On June 24, 2016, the Centers for Disease Control and Prevention (CDC) released the new 2017 ICD-10-CM codes that went into effect on October 1, 2016. According to Laurie Johnson, MS, RHIA, CPC-H, FAHIMA—the director of health information management (HIM) consulting services for Panacea Health Solutions, Inc. and author of this ICD10 Monitor article—there are “1,974 additions, 311 deletions, and 425 revisions,” resulting in a total of 71,486 codes. Now, not all of these changes are relevant to rehab therapists—thank goodness—but many are, which is why we’re going to use this post to:

  • summarize the new changes for the three chapters most relevant to therapists;
  • provide you with some examples of deleted, added, and updated codes that may impact your daily practice; and
  • offer you with a helpful reminder about coding now that Medicare’s ICD-10 grace period has ended.

Ready? Let’s dive in.

Is PT Valuable? Why Outcomes Data is the Proof We Need - Regular BannerIs PT Valuable? Why Outcomes Data is the Proof We Need - Small Banner

ICD-10 Changes by Chapter

Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue

Johnson said CMS added “bunion, bunionette, pain in joints of the hand, more specificity to temporomandibular joints, cervical disc disorders at specific levels, atypical femoral fractures, and periprosthetic fractures.”

Chapter 19: Injuries, Poisoning, and Certain Other Consequences of External Causes

As noted in the above-cited article, CMS also made a “significant number of additions [to] the specific fractures to bones of the skull”—as well as “various fracture types of the foot.” There also are “title revisions to complications involving prosthetic devices; new stenosis of cardiac stent codes, and additions to complication types, including breakdown, displacement, infection, erosion, exposure, pain, fibrosis, thrombosis, and leakage.”

Chapter 20: External Causes of Morbidity

The CDC also updated several vehicular accident codes and “added contact with paper or sharp objects, overexertion, and…the choking game.” (Let’s hope you never need to use the code for that last one.)

Deleted, Added, and Updated Codes

Deleted Codes

As Johnson mentioned, this update removed more than 300 ICD-10 codes from the code set. If you’ve used any of these codes in your documentation for existing patients—and then continued to see those patients on or after October 1, 2016—then you would need to select new diagnosis codes for any dates of service falling after the new code set went into effect.

Now, let’s look at some examples. Here are six codes that have been removed from Chapter 19: Injuries, Poisoning, and Certain Other Consequences of External Causes:

  1. T84.040  Periprosthetic fracture around internal prosthetic right hip joint
  2. T84.041  Periprosthetic fracture around internal prosthetic left hip joint
  3. T84.042  Periprosthetic fracture around internal prosthetic right knee joint
  4. T84.043  Periprosthetic fracture around internal prosthetic left knee joint
  5. T84.048  Periprosthetic fracture around other internal prosthetic joint
  6. T84.049  Periprosthetic fracture around unspecified internal prosthetic joint

Added Codes

Based on Johnson's assessment, we know that the CDC added more codes than it deleted, which means you should have no problem finding a satisfactory replacement for any code you can no longer use. Let’s continue our previous example of deleted codes: if you used one of the above-listed codes for periprosthetic fracture for an existing patient—and that patient returned to your clinic on or after October 1, 2016—then you would need to enter a new code. Luckily, as part of the update, a new family of codes for this injury is available: M97, Periprosthetic fracture around internal prosthetic joint. If one of the below-listed replacement codes accurately reflects the patient’s condition, you could use it as a replacement for the deleted code:

  • M97.0 Periprosthetic fracture around internal prosthetic hip joint
  • M97.01 Periprosthetic fracture around internal prosthetic right hip joint
  • M97.02 Periprosthetic fracture around internal prosthetic left hip joint
  • M97.3 Periprosthetic fracture around internal prosthetic shoulder joint
  • M97.2 Periprosthetic fracture around internal prosthetic ankle joint

Updated Code Descriptions

With more than 400 updated code descriptions, there’s a good chance you’ll run into one of these revisions sooner rather than later—but they shouldn’t cause too much confusion, because the ICD-10 code is the same; only the description is different. Still, you should double-check the descriptions for codes on any active cases to ensure they still accurately reflect your patient’s condition. Here are three examples of updates from Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue:

