With 363 new codes, 142 deletions, and 226 code revisions made to the ICD-10 code set this FY, diagnostic coding has become even more challenging. As medical coding service providers know, knowing how to use combination codes is a key aspect in reducing the complexity of ICD-10 coding. Importantly, reporting them correctly is necessary to avoid claim denials. Combination codes allow for the reporting of a single code to express multiple aspects of the diagnosis. The ICD-10-CM Official Guidelines for Coding and Reporting describe a combination code as one used to classify the following:
In ICD-10, combination codes identify both the definitive diagnosis and common symptoms of that diagnosis. When using a combination code, an additional code should not be assigned for the symptom. Combination Codes – ICD-9 versus ICD-10Technically, this is similar to the way ICD-9 defined combination codes. However, ICD-10 expands on the use of combination codes. Consider the following examples:
Points to Note
Identifying and Applying Combination CodesCombination diagnoses can be found in the Alphabetic Index by locating the primary condition and using the subterm entries to narrow the search. If the subterms include words such as “with,” “due to,” “in” or “associated with” to tie two diagnoses together, this would be a clear indicator of a combination code. Referring to the inclusion and exclusion notes in the Tabular List would provide additional clues on the matter. Experienced coders in medical coding companies understand ICD-10 coding guidelines and would know when only one code should be reported. To determine whether a combination code might exist, they will determine:
Combination codes will used only when they meet the following criteria:
To illustrate this, an article in www.hcpro.com offers the example of a patient who presents with toxic liver disease, chronic active hepatitis, and ascites. Expert coders would recognize that toxic liver disease is associated with the hepatitis and that the two disease processes occur together along with a manifestation (ascites). They would report the condition correctly using combination code K71.51 Toxic liver disease with chronic active hepatitis with ascites. Experienced coders can ease the challenges involved in reporting these complex combination codes. They are familiar with:
Reliable coders will query the physician if they find that a combination code may be applicable, but documentation does not clearly link the two diagnoses. If the condition is “due to” another condition, the physician’s documentation must indicate this. Expert medical billing and coding services can go a long way in helping physicians to ensure compliance, prevent denials, and maximize reimbursement. |