CPT code G9002, G9012, H2011, H2011 and S5121 with covered ICD 10 codes

HCPCS Modifier Description Diagnosis

G9002 Coordinated Care Fee, Maintenance Rate (Ongoing Children’s Service Coordination) 1 Unit = 15 minutes, PA is required.

G9002 HM Service Coordination Paraprofessional, PA is required.

G9003 Coordinated Care Fee, Risk Adjusted High, Initial (Emergency service coordination). PA is required by Medicaid. 1 Unit = 15 minutes

G9012 Children’s Plan Development. 1 Unit = 15 minutes

H2011 Children’s Crisis Assistance (1 unit = 15 min)

H2011 HM Children’s Crisis Assistance Paraprofessional (1 unit = 15 min)

Based on dates of service, use the ICD-9-CM diagnosis code V60.4 or ICD-10-CM code Z74.2 as the primary diagnosis code for personal care case management.

For more information on which ICD version to use, refer to ICD-9 and ICD-10 Diagnosis Billing Requirements.

S5121 Chore Services (Skilled) Based on dates of service, enter the ICD-9-CM code V60.4 or the ICD-10-CM code Z74.2 for the primary diagnosis.

ICD 10 CODE for Osteopenia - M85.811 - M85.871 Bone density and structure

The Centers for Medicare & Medicaid Services (CMS) will implement Change Request  (CR) 9252 on January 4, 2016, effective October 1, 2015. (See related MLN Matters® article MM9252.) This CR establishes the list of covered conditions and corresponding ICD-10-CM diagnosis codes approved for Bone Mass Measurement studies according to the requirements set forth in National Coverage Determination (NCD) 150.3. CR9252 and  accompanying spreadsheet inadvertently omitted the condition of osteopenia and the ICD- 10-CM codes that describe it which are classified to subcategory M85.8- Other specified disorders of bone density and structure. The codes and conditions identified within this subcategory are considered covered indications for bone mass measurement under NCD 150.3 and providers should report theseappropriately according to medical documentation. Additional guidance and education as to the updated complete list of covered indications will be forthcoming as CMS continues to review this issue and the systems updates required.

Background

Under ICD-9-CM, the term “Osteopenia” was indexed to ICD-9-CM diagnosis code 733.90 (Disorder of bone and cartilage). This code was listed as a covered condition under the Business requirement 5521.1.1 for CR 5521/NCD 150.3, dated May 11, 2007, when reported with CPT code 77080. (See related MLN Matters article MM5521.) The accompanying Benefit Policy Manual, Publication 100-02, chapter 15, section 80.5.6, Beneficiaries Who May Be Covered, includes: 2. An individual with vertebral abnormalities as demonstrated by an x-ray to be indicative of osteoporosis, osteopenia, or vertebral fracture.

Under ICD-10-CM, the term “Osteopenia” is indexed to ICD-10-CM subcategory M85.8- Other specified disorders of bone density and structure, within the ICD-10-CM Alphabetic Index. The codes within this subcategory were inadvertently omitted from the CMS spreadsheet that accompanied CR 9252 containing the list of covered conditions and corresponding diagnosis codes. These are considered covered for NCD 150.3 indications.

Below is the list of ICD-10-CM diagnosis codes within subcategory M85.8- that providers may report as covered indications in addition to the current list provided in CR 9252 and its accompanying CMS spreadsheet.

** M85.811 Other specified disorders of bone density and structure, right shoulder

** M85.812 Other specified disorders of bone density and structure, left shoulder

** M85.821 Other specified disorders of bone density and structure, right upper arm

** M85.822 Other specified disorders of bone density and structure, left upper arm

** M85.831 Other specified disorders of bone density and structure, right forearm

** M85.832 Other specified disorders of bone density and structure, left forearm

** M85.841 Other specified disorders of bone density and structure, right hand

** M85.842 Other specified disorders of bone density and structure, left hand

** M85.851 Other specified disorders of bone density and structure, right thigh

** M85.852 Other specified disorders of bone density and structure, left thigh

** M85.861 Other specified disorders of bone density and structure, right lower leg

** M85.862 Other specified disorders of bone density and structure, left lower leg

** M85.871 Other specified disorders of bone density and structure, right ankle and

foot

** M85.872 Other specified disorders of bone density and structure, left ankle and foot

** M85.88 Other specified disorders of bone density and structure, other site

** M85.89 Other specified disorders of bone density and structure, multiple sites

ICD 10 countdown - Some important website to brush up

List of Valid ICD-10-CM Codes

CMS has posted a complete list of the 2016 ICD-10-CM valid codes and code titles on the 2016 ICD-10-CM and GEMs web page

