Running an orthopedic practice means that you must always be aware of changes to coding and policy in the industry, so that the information you submit and care you provide is up to date, accurate, and abides by all necessary rules and regulations. At HIS, we strive to keep you up to date on all industry changes, and below we have detailed recent ICD-10-CM changes and policy updates for 2019.
ICD-10-CM Changes for 2019
Changes to ICD-10-CM occur annually, and the changes listed below are in effect as of October 1, 2018. It is important to be aware that the ICD-10-CM code for myalgia has been expanded, and codes that are to be used from now on include:
- 11: Mastication muscle
- 12: Auxiliary muscles, head and neck
- 19: Other site
There have also been changes regarding the use of BMI as a diagnosis for patients who are overweight. The new updates require the reporting of the condition associated with the patient’s BMI. Below is a list of applicable codes.
- 01: Morbid (severe) obesity due to excess calories
- 09: Other obesity due to excess calories
- 1: Drug-induced obesity (There is an instructional note that states to use an additional code for adverse effect, if applicable, to identify the drug: T36-T50 with a fifth or sixth character 5)
- 2: Morbid (severe) obesity with alveolar hypoventilation
- 3: Overweight
- 8: Other obesity
Policy Updates
Being aware of policy changes is essential for practices who offer various services. Below you will find information on policies that have been updated and details regarding changes that were made.
Humana
Humana coverage changed regarding treatments under three categories: spinal decompression, physical and occupational therapy, and joint resurfacing. There are a number of codes associated with spinal decompression coverage, and they cover the various procedures intended to relieve pressure on the spinal cord and nerve roots. Regarding physical or occupational therapy, if the service is rehabilitative, any state mandates for it to take precedence over the stated clinical policy. Rehabilitative services refer to services that help a person regain daily living skills that were lost due to an injury, illness, or disability, while habilitative services focus on helping patients keep, learn, or improve skills essential to daily living. For joint resurfacing arthroplasty, ICD-10-CM codes depend on specific categorizations, some of which include Felty’s syndrome, rheumatoid lung disease, rheumatoid heart disease, and juvenile rheumatoid arthritis, among many others.
Aetna
Aetna updated three of their policies: bunionectomy, hammertoe, and knee arthritis treatment. In the category of bunionectomy, continuous wound infiltration with local anesthetics was updated. Hammertoe policy updates include changes to Cannulink and intramedullary fusion device. Updates to knee arthritis treatment specifically focus on osteoarthritis of the knee, which can be treated either with non-pharmacological approaches or arthroscopic surgery.
Cigna
To add to the radiology imaging requirement, Cigna made updates to their policy on vertrebroplasty, kyphoplasty, and sacroplasty. The first two treatments are used for osteoporotic vertebral compression fractures, as well as similar fractures from multiple causes. Sacroplasty is a variation of vertrebroplasty, and has been discussed for the use of treating sacral insufficiency fractures.
BlueCross BlueShield of Illinois
BlueCross BlueShield of Illinois updated their policy on Sacroiliac Joint Fusion and Stabilization, specifically their conservative treatment requirements. This treatment may be considered medically necessary when certain criteria are met. Updates were also made in terms of orthopedic applications of Stem-Cell Therapy, and these updates state that this treatment is considered experimental, investigational, and/or unproven for all orthopedic applications, so no coverage is applicable. The policy for Amniotic Membrane and Amniotic Fluid also changed, and there is now a new coverage policy for non-healing diabetic lower-extremity ulcers. Documentation guidelines for Urine Drug Testing were updated as well, in accordance with BCBSIL Medical Policy MED207.154 Drug Testing in Pain Management and Substance Use Disorder Monitoring. Claims must be properly documented and the documentation must reflect the medical necessity of the testing.
Physician Management Services with HIS
If you are looking for support on the management side of your practice that will allow you to fully focus on the needs of your patients, HIS is here to help. We have been providing healthcare revenue cycle management, billing, coding, management, and consulting for over 30 years, and our team is experienced and dedicated to providing practices with the best services possible. Our established divisions for orthopedics and radiology will ensure that you receive services that are perfectly tailored to your needs for your practice. Contact us today to learn more about how partnering with HIS can bring you positive practice growth.