As you recall, the introduction of the ICD10 Codes last fall resulted in quite a bit of confusion and frustration for clinics and other service providers as they grappled with going from 13,000 (ICD9) to 68,000 (ICD10) codes.
We know members are still trying to adjust and we wanted to provide some assistance. Let’s start with a little terminology.
ICD stands for International Statistical Classification of Diseases and Related Health Problems which is published by the World Health Organization (WHO). These codes are used for data collection purposes worldwide. They allow the WHO to monitor the incidence and prevalence of diseases and other health problems.
The WHO allows the United States to adapt the ICD to our system. The National Center for Health Statistics (NCHS) is the federal agency responsible for making these modifications. The NCHS, along with guidance from the Centers for Medicare and Medicaid Services (CMS), produce the International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS)
Just to clarify, the ICD codes are different from the CPT® codes, which are owned by the American Medical Association (AMA). CPT® codes are a series of numbers – usually 5, that identify medical procedures and services. They facilitate communication with insurance providers..
- CPT codes are used by all healthcare providers for outpatient procedures and services
- ICD-10-CM codes are used for all inpatient and outpatient diagnoses
- ICD-10-PCS codes are used by hospitals for inpatient procedures
Keep in mind that coding is the same, regardless of someone’s coverage but what gets covered can be very different from plan to plan and setting to setting. For example, while routine immunizations such as Tdap are covered under the Affordable Care Act (ACA), some plans don’t have to abide by ACA. Also, if someone came in for a combination of routine and travel vaccines, then co-pays, co-insurance and deductibles may apply.
Be advised the same diagnostic code can be associated with different terminology. For example, some clinics may refer to Z41.8, Encounter for other procedures for purposes other than remedying health state, as “Need for prophylactic measure” or “Travel medicine advice and prophylaxis“. All are correct.
Generally, pre-travel visits usually involve very few codes. However, because of the differences above, visit notes can vary considerably from clinic to clinic. Since clinicians often have limited knowledge about these issues, it is best to work in concert with billing and insurance staff.
Whether you provide pre-travel, post-travel or both types of services, below is a list of codes you may find helpful for your practice.
Julie Richards, President
American Travel Health Nurses Association