Thursday, October 8, 2015

what is ICD 10 code for depression

what is ICD 10 code for depression:

ICD 10 codes for depression are grouped under many categories, as listed below:

F32 - Major depressive disorder, single episode

The intent of this category, from what I understand, is to include single episodes of major depression. There are several ICD-10 codes that can be used here, depending on severity, the presence of any associated symptoms, and whether the episode of depression is in partial of full remission (note that F32 is NOT a billable code):
  • F32.0 - Major depressive disorder, single episode, mild
  • F32.1 - Major depressive disorder, single episode, moderate
  • F32.2 - Major depressive disorder, single episode, severe without psychotic features
  • F32.3 - Major depressive disorder, single episode, severe with psychotic features
  • F32.4 - Major depressive disorder, single episode, in partial remission
  • F32.5 - Major depressive disorder, single episode, in full remission
  • F32.8 - Other depressive episodes
  • F32.9 - Major depressive disorder, single episode, unspecified

F33 - Major depressive disorder, recurrent

F33 codes are similar to F32, except that they refer to recurrent episodes of major depression:
  • F33.0 - Major depressive disorder, recurrent, mild
  • F33.1 - Major depressive disorder, recurrent, moderate
  • F33.2 - Major depressive disorder, recurrent severe without psychotic features
  • F33.3 - Major depressive disorder, recurrent, severe with psychotic symptoms
  • F33.4 - Major depressive disorder, recurrent, in remission
  • F33.40 - Major depressive disorder, recurrent, in remission, unspecified
  • F33.41 - Major depressive disorder, recurrent, in partial remission
  • F33.42 - Major depressive disorder, recurrent, in full remission
  • F33.8 - Other recurrent depressive disorders
  • F33.9 - Major depressive disorder, recurrent, unspecified
F32 and F33 codes for depression correspond to 296.xx codes under the ICD-9-CM classification. The exception is ICD-9 code 298.0 - Depressive type psychosis), which in ICD-10 correspondds to F32.3 - Major depressive disorder, single episode, severe with psychotic features, and F33.3 - Major depressive disorder, recurrent, severe with psychotic symptoms.
ICD-9 code 311 (Depressive disorder, not elsewhere classified) translates to ICD-10 code F32.9 (Major depressive disorder, single episode, unspecified).

Other Codes For Depression

  • F03.90 (Unspecified dementia without behavioral disturbance) has two ICD-9 partially equivalent codes:
    • 290.13 - Presenile dementia with depressive features
    • 290.21 - Senile dementia with depressive features
  • F34.1 (Dysthymic disorder) corresponds to ICD-9 code 301.12 (Chronic depressive personality disorder)
  • F43.21(Adjustment disorder with depressed mood) is tranlated from 309.1 (Prolonged depressive reaction)
  • 293.83 (Mood disorder in conditions classified elsewhere) has been expanded to two ICD-10-CM codes:
    • F06.31 - Mood disorder due to known physiological condition with depressive features
    • F06.32 - Mood disorder due to known physiological condition with major depressive-like episode
  • Finally, F25.1 (Schizoaffective disorder, depressive typ) translates 295.70 (Schizoaffective disorder, unspecified)

List of ICD 10 Codes

The following is a List of ICD-10 codes
International Statistical Classification of Diseases and 
Chapter Blocks Title
I A00–B99 Certain infectious and parasitic diseases
II C00–D48 Neoplasms
III D50–D89 Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
IV E00–E90 Endocrine, nutritional and metabolic diseases
V F00–F99 Mental and behavioural disorders
VI G00–G99 Diseases of the nervous system
VII H00–H59 Diseases of the eye and adnexa
VIII H60–H95 Diseases of the ear and mastoid process
IX I00–I99 Diseases of the circulatory system
X J00–J99 Diseases of the respiratory system
XI K00–K93 Diseases of the digestive system
XII L00–L99 Diseases of the skin and subcutaneous tissue
XIII M00–M99 Diseases of the musculoskeletal system and connective tissue
XIV N00–N99 Diseases of the genitourinary system
XV O00–O99 Pregnancy, childbirth and the puerperium
XVI P00–P96 Certain conditions originating in the perinatal period
XVII Q00–Q99 Congenital malformations, deformations and chromosomal abnormalities
XVIII R00–R99 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
XIX S00–T98 Injury, poisoning and certain other consequences of external causes
XX V01–Y98 External causes of morbidity and mortality
XXI Z00–Z99 Factors influencing health status and contact with health services
XXII U00–U99 Codes for special purposes

