in collision with two- or three-wheeled motor vehicle in nontraffic accident)
• V24.19 (Other motorcycle passenger injured in collision with heavy transport vehicle or bus in nontraffic accident)
• V27.01 (Electric (assisted) bicycle driver injured in collision with fixed or stationary object in nontraffic accident)
• V28.99 (Unspecified rider of other motorcycle injured in noncollision transport accident in traffic accident)
• V29.31 (Electric (assisted) bicycle (driver) (passenger) injured in unspecified nontraffic accident).

 

 

Know How to Support Appending Modifier 25 with Accurate Documentation

Even expert coders may struggle to know exactly when to append modifier 25 because the descriptor phrase “significant and separately identifiable” is less than straightforward.

These tips will help you brush up on your understanding of evaluation and management (E/M) basics and feel confident about knowing when and how to use modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service).

Review What Qualifies as E/M

Whether to report an E/M separately from a procedure depends on what was performed and documented. In many cases, providers actually are performing “significant, separately identifiable” evaluation and management service,” but not documenting it – resulting in passing up a justifiable revenue opportunity.

When a patient comes in for a planned procedure, but also indicates a new a second or new problem that is “significant and separately identifiable,” providers commonly ask questions and dig in to learn possible reasons for the second problem such as history, exposure, or additional related conditions – and may determine a new or additional diagnosis. The provider can support an E/M since evaluation and management services occurred during the visit. In this situation, the provider should accurately document this E/M service to show it was a billable service – and can append with modifier 25.

The following are some common visits where both a procedure and E/M are allowable:

• New patient (most of the time, but not always)
• Established patient with a new problem
• Established patient with a change in an existing problem
• One problem gets E/M and another problem gets a procedure

Don’t Equate H&P With E/M

In any encounter, history and a physical examination (H&P) is just evaluation. The service is management, where the provider is using education, expertise, and training to manage a medical problem.

What defines a significant and separately identifiable E/M service is the existence of an E/M service and a procedural service that don’t overlap in the work needed to complete either one, according to Chapter 1 of the National Correct Coding Initiative [NCCI] Policy Manual for Medicare services. You can have work devoted to the E/M where there is no overlap with the work needed to perform the procedure. But it must be documented.

Don’t Use E/M for Every New Patient Scenario

A new patient encounter with a procedure usually warrants the submission of an E/M, but nothing is automatic without documentation to back it up. For example, the fact that a patient is new to the provider is not sufficient to justify reporting an E/M service on the same date of a minor surgical procedure, according to the NCII Policy Manual for Medicare. These rules hold true for nonsurgical establishments and encounters, as well as preventative services.

The 2021 E/M guidelines for MDM require details to provide an accurate E/M level and maximum possible revenue.

Before you use modifier 25, be sure the documentation of E/M meets the standards set by government regulators.

Interested in more urgent care tips, best practices, and industry updates? Check out our June and July installments.

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