Straight Talk Tuesday

Last week I mentioned ICD-10 so I thought it might be interesting to discuss why using the right “words” in the chart, to get a coder to code correctly for HBOT, is going to be very tricky. I’m going to try to explain this for “late effects of radiation” but it IS really complicated. If you want to find the ICD-10 code for “late effects of radiation,”  start your search for the code using the ICD-10-CM Alphabetic Index, not the Tabular Index. No results are found in ICD-10 for the condition “Late Effects of Radiation.” Lets search for the broader term, “Radiation.”  Under that term, there are 2 options: “effects Not Otherwise Specified” and “sickness Not Otherwise Specified.” The code T66 –“Radiation, effects NOS” reflects the best ICD-10 match for ICD-9-CM Code 990 “Late Effects of Radiation.”  It’s important to note that while “Radiation, effects NOS” sounds better to our ears than “Radiation, sickness unspecified,” the fact is that “Radiation, sickness Not Otherwise Specified,” IS the specific code. To make things more confusing, T66 “lives” inside the injury and poisoning code set.

ICD-10-Code-Structure_7th-CharacterT66 is found in ICD-10-CM Chapter 19 and these codes require a 7th Character. Guidance for 7th Character Usage comes from the “ICD-10-CM Official Guidelines for Coding and Reporting; FY 2015”. The guidelines explain that most categories in chapter 19 have a 7th character requirement for each applicable code: A, initial encounter, D, subsequent encounter and S, sequela. While the patient may be seen by a new or different provider over the course of treatment for an injury, assignment of the 7th character is based on whether the patient is undergoing active treatment and not whether the provider is seeing the patient for the first time. The 7th character must always be the 7th character in the data field. If a code that requires a 7th character is not 6 characters, a placeholder X must be used to fill in the empty characters. That makes the complete code: T66.XXXA.

What does this mean? The code CMS has chosen as the code they will PAY FOR and the code that BEST DESCRIBES what we are treating for “late effects of radiation”, is T66.XXXA. This code means that ALL the problems that occur in all tissues (bladder, bowel, jaw, etc.) are due to an injury from radiation that was provided at an earlier time. We are NOT treating the patient for their CANCER, and we are not actually treating their hemorrhagic cystitis, or their proctitis, their dysphagia or their pain, etc. We are treating the sequelae of the original radiation. If there is a movement to ask CMS to cover specific diagnoses (e.g. hemorrhagic cystitis which can be due to many other things besides radiation), CMS will likely say NO because a condition like “hemorrhagic cystitis” can be due to a bladder infection and not just to late effects of radiation. The reason CMS specifically selected this code was to allow a host of different types of tissue injury to be included in this ONE CODE all of which describe an injury due to previous radiation.

For those of you who are not fortunate enough to be able to just put this specific CODE in your EHR, you are going to have to think very carefully how you are going to word this in your note. Otherwise, you are going to end up with coders who don’t get to a covered ICD-10 diagnosis and the problem will NOT be with the coder.