Journal of Urgent Care Medicine

ICD-10 Changes for 2022

Every year on October 1, the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics release an updated ICD-10-CM Official Guidelines, as well as changes to the code set. This year there are 159 new codes, 32 deleted codes, and 20 revised codes, with a total of 72,748 codes to choose from. (Visit ICD-10-CM Official Guidelines for Coding and Reporting FY 2022 at https://www.cms.gov/files/document/fy-2022-icd-10-cm-coding-guidelines.pdf to see the entire document.) Three …

Plantar Warts, Digital Nerve Block in Lacerations, and Established Patients

Q. We had a patient present with 12 plantar warts. The provider used liquid nitrogen to freeze all 12 of the warts. What code should I bill for this procedure? A. In this case, you would bill Current Procedural Terminology (CPT) code 17110, “Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement) of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions.” Use only code 17110 once because the …

Fracture Care

Q. Will you please help me understand initial visit, subsequent visit, and sequelae related to fracture care? If the patient is treated elsewhere for a fracture and the provider just stabilizes the fracture and instructs the patient to then come to my office for reduction, is this a subsequent visit or an initial visit? A. International Classification of Diseases 10th Revision, ClinicalModification (ICD-10-CM) guidelines state that a seventh character, A, is used for the initial …

Denial Rate Low—But Costly—4 Months Into ICD-10

The denial rate for claims initiated after the crossover from the ICD-9 system to ICD-10 codes in October has been steady—and lower than hysterics predicted it would be—if the 262 million claims processed by one company are any indication. RelayHealth Financial, a revenue cycle management provider, found a denial rate of 1.6% in each month from November 2015 through the first 3 weeks of February 2016. That reflects claims involving 630,000 healthcare providers. The financial …

Make More Profitable Billing Practices a New Year Resolution for 2016

It’s not news that operating margins can be very thin—making it all the more perplexing that so many practices leave money on the table by not billing or coding correctly. While the Centers for Medicare and Medicaid Services has said it will not deny claims for incorrect codes during the first year following implementation of ICD-10 in October 2015, provided that submitted codes are within the right code family, that’s only the tip of the …

ICD-10 Update: Transition Hysteria Much Ado About Nothing for Most

Much like concerns that the Y2K crossover would wreak havoc on civilization as we know it, the transition to ICD-10 codes has been far less disruptive than was feared by many. A new survey by KPMG shows that 79 percent of organizations have made the transition without any major hiccups, with 28 percent calling it “smooth” and 51 percent reporting “a few technical issues, but overall successful.” Just 11 percent called their transition experience a …

October 1: Out with ICD-9, in with ICD-10

“Urgent care” was in its infancy and electronic medical records were practically the stuff of science fiction when the ICD-9 codes were released in 1979. The Centers for Medicare and Medicaid Services (CMS) takes one giant leap toward catching up with the launch of ICD-10 codes on October 1. As of that date, ICD-9 codes will no longer be accepted. CMS has said the new coding set is expected to “advance public health research and …

Urgent care codes, E/M Guidelines, ICD-10

Q. Is there a defined set of diagnosis codes for urgent care services and is there a diagnosis code that indicates the services were urgent? A. All facilities use the same set of ICD-9 codes to report the patient’s diagnosis. There are no diagnosis codes to represent urgent care services, but there are certain procedure codes you can use to indicate that services were rendered in an urgent care clinic and also procedure codes to …

ICD-10

Q. My staff keeps telling me that my documentation will have to change in order for them to properly choose an ICD-10 diagnosis code. Is that true? A. Documentation practices should not have to change but it will be helpful to understand the granularity of the new codes. There is greater specificity including laterality, temporal factors, contributing factors, symptoms, manifestations, and anatomic location. Thus, if you currently gloss over details in the medical record, you …