The fiscal year 2018 will bring some changes to the current ICD-10 codes for gynecology diagnoses, as well as the Procedure Coding System (ICD-10-PCS) for inpatient settings. The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) allows for more expansion of codes, which enables physicians to be more specific with diagnoses. The ICD-10-CM codes, which will take effect on Oct. 1, 2017, have been updated to allow for combining codes of both diagnosis and symptoms, reducing the number of codes needed.
Compliance Drives Revenues for Gynecology Practices
The World Health Organization oversees the International Statistical Classification of Diseases and Related Health Problems (ICD), and the ICD-10-CM is a modification of this code for use within the U.S. Overall, more than 800 changes have been made to the coding system that will be implemented as of Oct. 1, but not all these changes apply to gynecology practices.
Because 3D ultrasound procedures can drive revenue in a gynecology practice, it is more important than ever to ensure that billing processes are compliant. Every ultrasound performed must be billed with an appropriate CPT code and ICD-10-CM code. Additionally, the medical record must contain copies of the ultrasound images and complete notes that support a diagnosis or suspected diagnosis.
What Makes Up an ICD-10-CM Code?
According to official guidelines provided by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), the ICD-10-CM coding consists of three parts:
- A category that is three characters long;
- A subcategory that is four or five characters long; and
- A code that is three to seven characters long.
If a code contains an X, this is a placeholder for future potential expansions of the code and must be included in the code submitted for billing. Codes will be considered invalid if they are not expanded as much as possible or do not contain the highest number of characters available for the diagnosis. Medical practices must maintain proper documentation of the patient's diagnosis, plus any procedures that were performed to arrive at the diagnosis, such as ultrasound.
The billed CPT codes must be consistent with the diagnosis. Because some billing may require physically looking at the patient's medical record to obtain the information needed, complete and thorough documentation is more important than ever in achieving a seamless claims process.
Implementing the Changes in ICD-10 Codes for Gynecology
Many new codes have been added and others changed. Some codes now allow for exclusions, while others have been expanded. For example, N63, the code for "unspecified lump in breast," has been expanded to 20 codes, which allows the physician to include more information, such as left or right breast and lump location specific to the quadrant of the breast.
With any billing compliance changes, it is important for both providers and billing coders to understand the changes that apply to them. Any incomplete, inaccurate or invalid claims will be kicked back to the practice, increasing the amount of manpower and time spent pursuing reimbursement.
Once changes take effect, complete and accurate documentation of all procedures will be paramount to a smooth claims process and a steady stream of revenue. Now is the time for gynecology practices to decide whether their electronic systems have the capability to meet these challenges. Glitches do not have to be inevitable — they can be avoided by proactively retraining staff and updating software systems to ensure a smooth rollout.
