In an interview, the section chief of hepatology at Rush University Medical Center discussed why the addition of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis code K76.82 is necessary.
Earlier this month, a new diagnosis code went into effect to reflect hepatic encephalopathy (HE), a move intended to ease access to testing and treatment for the disease.
International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis code K76.82, took effect October 1, 2022.
In August, Bausch Health Companies Inc and its gastroenterology business, Salix Pharmaceuticals, announced support of the new ICD-10 code being published by CMS.
This month, Salix Pharmaceuticals released the 2nd edition of the Salix Liver Health Annual Trends Report. In this report, Salix highlighted survey results from 400 total community-based gastroenterologists, institution-based specialists, primary care physicians, nurse practitioners, and physician assistants, who answered questions relating to coding issues.
ICD-10-CM codes must be submitted to the payer in order for a health care provider to receive reimbursement for medical services. While the Current Procedural Terminology (CPT) codes offer providers a uniform language for coding medical services, ICD-10-CM codes depict the patient’s diagnoses that justify these services deemed medically necessary.
Prior to the publication of K76.82, providers said they used the following codes to classify HE regimens:
According to the report, use of these different codes may have caused issues with treatment reimbursement and follow-up upon transition of care. More than half of the 400 providers surveyed said they previously used code G93.40 or G93.49 most often.
In an interview with The American Journal of Managed Care® (AJMC®), Nancy Reau, MD, section chief of hepatology at Rush University Medical Center, talked about why establishing an ICD-10 code for a specific liver condition rather than having one code encompassing all liver conditions is necessary.
“The more granular label we have, the more someone's going to understand, well, this medication is being used not just for a person with liver disease, but a person with liver disease and complication X,” Reau said. “The better we can label our patient with the comorbid conditions that are associated with liver disease, the better we're going to be able to track outcomes, the better we're going to be able to justify cost, the better we're going to be able to tag the appropriate management for that patient to the condition that they have.”
Reau also discussed the effects of the new ICD-10 code for HE, noting this updated code allows for more simplified prior authorization.
“I have patients that cannot get the medications or the testing that they need because the insurer just doesn't know what I'm asking for,” Reau said. “I think that this is a big step forward for us to be able to justify why we're asking for what we are, and for an insurer to standardize what they need.”
According to the Salix report, improper diagnosis coding can lead to issues with payer coverage and prior authorization rejections. These issues, as well as a patient’s inability to pay out-of-pocket costs and/or lack of insurance coverage, are the most frequent barriers for patients to receive treatment and prescription fulfillment for liver disease after hospital discharge.
“The better we match the diagnostic code to the therapy and the tests that we're doing and the educational support that we're getting, the more comprehensive it's going to be for the patient in front of us,” Reau said.