WELTER HEALTHCARE PARTNERS

ICD-10 2021 Updates

Jan 1, 1970 | Uncategorized

The ICD-10 2021 updates include over 500 significant changes. These updates, set to take effect on October 1, 2020, include 490 new codes, 47 revised codes, and 58 codes deemed invalid. We will also see increased instructions on reporting manifestations of COVID-19. New guidance on social determinants of health, insulin use & acute kidney failure. See Welter Healthcare Partners’s summary of these changes in the information below!nnWith over 500 diagnosis coding changes just around the corner, the FY 2021 ICD10CM Official Guidelines bring updates that are set to be significantly larger than the FY2020 update brought to us last year.nnUpdates that are set to take effect October 1st, 2020 include 490 new codes, 47 revised codes and 58 codes deemed invalid (see table below), additional instructions on reporting manifestations of COVID-19, as well as new guidance on social determinants of health, insulin use and acute kidney failure, among several other changes.nnBelow is a summary of the anticipated FY2021 ICD10CM Updates by Chapter:nnChapter 1: Certain Infectious & Parasitic Disease brings a new section 1.g for reporting Coronavirus infections.nnChapter 3: Diseases of Blood & Blood-forming organs has eighteen new, detailed codes available for sickle cell anemia. These new codes describe complications associated with sickle- cell and hemoglobin-C (Hb-C) diseases. For example, a note for new sickle-cell thalassemia code D57.418 (Sickle-cell thalassemia, unspecified, with crisis with other specified complication) instructs the coder to code any identified complications such as cholelithiasis (K80.-) or priapism (N48.32).nnChapter 4: Endocrine, Nutritional & Metabolic Disease includes new coding instructions to follow for diabetic patients treated with insulin, oral hypoglycemics and injectable non-insulin drugs. For example, if the patient is taking both insulin and an injectable non-insulin antidiabetic drug, assign both Z79.4 (Long term [current] use of insulin) and Z79.899 (Other long term [current] drug therapy). If the patient is taking oral hypoglycemic drugs and an injectable non-insulin antidiabetic drug, assign code Z79.84 (Long term [current] use of oral hypoglycemic drugs) in addition to code Z79.899.nnChapter 5: Mental, Behavioral and Neurodevelopmental Disorders contains twenty-one new codes that describe withdrawal from substances including alcohol, cocaine, and opioids. For example, F10.932 (Alcohol use, unspecified with withdrawal with perceptual disturbance).nnChapter 6: Diseases of the Nervous System has added “pseudotumor” as a clarifying term to G93.2 (Benign intracranial hypertension) and coders are instructed to code G98.81- (intracranial hypotension) with G96.0 (Cerebrospinal fluid leak) when applicable.nnChapter 9: Diseases of the Circulatory System contains many revisions to the includes and excludes notes for existing codes. For example: Atherosclerosis of native arteries of the legs with ulceration (I70.2-) now includes both critical and chronic ischemia of native arteries with ulceration. Hypertensive Heart Disease (I11) has been revised to exclude Takotsubo Syndrome (I51.81), also known as “broken heart” syndrome.nnA new hypertension guideline provides instruction that when a patient has hypertensive chronic kidney disease and acute renal failure, code both conditions and sequence the codes based on the reason for the encounter.nnChapter 10: Diseases of the Respiratory System now has code also instructions for cases of acute laryngitis and tracheitis (J04) and acute obstructive laryngitis (croup) and epiglottitis (J05). Coders are instructed to code also influenza if present, including influenza due to identified novel influenza A virus with other respiratory manifestations (J10.1). This chapter also has a new section 10.e specifically for vaping-related disorders.nnChapter 13: Musculoskeletal System found several updates this year including twelve new codes to capture other pathological fractures (M80.8AX- and M80.0AX-). Updates include an expanded list of codes for rheumatoid arthritis, as well as primary and secondary arthritis, and arthritis caused by trauma. New codes in the M24 category for other articular cartilage disorders, disorders of ligament, pathological dislocation, recurrent dislocation, contracture and ankylosis.nnChapter 14: Disease of Genitourinary brings two new sub-stages to Stage 3 chronic kidney disease (CKD). The new codes are: N18.30 (Chronic kidney disease, stage 3 unspecified), N18.31 (Chronic kidney disease, stage 3a) and N18.32 (Chronic kidney disease, stage 3b).nnChapter 15: Pregnancy, Childbirth and the Puerperium contains new language that warns coders they should not report O85 for sepsis that follows an obstetrical procedure. A notenpoints them to the Sepsis due to a postprocedural infection of Chapter 1 Certain Infectious and Parasitic Diseases (A00-B99), U07.1.nnA new section 15.s provides instruction on reporting COVID-19 infections in pregnancy, childbirth, and the puerperium. E.g. when a newborn tests positive for COVID-19 and the provider has not documented a specific method of transmission, assign code U07.1 and the appropriate codes for associated manifestations. Code P35.8 (Other congenital viral diseases) followed by U07.1 when the provider documents that the newborn contracted the disease in utero or during birth.nnChapter 16: Certain Conditions Originating in the Perinatal Period has a new section 16.h for reporting COVID-19 Infections in Newborn.nnChapter 18: Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified contains several changes. Code R51 (Headache) will be split into two codes: R51.0 (Headache with orthostatic component, not elsewhere classified) or R51.9 (Headache, unspecified).nnAnother source of new headache coding will come from five new codes for intracranial hypotension – the severe orthostatic headache that is a common symptom of a cerebral spinal fluid (CSF) leak: For example, G96.810 (Intracranial hypotension, unspecified), G97.83 (Intracranial hypotension following lumbar cerebrospinal fluid shunting) and G97.84 (Intracranial hypotension following other procedure). Five new codes for CSF leaks can now be found in place of the current code G96.0 (CSF leak).nnChapter 19: Injury, poisoning & certain other consequences holds 128 additions that include new codes for adverse effects and poisoning by fentanyl and tramadol as well as other synthetic narcotics.nnChapter 21: Factors influencing health status and contact with health services includes new observation language. The new language creates a second exception to the rule that observation codes are primary. The GL state, “An observation code may be assigned as a secondary diagnosis code when the patient is being observed for a condition that is ruled out and is unrelated to the principal/first-listed diagnosis.”nnNEW Chapter 22: Codes for Special Purposes (U00-U85) includes just two codes: U07.0 Vaping- related disorder and U07.1 COVID-19, these codes took effect in the earlier this year.nDeletions from the 2021 ICD-10-CM code set include: Q51.20 (Other doubling of uterus, unspecified), and the entire code family of T40.4X- (Poisoning by adverse effect of and underdosing of other synthetic narcotics).nnThe general coding guidelines clarify that social determinants of health may be coded if self- reported by patients, “as long as the patient self-reported information is signed off by and incorporated into the health record by either a clinician or provider.” Social determinants of health, found in code categories Z55-Z65, report potential health hazards related to socioeconomic and psychosocial circumstances that may complicate the care of the patient (e.g., the patient is unemployed).nnReferencesnnInternational Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) nnICD-10-CM Official Guidelines for Coding and ReportingnnProposed 2021 ICD-10-CM update flashes nearly 500 new codes, additional changes 

