New ICD-10 codes effective 10-1-16

The Coordination and Maintenance Committee of ICD-10, in the Office of Vital Statistics, met in March 2016 and approved the addition, deletion and review of codes. These codes will be effective Oct. 1, 2016, and there are more coming October 2017. While there were a total of 1,900 new codes; 313 deletions and 315 reviews, allergy and immunology received only a small number of new or revised codes. Remember these new codes cannot be used before Oct. 1, 2016, but we wanted you to be aware of the upcoming change.

Since the ICD-10 coding regulatory body appears to be opening-up the process for additions of new or revised codes, we would like to hear what you think may be needed. Also tell us what codes you have tried and why the current coding is insufficient to meet your needs at AdvocacyCouncil@ACAAI.org. We will request an opportunity to present your suggestions to the ICD-10 regulatory body.

New ICD-10 allergy codes will be added on Oct. 1, 2016.

D8940    Add       "Mast cell activation, unspecified"

D8941    Add       Monoclonal mast cell activation syndrome

D8942    Add       Idiopathic mast cell activation syndrome

D8943    Add       Secondary mast cell activation

D8949    Add       Other mast cell activation disorder

K522      Delete    Allergic and dietetic gastroenteritis and colitis

K5221    Add       Food protein-induced enterocolitis syndrome

K5222    Add       Food protein-induced enteropathy

K5229    Add       Other allergic and dietetic gastroenteritis and colitis

K9041    Add       Non-celiac gluten sensitivity

Z053      Add       Observation and evaluation of newborn for suspected respiratory condition ruled out

Z0543    Add       Observation and evaluation of newborn for suspected immunologic condition ruled out

A new look at specificity

When ICD-10 became effective, one of the potential benefits was held out to be greater specificity in coding with resultant improved reimbursement for providers. For the first year of ICD-10, CMS instructed payers to give the benefit of the doubt to providers on the level of specificity. That was only for the first year! The Advocacy Council believes providers will have to show support – in the medical record – for higher levels of specificity.

This means your medical records should be reviewed now to ensure the level of specificity claimed is accurately supported by the medical record. This will mean more audits of your records and, we expect, more denials for failure to support the claimed level of specificity.

The Advocacy Council suggests you pay attention to your documentation to ensure sufficient history to fully support the level of coding chosen. We will try to help. If you receive claims denials you believe were the result of failure of documentation, we suggest you appeal the denial. If your claim is denied again, please remove all patient identifiers and send a copy of the denial letter to the Advocacy Council at AdvocacyCouncil@ACAAI.org or fax 847-427-9656 – Attn: Advocacy Council. We will try to help provide guidance as to next steps.

BCBSM Meeting a Success

The Michigan Allergy & Asthma Society (MAAS) and the Advocacy Council of ACAAI met with Blue Cross Blue Shield of Michigan (BCBSM) Chief Medical Officer Dr. Thomas L. Simmer last Friday. The discussion focused on several concerns regarding BCBSM proposed changes for allergen immunotherapy preparation billing procedure code 95165, changing the definition of a dose of allergy extract to be one cubic centimeter (1 unit). The meeting was a team effort which also included representatives from the Michigan State Medical Society and the American Academy of Otolaryngic Allergy. 

After a cordial discussion, Dr. Simmer agreed that BCBSM will stay with the CPT book definition that a dose of allergy extract is the amount of antigen(s) administered in a single injection from a multiple dose vial.  Therefore, if you are mixing a set, you would charge for all of the doses in the set according to the number of anticipated doses you expect the patient to receive. Dr. Simmer indicated this confirmation will be published in an upcoming issue of BCBSM's The Record.

Congratulations to MAAS on this accomplishment, which ensures Michigan allergists can continue to provide effective and cost-saving allergy immunotherapy to patients. We are pleased the Advocacy Council was able to assist in this effort and that MAAS used the system set up through the Advocacy Council for advocacy at the state level. "Having Dr. Gary Gross attend the meeting as a representative of the Advocacy Council was a great benefit," said Razi Rafeeq, MD, FACAAI, and MAAS President.  "Dr. Gross is very knowledgeable and his presence was extremely helpful. Thank you to the Advocacy Council."

We appreciate the opportunity to partner with MAAS to improve the overall health, quality of life, and productivity potential of the people of the State of Michigan. 

Advocacy Issue: 
Billing, Coding & Payments