"Location: All Locations" & "ICD10CM Coding" Articles


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Medicare Advantage - The Fastest Growing Government-Funded Program Undergoing Multiple Fraud Investigations

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Medicare Advantage is the fastest growing form of government-funded healthcare and the rate of fraud within this segment has come under increased scrutiny. Funding is determined by the health status of each beneficiary; therefore, accurate coding based on detailed documentation makes the medical record vital to the process because some ...

Will CMS Allow Medicare Advantage Organizations to Risk Adjust from Audio-Only Encounters? 

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While audio-only telehealth services became a covered benefit during the PHE, CMS put limitations on using the data from those encounters for risk adjustment scoring. Medicare Advantage (MA) plans cannot use the information from these encounters to be scored for risk adjustment; however, it can be used for risk adjustment scoring of ACA plans.

Chronic Pain Coding Today & in the Future

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Properly documenting and coding chronic pain can be challenging. As is commonly the case with many conditions, over the years, there has been a shift in the identification of different types of pain, including chronic pain. Understanding where we are now and where we are going will help your organization prepare for the future by changing documentation patterns now.

How Does Global and Professional Direct Contracting (GPDC) Affect Risk Adjustment?

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CMS recently announced the 53 Direct Contracting Entities (DCEs) that will be participating in the April 1, 2021 through December 31, 2021 Global and Professional Direct Contracting (GPDC) Model. Among those participating is Clover Health Partners, who runs an in-home primary care program that has the potential to help Medicare ...

How to Properly Assign ICD-10-CM Codes for Pain

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Pain is a common diagnosis among all specialties so it should not be surprising to find there are 162 ICD-10-CM codes for reporting it and over 80 mentions in the ICD-10-CM Official Guidelines for Coding and Reporting which describe when certain types of pain should be reported and how the codes should be sequenced.

Managed Care Organizations Use CMS Tools to Identify Outliers

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Managed Care Organizations (MCOs) include risk-adjusted plans whose funding is based on the health status of their beneficiaries. Government-funded MCOs use CMS information to search for suspected cases of fraud and abuse.

OIG Plans for Onslaught of Risk Adjustment Audits Claiming 9.5% Error Rate in Code Assignment

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As the OIG has published their intent to further investigate the 9.5% of improper payments based on incorrect ICD-10-CM code assignation, they implore Managed Care Organizations (MCOs) to begin employing some of the CMS tools and data analytic programs used to help identify outliers.

Since When did Dental Claims Require Diagnosis Codes?

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The objective of the Accountable Care organization is to integrate and consolidate patient care management to improve patient outcomes. Changes and coordination of dental and medical care are already becoming more apparent when dental offices are being required to bill a patient's medical plan for dental visits due to an ...

Identifying Risk-Adjusted Services During the Opioid Crisis

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Between June 2019 and June 2020, the United States saw a total of 107,750 deaths from COVID-19. The spread of this virus was so extraordinary that it led President Trump to declare a public health emergency, and we watched as individual states began implementing laws and regulations to limit social interaction ...

ICD-11 — What’s Happening?

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ICD-11 is officially released, but what does that mean for diagnosis coding in the United States? What's really different? This article discusses what has been happening with ICD-11, some interesting things to note about it, as well as links to other important information.

Q/A: For E/M, How do I Count Tests Ordered in One Department and Performed in Another?

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Question: I am in an ENT office as part of a large clinic with separate practices including audiology, CT, and allergy, all billing under the same TAX ID. Sometimes tests are ordered which are done in other departments that my office does not bill for, would those be considered an outside source? Answer: This is a great question and one that has been asked by many coders and auditors.

How to Combat COVID-Related Risk Adjustment Losses with the Medicare Annual Wellness Exam

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Identifying new ways to encourage Medicare beneficiaries to schedule and attend their Annual Wellness Exam (AWE) can be difficult, but the Open Enrollment period is a prime time for every payer to identify new beneficiaries and provide a reminder to both new and existing patients that this preventive service does ...

ICD-10-CM 2021 Codes for your Specialty

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21. Factors influencing health status and contact with health services (Z00-Z99)    Code:            Description:Z03.821         Encounter for observation for suspected ingested foreign body ruled outZ03.822         Encounter for observation for suspected aspirated (inhaled) foreign body ruled outZ03.823         Encounter for ...

