Change is in the air. Not only are the summer days shortening, but the days to use existing ICD-10-CM codes are too. ICD-10-CM changes will take effect Oct. 1, 2018 – barely over a month away. Plus, CPT® 2019 is on the horizon and will bring with it a fresh season of codes, bundles, and E&M service guidelines. Taking the time this fall to polish your coding know-how means you won’t be left scratching your head in the year to come.
And here’s a particular spot to polish: A common trip-up area for pediatrics coders is developmental screening coding, notes medical records consultant Donelle Holle. To add to the current confusion, many screening codes will see changes for 2019. During Holle’s presentations on ICD-10-CM updates for pediatrics, as part of ProfEdOnDemand’s 2019 Coding Updates Virtual Boot Camp, she lays out exactly what documentation you need for each screening code, as well as which codes are changing, so you can sharpen and speed up your claim submissions.
Catch Up to the Requirements for Hearing Screening Codes
The key ICD-10-CM hearing screening codes are:
- 10, ears and hearing exam without abnormal findings
- 110, hearing exam after a failed hearing screening
- 18, ears and hearing exam with other abnormal findings
Same Codes: All indications are that these ICD-10-CM codes will stay the same for the upcoming year, so focus your attention on the documentation required for each. To use Z01.10 and Z01.18, the medical record must indicate that the patient’s appointment was specifically to check ears and hearing. It is not appropriate to use these codes to describe a well visit where hearing was routinely checked. Instead, use codes Z00.121 (abnormal findings) and Z00.129 (no abnormal findings) for well visits.
Which Ear? These screening codes include the testing of both ears, but: If only one ear was tested, append pediatric modifier 52 to the appropriate code to indicate that the service was partially reduced at the doctor’s discretion.
Grasp the Developmental Screening Doc Requirements
As mentioned in a previous post, pediatric neurology is seeing significant code modifications this year. Code Z13.4, Encounter for screening for certain developmental disorders in childhood, was axed and replaced by these codes:
- 40, Screening for unspecified developmental delays
- 41, Autism screening
- 42, Screening for global developmental delays (GDD)
- 49, Screening for other developmental delays
For these codes, the documentation must clearly state was exactly was being tested. Code Z13.42 is appropriate if a child was being tested because he or she was not achieving milestones (such as walking or talking) at the recommended time. The record must specify testing for autism to use Z13.41. To decide between Z13.40 and Z13.49, follow the 2019 ICD-10-CM Coding Guidelines.
Beware: Whichever code you select, remember these codes are not to be used for well-child visits where routine developmental screenings were performed. An overuse of Z13.4- codes would certainly catch the eye (and ire) of payers. Be extra cautious, as Z13.4- codes are only to be used for visits scheduled specifically for these screenings because of a concern on the part of the physician.
Adaptability: A Key Trait for Coders
Lately, more and more payers are auditing pediatricians, meaning that you (and your practice) can’t afford to rely on behind-the-times coding knowledge. Don’t get lackadaisical: Just because you’ve “always” used a code for a particular service doesn’t mean it’s still correct. Review your practices to make sure they’re always accurate and will stand up to payers’ and auditors’ scrutiny.
You still have a month before ICD-10 changes take effect, so use the time wisely to being your skills upgrade—and don’t forget to continue that work as you prepare for CPT® codes, which come out Jan. 1, 2019. There have already been hints of significant changes to pediatric CPT® procedure codes. There’s no such thing as too much training – a prepared coder is exactly what your practice is looking for!
