Tuesday, May 18, 2021 | Jammie Quimby
With 15+ years as a certified coder, I have seen firsthand how important it is to understand diagnosis coding and the complex guidelines that come with it. However, you may ask just how important can it be? It’s a pretty big deal because it drives the medical necessity for payment of services rendered. As coders, we want to accurately capture all services rendered for our providers. Getting them the maximum allowed reimbursement by applying the guidelines correctly is one of our main goals. So how is this defined? Medicare defines medical necessity as “Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and meet accepted standards of medicine.”
COVID-19 Diagnosis Reporting
In early 2020, in response to the COVID-19 pandemic, new ICD-10-CM codes were released to identify this condition as well as new ICD-10-CM guidelines for coding and reporting. The new codes were made effective on April 1, 2020, followed by updates to the coding and guidance. Each fiscal year on Oct. 1, ICD-10-CM updates are released including new codes, deleted codes and revised codes, and official coding and reporting guidelines.
In mid-December of 2020, after the 2021 ICD-10-CM new fiscal year had already been in effect, the Centers for Medicare & Medicaid Services (CMS) implemented six new diagnosis codes for reporting additional conditions related to COVID-19 on medical claims effective Jan. 1, 2021. Because of this, there were new updates made to the 2021 ICD-10-CM official coding and reporting guidelines. Below are the current diagnosis codes and descriptions available for reporting specific to COVID-19 in the current 2021 ICD-10-CM fiscal year.
Applying the Guidelines
As coders know, there are some gray areas when applying guidelines to services rendered. My best advice: If you find an area in any guidelines that doesn’t clearly explain a situation, it’s always best to call your carriers directly to ask for guidance. If you can get this in writing from them, even better. That way you will have something you can refer back to and even use in an appeal if needed.
Below is a table that illustrates the differences in coding and reporting when applying the guidelines released.
It is increasingly important to stay on top of coding and guidance changes, keeping in mind that ICD-10-CM is updated every fiscal year, on Oct. 1. Typically, the Centers for Disease Control and Prevention and CMS will release new ICD-10-CM updates in June of each year. This gives you time to review and implement any training needed to prepare before the Oct. 1 start date. MedAxiom is a great resource for all your coding education needs. Our Revenue Cycle Solutions team is your premier coding, billing and reimbursement resource focused on helping you identify opportunities, maintain regulatory compliance and improve financial and operational performance throughout the revenue cycle.
Everything you need to maximize your revenue cycle is available in one place, from revenue cycle consulting services to coding tools and education.
Visit Medaxiom.com/RevenueCycle today to access these resources as you work to streamline processes, integrate best-practice workflows and monitor key performance indicators to eliminate lost revenue and identify new opportunities for revenue enhancement.
Illustration: Lee Sauer
Jammie Quimby, CPC, CCC, CEMC, CCS-P, CPMA, CRC, CDEO, is a Revenue Cycle Solutions Consultant at MedAxiom with 15+ years of diverse experience in medical coding, medical auditing, business administration, relationship management and customer service. Jammie is committed to continuously seeking educational opportunities and achieving relevant certifications and proficiencies in all aspects of medical billing, coding and compliance. She has worked as a lead coder and educator and performed daily claim audits and reviews of clinical documents, ensuring compliance with industry regulations and maintaining quality assurance.
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