How Reporting E/M Based on Time May Lose Money

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Just like math teachers who require students to show their work so they can see how the student reached their answer, providers are also required to "show their work" through the documentation process in the medical record. By the time a provider has reviewed the patient's subjective complaints (i.e., patient's ...

Q/A: Why is My Claim Being Denied When I Report a Secondary Diagnosis Code?

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Question: Recently my claims to Medicare are being denied when I submit a secondary diagnosis code. I’ve heard that this is happening in several states including Washington, California, and New York. Has there been a recent change in what secondary diagnosis codes are allowed?

ICD-10-CM 2021 Codes for your Specialty

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4. Endocrine, nutritional and metabolic diseases (E00-E89) Code:            Description:E70.81          Aromatic L-amino acid decarboxylase deficiencyE70.89          Other disorders of aromatic amino-acid metabolismE74.810        Glucose transporter protein type 1 deficiencyE74.818        Other disorders of glucose transportE74.819    ...

ICD-10-CM 2021 Codes for your Specialty

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5. Mental, Behavioral and Neurodevelopmental disorders (F01-F99) Code:          Description:F10.130       Alcohol abuse with withdrawal, uncomplicatedF10.131       Alcohol abuse with withdrawal deliriumF10.132       Alcohol abuse with withdrawal with perceptual disturbanceF10.139       Alcohol abuse with withdrawal, unspecifiedF10.930       Alcohol use, unspecified with withdrawal, ...

ICD-10-CM 2021 Codes for your Specialty

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6. Diseases of the nervous system (G00-G99) Code:            Description: G11.10          Early-onset cerebellar ataxia, unspecifiedG11.11          Friedreich ataxiaG11.19          Other early-onset cerebellar ataxiaG40.42          Cyclin-Dependent Kinase-Like 5 Deficiency DisorderG40.833        Dravet syndrome, intractable, ...

ICD-10-CM 2021 Codes for your Specialty

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7. Diseases of the eye and adnexa (H00-H59) Code:            Description: H18.501        Unspecified hereditary corneal dystrophies, right eyeH18.502        Unspecified hereditary corneal dystrophies, left eyeH18.503        Unspecified hereditary corneal dystrophies, bilateralH18.509        Unspecified hereditary corneal dystrophies, unspecified eyeH18.511        Endothelial ...

ICD-10-CM 2021 Codes for your Specialty

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10. Diseases of the respiratory system (J00-J99) Code:            Description:J82.81           Chronic eosinophilic pneumoniaJ82.82           Acute eosinophilic pneumoniaJ82.83           Eosinophilic asthmaJ82.89           Other pulmonary eosinophilia, not elsewhere classifiedJ84.170         Interstitial lung disease with ...

ICD-10-CM 2021 Codes for your Specialty

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11. Diseases of the digestive system (K00-K95) Code:            Description:K20.80          Other esophagitis without bleedingK20.81          Other esophagitis with bleedingK20.90          Esophagitis, unspecified without bleedingK20.91          Esophagitis, unspecified with bleedingK21.00          Gastro-esophageal reflux disease with esophagitis, ...

ICD-10-CM 2021 Codes for your Specialty

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13. Diseases of the musculoskeletal system and connective tissue (M00-M99) Code:            Description:M05.7A          Rheumatoid arthritis with rheumatoid factor of other specified site without organ or systems involvementM05.8A          Other rheumatoid arthritis with rheumatoid factor of other specified siteM06.0A        ...

ICD-10-CM 2021 Codes for your Specialty

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14. Diseases of the genitourinary system (N00-N99) Code:            Description:N00.A            Acute nephritic syndrome with C3 glomerulonephritisN01.A            Rapidly progressive nephritic syndrome with C3 glomerulonephritisN02.A            Recurrent and persistent hematuria with C3 glomerulonephritisN03.A          ...

ICD-10-CM 2021 Codes for your Specialty

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16. Certain conditions originating in the perinatal period (P00-P96) Code:            Description:P91.821         Neonatal cerebral infarction, right side of brainP91.822         Neonatal cerebral infarction, left side of brainP91.823         Neonatal cerebral infarction, bilateralP91.829         Neonatal cerebral infarction, unspecified side ...