2021 ICD-10CM Update Effective October 1,2020

Jan 1, 1970 | Uncategorized

One of the biggest changes to our ICD-10-CM books for the upcoming new year will be the addition of Chapter 22: Codes for special Purposes (U00-U85). Although this new chapter only consists of two codes and these codes were actually created and valid as early as April 2020, the creation of this chapter is proof that lessons from our current pandemic have been learned. nnHere are the codes, and their guidelines as printed in the Official ICD-10-CM FY 2021 Guidelines;

AMA Urges Congress to Update Medicare Physician Payment System

Jan 1, 1970 | Uncategorized

The AMA wrote a letter to congressional leaders to urge them to reconsider the Medicare physician payment system. Continue reading to learn why this is important.nnFollowing a recent Medicare Payment Advisory Commission (MedPAC) report, the American Medical Association (AMA) has asked Congress to update the Medicare physician payment system to include a stable annual payment rate that keeps up with inflation and practice costs.nnIn a letter to congressional leaders, the organization expressed concerns about the MedPAC recommendation to continue the freeze on Medicare physician payment rates and the lack of an adequate annual update for the payment system.nnThe MedPAC report, sent to Congress on March 15, 2022, recommended that federal officials maintain Medicare reimbursement rates for physicians and not provide any increases for 2023. According to AMA, this would hurt patient access to care as it becomes more expensive for physicians to practice medicine.n“Although clinicians have experienced declines in their Medicare service volume and revenue due to the pandemic, Congress has provided tens of billions of dollars in relief funds to clinicians during the PHE, and we expect volume and revenue to rebound to pre-pandemic levels (or higher) by 2023,” MedPAC stated in the report.nnHowever, AMA affirmed that financial challenges for physicians persist.nn“Physicians have been enduring an increasing financial instability of the Medicare physician payment system due to a confluence of fiscal uncertainties related to the COVID-19 pandemic, statutory payment cuts, consistent lack of inflationary updates, and significant administrative barriers,” the letter stated.nnAdditionally, AMA noted that MedPAC cannot justify freezing Medicare physician payment rates as CMS projects an 80 percent increase for Medicare Advantage plans in 2023.nnData from the Medicare Trustees showed that Medicare physician pay has increased by only 11 percent between 2001 and 2021. Around one-third of that increase includes the temporary 3.75 percent update set to expire this year.nnIn contrast, Medicare hospital and skilled nursing facility payments rates increased by more than 60 percent over the same period.nnAfter being adjusted for inflation, Medicare physician payment rates have declined 20 percent over the last two decades, the letter noted. Meanwhile, the cost of running a medical practice—including physician office rent, employee wages, and liability insurance premiums—has increased 39 percent since 2001.nnMedicare physician fee schedule spending per enrollee has also declined by 1 percent over the last ten years or 0.1 percent each year, while other Medicare benefits spending has increased. For example, Part B fee-for-service (FFS) spending per enrollee, excluding physician fee schedule spending, increased by 42 percent over the last decade. Part A FFS spending increased by 3.6 percent, Part C spending rose 29.4 percent, and Part D spending increased 20 percent.nnThe Medicare physician payment freeze is scheduled to last until 2026. Once the freeze ends, payment updates are set to resume at a rate of 0.25 percent per year, which is significantly below the rate of medical or consumer price index inflation, AMA stated in the letter.nnUnless Congress provides Medicare physicians with an update that reflects inflation, the gap between physician payment rates and rising inflation in medical practice costs will widen, AMA said.nnThe organization also referenced a May 2021 study that revealed that it costs physician practices around $12,800 and more than 200 hours per physician per year to comply with the Medicare Merit-Based Incentive Payment System (MIPS). Additionally, physicians have not been able to receive annual incentive payments for Medicare Advanced Alternative Payment Models (AAPM), as they have not had the chance to transition into a model.nnAMA stressed that financial hardships, burnout, and stress, are pushing physicians to consider leaving their practice within two years.nnWhile AMA expressed its gratitude to Congress for providing financial relief during the pandemic and preventing the 10 percent physician payment cuts in 2022, the organization urged officials to work with the physician community to develop solutions to the systematic problems with the Medicare physician payment system.