Wiki Unspecified Codes

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opheliamoore

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Hey All! I have always learned and been instructed that unspecified codes are not the way to go unless ABSOLUTELY necessary. However, I recently reached out to a provider who advised for a specific diagnosis set that since there was not a bilateral code that the unspecified is more accurate then coding both a right and left. Example M24.569 Contracture, unspecified knee; I had suggested M24.561/M24.562. Please help I am not understanding what maybe I have missed
 
This year's ICD-10-CM coding guidelines state that if there is no bilateral code and the condition exists bilaterally to code both the left and right side diagnosis codes instead of unspecified. "If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side. If the side is not identified in the medical record, assign the code for the unspecified side." Then, later it says this: "Codes for “unspecified” side should rarely be used, such as when the documentation in the record is insufficient to determine the affected side and it is not possible to obtain clarification."
 
opheliamoore said:
Hey All! I have always learned and been instructed that unspecified codes are not the way to go unless ABSOLUTELY necessary. However, I recently reached out to a provider who advised for a specific diagnosis set that since there was not a bilateral code that the unspecified is more accurate then coding both a right and left. Example M24.569 Contracture, unspecified knee; I had suggested M24.561/M24.562. Please help I am not understanding what maybe I have missed
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Remember: Providers aren't always familiar with coding guidelines - and in this case, your provider was incorrect from a coding and billing standpoint.

As Carly mentioned, the ICD-10-CM guidelines are very clear when it comes to laterality: If no specific bilateral code exists and the condition is bilateral, assign separate codes for the right and left side.

(Unless your organization has an internal policy that requires every diagnosis correction to be run by a provider, laterality is something that you can correct yourself when supported by the documentation.)

Coding laterality helps create a more accurate and complete clinical picture.

Which paints a clearer image of the patient's condition?

The patient has a contracture in an unspecified knee.

OR

The patient has a contracture in both the right and left knees.

Also remember that payers are starting to deny unspecified laterality codes when laterality should be known and coded. Your provider isn't treating an unspecified knee, so it shouldn't be billed to the payer that way.
 
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