Orthotic and Prosthetic Services
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Getting Started with ICD10 codes

ICD-10 take effect for all dates of service after 10-1-2015. Presently we have the dubious honor of filling in the ICD-10 coding for a written description. This is not all bad, consider it a crash course to get us up to speed. Medicare has not yet come up with a useable cross walk. We are including links here and on our web site both the Medicare information and to a crosswalk we have found that is fairly user friendly.

Medicare is considered the initiator and therefore the gold standard by most insurances.   This blog will cover their initial handling of this basic change. Judging from past experience, we must be prepared for many updates, maybe for years.

 

I have spoken to several groups who have opted out of taking Medicare assignment, a word of caution. There are 219 pages in the manual describing our liability. Due diligence should be shown for paperwork propriety. A private suit due to a patient takeback could make a RAD seem like child’s play.

 

Modifiers and notes remain important:

K level modifiers, and shoes are still very sensitive to notes. There must be at least two sets of notes 1 you saw the patient and 2 you delivered and patient was demonstrated satisfactory potential. The K modifier demands doctors notes demonstrating patient potential to achieve the level used. RT & LT modifiers are still necessary even though ICD-10 also denote side and dominance.

We have won cases using a time stamped videos with the patient giving verbal input on how they were progressing.

Code basics:

We are considered DME code our code must be for a sequential visit D or S.

Do not use first visit (A) it is for physician’s office use.

In the L series there is no bilateral code you must use ICD-10 for right and left and the codes are dominate side specific.

There is also a S series which has some diagnoses relevant to amputation.

There are Coding differences in both prosthetics orthotics even when a crosswalk is used. The biggest is specificity. The crosswalks give several choices the onus is on you to read and pick what most matches the written description.

Prosthetics is fairly straightforward

Traumatic amputation at the level specified this applies both to upper and lower extremities.

It is specific denoting complications. It is also specific as to dominate side. This will probably be especially important in upper extremity prosthetics

Orthotics is different.

You must pick the code that best describes the condition

For instance you are concidering an AFO and had the following diagnosis. Patient had a stroke left hemisphere resulting with some speech impediment, difficulty using right arm, and is dragging her right foot. This would be ICD-9 code 438.4. ICD-10 uses two codes one as dominate side and one as non-dominate side I69941 or I69943.

The spine has multiple interpretations. Consider degeneration of spine ICD-9 722. Each level has at least a two to one ratio on specificity in ICD-10.

In time using what we have for a crosswalk and rulings we can develop our own cheat sheet, but it will be much more extensive, and we are going to need care using it.

If you have any suggestions please put them in the comments, and MAY THE FORCE BE WITH YOU.

REFERENCENCE SITES

Medicare https://www.cms.gov/medicare/coding/icd10/2014-icd-10-cm-and-gems.html

Crosswalk http://www.icd10codesearch.com/

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