May 2019 Vol. 149
Using the internet for ICD-10 Coding
The internet has become the single most important search tool in the world today and there are precious few, if any, medical practices that do not have access to the internet.
The internet can be a very efficient and accurate way of accessing and utilising information, but not if it is incorrectly used, as this can result in errors and endless frustration. This can be particularly true when it comes to the all-important ICD-10 coding tool, which is so pivotal to the running of doctor practices the world over.
The original version of ICD-10, as released by the World Health Organization (WHO), is currently the most readily available and utilised source for ICD-10 coding worldwide.
Many countries adapt the ICD-10 codes to suit their own specific coding needs and requirements. An example of such an adaptation is the ICD-10 CM (Clinical Modification) version that has been specifically tailored for use in the United States of America (USA).
This ICD-10 CM version can be accessed through app stores as well as on the internet by searching “ICD-10 code” using Google.
It is important to note that when searching for ICD-10 codes via Google, the CM version used in the USA will often rank right at the top of the search list, as it is the most globally searched version of the ICD-10 codes.
In South Africa we make use of the original ICD-10 codes as published by the WHO in 2010, including the errata files for 2011 – 2012. The South African Department of Health (DoH) incorporates these ICD-10 codes within what is known as the Master Industry Table (MIT). This MIT has not been updated since the release of the ICD-10 codes in 2010.
The ICD-10 codes found on the internet may not necessarily be incorporated in the South African MIT. Consequently, they may not be recognised as valid codes when they are used in South Africa.
The original ICD-10 codes are incorporated in most, if not all the medical billing software currently available within the South African medical industry and the use of any non-original ICD-10 codes will automatically result in a rejection of the claim submitted, leaving your practice out of pocket.
The ICD-10 CM version contains approximately 75 000 codes, while the original ICD-10 version contains approximately 44 000 codes. The highest level of specificity provided for in the original ICD-10 codes is five character coding, while the ICD-10 CM version makes provision for seven character coding.
Even though there are considerably more ICD-10 CM codes than there are original ICD-10 codes, and they are more descriptive, they cannot be incorporated within our current South African medical coding environment.
Phishing, smiting and vishing may sound harmless enough but they are in fact all attempts to defraud you via e-mail, mobile messaging, and/or telephone.
Maintain a healthy scepticism
Be suspicious of any e-mail, SMS or phone call that either asks for your personal information, banking details or information pertaining to your medical practice or patients.
Treat all information as highly confidential
All information collected or processed during the course of performing your daily tasks must be treated as highly confidential. Do not collect, process or pass any information onto a third party without the express permission of those concerned. It is particularly important to safeguard the medical confidentiality of your patients.
Look at your URL bar
Secure web sites always start with 'https', not only 'http', and have a lock icon next to them. Please be aware when you see the lock icon next to “http", rather than an “https", address, as it may well indicate that you may be entering a fraudulent site.
Hover over hyperlinks
Hover your mouse over any hyperlinks to reveal the actual URL and check that it is in fact the exact address as stated in the email.
Modifier 0005 is a reduction modifier to be applied on accounts where multiple therapeutic procedures are performed under the same anaesthetic.
The full description indicates how the fees must be reduced:
Multiple procedures or operations: Unless where otherwise identified in the structure, when multiple procedures or operations add significant time and/or complexity, and when each procedure or operation is clearly identified and defined, the following values prevail:
100% (full value) for the first major procedure or operation,
75% for the second procedure or operation,
50% for the third procedure or operation,
25% for the fourth and subsequent procedures or operations
Please note the following guidelines regarding this modifier:
- Reduction in the units of a procedure is not due to the fact that the risk/time/expertise of the reduced item is less. It is rather a reduction of the post-operative care component of the procedure, as the post-operative care is done concurrently when more than one procedure has been performed under the same anaesthetic.
- Modifier 0005 is applicable to a procedure performed in the consulting rooms under local anaesthetic and conscious sedation (unless otherwise indicated), where aftercare is included in the procedure units.
- Modifier 0005 is not applicable to procedures for the treatment of pain, e.g. code 2802:
Peripheral nerve block, as the units for such procedures do not include aftercare.
- Modifier 0005 is not applicable when pure endoscopic diagnostic procedures or diagnostic endoscopy procedures, unrelated to the therapeutic procedure, are performed under general anaesthetic.
- Modifier 0005 is applicable to multiple procedures performed under the same anaesthetic, not through the same incision.
- Modifier 0005 is applicable in the case of multiple fractures and/or dislocations.