specificity. They allowed any code that was in the correct family of codes, including unspecified codes. However, in order to support the medical necessity of every visit and every procedure performed, coding to the highest level of specificity is required. Starting on Oct. 1 of this year, CMS will reject unspecified codes and the claim will be unpaid.
What does this have to do with ortho, you may ask? Codes pertinent to orthopedics are the most specific and detailed in the entire code set. For example, when coding traumatic fractures, details such as the specific bone, location on the bone, side of the body, type of fracture (among dozens), open vs. closed, intra-articular vs. extra-articular, and more are required in order to choose the most specific code.
In order to achieve this level of specificity, providers and their coding and billing staff must work together in a continuous process of clinical documentation improvement. Hopefully, this has already been taking place in your practice. If not, it must start NOW. Coders need to provide documentation guidance to their surgeons by explaining where and how the documentation needs to be more specific. Then, they should provide feedback to their providers on how to further improve documentation. Providers need to recognize that the higher specificity requirements lead to better quality documentation, which in turn protects them during appeals and audits.
And don't overlook the many acronyms used in your documentation. Coders and providers must ensure that these acronyms provide specific enough documentation to select the correct ICD-10 code. The goal is to submit a clean claim the first time, every time, to keep your revenue cycle running smoothly and save time and work for everyone.
NEW AND CHANGED CODES
A large number of new codes have been added to Chapter 19 for Salter-Harris fractures of the foot: calcaneus S99.0_, metatarsal S99.1_, and phalanx S99.2_. In Chapter 13, codes have been added for atypical fractures, for example Fosamax fractures of the femur, in section M84.75_. Other additions and changes to these chapters include:
You can download the complete 2017 ICD-10 Addendum here: addendum. I extracted the chapters relevant to orthopedics and converted the file into Word format for easy editing by your office staff: Ortho Updates 2017.
Kimberly A. Sherman, MA, CPC - Reimbursement warrior and HIPAA guru.