EXECUTIVE SUMMARY
The new ICD-10 codes allow healthcare providers to better capture data on signs, symptoms, risk factors, and comorbidities to better describe overall clinical issues and support reimbursement for the level of care provided.
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The ICD-10 system classification system is used by most of the world. The United States was the only industrialized nation not using an ICD-10-based classification system prior to the switch on Oct. 1, 2015.
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In The New Structure, Diagnosis Codes Break Down Into Up To Seven Characters. The First Three Characters Describe The Category; The Next Three Point To Cause, Location, And Severity; And The Seventh Character Is For Greater Specificity.
While the purpose of ICD-10 is to improve clinical communication and accuracy, it will require more precise documentation of clinical care. Clinicians received vital tips on how to integrate the new coding in their family planning practices at the recent Contraceptive Technology Quest for Excellence conference in Atlanta.
The new ICD-10 codes allow healthcare providers to better capture data on signs, symptoms, risk factors, and comorbidities to better describe overall clinical issues and support reimbursement for the level of care provided, says Michael Policar, MD, MPH, clinical professor of obstetrics, gynecology, and reproductive science at the University of California, San Francisco. Policar presented on the subject at the conference.1
The ICD-10 system classification system is being used by most. The United States was the only industrialized nation not using an ICD-10-based classification system prior to the switch on Oct.1, 2015.
Not only will the new coding structure more effectively measure quality, safety, and efficacy of care, but it will reduce fraud and make sure that healthcare dollars are used most efficiently, said Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA, chief executive officer of the American Health Information Management Association. “ICD-10 will enhance the value of information for population and public health and research,” said Gordon in a released statement. “Ultimately, this will lead to improved patient care and better health outcomes at reduced cost.”
WHAT YOU NEED TO KNOW
The new coding structure accommodates new codes; the old ICD-9 configuration was unable to add new diagnoses and procedures, explains Policar. CPT coding for outpatient and office procedures is not affected by the ICD-10 transition, he notes.
In the new structure, diagnosis codes break down into up to seven characters, explains Policar. The first three characters describe the category; the next three point to cause, location, and severity; and the seventh character is for greater specificity.1 The seventh digit also is used to identify the timing of the patient encounter, he notes.
Categories of interest to reproductive health professionals include:
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A 00-B 99, infectious and parasitic diseases;
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C 00-D 49, neoplasms;
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N 00-99, diseases of the genitourinary system;
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O 00-9A, pregnancy, childbirth, and puerperium;
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R 00-99, symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified;
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Z 00-99, factors influencing health status and contact with health services.
The Z codes will become quite familiar to those in family planning, with such codes as:
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Z 30, encounter for contraceptive management;
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Z 31, encounter for procreative management;
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Z 32, encounter for pregnancy test, childbirth, and childcare instruction;
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Z30.02, counseling and instruction in natural family planning to avoid pregnancy;
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Z30.09, encounter for other general counseling and advice on contraception, no method prescribed;
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Z30.2, encounter for sterilization.
CHECK THE METHODS
The good news: Improvements in coding for family planning visits include codes for injectable contraception visits (Z30.013 for initiation, Z30.42 for surveillance) and a code for initial prescription of an intrauterine device (IUD) (Z70.014), which is used for a visit when an IUD is ordered, but not inserted, says Policar.
The not-so-good news: There still are no specific ICD-10 visit codes for the contraceptive patch and ring, and there are no crossover codes for visits for the contraceptive implant or barrier methods. The American College of Obstetricians and Gynecologists (ACOG) has submitted requests for specific codes to the National Center for Health Statistics and the Centers for Disease Control, the agency tasked with revisions to the ICD-10 diagnosis code set. If the codes are approved, they will become part of the first regular ICD-10-CM release scheduled for Oct. 1, 2016.
Look at the four possible coding options for the four methods without a specific code, and check with payers to determine which codes they want used:
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Z30.018, initial prescription of other contraceptives;
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Z30.49, surveillance of other contraceptives (which is recommended by ACOG for implant visits and may be used for patch, ring, and barrier method visits);
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Z30.019, initial prescription of contraceptives, unspecified;
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Z30.40, surveillance of contraceptives, unspecified.
What should clinicians do to enhance their documentation habits? Policar advises that providers should continuously improve their coding sheets, as well as take a full coding course every few years. Reading a monthly obstetrical/gynecological coding newsletter is helpful as well, and if your office has an in-house coder, get to know him/her on a first-name basis, Policar suggests. Also, www.icd10data.com is a good Web-based resource for converting ICD-9 codes to ICD-10, and vice versa, he notes.
“If you didn’t write it down, you didn’t do it,” says Policar. “Follow coding guidelines, and only code what is contained in the medical record. Reimbursement will follow.”
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Policar MS. The impact of ICD-10 coding on reproductive health services: Are you up to speed? Presented at the 2015 Contraceptive Technology Quest for Excellence conference. Atlanta; November 2015.