M96.83
  • Original description: Postprocedural hemorrhage and hematoma of a musculoskeletal structure following a procedure
  • Revised description: Postprocedural hemorrhage of a musculoskeletal structure following a procedure
M96.830
  • Original description: Postprocedural hemorrhage and hematoma of a musculoskeletal structure following a musculoskeletal system procedure
  • Revised description: Postprocedural hemorrhage of a musculoskeletal structure following a musculoskeletal system procedure
M96.831
  • Original description: Postprocedural hemorrhage and hematoma of a musculoskeletal structure following other procedure
  • Revised description: Postprocedural hemorrhage of a musculoskeletal structure following other procedure

The End of the Grace Period

When ICD-10 first went into effect on October 1, 2015, Medicare implemented a one-year “grace period” that culminated with dates of service falling on or after September 30, 2016. During this period, as long as the provider selected a code from the correct family of codes, CMS would accept that code—regardless of whether it was the most specific code available.

As you well know, the first three characters of any ICD-10 code typically denote the code family. Providers must then use the remaining characters to account for additional clinical details relevant to that patient’s condition. Before October 1, 2016, submitting a code with the correct first three digits was enough to receive payment. However, that’s no longer the case. Codes on claims with dates of service falling on or after October 1, 2016, will be subject to more intense scrutiny, which could lead to more ICD-10-related denials.

Example

Consider the following table of codes:

Code

Description

M54.0

Panniculitis affecting regions of neck and back

M54.01

Panniculitis affecting regions of neck and back, site unspecified

M54.03

Panniculitis affecting regions of neck and back, cervical region

M54.04

Panniculitis affecting regions of neck and back, cervicothoracic region

M54.3

Sciatica

M54.30

Sciatica, unspecified side

M54.31

Sciatica, right side

M54.41

Lumbago with sciatica, right side

All the codes above fall within the M54 family of Dorsalgia. The additional characters that come after “M54” convey more specific information about the patient’s condition. During the grace period, if a patient presented with a condition falling under the M54 umbrella, the provider could use any of the codes beginning with “M54” to receive reimbursement. Today, providers could receive a claim denial for using a code that is either incorrect or lacking specificity. That’s why it’s imperative that providers—and billers—use the most accurate, specific codes available to describe their patients’ conditions.

Using an EMR? Be sure your software vendor has updated the system to account for all of the coding changes mentioned in this post. Otherwise, you might not receive accurate payment for your services. (If you’re a WebPT Member, don’t worry—you’re covered.) For a complete explanation of these ICD-10 changes, check out Johnson’s blog post in full here or refer to the CMS 2017 ICD-10-CM files here.


How is your practice handling the new codes and the end of the grace period? Have you noticed an increase in denial rates, or is it still too soon to tell? Share your experiences in the comments section below.

  • Goodbye, Grace: CMS Ends ICD-10 Flexibility Period Image

    articleOct 5, 2016 | 4 min. read

    Goodbye, Grace: CMS Ends ICD-10 Flexibility Period

    As healthcare providers say “goodbye” to the month of September, they’ll have to say “ hello ” to more than just cooler temps and the beginning of a new season. That’s because, as of October 1, 2016, Medicare’s ICD-10 grace period is officially over. That means if providers continue to submit unspecified codes when other, more specific codes exist, Medicare will start saying “no” to paying for those claims. Feeling a bit underprepared for this change? Here’s …

  • The Ultimate ICD-10 FAQ: Part Deux Image

    articleSep 24, 2015 | 16 min. read

    The Ultimate ICD-10 FAQ: Part Deux

    Just when we thought we’d gotten every ICD-10 question under the sun, we got, well, more questions. Like, a lot more. But, we take that as a good sign, because like a scrappy reporter trying to get to the bottom of a big story, our audience of blog readers and webinar attendees aren’t afraid to ask the tough questions—which means they’re serious about preparing themselves for the changes ahead. And we’re equally serious about providing them with …

