MORE FOR FEET PROGRAM. User guide for podiatrists and podiatry code list (ICD-10-AM codes)

Transcription

1 MORE FOR FEET PROGRAM User guide for podiatrists and podiatry code list (ICD-10-AM codes) APRIL 2017

2 WELCOME TO THE MORE FOR FEET PROGRAM This program reimburses 100% of the agreed charge for an initial consultation (comprehensive service), once per year, when your HCF patient presents with a new health condition or flare up of an existing condition which is represented by a More for Feet podiatry code (ICD-10-AM) from this user guide. Two important features of this program are: the introduction of a new More for Feet initial consultation item for podiatrists to use the use of ICD-10-AM codes. When you submit a More for Feet no-gap claim please select a More for Feet podiatry code (ICD-10-AM) that most closely describes the provisional diagnosis you make in your assessment and submit it to us as part of the service description with the claim. The codes in the appendix of this guide reflect the conditions that are commonly treated by podiatrists and are thematically grouped. In this guide you ll also find steps for how to successfully claim a no-gap consultation on behalf of your patient, a description of the new More for Feet initial consultation item and instructions on when to use it. INITIAL CONSULTATIONS (F099) IN THE MORE FOR FEET PROGRAM We ve introduced a new consultation item to use specifically for claims under the More for Feet program. The new item number is F099 and it describes a More for Feet initial consultation, which is a comprehensive service that includes: a diagnosis, history taking, treatment plan and clinical intervention where the consultation exceeds 30 minutes New or existing patients. Please note: you must use More for Feet item number F099 for the no-gap benefit to be claimable (see page 4 for instructions on electronic claiming). SOME THINGS TO REMEMBER 2 ICD-10-AM Seventh Edition: Copyright Commonwealth of Australia 2010 and based on the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) 2008 Edition Copyright World Health Organisation. All rights reserved. The no-gap benefit applies to a member s initial consultation (item number F099) for a new episode of care We define a new episode of care as a new health condition or flare up of an existing condition where there s been a gap in treatment, with any podiatrist, of at least 90 days A member may claim this no-gap benefit once in a calendar year A More for Feet podiatry code (ICD-10-AM) must be submitted for every initial consultation (item number F099) that you provide to a member You have agreed to charge no more than your customary fee for an initial consultation (which is equivalent to a comprehensive service with a new patient) for any More for Feet consultation If the More for Feet no-gap benefit has already been claimed by that patient in the current calendar year, the non-program benefit will apply Claims should be submitted electronically Services that are payable by a third party (e.g. workers compensation, personal injury, public liability or motor vehicle accident insurance) can t be claimed through HCF.

3 HOW TO SUBMIT A NO-GAP CLAIM THROUGH YOUR ELECTRONIC CLAIMS TERMINAL STEP 1 Select the provider, patient ID and enter item number 099 for HICAPS, or select 99 for HealthPoint terminals. Then enter the date of service and item cost as you would normally. STEP 3 (If you use a Healthpoint terminal then please skip to step 4). Enter the patient ID again. STEP 5 a) Enter the relevant More for Feet podiatry code (ICD-10-AM) from the appendix in this guide. b) If you are providing general care only such as nail clipping enter code Z99 (non-program benefit will apply). STEP 2 Select ADD to add another item. STEP 4 Enter or select the item code STEP 6 Transmit the claim to HCF or start back at step 1 for additional patients. FREQUENTLY ASKED QUESTIONS What does ICD-10-AM mean? ICD-10-AM means the International Classification of Diseases and health related problems, 10th revision, Australian Modification. This is a nationally recognised standard. What does HCF do with the ICD-10-AM codes it receives? ICD-10-AM codes help us get a better understanding of the health of the population and the reasons why our members seek treatment from podiatrists. Do I need to get my patient s permission before I transmit the diagnosis code through the claims terminal? No, the data is encrypted and we have our members permission to request and receive this information. What should I do if my terminal isn t working? If you can t collect payment through your claims terminal, please issue an unpaid account to your patient and print the More for Feet podiatry code (ICD-10-AM) clearly on the invoice. Your patient will need to present the account as a claim and we ll provide a cheque to our member, made payable to you. What if I make a mistake when I enter the code? You can reverse the claim as you would normally. If you enter a code that isn t listed, you will be prompted to start the claim again. How do you define a flare up of an existing condition? When a chronic or long term condition flares up for which no podiatry treatment has been provided within 90 days. What code do I use for general care such as nail clipping? Enter Z99 (which means an ineligible condition under this program) and the non-program benefit will apply. I m treating a health condition for which you haven t listed a More for Feet podiatry code (ICD-10-AM), what should I do? Let us know by ing provider_networks@hcf.com.au For any membership related enquiries, call our customer service team on