ICD-10-CM 2021 Codes for your Specialty

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18. Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) Code:            Description:R51.0            Headache with orthostatic component, not elsewhere classifiedR51.9            Headache, unspecifiedR74.01          Elevation of levels of liver transaminase levelsR74.02     ...

ICD-10-CM 2021 Codes for your Specialty

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19. Injury, poisoning and certain other consequences of external causes (S00-T88) Code:            Description:S20.213A      Contusion of bilateral front wall of thorax, initial encounterS20.213D      Contusion of bilateral front wall of thorax, subsequent encounterS20.213S      Contusion of bilateral front wall of thorax, sequelaS20.214A      Contusion of ...

ICD-10-CM 2021 Codes for your Specialty

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20. External causes of morbidity (V00-Y99) Code:            Description:V00.031A       Pedestrian on foot injured in collision with rider of standing electric scooter, initial encounterV00.031D       Pedestrian on foot injured in collision with rider of standing electric scooter, subsequent encounterV00.031S       Pedestrian on foot injured ...

How Social Determinants of Health (SDOH) Data Enhances Risk Adjustment

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The role of SDOH in overall patient care and outcomes has become a more common topic of discussion among healthcare providers, payers, and policymakers alike. All are attempting to identify and collect SDOH and correlate the data to patient management which is increasingly seen as necessary to address certain health disparities and identify exactly how SDOH affects patient health outcomes. Learn how to address this important subject.

Looking Beyond an Employee's Coding Credentials

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In today's ever-changing healthcare environment, it is important that organizations hire coding and reimbursement personnel who enjoy learning. Each year changes are made in how healthcare services are coded and reported from federal and state laws, the code sets themselves, and varying payer policies. During the public health emergency (PHE) ...

ICD-10 Code Updates for January 1st

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Be aware that new ICD-10-CM and ICD-10-PCS codes took effect on January 1, 2021. Rarely have ICD-10-CM codes been released in January, but as you may have guessed, these changes are in relation to COVID-19. The information in this article will help your organization understand these changes.

CMS Reduces the Exchange User Fee to Support Lower Premiums for the Consumer

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It has been no secret that Americans have been complaining about the high cost of health plans since implementation of the Affordable Care Act (ACA). Premiums and deductibles have skyrocketed and in many states are equal to or exceed the cost of their rent or mortgage payments. As such, most ...

ICD-10-CM 2021 Codes for your Specialty

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1. Certain infectious and parasitic diseases (A00-B99) Code:            Description:A84.81          Powassan virus diseaseA84.89          Other tick-borne viral encephalitisB60.00          Babesiosis, unspecifiedB60.01          Babesiosis due to Babesia microtiB60.02          Babesiosis due to Babesia duncaniB60.03        ...

ICD-10-CM 2021 Codes for your Specialty

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15. Pregnancy, childbirth and the puerperium (O00-O9A) Code:            Description:O34.218        Maternal care for other type scar from previous cesarean deliveryO34.22          Maternal care for cesarean scar defect (isthmocele) O99.891        Other specified diseases and conditions complicating pregnancyO99.892        Other ...

ICD-10-CM 2021 Codes for your Specialty

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3. Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89) Code:            Description:D57.03          Hb-SS disease with cerebral vascular involvementD57.09          Hb-SS disease with crisis with other specified complicationD57.213        Sickle-cell/Hb-C disease with ...

Locating Periodontal Disease in ICD-10-CM

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When coding a diagnosis for periodontal disease, keep in mind there are more options than just chronic or acute. To get started, look at chapter 11, Diseases of the digestive system (K00-K95). Looking at this section a little further, you can see this is where the oral cavity is coded ...

How Might the New 2021 E/M Guideline Changes Impact Risk Adjustment?

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While provider organizations are busy learning the new E/M guideline changes being implemented January 1, 2021, Medicare Advantage Organizations (MAOs) are contemplating how the documentation changes for these services may impact risk adjustment coding. To be clear, the new E/M guidelines only pertain to Office and Other Outpatient E/M Services ...

Are You Aware of the 2021 Star Rating System Updates?