Friday, September 18, 2015

Claims Part A – Skilled Nursing Facility (SNF) Providers

Claims Part A – Skilled Nursing Facility (SNF) Providers

There has been an increase in overlap claim situations due to Skilled Nursing Facility (SNF) providers not submitting their discharge claims correctly.

There are two situations that force a discharge from a SNF: 1) the beneficiary’s admission as an inpatient to a Medicare participating hospital or Critical Access Hospital (CAH), or 2) the beneficiary’s transfer to another SNF for inpatient services. A beneficiary cannot be an inpatient in more than one facility at a time. Consequently, the SNF must submit a discharge bill if either of these events occur.  It is inappropriate to add a 74 span code in lieu of a discharge status.  Reference IOM 100-04, Chapter 6, Section 40.3.4

SNF providers shall submit no-payment claims for beneficiaries that previously dropped to non-skilled care and continue to reside in the Medicare-certified area of the facility. The provider must only submit the final discharge bill that may span multiple months but must be as often as necessary to meet timely filing guidelines. Reference IOM 100-04, Chapter 6, Section 40.8

Saturday, August 22, 2015

Difference between ICD 9 – ICD 10

Difference Between ICD 9 - ICD 10
Basic Information about ICD 9: The United States Implemented ICD 9 in 1979. But most of the countries moved to ICD 10 several years ago, it’s time for United States medical history to reflect modern Medical terms. 

Code set differences

ICD-9-CM codes are very different than ICD-10-CM/PCS code sets:
  • There are nearly 19 times as many procedure codes in ICD-10-PCS than in ICD-9-CM volume 3
  • There are nearly 5 times as many diagnosis codes in ICD-10-CM than in ICD-9-CM
  • ICD-10 has alphanumeric categories instead of numeric ones
  • The order of some chapters have changed, some titles have been renamed, and conditions have been grouped differently
ICD-9-CM Diagnosis Codes
ICD-10-CM Diagnosis Codes
No Laterality
Laterality –
Right or Left account for >40% of codes
3-5 digits
  • First digit is alpha (E or V) or numeric
  • Digits 2-5 are numeric
  • Decimal is placed after the third character
7 digits
  • Digit 1 is alpha; Digit 2 is numeric
  • Digits 3–7 are alpha or numeric
  • Decimal is placed after the third character
No placeholder characters
“X” placeholders
14,000 codes
69,000 codes to better capture specificity
Limited Severity Parameters
Extensive Severity Parameters
Limited Combination Codes1 type of Excludes Notes
Extensive Combination Codes to better capture complexity

2 types of Excludes Notes


Saturday, August 8, 2015

Coding guidelines for part b hospice GV and GW

When hospice coverage is elected, the beneficiary waives all rights to Medicare Part B payments for services that are related to the treatment and management of his terminal illness during the period his hospice benefit election is in force, except for professional services of an “attending physician” who is not an employee of the designated hospice and does not receive compensation from the hospice for those services. Professional services of an “attending physician” are submitted with the GV modifier if all conditions are met (description below). Any services provided to a patient enrolled in hospice that are not related to the treatment and management of the patient’s terminal illness are submitted with the GW modifier (description below).

