![]() Pointers for selecting the appropriate ICD-10 code for cytology specimens are provided below. In the example above, if you supply a wrong ICD-10 code, like R51 (denoting “headache”) with the bill for the urine cytology, it is likely that Medicare will deny the claim because R51 doesn’t justify the medical necessity of urine cytology. (It might be the same “clinical code” you received from the ordering physician, or it might be different, a “pathologic code,” as discussed below.) Payers have lists of approved ICD-10 codes for many laboratory tests, and will deny payment if a non-approved code is provided. ![]() Similarly, when your laboratory bills an insurer for having performed a cytologic examination of a specimen, the bill must include an appropriate ICD-10 code to justify the medical necessity of the test. For example, if a urine cytology test is ordered for a patient with gross hematuria, the patient’s physician will furnish ICD-10 code R31.0, which denotes gross hematuria, on the requisition form that accompanies the urine specimen. In the United States, all healthcare providers must furnish an ICD-10 code to justify the medical necessity of a diagnostic test. For convenience, hereinafter we refer to ICD-10-CM simply as ICD-10. With the passage of the Medicare Catastrophic Coverage Act of 1988, diagnostic coding using the previous version (ICD-9-CM) became mandatory for Medicare claims, and when HIPAA was implemented in 2003, ICD-CM coding became universal, meaning that private insurers, as well as government agencies, are required to use it. (For example, in ICD-10-CM “speak,” gross hematuria is R31.0, and a solitary thyroid nodule is E04.1.) ICD-10-CM coding is used to determine whether a procedure billed to an insurer is medically necessary, in which case it is a covered benefit for the patient. 14 The version of ICD-10 used for billing purposes in the United States is “clinical modification” (CM). ![]() The International Classification of Diseases, now in its tenth revision (ICD-10), is the taxonomy used by all healthcare professionals and insurers in the United States when discussing medical conditions. Cibas MD, in Cytology, 2021 International Classification of Diseases (ICD)-10-CM Codes
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