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Each year the Centers for Medicare & Medicaid Services (CMS) publishes the Star Ratings System Updates for Medicare Advantage (Part C) and Medicare Prescription (Part D). This rating system was developed to help beneficiaries identify and select the health plans that best meet their needs, specifically addressing main issues:  Quality of ...

Delving Into the 360 Assessment Fraud Complaint

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The Department of Justice is pursuing claims of healthcare fraud against Cigna Health-Spring Medicare Advantage plan based on how they used data from their 360 Program in 2012. A review of the allegations may help other payers avoid similar accusations.

What is the Difference Between the Medicare 1995 and 1997 Documentation Guidelines for E/M Services?

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When Medicare determined that providers could follow EITHER the 1995 OR the 1997 Documentation Guidelines for Evaluation and Management Services to determine which level of E/M service to report, because CMS had not clarified that portions of the 1995 and 1997 guidelines could be used together to determine the level of ...

New Codes for Cytokine Release Syndrome (CRS)

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New codes for Cytokine Release Syndrome (CRS) are effective October 1, 2020 based on the grade/severity of the symptoms. This article covers the new grading scales.

ICD-10-CM 2021 Coding Updates for Chiropractic

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October 1st is just around the corner and that means it’s time for updates to the ICD-10-CM code set. This year there are some interesting changes such as a new headache type, new codes related to TMJ, several new codes for reporting accidents involving micro-mobility devices (e.g., hoverboard), and some other changes.

Locating a Diagnosis Code in ICD-10-CM for Dental Offices

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Diagnosis codes used to report with procedures are called ICD-10-CM - International Statistical Classification of Diseases. These codes are published annually in October. To find a diagnosis code in ICD-10-CM, it is important to understand how the chapters and sections are set up. Each chapter is broken down into sections and ...

2021 Brings Another Risk Adjustment Calculation Change

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In 2021, a big change in Risk Adjustment score calculations will take place, which will affect payments to Medicare Advantage (MA) plans for the coming year and take us closer to quality and value-based programs instead of fee-for-service (FFS) or risk-adjusted (RA). Currently, CMS pays a per-enrollee capitated...

Coding with PCS When There is No Code

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ICD-10-PCS covers ALMOST everything! But not quite! What if a body system does not contain a body part for toes or fingers? What about an elbow? When it does not cover what you are looking for, where do you turn?  To the guidelines, of course! There are ICD-10-PCS guidelines just as ...

Use the Correct Diagnosis Codes and Revenue Codes to Get Paid for PAD Rehab

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The initial treatment in rehabilitation for patients suffering from Intermittent Claudication (IC) is Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD).  Rehabilitation using SET involves the use of intermittent walking exercise, which alternates periods of walking to moderate-to-maximum claudication, with rest.   When reporting 93668 for peripheral arterial disease rehabilitation the following ...

Are Diagnoses from Telehealth Services Eligible for Risk Adjustment?

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On April 10th, CMS released a memo with the subject line, “Applicability of diagnoses from telehealth services for risk adjustment,” suggesting there may be some telehealth services that might not qualify for risk adjustment. However, in the memo CMS states: “Diagnoses resulting from telehealth services can meet the risk adjustment face-to-face ...

ICD-10-CM - Supplement information for E-Cigarette/Vaping Reporting

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The CDC has released additional information and coding guidance for reporting encounters related to the 2019 health care encounters and deaths related to e-cigarette, or vaping, product use associated lung injury (EVALI).  The update offers coding scenarios for general guidance, poisoning and toxicity, substance abuse and signs and symptoms.  ICD-10-CM Official Coding Guidelines - ...

Additional Telehealth Changes Announced by CMS

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On April 30, 2020, CMS announced additional sweeping changes to meet the challenges of providing adequate healthcare during this pandemic. These changes expand the March 31st changes. The article covers some of the key changes. See the official announcement in the references below.

Dismal OIG Report on Telemedicine

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Providers need to understand the rules for reporting telemedicine services. A recent OIG report shows that this is not the case. What problems are being found in documentation claims? As providers are expanding their telehealth offerings, now is the time to understand the potential pitfalls since disallowed amounts will be taken back.

