RCCS’ Declassified Coding Survival Guide

By far, one of the biggest advantages of living in the 21st century is the rapid progress and evolution of modern medicine. Developments in science and technology are constantly making diagnosis and treatment easier and helping people to live longer healthier lives. As diagnostic criteria are refined and new tests and procedures are developed, the field of medical coding must also evolve to ensure proper records are kept and practitioners are paid correctly. Prepare for the changes you can expect in 2023 with our End of Year Coding Survival Guide.

Standards for Medical Coding

There are three main types of codes used by medical coding professionals. The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is published by the Centers for Disease Control (CDC) and the World Health Organization (WHO) and is used for diagnosis coding. This code set undergoes an extensive biannual update each April 1 and October 1, the latest of which took effect on October 1, 2022.

The ICD and its revisions and Clinical Modifications are important tools for consistently identifying and reporting diseases, injuries, and other ailments. This helps the WHO, the United States Government, and other regulatory bodies to identify trends in disease and mortality. It also helps individual patients seamlessly transfer their medical records and history between providers without confusion.

In addition to the ICD-10-CM code set maintained by the CDC and WHO, the American Medical Association (AMA) publishes and maintains Current Procedural Terminology (CPT®) codes for use by physicians, outpatient hospitals, physician offices, Medicare, Medicaid, and private payers. While the ICD-10-CM code identifies the patient’s condition or diagnosis, the CPT® code describes the procedures, treatments, and tests performed and allow the provider to communicate to the payer the services and/or procedure(s) performed and for which they are seeking payment. The use of an established code set ensures continuity in describing and applying coding for the same procedure regardless of who or where the service was provided. The CPT® manual is updated following meetings by the CPT(R) Editorial Panel annually with revisions, deletions, and additions to the entire code set.

Finally, the Healthcare Common Procedural Coding System (HCPCS) Level II code set is maintained by the Department of Health and Human Services (DHS). HCPCS Level II is a standardized coding system used to report supplies, equipment, and services not identified by the AMA’s CPT® code set and updated on a quarterly basis. This includes durable medical equipment, ambulance services, supplies, and innovative procedures. All Level II HCPCS codes are alphanumeric and begin with a letter followed by a series of four numbers. While many organizations think in terms of Medicare reimbursement, some of the HCPCS Level II codes are accepted only by Medicaid, Blue Cross Blue Shield, or by other private payers.

When used together, the ICD-10-CM, CPT®, and HCPCS codes paint a picture to the payer of the services (CPT® and HCPCS) the provider is looking to be reimbursed for, and the ICD-10-CM will determine if the provider will be reimbursed by the payer. Ensuring accurate and current coding is used and applied as outlined by payer guidance is extremely important. Coding changes are published regularly and must be kept up with. The use of outdated or incorrect billing can result in more than a lack of payment.

What Do the Latest Updates Mean for Radiology and Oncology Coding?

Several of the updates to both diagnostic and procedural codes affect the fields of radiology and oncology. The changes to ICD-10-CM codes utilized in radiology primarily include dementia, cardiovascular conditions, and gynecological diagnoses.

Dementia

The fourth and fifth digits were added to the F03.9 series of ICD-10-CM codes to provide additional specificity for dementia coding (now F03.90-F03.C4). The changes now classify dementia by severity and whether there is any associated behavioral disturbance, psychotic disturbance, mood disturbance, or anxiety.

Cardiovascular Diagnoses

Several additional digits were added to the I71 series of codes for aortic aneurysms and dissection. The new fourth and fifth digits help to specify the specific location within the aorta where the aneurysm or dissection has occurred and whether it is with or without rupture. New codes range from I71.010-I71.62.

New code I20.2 was added to represent refractory angina pectoris. Additionally, codes I25.11 (Atherosclerotic heart disease of the native coronary artery with angina pectoris) and I25.7 (Atherosclerosis of coronary artery bypass graft[s] and coronary artery of transplanted heart with angina pectoris) were revised to add fifth digits specifying atherosclerotic heart disease with refractory angina pectoris (now I25.112; I25.702-I25.792).

Code I31.3 (pericardial effusion) also received additional fourth digits to identify malignant pericardial effusion in diseases classified elsewhere (I31.31) and pericardial effusion (non-inflammatory) (I31.39).

An additional digit was also added to code I34.8 (now I34.81-I34.89) to represent nonrheumatic mitral (valve) annulus calcification and other nonrheumatic mitral valve disorders.

