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Examples of ICD-10 codes causing claim denials

1) Fracture: Make sure the specified site and laterality is documented and ask the physician for more information if necessary. Example: right neck of femur fracture in homecare setting S72.001D.

2) Pressure ulcers: Diagnoses must be coded to the highest level of specificity. For pressure ulcers, this includes the site, laterality and stage (this includes unstageable). Do not use unspecified stage in home care, as the clinician must visualize the wound bed and stage the ulcer. Example: pressure ulcer left buttock stage III L89.323.

3) Depth of non-pressure chronic ulcer: ICD-10 requires the clinician to document the depth of tissue loss of the ulcer. The coding options are: limited to skin breakdown, with fat layer exposed, with muscle necrosis, and with bone necrosis. Example: right lower limb ulcer with muscle necrosis L97.913.

4) Combination codes: ICD-10 has many combination codes, and they should be used when appropriate. Coding conventions and guidelines must be utilized to ensure the correct code is selected. Example: DM Neuropathy is E11.40 and we are seeing E11.40 and G60.9 when it should only be one code.

5) HTN and CKD: Are still assumption codes and should be I12.0 or I12.9 and not I10. Example: HTN with ESRD I12.0 and N18.6.

Interested in exploring ways to address your ICD-10 challenges?

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