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Spine procedures require detailed coding under ICD-10-CM
In this Spine Coding Source column, Kim Pollock, RN, MBA, CPC, CMDP, and Teri Romano, RN, MBA, CPC, CMDP, explain some of the common questions and concerns with ICD-10-CM implementation. This implementation will require a steep learning curve and careful attention to coding and reimbursement.
Daniel Refai MD
Associate Editor, Neurosurgery
Like it or not, ICD-10-CM is here and an expanded and more clinically specific diagnosis code set is now required on all claims to ensure payment. If you have not yet educated yourself or your staff, it is not too late. Coding under ICD-10-CM will require more detailed and more specific diagnosis documentation. Payers will scrutinize your use of the new diagnosis codes and will likely expect more specificity than was required under ICD-9-CM.
The frequently asked questions that appear here are just a sample of what is in store under ICD-10-CM.
Question: What are some of the new ICD-10-CM codes for nontraumatic spine surgery?
Kim Pollock, RN, MBA, CPC, CMDP, and Teri Romano, RN, MBA, CPC, CMDP: There are quite a few new codes involved, and some existing codes, that require more specific documentation regarding the areas of the spine involved, for example deformity codes and spondylolisthesis. New diagnosis codes are also now available for spinal instability, radiculopathy, disc disorders and spondylosis with radiculopathy, lumbago with sciatica, pathological fractures and pseudoarthrosis, to name a few.
Question: I see a lot of cervical fracture diagnosis codes. Have these codes changed?
Pollock and Romano: The injury section of ICD-10-CM has expanded codes in every category, including those that relate to the spine. While it is impossible to list them all here, there were nine possible cervical fracture codes under ICD-9-CM and there are almost 70 possible diagnosis codes under ICD-10-CM. Additional clinical specificity about the type of fracture accounts for much of the increase in codes.
Question: How is bilateral carpal tunnel syndrome coded under the ICD-10-CM codes-set?
Pollock and Romano: Many ICD-10-CM codes have a right, left and bilateral code. However, the codes for carpal tunnel syndrome do not have a bilateral option. The available ICD-10-CM codes for carpal tunnel syndrome are G56.01 Carpal tunnel syndrome, right upper limb, and G56.02 Carpal tunnel syndrome, left upper limb.
There is not a diagnosis code for bilateral carpal tunnel syndrome. So if a patient has bilateral carpal tunnel syndrome, both ICD-10-CM codes, G56.01 and G56.02, are reported.
Question: What is the seventh character extension I keep hearing about in ICD-10-CM?
Pollock and Romano: The 7th character extension is new to ICD-10-CM and it is used to indicate the episode of care. The seventh character of A or B is defined by ICD-10-CM as denoting an “initial encounter.” This is added to an ICD-10-CM code to indicate the patient is receiving active treatment for the condition (e.g., consultation in the ER, surgery). The seventh character for subsequent encounters (e.g., D, G, K, P) is used when the patient has completed active treatment and is in the healing or recovery phase of treatment.
Question: Which specific spine ICD-10-CM codes require a seventh character extension?
Pollock and Romano: Only certain categories of codes have the seventh character extension requirement. For spine, the most common categories of diagnosis codes include pathological fractures (M80, M84), traumatic injuries (S00-S39) and complications, such as wound infections, wound dehiscence or spinal cord stimulator malfunctions (e.g., T codes).
- For more information:
- Kim Pollock, RN, MBA, CPC, CMDP, and Teri Romano, RN, MBA, CPC, CMDP, are consultants with KarenZupko & Associates Inc. and serve as faculty members of the American Association of Neurological Surgeons national coding and reimbursement courses. For more information, visit www.karenzupko.com.
Disclosures: Pollock and Romano report no relevant financial disclosures.