How Lyme disease, ear pain diagnosis will change in 2013

Suggestion: Your diagnosis coding will depend on which ear was affected once ICD-10 hits.

Since CMS has reiterated that it'll not push back the deadlines for the conversion to ICD-10, you will need to have your ICD-10 coding skills ready by October 1, 2013. Here are some examples of how ICD-10 will change your coding choices for two common conditions.

Lyme disease Dx will need thorough documentation of attributable conditions

Right now, if a patient is confirmed to have Lyme disease, you report code 088.81 (Lyme disease).

ICD-10 changes: With effect from October 1, 2013, you will find that the Lyme disease diagnosis codes have been expanded to include symptoms due to confirmed cases of Lyme disease, as below:

• A69.20 (Lyme disease, unspecified)
• A69.21 (Meningitis due to Lyme disease)
• A69.22 (Other neurologic disorders in Lyme disease)
• A69.23 (Arthritis due to Lyme disease)
• A69.29 (Other conditions associated with Lyme disease)

  Documentation: Your doctor will need to clearly note whether the patient has Lyme disease alone (A69.20) or Lyme disease with other contributing factors (A69.21- A69.22). For example, you cannot use A69.21 unless the documentation includes confirmation that the patient ails from meningitis as well as Lyme disease, and that the two conditions are related.

  You shouldn't report the Lyme disease diagnosis code unless your practice gets confirmation from a lab test indicating that the patient tested positive for a Lyme disease. If you do not have a positive lab test confirming strep throat, you should simply use the diagnosis codes for the symptoms.

  As such, your documentation must include a copy of the laboratory report confirming that the patient had Lyme disease before you select your diagnosis code.

  ICD-10 coding tips: teach your practitioners about the just-in and let them know that documentation must indicate which specific Lyme disease diagnosis the patient has.

  Otalgia will need identification of affected ear

  To put it simply, otalgia refers to an ear ache. Part B practices often report otalgia diagnoses when patients complain of ear pain however no more definitive diagnosis is found. Presently, the ICD-9 manual offers just one code for unspecified otalgia: 388.70 (Otalgia, unspecified).

  ICD-10 coding changes: From October 1, 2013, you will be dealing with a series of four codes that describe otalgia, organized according to the location of the diagnosis, as here:

  Documentation: Doctors should already include the affected ear in their documentation. All you require to do as a coder to capture this already present information is to format your superbill to see to it that physicians document the additional anatomical information.

  Tips: You can arrange your superbill in a way that ensures that the physician documents all information applicable for you to submit the most proper code. For example, you can print it like this:

  H92.0x (x=1 for right ear, x=2 for left ear, x=3 for bilateral, and x=9 for unspecified ear)

  Or you can simply list "H92.0x" and have the doctor circle "left ear," "right ear," or "bilateral" on the form.

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