3 Healthcare Coding Updates You Can’t Afford to Miss

ICD-10 Medical Coding Orthopedics

Healthcare coding is constantly in a state of change. Since ICD-10’s implementation, we’ve done our best to keep you informed and updated on all decisions, changes, and clarifications. Following proper coding practices increases the likelihood of prompt payment and keeps processing as efficient as possible. Below I’ve included a breakdown of changes and updates regarding comparison view x-rays, foot care, and surgical spine treatment. 


X-ray Comparison Views 

3_Healthcare_Coding_Updates_You_Cant_Afford_to_Miss The HIS Coding Committee has made the following decision regarding how to bill comparison x-rays within the laterality of ICD-10’s diagnoses codes. Example: A patient has complaints of LT knee pain, no reported injury and no previous history. RT knee is asymptomatic, no pain, swelling or any other symptoms.

Doctor orders the following: LT knee x-ray for pain 3 view and RT knee 3 view for comparison. These would be coded as: 73562-LT: M25.562; 73562-RT: Z01.89.

ICD-10-M25.562 is the painful LT knee. ICD-10-Z01.89 is “Encounter for Other Specified Special Examination” for the RT knee. In the above example, M25.561 would not be assigned to the RT knee as there is not an indication the patient is experiencing RT knee pain. In this scenario, each set of x-rays should have its own documentation.

NGS Change to Foot Care and Nail Policy

The following change was made to the LCD as of January 2016. It is in reference to Routine Foot Care and Debridement of Nails (L33636), and the explanatory note has been revised for clarity. For treatment of mycotic nails, or onychogryphosis, or onychauxis, in the absence of a systemic condition or where the patient has evidence of neuropathy, but no vascular impairment, for which class findings modifiers are not required, ICD-10-CM code B35.1 or L60.2 respectively, must be reported as primary, with the diagnosis representing the patient’s symptom reported as the secondary ICD-10-CM code. Refer to the “Indications and Limitations of Coverage and/or Medical Necessity” section of the LCD. 

UHC Changes Policy on Surgical Spine Treatment

XLIF+DLIF: extreme lateral Interbody fusion (XLIFâ) or direct lateral Interbody fusion (DLIF) is proven. The changes stated that these methods for a fusion are covered by UHC, and CPT codes 22554-22585 should be used when the fusion is performed with these methods.

It’s important to note, UHC requires pre-authorization for any spine surgery; if a provider is considering any of the decompression/fusion via the methods listed below it should be mentioned when obtaining authorization so they can know upfront if it will be covered.

The following spinal procedures are unproven:

  1. Laparoscopic anterior lumbar interbody fusion (LALIF) 

  2. Transforaminal lumbar interbody fusion (TLIF) which utilizes only endoscopy visualization (such as a percutaneous incision with video visualization) 

  3. Axial lumbar interbody fusion (AxiaLIF) 

  4. Interlaminar lumbar instrumented fusion (ILIF) 

Spinal Decompression and Interspinous Process Decompression Systems

  1. Interspinous process decompression (IPD) systems, for the treatment of spinal stenosis
  2. Minimally invasive lumbar decompression (MILDâ)

Spinal Stabilization

  1. Stabilization systems for the treatment of degenerative spondylolisthesis

  2. Total facet joint arthroplasty, including facetectomy, laminectomy, foraminotomy, and vertebral column fixation
  3. Percutaneous sacral augmentation (sacroplasty)

  4. Stand alone facet fusion without an accompanying decompressive procedure


Staying Updated on Healthcare Coding Changes

Changes and clarifications are perfectly normal, especially during these first months following ICD-10’s required implementation. HIS will keep you updated and in-the-know when it comes to these changes. Beyond our blog and monthly newsletter, we provide educational resources and onsite training, trained and certified coding experts to handle your coding and billing services, and the assistance needed to make the transition easier on your staff and avoid lost dollars due to coding errors.

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