Are You Ready for ICD-10 Changes for SNFs?

Fri, Sep 11, 2015 --

Coding Updates, ICD-10

Post Acute Care coding and billing, home care coding and compliance, home care coding guidelines, home health care coding, hospice coding, long term care

ICD-10 affects all parts of healthcare, including skilled nursing facility (SNF), home health care, and hospice coding. This means that post acute care providers like therapists must know ICD-10, too. Make sure your billing and minimum data set (MDS) software supports ICD-10, as well as other software such as the ones your providers use to code for activities of daily living.

Big Changes Coming

Some important changes in ICD-10 for SNFs include elimination of some familiar coding practices. The old ICD-9 V codes for therapy encounters are replaced with Z codes in ICD-10. ICD-9’s aftercare codes for fractures have been replaced by seventh character extensions of “D,” referring to subsequent encounters, in ICD-10-CM. Occupational and physical therapy treatments are examples of subsequent encounters. And late effects? ICD-10 calls those sequelae.

Sue Bowman, MJ, RHIA, CCS, FAHIMA, senior director of coding policy and compliance for the American Health Information Management Association (AHIMA), said that ICD-10 has expanded use of combination codes, such as codes that combine conditions and their associated common symptoms or manifestations, or codes that combine poisonings with the associated external cause. She added that ICD-10 codes are also longer than ICD-9 codes, up to seven characters in length, with three characters before the decimal and up to four after it. The seventh character has a different meaning depending on the section in which it’s used. In some cases, the seventh character is used to identify the type of encounter, such as initial, sequential, or sequelae.

Coding for Cases Crossing the October 1 Deadline

When your patient is in the facility with a stay spanning the October 1 transition date, figuring out which code set to use gets tricky. Though dates of service affect the decision, whether you submit the entire claim under ICD-10 or split the claim into ICD-9 and ICD-10 depends on the type of facility and provider. For example, Medicare requires skilled nursing facilities that bill inpatient part A services to submit claims using ICD-10 if a patient is discharged on or after October 1, no matter what the admission date. However, SNFs billing for inpatient part B services must split their claims, billing with ICD-9 for dates of service (DOS) through September 30 and with ICD-10 for DOS on October 1 and beyond.

Fortunately, CMS’s MLN Matters Number SE1408 (Revised June 27, 2015) includes a handy set of tables that clarify which code set to use for what DOS. One thing’s for certain about dates of service. CMS won’t accept ICD-9 codes on claims with from dates, dates of discharge, or through dates after October 1, 2015. And one other thing that CMS and most third-party payers agree on: Do not include ICD-9 and ICD-10 codes on the same claim form. Period.

Aftercare Coding Changes – An Example Scenario

It should not surprise you that coding for aftercare will be different in ICD-10 than in ICD-9. Judy Adams, RN, BSN, HCS-D, HCS-O, with Adams Home Care Consulting in Asheville, N.C., shared a practice scenario.

A new patient is referred to home health for care of an abdominal abscess that occurred following bariatric surgery a month ago; the abscess is due to Group D streptococcus resistant to vancomycin. The patient also has abdominal cellulitis. What ICD-10 diagnosis codes do you apply for this patient?


  • K95.81 (Infection due to other bariatric surgery)
  • B95.2 (Enterococcus as cause of disease classified elsewhere)
  • Z16.21 (Resistant to vancomycin)
  • L03.311 (Cellulitis of abdominal wall).

When you look at K95.81 in the tabular portion of your ICD-10-CM code book, you’ll see a note reminding you to use an additional code to specify the organism causing the infection. In this case, that’s B95.2, enterococcus. Another of the ICD-10 guidelines requires identification of antibiotic-resistant medications using a code from category Z16, Resistance to antimicrobial drugs. In our patient’s case, we report Z16.21 for the vancomycin-resistant bacterial infection.

Finally, don’t forget to code the abdominal wall cellulitis with L03.311. The provider’s documentation in this case doesn’t identify the organism causing the cellulitis, but if it did implicate the enterococcus as the etiology of the cellulitis, we’d have to change the sequencing of these codes. Because the organism code for enterococcus would in that case identify the cause of both infections, L03.311 would be moved up to sit right after K95.81 in the list.

What Do You Think?

What have you found to be the most frustrating thing about getting your SNF or home health agency ready for ICD-10? You’ll feel better if you talk about it.  We love to hear from you!

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Susan taught health information and healthcare documentation at the community college level for more than 20 years. She has a special love for medical language and terminology. She is passionate about ensuring accurate patient healthcare documentation through education. She has a master's degree in healthcare administration, is a certified healthcare documentation specialist, and serves as immediate past president for the Association for Healthcare Documentation Integrity (AHDI).

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