ICD10 External Cause Codes

ICD10 Whole story

On your CD and on my website www.madetomeasure.co.za (on downloads documents page), is an xls list of ICD10 codes in the format G23.5 which seems to be long enough(ie complete) at the moment. Maybe there are better lists/lookups around such as the WHO (http://www.who.int/classifications/apps/icd/icd10online/) website a link to which is also on your CD. It makes no difference which you use. In your MTM software Add the ones you want to use under File – diagnoses (If you want to use only the code and never access or print the description then enter both the code and description as the code, otherwise enter a vague abbreviated description). Add the External cause codes (eg X34.5 fell off a ladder) here as well.

On each patient's acct details there is space for 3 diag codes. Drop down the box and pick them up from your list. Or if it is a new one for you click the add button to add it to your list. DO NOT JUST TYPE IT IN

Note that codes that do not have the .n on the end will cause rejections. ..Discussion among colleagues will help you determine ‘good' codes to use. It appears that some are refused payment at the medaid ie Mild depression, Headaches, Scholastic tests etc. Use codes that reflect the worst things wrong with the patient.

On each line item (invoice) pick up the diag or whichever of those loaded onto the patient is most relevant to this treatment. Do not get in a flap because you see only one code on the line - see below

ICD10 External Cause Code (ECC )

This issue mostly concerns Physios I think. The law allows medaids to demand a cause code for fractures etc. The medaids seem to be implementing this far more widely than intended and are rejecting claims where there is no secondary ECC for any diagnoses beginning R S and T.

On the Patient account details put your ECC with the 1 or 2 diagnoses eg

S23.4 Sore neck

S43.9 Sore leg

V42.7 Hit by a 3 wheeled vehicle

Then on each treatment line pick up the one relevant diag you are treating eg Sore neck

If you are using EDI then ALL 3 CODES WILL BE SENT ON EACH LINE and always have been. So long as you have put the ECC onto the patient acct details and have sent via EDI – THEN THE MEDAID ARE GETTING THE ECC even though you do not see it on every line.

Printed claims :

Here we have implemented an automatic procedure whereby if the code on the line is one of the R S or T ones that supposedly must get an ECC, then so long as you have put one of the U V W X Y cause codes onto the patient acct it will be picked up and printed after the R S or T one.

This change was added into the Millenium program in Dec 2005 – to get the update go to the website to the downloads – software updates page and download the millennium update. Instructions to download and apply it are on the website. Please read carefully.

If you are using the Professional version of the program this function is already included.

We are reluctant to print more icd10 codes on a line as this will mean printing 2 lines per treatment which will double printing costs and time. If this does become neccassary it will be released as an optional extra module for Physios only as no other practices are receiving these demands from medical aids. The way the mtm program is submitting via EDI and Printing a secondary code per line – fulfills legal requirements as per the government gazette as to what medaids may demand.

We consider that medaids are using this as an excuse to delay /refuse payments, greatly increasing their profits, and that co-operation/ communication with them should not be encouraged. We suggest that you find codes that work and use them exclusively.