Hypertension ICD-10-CM Coding Table, Guidelines, and Tips

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Coding hypertension properly requires knowing all the guidelines. This article summarizes how hypertension is coded using ICD-10-CM and includes tips, definitions and a very helpful coding table summarizing your options.

New CPT® Codes Approved for COVID-19 Antibody Identification

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On April 10, 2020, the American Medical Association approved and published a revision of code 86318 and added two new codes 86328 and 86769 for reporting Coronavirus [COVID-19] antibody testing.

CMS Temporarily Suspends Contract-Level RADV Audits

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The Centers for Medicare and Medicaid Services (CMS) is suspending contract-level RADV audits, related to the payment year 2015 and will not initiate any new ones until after the public health emergency has ended. Any documentation already submitted will be reviewed as usual.

CMS Announces Final 2021 HCC Risk Adjustment Changes

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On April 6, 2020, the Centers for Medicare & Medicaid Services (CMS) published their final Medicare Advantage (MA) and Part D payment methodologies for CY 2021. Read more to be prepared for these upcoming changes.

ICD-10-CM Official Coding and Reporting Guidelines Updated for COVID-19

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The ICD-10-CM Official Coding and Reporting Guidelines have just been updated to include COVID reporting. Additional information beyond the previously released interim guidelines are included. These are the rules that should be followed for claims submission. The notice states that this is for April 1, 2020 through September 30, 2020.

External Cause Status Coding (Y99)

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This innoviHealth book (i.e., ICD-10-CM Coding, Reimbursement Guide) resource discusses requirements for properly coding external causes. Mandatory reporting of these codes is not always required by all payers and even when they are required, it might only be in certain situations (e.g., drug overdose, personal injury).

"What is the ICD-10 code for...?" - Search Smarter With Find-A-Code Tools

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Do you still find yourself searching the internet for an ICD10 code? Medical coders often type into their search engine, what is the ICD10 code for ... and a specific diagnosis code, to avoid repeatedly dragging out the incredibly large ICD10 codebook. Ironically, some of the most commonly searched ICD10 diagnoses include: ...

Understand the New Codes for Testing & Reporting the COVID-19 Coronavirus (SARS-CoV-2)

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The current coronavirus pandemic refers to COVID-19, a novel or new type of coronavirus known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The first victim of the virus was identified in Wuhan, Hubei, China at the end of 2019. There is no immunization available to prevent it from spreading and ...

Implementing Telehealth Visits

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The following is a step-by-step guide on how to convert office-based encounters to telehealth encounters during the current COVID-19 pandemic. These rules may change post-pandemic, as many changes relaxing existing rules were made on a temporary basis by CMS and commercial payers to facilitate patient access and minimize risk of infection. Step ...

Coronavirus - What in the World is it and How is it Coded? 2020-02-20

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On December 31, 2019, we learned of a deadly outbreak of an unknown virus, with an unknown cause. We have since learned the virus was identified in Wuhan, China as a novel coronavirus (2019-n-CoV). Until we have more information on the 2019-nCoV, persons with an underlying medical condition are considered high ...

New HCPCS Code for Coronavirus Testing Announced

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Currently, healthcare providers testing patients for Coronavirus must use an unspecified code. To provide better tracking, on February 13, 2020, CMS announced the creation of a new HCPCS code.

Q/A: Did Noridian Stop Covering the M99.0- Codes?

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Question: I heard that Medicare Noridian Jurisdiction F (Alaska) has been denying claims with M99.00, M99.01, M99.02, M99.03 etc codes when billed with the CMT CPT codes. Did Medicare change their policy?

A 2020 Radiology Coding Change You Need To Know

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The radiology section of the 2020 CPT© has 1 new, 18 revised, and 14 deleted codes. Interestingly, six of the 14 deleted codes were specific to reporting single-photon computerized tomographic (SPECT) imaging services of the brain, heart, liver, bladder, and others. If your organization reports radiology services, it is...

Medicare Announces Coverage of Acupuncture Services

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On January 21, 2020, a CMS Newsroom press-release read, This new announcement is both exciting and refreshing. Acupuncture, a key component of traditional Chinese medicine and most commonly used to treat pain, is now being officially recognized by Medicare and several other large payers as a covered, alternative treatment option for ...


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