The more expansive ICD-10 code set that was implemented on Oct. 1, 2015, replaced ICD-9 diagnosis and procedure codes, but it did not affect Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes used for physician services. This has caused confusion for some health care providers who assumed that the more detailed ICD-10 diagnosis codes supplant the need to include anatomical modifiers for certain CPT/HCPCS codes.
Humana policy follows CMS guidance in most coding matters, and CMS’ “ICD-10-CM/PCS: The Next Generation of Coding” states, “While ICD-10-CM codes have expanded detail, including specification of laterality for some conditions, you should continue to follow CPT and CMS guidance when you report CPT/HCPCS modifiers for laterality.”
Claims that include CPT codes without required anatomical modifiers may not be covered. This applies to all claims submitted to Humana.
Health care providers can view the anatomical modifiers presentation at humana.com/HealthCareProviderHowTo for more information about Humana’s claims payment policy.
CMS provides additional ICD-10 information on its website at cms.gov/Medicare/Coding/ICD10/downloads/ICD-10Overview.pdf.