General Surgery Coding Alert

Change should aid payment during code set transition.

Your general surgery practice should be getting ready to start using ICD-10 on Oct. 1, 2014, but have you ever thought about how that will mesh with National Coverage Determinations (NCDs)? Recall that NCDs list ICD-9 codes that show medical necessity for — and will garner payment for —procedures that your surgeons perform?

The time has come ensure timely replacement of applicable ICD-9 codes with corresponding ICD-10 codes in NCDs, according to recent CMS communications.

Here’s theCrosswalk Plan

CMS recently instructed contractors in to start the process of creating and updating NCDs that contain ICD-9 codes. CMS said that carriers should assign comparable ICD-10 codes to them by the ICD-10 implementation date of Oct. 1, 2014. The directive was part of MLN Matters article MM8109.

This should help practices immeasurably, since inclusion of applicable ICD-10 codes on NCDs could at least offer a window into how Medicare payers will view each new diagnosis code and which codes it deems payable for particular services.

For instance: When your surgeon performs a colonoscopy for a patient with Crohn’s disease of the small intestine, you should stop using ICD-9 code 555.0 (Regional enteritis of small intestine) on Oct. 1, 2014, and should instead expect payment based on one of the following ICD-10 codes, according to CMS:

·         K50.00 — Crohn’s disease of small intestine without complications

·         K50.011 — Crohn’s disease of small intestine with rectal bleeding

·         K50.012 — Crohn’s disease of small intestine with intestinal obstruction

·         K50.013 — Crohn’s disease of small intestine with fistula

·         K50.014 — Crohn’s disease of small intestine with abscess

·         K50.018 — Crohn’s disease of small intestine with other complication

·         K50.019 — Crohn’s disease of small intestine with unspecified complications

To read the complete MLN Matters article associated with CR 8109, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8109.pdf.