  • The Definitive Medicare Part B FAQ for Outpatient PT, OT, and SLP Image

    articleOct 27, 2016 | 33 min. read

    The Definitive Medicare Part B FAQ for Outpatient PT, OT, and SLP

    In October, we hosted a webinar dedicated to the most common Medicare misconceptions . We received a lot of questions from the audience—so many, in fact, that we’ve organized them all into one huge FAQ. Scroll through and check them out, or use the link bank below to skip to a particular section. The Therapy Cap ABNs Modifiers Supervision Prescriptions and Certifications Cash-Pay Rules and Regulations Re-Evaluations Everything Else   The Therapy Cap If a patient reaches …

  • articleNov 7, 2013 | 2 min. read

    FLR and PQRS: How Are They Different?

    Functional limitation reporting (FLR) and PQRS both fall under the ever-widening umbrella of Medicare regulations, and they both involve outcome measures and data codes. Still, they are completely separate requirements, each with its own set of rules. Confusing, we know. To help you sort out the differences, we’ve put together a short breakdown of each one as well as a detailed compare/contrast chart: The Basics of FLR On July 1, 2013, Centers for Medicare & Medicaid Services …

  • ICD-10 Crash Course: Last-Minute Training for PTs, OTs, and SLPs Image

    webinarSep 2, 2015

    ICD-10 Crash Course: Last-Minute Training for PTs, OTs, and SLPs

    It’s officially here: the last month before all HIPAA-eligible professionals must switch to the ICD-10 code set. As the regret of procrastination washes over many of those professionals, they’re scrambling to ready themselves and their practices for the big switch. If you, like so many other rehab therapists, find yourself asking, “ICD-what?” then you’re in dire need of straightforward training—stat! Otherwise, you could leave your practice vulnerable to claim denials after October 1. Join us at 9:00 …

  • articleNov 5, 2013 | 3 min. read

    Founder Letter: PQRS 2014

    Well, it’s November already, and that means two things: Thanksgiving and Physician Quality Reporting System (PQRS). Sure, PQRS doesn’t involve mouthwatering roasted turkey, savory stuffing, or creamy mashed potatoes, but it has become quite the November tradition for us here at WebPT. You see, this is the time of year that the Centers for Medicare & Medicaid Services (CMS) typically confirms the details of next year’s reporting requirements, thus allowing us to update our PQRS solution (claims- …

  • ICD-10 Open Forum Image

    webinarOct 5, 2015

    ICD-10 Open Forum

    On October 1, the US officially said RIP to ICD-9 and brought ICD-10 to life. For some of you, the transition might’ve been all sugar and spice—a real treat. But for many others, the switch to the new code set might’ve left you feeling overwhelmed, tricked, or even a bit scared. At the very least, you might be haunted by some lingering questions. That’s where we can help. We’ve brewed a cauldron filled to the brim with …

  • 9 Most Common Medicare Misconceptions for PTs, OTs, and SLPs Image

    webinarSep 8, 2016

    9 Most Common Medicare Misconceptions for PTs, OTs, and SLPs

    To say that Medicare regulations are confusing is an understatement. But, it’s not just the barely-readable government gobbledygook that throws providers for a loop; it’s also the fact that the rules are always changing. If you treat Medicare patients, we’re willing to bet you’ve been tripped up by at least one of these common misconceptions—maybe without even knowing it. And that could leave a nasty bruise on your practice’s bottom line—especially if you ever find yourself at …

  • The Scoop on PQRS Image

    articleNov 18, 2013 | 5 min. read

    The Scoop on PQRS

    What is PQRS? The Centers for Medicare and Medicaid Services (CMS) developed Physician Quality Reporting System (PQRS), which mandates that eligible professionals meet standards for satisfactory reporting. If you are not PQRS-compliant in 2014, CMS will assess penalties. However, we do not yet know what the penalty amount is or how CMS will assess it. There also is a chance that CMS will provide incentive payments for successfully completing PQRS, as they did in 2013. Again, we …

Achieve greatness in practice with the ultimate EMR for PTs, OTs, and SLPs.