07/13/2015    Josh White, DPM, CPed

ICD-10 Grace Period (Jack Ressler, DPM)

It was good news that CMS recently announced
that for the first year ICD-10 is in place,
Medicare claims will not be denied solely based
on the specificity of the diagnosis codes as
long as they are from the appropriate family of
ICD-10 codes.

This means that Medicare will not deny payment
for these unintentional errors as practices
become accustomed to ICD-10 coding. In
addition, Medicare claims will not be audited
based on the specificity of the diagnosis codes
as long as they are from the appropriate family
of codes. This transition period will give
physicians and their practice teams time to get
up to speed on the more complicated code set.
http://www.ama-assn.org/ama/ama-
wire/post/cms-icd-10-transition-less-
disruptive-physicians

Unfortunately, Medicare has not yet defined
what appropriate family is.

My assumption at this point is that where codes
exist for left, right and unspecified, that it
would be acceptable to only use the
“Unspecified” code, i.e.:

G57.50 Tarsal tunnel syndrome, unspecified
lower limb
G57.51 Tarsal tunnel syndrome, right lower
limb
G57.52 Tarsal tunnel syndrome, left lower limb

G81.00 Hemiplegia, flaccid affecting
unspecified side
G81.01 Hemiplegia, flaccid affecting right
dominant side
G81.02 Hemiplegia, flaccid affecting left
dominant side

That we could use any E10 code to refer to all
variations of Type 1 diabetes, any E11 code to
refer to all variations of Type 2 diabetes and
any L89 code to refer to all pressure ulcers of
the foot:

E10.65 Type 1 diabetes mellitus with
hyperglycemia
E10.40 Type 1 diabetes mellitus with diabetic
neuropathy, unspecified
E10.42 Type 1 diabetes mellitus with diabetic
polyneuropathy
E10.51 Type 1 diabetes mellitus with diabetic
peripheral angiopathy without gangrene
E10.52 Type 1 diabetes mellitus with diabetic
peripheral angiopathy with gangrene
E10.610 Type 1 diabetes mellitus with diabetic
neuropathic arthropathy
E10.621 Type 1 diabetes mellitus with foot
ulcer
Use additional code to identify site of ulcer
(L97.4-, L97.5-)
E10.9 Type 1 diabetes mellitus without
complications
E11.9 Type 2 diabetes mellitus without
complications
E11.65 Type 2 diabetes mellitus with
hyperglycemia
E11.42 Type 2 diabetes mellitus with diabetic
polyneuropathy
E11.42 Type 2 diabetes mellitus with diabetic
polyneuropathy
E11.65 Type 2 diabetes mellitus with
hyperglycemia
E11.51 Type 2 diabetes mellitus with diabetic
peripheral angiopathy without gangrene
E11.52 Type 2 diabetes mellitus with diabetic
peripheral angiopathy with gangrene
E11.610 Type 2 diabetes mellitus with diabetic
neuropathic arthropathy
E11.621 Type 2 diabetes mellitus with foot
ulcer
Use additional code to identify site of ulcer
(L97.4-, L97.5-)
E11.9 Type 2 diabetes mellitus without
complications
L89.611 Pressure ulcer of right heel, stage 1
L89.612 Pressure ulcer of right heel, stage 2
L89.613 Pressure ulcer of right heel, stage 3
L89.614 Pressure ulcer of right heel, stage 4
L89.621 Pressure ulcer of left heel, stage 1
L89.622 Pressure ulcer of left heel, stage 2
L89.623 Pressure ulcer of left heel, stage 3
L89.624 Pressure ulcer of left heel, stage 4
L89.891 Pressure ulcer of other site, stage 1
L89.892 Pressure ulcer of other site, stage 2
L89.893 Pressure ulcer of other site, stage 3
L89.894 Pressure ulcer of other site, stage 4

Josh White, DPM, CPed, Maplewood, NJ

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