By Devin Partida, technology writer and the editor-in-chief, ReHack.com.
Devin Partida
Medical billing records may help create a fuller picture of how the COVID-19 virus has impacted the country.
Researchers have started taking to repositories of claim and billing code data to learn more about patients — who they are, what challenges they faced and how they had to navigate the health care system during a pandemic.
Combined with other data on the financial impact of COVID, this research offers a much clearer view of how the pandemic has impacted patients and strained the American medical system.
1. Chronic Kidney Disease May Be the Most Common COVID-19 Comorbidity
In July, FAIR Health, a provider of health care solutions, released a report on how billing records could reveal more about COVID patients’ stories. Most prior case studies found that type 2 diabetes and hypertension were the most common comorbidities. Respiratory conditions, like asthma, COPD and sleep apnea, along with heart conditions, typically made up the rest of the top 10.
The billing data was mostly in line with these previous findings — but had one key difference. The No. 1 comorbidity was chronic kidney disease and failure, rather than hypertension or diabetes.
The FAIR Health report also diverged from other case studies in finding that anxiety was one of the top 10 comorbidities, coming in at ninth place.
Have you reviewed the changes to the Circulatory System section in the ICD-10-CM 2019 Official Guidelines for coding and reporting? To support medical necessity and payment for your cardiology CPT codes and cardiology HCPCS codes, your ICD-10-CM coding needs to be spot-on. And that doesn’t mean just checking the ICD-10-CM index in your manual or cardiology coding tool. You’ve got to have the Official Guidelines down cold, or at least know where to find them when you need them. As you use the ICD-10-CM code set for 2019 cardiology coding, make sure you’re aware of these revisions to the Official Guidelines (OGs) so your coding complies with the rules.
Check for 2 Changes When Coding Hypertension with Heart Disease
In 2018, section I.C.9.a.1 of the OGs (Hypertension with Heart Disease) stated that “Hypertension with heart conditions classified to I50.- or I51.4-I51.9, are assigned to a code from category I11, Hypertensive heart disease.”
Watch out: In the 2019 OGs, the code listing changes to “I50.- or I51.4-I51.7, I51.89, I51.9.” You’ll continue to use additional code(s) from category I50.- (Heart failure), to identify the heart failure type, when applicable. What’s different? The change removes I51.81 (Takotsubo syndrome) from the guideline.
Clarity on when to code separately: The Hypertension with Heart Disease subsection gets an additional clarification for the instruction about when to code those heart conditions separately from the hypertension. The 2018 wording was “if the provider has specifically documented a different cause.” The 2019 wording is “if the provider has documented they are unrelated to the hypertension.”
See a Similar Documentation Clarification for Hypertensive CKD
The Hypertensive Chronic Kidney Disease subsection sees an update like the one above for separate coding of hypertension and heart disease. Here’s the exact wording in section I.C.9.a.2:
2018: “CKD should not be coded as hypertensive if the physician has specifically documented a different cause.”
2019: “CKD should not be coded as hypertensive if the provider indicates the CKD is not related to the hypertension.”
Know Proper Sequencing for Pulmonary Hypertension
The 2018 OGs had incorporated changes for Pulmonary Hypertension (I27.-) in section I.C.9.a.11. A clarification in 2019 assists by better defining sequencing rules.
The 2018 OGs said that for secondary pulmonary hypertension, you should “code also” associated conditions or adverse effects of drugs or toxins and base the sequencing on the reason for the encounter.
The 2019 OGs revise the instruction to base sequencing on the reason for the encounter “except for adverse effects of drugs (section I.C.19.e).” The section referenced covers coding for Adverse Effects, Poisoning, Underdosing, and Toxic Effects.
Steer Clear of Subsequent AMI Coding Mistakes
Codes and OGs for myocardial infarction got a facelift in 2018, and the 2019 OGs continue to add clarification about how to code properly.
The new instruction added to section I.C.9.e.4 states, “If a subsequent myocardial infarction of one type occurs within 4 weeks of a myocardial infarction of a different type, assign the appropriate codes from category I21 [Acute myocardial infarction] to identify each type. Do not assign a code from I22 [Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction].”
The new instruction goes on to state, “Codes from category I22 should only be assigned if both the initial and subsequent myocardial infarctions are type 1 or unspecified.”
Payers don’t accept deleted CPT codes, so your claims can’t succeed if your medical procedure codes are out of date. But do you know how often you need to update your CPT code set? It may be more often than you think. Here are some pointers to keep in mind to give your claims their best chance at accurate payment.
Make the Biggest Transition with January Updates
Each year, a new CPT code set is effective on January 1. For instance, for CPT codes, 2018 codes will give way to the 2019 code set on Jan. 1, 2019.
If you use an online CPT code search product, you’ll want to be sure that the updates are searchable January 1. It’s also helpful if the CPT lookup includes deleted codes (marked with the deletion date) because you use the code set based on the date of service. You may need access to previous code sets to finish filing claims and for working on appeals.
Reminder: You need to update your CPT modifiers list, as well as your procedure code lookup resource each January.
Plan for These Other Regular CPT Code Set Releases, Too
The AMA, which owns and maintains the CPT code set, implements certain types of codes more than once a year. You should be aware of these updates and have a strategy for ensuring you have them when you need them. All specialties may see CPT updates throughout the year, but path/lab coders need to watch for a few special categories that apply to them.
Category III and vaccine codes: Category I vaccine codes and Category III codes (temporary codes for emerging technology and services) are implemented January 1 and July 1. You’ll typically find them posted on the AMA site six months before the codes are effective, giving you time to learn how to apply them.
Category II: Category II codes are tracking codes that you may use for performance measurement programs, like MIPS. The AMA site indicates you may see release March 15, July 15 and November 15, with implementation three months after release.
Molecular pathology tier 2 codes: To help with reporting MoPath procedures, these codes go from approved to effective quickly. After approval by the CPT Editorial Panel, codes are released to the AMA site March 1, September 1, and December 1. The effective date may be as soon as one month after the release.
Administrative MAAA codes: Similar to the MoPath codes, Multianalyte Assays with Algorithmic Analyses (MAAA) see a quickened schedule. After Panel approval, the codes are released to the AMA site March 1, September 1, and December 1. The effective date is typically one month after release, although some codes are held until the major January 1 update.
