ICD-10 Guidelines and Code Changes Take Effect October 1, 2021
SOURCE: Illinois Chiropractic Society
Mario Fucinari DC, CCSP, APMP, MCS-P, CPCO
The World Health Organization and the Centers for Medicare and Medicaid Services have released the diagnosis code updates for the fiscal year 2022. The changes in codes and guidelines take effect on October 1, 2021, and affect all services rendered on or that date. Therefore, all offices must be aware of the changes and assess how the changes will impact your office. Ignorance or a lack of action on your part may lead to denials or recoupment.
Unlike FY 2021, there are not as many code changes this year, but the impact may still be the same in your office. 165 new codes have been implemented this year, compared to 485 codes last year.
In addition, there were updates to the ICD-10-CM Official Guidelines for Coding and Reporting. Every physician and their staff should remember that it is imperative to “code to the highest level of specificity.” Insurance carriers base their reimbursement on the codes you list on the claim form. A non-specific code yields limited information and will yield a limited amount of approved treatment. It is essential to review the guidelines and the new codes to ensure you are assigning the most appropriate codes.
Among the notable guideline changes are involving laterality. When the patient’s provider does not document laterality, code assignment for the affected side may be based on medical record documentation from other clinicians. Codes for an “unspecified” side should rarely be used, such as when the documentation in the record is insufficient to determine the affected side, and it is impossible to obtain clarification. Any unspecified code is deemed a red flag in coding. Be specific.
In the past, the provider or their staff had to confirm a condition. The guidelines now state that exceptions will allow the doctor to report information gained from outside records.
These would include the following:
Body Mass Index (BMI)
Depth of non-pressure chronic ulcers
Pressure ulcer stage
NIH stroke scale (NIHSS)
Social determinants of health (SDOH)
Blood alcohol level