Code I47.2 (ventricular tachycardia, unspecified) was revised to include fourth digits (now I47.20-I47.29) to identify specific types of ventricular tachycardia.

Endometriosis

Diagnostic codes for endometriosis have also been made more specific. The codes for endometriosis of the uterus (N80.00-N80.03), ovary (N80.10-N80129), and fallopian tube (N80.20-N80.229) now include a fourth digit to identify both the type and the location of the endometriosis. The code updates also clarify how to report on encounters with patients who are pregnant or have recently elected to terminate a pregnancy. When referring to “completed” weeks of gestation, only full weeks should be counted. A patient who is 20 weeks and 6 days pregnant would be recorded as 20 weeks, not 21. When a patient experiences complications following an elective abortion, it is important to specify the complications and not simply use the code for “encounter for elective termination of pregnancy (Z33.2).” It is also important not to use postpartum codes for encounters following an elective abortion.

Cancer Diagnosis

The main change to oncological coding in the latest updates to the ICD-10-CM concerns cancers of the lymphatic system that have metastasized. Formerly, this diagnosis would be coded as a secondary neoplasm of the affected tissue. Coding guidelines have now changed, and such cases should be recorded as the primary cancer diagnosis with the addition of “9” to indicate that it has spread to “extranidal and solid organ sites.”

Reimbursement

Some coding changes will affect how payers are billed and which services can be covered under Medicaid and other insurance programs. 2023 will see a decreased conversion factor for the valuation of expenses. Radiology practice expenses will be valued lower in 2023 than in 2022, leading to an overall negative impact on compensation. The public health emergency (PHE) that was declared in response to the SARS-COV-2 pandemic is currently set to expire in mid-January 2023. CMS has approved many services to be performed via telehealth during the PHE, but those services will no longer be covered under telehealth 152 days after the PHE expires. Some services will be granted permission to continue via telehealth on a Category III basis while CMS considers adding them to the permanent list of Medicare Telehealth Services. Any services not included in the extension will have to cease telehealth visits anywhere outside of the originating site.

CPT® Coding Changes

In the interventional radiology setting, two new codes (36836 and 36837) were added for percutaneous arteriovenous fistula (AVF) creation (also called EndoAVF). Code 36836 describes this procedure when performed via a single access site, usually an arm vein. 36837 describes EndoAVF creation via two separate access sites (into a peripheral artery and a peripheral vein). Previously, codes only existed for AVF creation via an open approach. These codes represent percutaneous AV fistula creation in the upper extremity only; an unlisted code (37799) should be used in this service is performed in the lower extremity (or any location other than the upper extremity).

For diagnostic radiology, code 76882 (limited extremity ultrasound) was updated to include the term “focal evaluation.” The description was updated to clarify that this code should be used for limited or focal evaluation of specific non-vascular anatomic structure(s) (e.g., joint space only) OR tendon(s), muscle(s), nerve(s) and/or other soft tissue structure(s) or mass(es) that surround the joint (without assessing all the required elements included in 76881).

Code 76883 was created to represent comprehensive ultrasound of extremity nerve(s) and accompanying structures throughout the entire anatomic course in one extremity. This service includes cine and real-time imaging documentation and is coded per extremity evaluated.

In the Nuclear Medicine section, the SPECT codes (78803, 78830-78832) received updated descriptions to clarify the intention of this code family and to differentiate between single area or single acquisition examinations versus two or more separate acquisitions with two different radiopharmaceuticals on the same date of service or over two or more days.

RCCS Can Help You Stay on Top of Updates

In an industry that is constantly changing, it is vital to stay on top of the latest coding and guideline updates. RCCS offers a wide selection of medical coding resources to prepare you for the upcoming year. Our medical coding resources cover specialty-related topics and provide you with real-life scenarios that put each code into context and help you and your organization avoid costly missteps. As an industry leader in healthcare, we invest our time and resources in providing valuable content for our clients through webinars, blogs, and products, ensuring your knowledge is up to date. Attend our annual CROWN® seminar series for face-to-face education with our experts as they review and summarize the coding updates you need to be prepared for the new year. Our content library is filled with industry-related resources for year-round assistance with coding accuracy. To ensure current processes are fully optimized, RCCS also offers review services that can identify opportunities and repeated mistakes that may be costing your organization revenue. We also offer frequent free webinars and online courses year-round to ensure your knowledge is always up to date.