For purposes of administering the hospice benefit provisions an “attending physician” is defined as follows (must meet all requirements):

An individual who is a doctor of medicine, doctor of osteopathy or a nurse practitioner.
Is identified by the beneficiary as having the most significant role in the determination and delivery of his medical care at the time hospice coverage is elected.
Is not an employee of the hospice and does not receive compensation from the hospice.
The following applicable modifiers must be used when billing for services of a patient enrolled in hospice. The appropriate modifier usage will depend on who is providing the service, what services are being provided and if the services are for/related to the reason the patient is enrolled in hospice.
GV Modifier
Attending physician not employed or paid under arrangement by the patient’s hospice provider
This modifier should be used by the attending physician when the services are related to the patient’s terminal condition and are not paid under arrangement by the patient’s hospice provider. Also, this modifier must be submitted when a service meets the following conditions, regardless of the type of provider: 
The service was rendered to a patient enrolled in a hospice.
The service was provided by a physician or non-physician practitioner identified as the patient’s attending physician at the time of that patient’s enrollment in the hospice program. 
Do not submit the GV modifier in the following conditions:                        
The service was provided by a physician employed by the hospice.
The service was provided by a physician not employed by the hospice and the physician was not identified by the beneficiary as his attending physician.

GW Modifier
Service not related to the hospice terminal condition
This modifier should be used when a service is rendered to a patient enrolled in a hospice and the service is unrelated to the patient’s terminal condition. All providers must submit this modifier when:
The service(s) provided are unrelated to the patient’s terminal condition.
Claims are submitted for treatment of a non-terminal condition to the Part A MAC with condition code 07.
The following charts should be used to determine when the services of a hospice patient should be covered and when to report the appropriate modifiers.

Medicare pre-authorization

Recently, Novitas Solutions has received numerous requests to provide pre-authorization for surgery scheduled to occur within days. Traditional Medicare does not provide pre-certification or pre-authorization of a surgery. Medically necessary services should not be withheld or delayed.

Medically necessary services that have been provided to the patient are billed to Medicare for consideration and processing. If a service is denied, the provider and the patient have a right to request a redetermination of the denial.

Title XVIII of the Social Security Act, Section 1862(a)(1)(A) allows coverage and payment for items and services that are reasonable and necessary for the diagnosis or treatment of an illness or injury or to improve the functioning of a malformed body member.

Section 1862(a)(1)(A) of the Social Security Act is the basis for denying payment for types of care, specific items, services, or procedures, not excluded by any other statutory clause, meet all technical requirements for coverage, but are determined to be any of the following:

Not generally accepted in the medical community as safe and effective in the setting and for the condition for which it is used;
Not proven to be safe and effective based on peer review or scientific literature;
Not medically necessary in the particular case;
Furnished at a level, duration or frequency that is not medically appropriate;
Not furnished in accordance with accepted standards of medical practice; or
Not furnished in a setting (such as inpatient care at a hospital or SNF, outpatient care through a hospital or physician's office or home care) appropriate to the patient's medical needs and condition.
To be considered medically necessary, items and services must have been established as safe and effective. That is, the items and services must be:

Consistent with the symptoms or diagnosis of the illness or injury under treatment;
Necessary and consistent with generally accepted professional medical standards (e.g., not experimental or investigational);
Not furnished primarily for the convenience of the patient, the attending physician or other physician or supplier; and
Furnished at the most appropriate level that can be provided safely and effectively to the patient.

Thursday, July 2, 2015

Internet based PECOS submission

Medicare Novitas is currently receiving a high volume of duplicate certifications/signatures for Internet-based PECOS (Provider Enrollment, Chain and Ownership System) CMS-855  submissions.  This is a result of customers submitting both an electronic signature and a hardcopy/paper certification.  When submitting an application via Internet-based PECOS, please elect only one method of submitting your signature; electronic OR hardcopy.  For additional details, please review Novitas educational article titled “Internet-based PECOS Signature Submissions” on our website in the Enrollment Center.  

When submitting an application via Internet-based PECOS, please elect one form of signature submission.

1. Electronic Signature: Internet-based PECOS allows for the provider or Authorized/Delegated Official to electronically sign the application submission. Utilizing the electronic signature process will ensure faster application submission, resulting in an earlier effective date.  This feature does not change who is required to sign the application.


2. Hardcopy Certification Statement: After the ‘Submission Receipt’ page appears, the user will be notified to print the 2-page Certification Statement to be signed, dated and mailed to the Medicare Administrative Contractor. Please do not submit your certification using the certification pages from the paper CMS-855 enrollment applications.