Thursday, July 7, 2022

2022 ICD-10-CM Official Coding and Reporting Guidelines

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2022 ICD-10-CM Official Coding and Reporting Guidelines with the Updates

The year before, urgent care centres struggled to grasp and implement major revisions to ICD-10-CM coding requirements, shifting the emphasis to medical decision making (MDM). This year’s CMS guideline isn’t quite as intimidating, but it’s still worth mentioning to ensure your staff is up to speed.

The Centers for Medicare and Medicaid Services (CMS) formally issued the fiscal year 2022 ICD-10-CM diagnostic code modification on June 24, 2021, applicable for hospitalizations and encounters on or around October 1, 2021. In the year, unlike Fiscal 2021, just 165 diagnostic codes are being introduced, as opposed to the 485 provided the previous year. Tables 6A, 6C, and 6E of the IPPS Final Rule for FY 2022 include a complete list of diagnostic codes that have been added, eliminated, or amended.

 ICD-10-CM

So today we are going to discuss some of the more significant changes 2022 ICD-10-CM Official Coding and Reporting Guidelines. So here we go!

ICD-10-CM Official Coding

Nine of the novel codes have been categorized as major complication and comorbidity (MCC) codes, and 11 as complication and comorbidity (CC) codes. Furthermore, the ICD-10-CM Official Guidelines for Coding and Reporting were updated, as discussed at the conclusion of this article. You must study both the recommendations and the updated codes to verify that you are allocating the correct codes.

The American Hospital Association (AHA), the American Health Information Management Association (AHIMA), CMS, and the National Center for Health Statistics (NCHS) have all endorsed these standards. These recommendations are a collection of regulations designed to accompany and supplement the formal standards and instructions contained in the ICD-10-CM. The classification’s guidelines and norms take priority over guidelines. Those guidelines are based on the coding and sequencing guidelines in ICD-10-CM’s Tabular List and Alphabetic Index, but they go a step beyond.

The Health Insurance Portability and Accountability Act requires that specific rules be followed when allocating ICD-10-CM diagnostic codes (HIPAA). HIPAA has mandated the use of diagnostic codes (Tabular List and Alphabetic Index) in all medical facilities. A collaborative effort between the healthcare practitioner and the coder is required to accomplish thorough and correct recording, code allocation, and documentation of diagnoses and procedures. 

These recommendations were created to help both the healthcare professional and the coder determine the conditions that must be recorded. The significance of regular, comprehensive recording in the health record cannot be overstated. Effective coding cannot be performed without such supporting documents. The whole records should be examined to discover the particular cause for the encounter, and the symptoms addressed.

coding hand book

Coding handbook – https://www.amazon.in/ICD-10-CM-ICD-10-PCs-Coding-Handbook-Answers/dp/1556484607

Changes to ICD-10 for 2022

As we approach the end of the following year, it’s appropriate to start considering more about the yearly updates to ICD-10-CM. Each year on October 1, the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics announce an upgraded ICD-10-CM Standard Procedures as well as code set revisions. There are 159 new codes, 32 removed codes, and 20 altered codes this year, for a total of 72,748 codes to pick from.

The single COVID-19 code introduced for this upgrade is U09.9 (Post COVID-19 condition, undefined). This code should be used for COVID-19 consequences or linked symptoms/conditions surviving a previous outbreak. It can not be used to treat existing infections. After you’ve coded the present symptoms/conditions, add code U09.9 as a secondary diagnosis.

Cough (R05), low back pain (M54.5), and polyuria are three typical symptoms needing emergency care (R35.8). For additional specificity, you will need to include a digit beginning 10/01/2021.

Cough:

  • Acute cough (R05.1)
  • Subacute cough (R05.2)
  • Chronic cough (R05.3)
  • Cough syncope (R05.4)
  • Other specified coughs (R05.8)
  • Cough, unspecified (R05.9)

Low back pain:

  • Low back pain, unspecified (M54.50)
  • Vertebrogenic low back pain (M54.51)
  • Other low back pain (M54.59)

Polyuria:

  • Nocturnal polyuria (R35.81)
  • Other polyuria (R35.89)

With the adoption of the 2021 E/M recommendations, social determinants of health may now have an influence on the degree of danger. There are codes for reporting these events, and additional detail is being provided. These would be considered secondary diagnoses.

