Urology Coding Alert

Take advantage of larger space for diagnosis codes in July

Complex patients require more than a few diagnosis codes, and your carriers may finally be catching up.

What's new: The Centers for Medicare & Medicaid Services recently issued a transmittal (CR5441) instructing carriers to consider all diagnosis codes on a claim, up to eight codes. The carriers have until July 1 to update the Medicare carrier standard system to meet this requirement.

This change will definitely help with conditions that require more than one code to report, such as diabetic complications, says Jan Rasmussen with Professional Coding Solutions in Eau Claire, Wis. It could also help with preoperative V72.8x codes, where the medical necessity determination will come from the secondary codes, not the V code.

If the carriers actually start considering multiple diagnoses for payment, this will be a huge step forward, says Quinten Buechner with ProActive Consulting in Cumberland, Wis.

Example: You may have a patient who's diabetic but also has high cholesterol and borderline high blood pressure. The patient might have a high-level evaluation and management visit because of the combination of all three of those problems, Buechner says.

The real problem: Will the carriers allow more than one digit in Box 24-E on the CMS-1500 form, which tells the carriers which diagnosis to assign to a particular procedure? Now you can list up to four diagnoses on the 1500 form, but some carriers will require you to put only one number (from one to four) or the main diagnosis next to each procedure.

You should urge your carrier to allow you to list more than one digit in Box 24-E, Buechner says. For example, if the first, third and fourth diagnoses are relevant, you should be able to list "1, 3, 4" in the box. That would be a really helpful change, he says.

Otherwise, it doesn't matter how many diagnoses you can list, because all but one of them will only be useful for appeals, he says. In an appeal, you can point to all eight of your diagnosis codes and say, "It's not my fault you can't figure out which ones really will apply, because you won't let me tell you which ones apply."

Hospital coders: If you submit claims for hospitals, skilled nursing facilities, and other institutional claim filers,  CMS will require you to begin using the UB-04 in May. The good news is that one of the most noticeable changes on the UB-04 is the expansion of the diagnosis code field (67) to accept 18 ICD-9 codes, which gives you room for up to eight additional diagnosis codes.

Field locator 67 should contain the ICD-9 code for the disease condition that most accurately reflects the main reason [...]