Many of the complexities of medicine are distilled down to a vocabulary of diagnostic codes, called the International Classification of Diseases (ICD), which are used by doctors, insurers, and hospitals.…
Tip: A diagnosis that falls under an ICD-9 ‘other’ code may have its own ICD-10 code.
Under ICD-9, when the manual doesn’t offer a code specific to your diagnosis, you usually choose one of the catch-all “other specified” codes available, such as 425.4 (Other primary cardiomyopathies). When you start applying ICD-10 codes in October 2013, you may find that your catch-all code has been divided into more specific options. Here’s how the ICD-10 counterparts for 425.4 will look.
ICD-9 coding rules: Cardiomyopathy literally means disease of the heart muscle and can refer to many types of heart disease. ICD-9 offers one code for “other” primary cardiomyopathies: 425.4. It’s appropriate for cardiomyopathy NOS, congestive, constrictive, familial, hypertrophic, idiopathic, nonobstructive, obstructive (but see 425.1 for hypertrophic obstructive), and restrictive. Code 425.4 is also appropriate for cardiovascular collagenosis.
ICD-10 changes: ICD-10 divides your options for “other” cardiomyopathy among three codes:
Code I42.2 will be appropriate for other cardiomyopathy: hypertrophic, nonobstructive. Code I42.5 will be appropriate for other cardiomyopathy: restrictive, constrictive NOS. Code I42.8 is appropriate for any other cardiomyopathies not listed elsewhere, including newborn and obscure of Africa, as well as cardiovascular collagenosis.
Caution: Check the index and full I42.- range in the tabular list before choosing an “other” code. For example, several of the diagnoses that fall under 425.4 in ICD-9 do not fall under the “other” cardiomyopathy codes in ICD- 10. Specifically, obstructive cardiomyopathy is coded to I42.1 under ICD-10, congestive falls under I42.0, and familial and idiopathic fall under I42.9.
Remember: When ICD-10 goes into effect on Oct. 1, 2013, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.
Be ready...
Do you ever meet with parents before their baby is even born? In these cases, you might be hesitant to charge for the visits because the patient isn’t present yet—but can you collect anything for the physician’s time? Check out the following 4 options, along with our expert advice before billing to insurance.
1. Consider an Office Visit
Some practices think of meet-and-greets, in which they tell the parents about the way they run their practice, more as an office visit, such as 99201. However, this would need to be billed based on time to the mother’s insurance company and would likely be questioned by the insurance company. For practices that do charge for these services, there’s a diagnosis code you can use: V65.11. ICD-9 guidelines allow you to list the code as a first or additional diagnosis.
2. Ensure You Meet Criteria Before Using 99401-99404
As an alternative to use a problem-oriented office visit code, the American Academy of Pediatrics (AAP) suggests the pediatrician may deem an appropriate counseling or risk factor reduction code. You may report these codes for prenatal counseling “if a family comes to the pediatrician/neonatologist either self-referred or sent by another provider to discuss a risk-reduction intervention (i.e., seeking advice to avoid a future problem or complication),” according to the AAP’s Coding for Pediatrics 2009.
You would report the service under the mother’s insurance, according to the AAP. Make sure you don’t use 99401-99404 if the mother or her fetus has any existing symptoms, an identified problem, or a specific illness. As per CPT®’s Counseling Risk Factor Reduction and Behavior Change Intervention guidelines, “these codes are used to report services for the purpose of promoting health and preventing illness or injury.”
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2991x, 9922x medical procedure CPT 2011 codes added.
If you’ve been frustrated about the lack of arthroscopic hip surgery codes that CPT offers, CPT 2011 will change that, with three new codes that debut on Jan. 1.
In fact, CPT will introduce over 200 new codes in 2011 to help keep your coding more specific than ever, spanning several categories, from dermatology to orthopedics to cardiology, and beyond.
In orthopedics, you’ll benefit from the following three hip arthroscopy codes, which will be excellent additions to CPT.
Check out New Observation Codes
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