  • a high school diploma or less (Z55.5)
  • Inadequate supply of drinking water (Z58.6)
  • Unspecified forms of homelessness (Z59.00)
  • Homelessness at a shelter (Z59.01)
  • Homelessness without a shelter (Z59.02)
  • Food scarcity (Z59.41)
  • Other others mentioned a lack of enough nourishment (Z59.48)
  • Housing insecurity, housed but at risk of homelessness (Z59.811)
  • In the previous 12 months, there was housing instability, housedness, and homelessness (Z59.812)
  • Housing insecurity, an undetermined number of occupants (Z59.819)
  • Other issues concerning housing and economic situations (Z59.89)

Prepare to Comply with 2022 Balance Billing Changes

According to the interim final rule, nonemergency treatments supplied by out-of-network practitioners must be classified as in-network procedures unless such insured individual is given informed and consent. This covers devices and gadgets and services such as telemedicine, imaging, and laboratory, regardless of whether the person providing the services is physically at the institution.

Despite the fact that the No Surprises Act and its interim final rule include many federal agencies, people will be able to file complaints with providers who breach the new regulations through a single central mechanism. Even though specifics have not yet been completed, here is what you can do to get ready right now.

  1. First, be mindful of how you enter into contracts with payers.
  2. Insurers may use this as a chance to revise existing agreements or dispute payment rates.
  3. Consider if you want to be in or out of network with specific payers.
  4. Aside from reviewing your contracts and payment rates with particular payers, you should begin planning how you will interact with patients.
  5. By January 1, 2022, your business must offer surprise billing notifications. Therefore, you should develop your models’ notification and disclosure documents by the beginning of next year, before you have to start expanding them

Highlights of the ICD-10-CM Official Coding and Reporting Guidelines

There are several revisions to the  ICD-10-CM coding rules that should be included as well.

Laterality has been modified to highlight that if the practitioner does not record this information, documentation from other doctors may be used. The “undefined” aspect should be used sparingly, and if there is inconsistent evidence of the laterality in the record, the accompanying practitioner should be contacted. (I.B.13). Documentation from physicians who are authorised to record in a patient’s formal health record due to regulation or accrediting requirements or administrative hospital regulations may be utilized for codes for (I.B.14.):

  • BMI (Body Mass Index) (BMI)
  • Non-pressure chronic ulcer dept
  • Stage of a pressure ulcer
  • Scale of coma
  • The NIH stroke scale (NIHSS)
  • Health-related social determinants (SDOH)
  • Laterality
  • Blood alcohol content

Breast implant-associated anaplastic large cell lymphoma – BIA-ALCL – is a kind of lymphoma that develops in the vicinity of breast implants. For this circumstance, use the novel code C84.7A rather than a complexity code from Chapter 19. (I.C.2.s).

Social Determinants of Health – This part of the rules were introduced to enable for use these codes whenever the information is recorded. Coding experts may employ social information documentation from social workers, community health workers, patient advocates, or nurses if it is included in the formal health record. Furthermore, patient self-reporting may be utilised for code assignments if entered into the health record by a physician or practitioner and approved by the physician. (I.C.21.c.17).

The ongoing process of increasing the accuracy of codes in the expanding healthcare business will assist in enhancing the quality and reliability of data reported.

 

 

 

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Nora R. Tripp
I am a self-motivated medical billing and coding professional with over 15 years of experience in health operations management, billing, and coding. Expertise in ICD-9 and ICD-10 coding, as well as CPT and HCPCS coding. Expertise in evaluating and validating patient information, diagnoses, and billing data. I demonstrated leadership abilities that allow for the processing of large amounts of patient information in order to satisfy revenue generation targets.

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