Emergency medicine coding and billing can be more than a little confusing, especially when updates and clarifications are happening practically every day. Take CMS for example. Recently, they released several important clarifications because there’s been some confusion and frustration regarding the codes in Chapter 20, External Causes of Morbidity (V, W, X, and Y codes), which will replace the current ICD-9-CM E-Code section.
According to CMS as reported in an article from American Association of Professional Coders, “the Official ICD-10-CM Guidelines (I.C.20) state that for any initial encounter from an illness or adverse effect, the codes found in this chapter should also be reported, along with the injury(ies) sustained. Many have asked if these codes in ICD-10-CM are required by all payers, as not all payers currently require the E-codes to be assigned in ICD-9-CM.” According to CMS, there will be no national stipulation for mandatory ICD-10-CM external cause code reporting. “If you do not report external cause codes for ICD-9-CM, you will not report external cause codes in ICD-10-CM unless a payer or state changes its current requirements.”
Usage of unspecified codes in ICD-10-CM also was addressed by CMS. Did you know there are about five times more specific codes in ICD-10-CM than in ICD-9-CM? And, yes, unspecified codes are still part of the code set. According to CMS, unspecified codes have acceptable, even necessary uses in ICD-10-CM.
Coding guidelines state that each encounter should be coded to the highest level of specificity known. CMS further comments that it is inappropriate to either select a specific code that is not supported by the medical record documentation or conduct medically unnecessary diagnostic testing in order to determine a more specific code. An unspecified code may be the most appropriate code to report when sufficient clinical information is not known or available to assign a more specific code.
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