Unspecified Depression
As the winter months approach, people spend more time indoors — often isolated from activities, family, and friends — and depression tends to trend upward. Effective October 1, 2022, there is a new code for Depression, unspecified (F32.A).
Prior to October 1, healthcare professionals were using ICD-10-CM code F32.9, which indicates the member had major depression, when they did not. When the depression is not indicated as major depression and would be classified as unspecified depression, please have your clinicians use the unspecified depression code, F32.A. Remember, it is always best to code to the highest specificity for the member. If the documentation is not clear, you may need to query the provider for a more specific definition of the type of depression.
CVA
Over the past few months, we have reviewed hundreds of records regarding the coding of a CVA. It is imperative to remember that once a patient leaves the hospital setting, it is no longer appropriate to code using the acute cerebral vascular accident (CVA) ICD-10-CM code I63. 0 – I63.9 code. We found most of these errors occurred as a follow-up visit in an office setting.
The appropriate code to use when the member is not experiencing any late effects of the CVA is
When the member has a late effect or sequelae condition after the stroke, please use the appropriate sequelae ICD-10-CM codes:
When coding the residual of a stroke, please remember to link the residual condition to the stroke in the chart note.
Examples of Unacceptable Coding of the Sequelae or Residual Condition
Exams (virtual and face-to-face)
Example 1
Reason for Visit: CVA
PMH: Paresis of lower extremity followed by the ROS below
ROS: (MS) Denies Gait problem (neuro) Denies weakness, numbness
Exam: Stride length is good but does drag R leg some
MS: moves all visible extremities without noticeable abnormality
HTA Notes: PMH and Exam conflict. A patient experiencing no residual effects from a previous stroke should NEVER be assigned a current stroke code. Chart Note documented a CVA occurred as far back as 2009, no residual documented. This condition should not remain as an active reason for the patient’s visit. When no sequelae or residual is indicated, code the Z86.73 ICD-10-CM code.
Example 2
Chief complaint: Follow up: S/P Stroke with left hemiparesis
PMH: Paralysis
ROS: Gait normal, Upper and lower extremities 5/5 strength bilaterally
Exam: 3+/5 LUE, 4-/4 LLE s/p stroke (Gait is intact) Moving all extremities, neuro intact
Plan: History of stroke with left hemiparesis
A&P: Left sided hemiparesis
HTA Notes: Left sided hemiparesis S/P Stroke is documented, however, ROS and Exam conflict with the A&P. Additional documentation to support the residual linked to a post-CVA would be required in order to support the I69 – I69.98 ICD-10-CM code range.
Tips to prevent this type of coding from occurring:
Tips to ensure accuracy with coding:
Last but certainly not least, when a request for records is made to a practice through the Risk Adjustment Department, it is being made on behalf of one of the governing entities. HTA has an obligation to fulfill these requests to remain in good standing. Two examples of government entities are CMS and OIG.
HTA has no control over any of these requests. We must comply. While we realize there have been some unforeseen hardships over the past couple of years, we remain obligated to comply. We have streamlined our requests to the bare minimum required to fulfill the obligation.
CMS and OIG want to ensure that HTA members are receiving the best possible care regardless of staffing issues. Safety should never be compromised when it comes to patient care, and this is a check point for them. They also set forth the timeframe for the review (they control the deadlines for submission). So again, please do not ignore these requests. They are mandatory, not “just an annoyance”! We do not have a say in what specifically they are requesting, which office receives the request, or how many requests an office may receive. Let's all work together as a team!