4 APPENDIX: MORE FOR FEET PODIATRY CODES (ICD-10-AM) The codes are grouped thematically and in alphabetical order, not in the order they appear in the ICD-10-AM version BONE AND JOINT CONDITIONS Acquired deformities of fingers and toes Acquired deformity of toe(s), unspecified Arthritis, unspecified Chronic instability of knee Diabetic arthropathy (including Charcot s) Disorders of patella Flat foot [pes planus] (acquired) Gout Hallux rigidus Hallux valgus (acquired) Hypertrophy of bone Juvenile arthritis Juvenile osteochondrosis of head of femur [Legg-Calve-Perthes] Juvenile osteochondrosis of pelvis Juvenile rheumatoid arthritis Metatarsalgia Neuropathic arthropathy Osteomyelitis Other hammer toe(s) (acquired) Paget s disease of other bones Primary arthrosis of other joints Reiter s disease Rheumatoid arthritis, unspecified Seropositive rheumatoid arthritis Unequal limb length (acquired) M20 M206 M139 M235 M142 M22 M214 M10 M202 M201 M893 M08 M911 M910 M080 M774 M146 M86 M204 M888 M19 M023 M069 M05 M217 CIRCULATORY CONDITIONS Cellulitis Diseases of capillaries Lymphoedema, not elsewhere classified Peripheral vascular disease, unspecified Phlebitis and thrombophlebitis of other deep vessels of lower extremities Raynaud s syndrome Thromboangiitis obliterans (Buerger) Venous insufficiency (chronic) (peripheral) CONGENITAL CONDITIONS Congenital absence of foot and toe(s) Congenital deformities of feet Congenital deformity of hip, unspecified Congenital malformations of knee Congenital pes planus Juvenile osteochondrosis, unspecified (including Osgood Sever s) Metatarsus varus Osteogenesis imperfecta Other congenital deformities of feet Other congenital malformations of nails Pes cavus Polydactyly Syndactyly Talipes equinovarus DIABETES Diabetic arthropathy (including Charcot s) Other specified diabetes mellitus with neurological complication Type 1 diabetes mellitus Type 1 diabetes mellitus with circulatory complication Type 1 diabetes mellitus with multiple complications Type 1 diabetes mellitus with neurological complication Type 2 diabetes mellitus FRACTURES AND ACUTE INJURIES Contusion of ankle Contusion of other and unspecified parts of foot Contusion of toe(s) with damage to nail Contusion of toe(s) without damage to nail Crushing injury of toe(s) Crushing injury of ankle Crushing injury of ankle and foot Crushing injury of other parts of ankle and foot L03 I78 I890 I739 I802 I730 I731 I872 Q723 Q66 Q659 Q741 Q665 M929 Q662 Q780 Q668 Q846 Q667 Q69 Q70 Q660 M142 E134 E10 E105 E107 E104 E11 S900 S903 S902 S901 S971 S970 S97 S