http://www.cms.gov/Medicare/Coding/ICD10/Downloads/2016-Code-Descriptions-in-Tabular-Order.zip

. The file is named icd10cm_codes_2016.txt. This file will be useful for physician offices and other providers who want to check to make sure that they are reporting all characters in a valid ICD-10-CM code. The codes are listed in tabular order (the order found in the ICD-10-CM code book). This list should assist providers who are unsure if additional characters are needed, such as the addition of a 7th character in order to arrive at a valid code.

A similar list of the 2016 ICD-10-PCS valid codes and code titles is available on the 2016 ICD-10 PCS and GEMs web page. The file is named icd10pcs_codes_2016.txt.

Use of Unspecified Codes in ICD-10-CM

CMS has a number of resources that explain unspecified codes and how they should be used in ICD-10-CM:

• MLN Matters® Article SE1518, “Information and Resources for Submitting Correct ICD-10 Codes to Medicare”

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1518.pdf

 • ICD-10 Basics MLN Connects National Provider Call - Call Materials from August 22, 2013

http://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events-Items/2013-08-22-ICD-10-Call.html?DLPage=1&DLEntries=10&DLFilter=ICD-10&DLSort=0&DLSortDir=descending

ICD 10 - Frequently asked question

1.  Q: What is ICD-10? 

A: ICD-10 is the International Classification of Diseases, version 10.  (ICD is the international standard for diagnostic classifications.) The current version, ICD-9, was adopted in 1979. 

2.  Q: What changes are occurring in the ICD-10 version? 

A: The changes will impact ICD-9-CM diagnosis codes and ICD-9-CM procedure codes.  The changes are as follows: 

** The diagnosis codes (ICD-9) are currently three to five digits that are alphanumeric in nature and combine to make around 14,000 unique diagnosis codes being used today. For ICD-10, the diagnosis codes will be seven digits that are alphanumeric in nature and combine to make around 68,000 unique diagnosis codes 

** Currently, ICD-9 procedure codes are three to four digits that are numeric in nature and  combine  to  make  about  4,000  unique  procedure  codes.    For  ICD-10-PC  S (inpatient), the procedure codes will be 7 alphanumeric in nature and combine to make around 72,000 unique procedure codes. 

3.  Q: What is the primary purpose of this change? 

A: The primary purpose of the change to ICD-10 is to improve clinical communication.  It allows for the capture of data about signs, symptoms, risk factors and comorbidities and better describes the clinical issues overall. It will also enable the United States to exchange information across country borders. 

4.  Q: What is CarePlus’ plan for ICD-10 acceptance? 

A:  CarePlus  will  accept  ICD-9  codes  on  claims  w/  date  of  service  (DOS),  or  discharge  dates  of September 30, 2014 or prior.  CarePlus will accept ICD-10 codes on claims w/ DOS, or discharge dates of October 1, 2014 or after. 

5.  Q: Do you plan to be ready to process ICD-10 codes submitted on claims forms by Oct 1, 2013? 

A: CarePlus will go live with the ICD-10 codes effective October 1, 2014. 

6.  Q: How long will support for both ICD-9 and ICD-10 coding be provided?

A:  CarePlus  will  process  correctly  coded  transactions  within  the  date  ranges  specified  in  the  answers above until the volume of ICD-9 submissions is diminished. 

7.  Q: When will CarePlus begin testing transactions? 

A: CarePlus will begin testing ICD-10 transactions in the second quarter of 2014.