2017 medical billing modifiers cheat sheet
[ASKDEEIPSNPPET-21-23] There's a lot of confusion regarding CMS's "grace period." According to CMS, "Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family.". Furthermore, once October 1 hits, we will allow for dual coding in cases involving non-HIPAA covered insurances, as the diagnosis code set will be tied to the insurance. So, if a particular insurance requires ICD-9, you'll be able to add ICD-9 codes for patients who have that insurance. While you can access the entire code set free of charge here, you may find a PT-specific ICD-10 code book useful for educational purposes, as it likely will provide guidance around coding strategy and processes. We actually sell one in the WebPT Marketplace, so if you're a Member, you can purchase it at a discounted price here. Otherwise, you can purchase it here. How do I format a code that requires a seventh character?. How do I know when to use the seventh character?. We have a wealth of educational resources that you can download here. However, we wouldn't recommend using a cheat sheet, specifically. As most providers know, certain CPT codes are only payable when used in conjunction with certain ICD-9 codes. Thus, you may be tempted to quickly crosswalk those ICD-9 codes and tack up a new reimbursement cheat sheet—or worse, download the first cheat sheet you find online. Don't. The rules aren't the same, and crosswalks typically yield unspecified ICD-10 equivalents. As this ICD-10 for PT article explains, " one of the main battle cries of the new code set is increased specificity, and the transition to ICD-10 represents a giant step away from the use of unspecified codes (unless one of those codes truly represents the most accurate description of a patient's condition). Thus, if you submit an unspecified code when a more specific code is, in fact, available, you could put yourself at risk for claim denial.". What are external cause codes? And how do I use them?. Do you have any ICD-10 information specific to pelvic health?. So, what does that mean? It means ICD-10 is absolutely happening on October 1. You'll still receive denials from your commercial payers if you code inaccurately. And, for Medicare claims, you still have to code using valid codes from the accurate code family. For all of the details on what this grace period means for providers, check out this blog post. As explained in this blog post, there's no national requirement mandating any provider—PTs included—to submit external cause codes. However, providers are encouraged to do so when possible. Most of the PT-relevant codes that allow for external cause codes are located in Chapter 19 of the tabular list (which you can access here ). Furthermore, some state and regional payers may require the use of external cause codes, so check with each one individually. Until October 1, only ICD-9 codes can appear on claims submitted for reimbursement. Otherwise, claims could be denied. Thus, we won't allow ICD-10 codes to appear on finalized notes for non-test patients until the transition takes effect. That said, you can begin using our Conversion Report to save ICD-10 codes to patient charts for those patients who likely will span the transition. Then, after October 1, our system will automatically start adding the ICD-10 codes—rather than the ICD-9 codes—to any finalized notes. S44.11 is only five characters long, so you add an X in the sixth position. How and when will I actually add ICD-10 codes to existing cases within WebPT that contain ICD-9 codes?. You look at the instructions for the S44 code category and determine that you must add a seventh character to this code. How will ICD-10 affect CPT codes (e.g., 97001, 97110, and 97140)? No, you do not. Instead, when it comes time to add ICD-10 codes for the patients who previously had ICD-9, you'll simply update the diagnoses in the patients' charts as they come in for appointments on or after October 1. There haven't been therapy cap exceptions for a while now. In 2014, Medicare introduced a two-tier exceptions process. In the first tier, which is the Automatic Exceptions tier, therapists affix the KX modifier to necessary services provided above the cap amount. To learn more about the therapy cap, check out this guide. It doesn't. You will continue using the KX modifier to denote automatic exceptions in the same way you currently use this modifier. No, there's no need for a sweeping code change for all your patient notes. You'll simply update codes within patients' charts as they come in for their visits. Or, if you are a WebPT Member, you can use the ICD-9 to ICD-10 Conversion Report to begin saving ICD-10 codes to current patient cases. Then, once October 1 hits, our system will automatically start sending ICD-10 codes—rather than ICD-9—through to your finalized notes. Do I need to do a progress note, evaluation, or re-evaluation to switch to ICD-10 codes?. Are the 1500 forms going to change? How many ICD-10 codes will be allowed on the 1500 form?. You can use our ICD-9 to ICD-10 Conversion Report to begin saving ICD-10 codes to patient cases now. Then, once October 1 hits, our system will automatically start recording ICD-10 codes—rather than ICD-9—on any finalized documentation. If you need to add additional codes to these cases as the patients come in for their visits after October 1, there will be no need to start a new case, or to complete a progress note or re-evaluation; you'll simply update the diagnosis codes in the patient's chart.