5 Dislocation of ankle joint S930 Injury of other nerves at ankle and foot level S948 Dislocation of knee S831 Lesion of plantar nerve G576 Dislocation of patella S830 Mononeuropathy of lower limb, unspecified G579 Dislocation of toe(s) S931 Multiple sclerosis G35 Dislocation, sprain and strain of joints and ligaments at ankle and foot level S93 Polyneuropathy, unspecified G629 Dislocation, sprain and strain of joints and ligaments of knee S83 Spastic hemiplegia G811 Fracture of calcaneus S920 Tarsal tunnel syndrome G575 Fracture of fibula alone S824 Wrist or foot drop (acquired) M213 Fracture of foot, except ankle Fracture of great toe Fracture of lateral malleolus Fracture of lower leg, including ankle Fracture of medial malleolus Fracture of metatarsal bone Fracture of other tarsal bone(s) Fracture of other toe Fracture of patella Fracture of talus Multiple fractures of foot Multiple fractures of lower leg Multiple superficial injuries of ankle and foot Open wound of ankle Open wound of ankle and foot Open wound of toe(s) with damage to nail Open wound of toe(s) without damage to nail Sprain and strain of ankle Sprain and strain of toe(s) Stress fracture, not elsewhere classified Tear of meniscus, current NERVE AND NEUROLOGICAL CONDITIONS Ataxic cerebral palsy Cerebral palsy Diabetic mononeuropathy Diabetic polyneuropathy Guillain-Barre syndrome Hemiplegia Injury of cutaneous sensory nerve at ankle and foot level Injury of deep peroneal nerve at ankle and foot level Injury of lateral plantar nerve Injury of medial plantar nerve Injury of multiple nerves at ankle and foot level Injury of nerves at ankle and foot level S92 S924 S826 S82 S825 S923 S922 S925 S820 S921 S927 S827 S907 S910 S91 S912 S911 S934 S935 M843 S832 G804 G80 G590 G632 G610 G81 S943 S942 S940 S941 S947 S94 SKIN AND NAIL CONDITIONS Acquired ichthyosis Allergic contact dermatitis Atrophic disorders of skin Bromhidrosis Corns and callosities Decubitus ulcer and pressure area Dermatitis, unspecified Ingrowing nail Keratosis punctata (palmaris et plantaris) Localised connective tissue disorder, unspecified Lupus erythematosus Nail dystrophy Onychogryphosis Onycholysis Other and unspecified skin changes Other epidermal thickening Other malignant melanoma of skin Other malignant neoplasms of skin Other nail disorders Paraesthesia of skin Tinea pedis Viral warts SOFT TISSUE AND TENDON CONDITIONS Achilles tendinitis Calcaneal spur Calcific tendinitis Fasciitis - plantar Ganglion Iliotibial band syndrome Injury of Achilles tendon Injury of intrinsic muscle and tendon at ankle and foot level Injury of multiple muscles and tendons at ankle and foot level Injury of muscle and tendon at ankle and foot level L850 L23 L90 L750 L84 L89 L309 L600 L852 L949 L93 L603 L602 L601 R238 L85 C43 C44 L608 R202 B353 B07 M766 M773 M652 M722 M674 M763 S860 S962 S967 S96 8 9

6 Injury of muscle and tendon of long extensor muscle of toe at ankle and foot level Injury of muscle and tendon of long flexor muscle of toe at ankle and foot level Injury of muscle(s) and tendon(s) of anterior muscle group at lower leg level Injury of muscle(s) and tendon(s) of peroneal muscle group at lower leg level Injury of other muscle(s) and tendon(s) of posterior muscle group at lower leg level Metatarsalgia Patellar tendinitis Peroneal tendinitis Residual foreign body in soft tissue Rupture of ligaments at ankle and foot level Short Achilles tendon (acquired) Soft tissue disorders related to use, overuse and pressure not elsewhere specified Spontaneous rupture of synovium and tendon Systemic lupus erythematosus Traumatic ischaemia of muscle (including shin splints) S961 S960 S862 S863 S861 M774 M765 M767 M795 S932 M670 M70 M66 M32 T796 NOTES 10 11

7 CALL US GO TO hcf.com.au/therapist The Hospitals Contribution Fund of Australia Limited. ABN ASFL HCF House 403 George Street, Sydney NSW 2000 Postal Address: GPO Box 4242, Sydney NSW 2001