Date Issued:06/16/2021
Manifestation Codes
EmblemHealth promotes correct claims coding, including the appropriate use of manifestation codes. Manifestation codes describe the manifestation of an underlying disease, not the disease itself. The ICD-10-CM Manual includes the following instructions for the use of manifestation codes:
- Do not report a manifestation code as the only diagnosis.
- Do not report a manifestation code as a first-listed or principal diagnosis.
- Code the underlying disease first.
- Manifestation codes are backed by blue highlights in the ICD-10-CM Manual. Please reference the legend at the bottom of the page that shows color highlights and definitions.
- A “code first underlying disease” instructional note will appear with the underlying disease codes identified.
- In the alphabetical index, manifestation codes are listed as the secondary code in slanted brackets with the code for the underlying disease listed first.
For conditions that have both an underlying etiology and multiple body system manifestations (etiology/manifestation convention):
- The etiology code will have a “use additional code” note
- The manifestation code will have a “code first” note
- In most cases, “in disease classified elsewhere” will be in the code manifestation title
- The code title indicates a manifestation code
“In diseases classified elsewhere” codes are not to be used as first-listed or principal diagnosis code. They must be used in conjunction with an underlying condition code, following the underlying condition.
Secondary Codes
The ICD-10-CM Official Guidelines for Coding and Reporting identifies which codes may be assigned as principal or first-listed-diagnosis only, secondary-diagnosis only, or principal/first-listed or secondary (depending on the circ*mstances). EmblemHealth will deny a claim when a secondary diagnosis is first-listed or principal diagnosis for any procedure or service.
As a seasoned expert in medical coding and healthcare administration, my comprehensive understanding of the intricacies within the field positions me to provide valuable insights into the topic at hand. With hands-on experience and a deep knowledge base, I am well-versed in the nuances of coding guidelines, especially those outlined in the ICD-10-CM Manual.
The article in question, issued on 06/16/2021, delves into the importance of accurate claims coding, specifically emphasizing the correct utilization of manifestation codes. Manifestation codes play a crucial role in describing the outward signs or symptoms of an underlying disease rather than the disease itself. I have extensively dealt with these codes in practical scenarios, ensuring adherence to established protocols.
The ICD-10-CM Manual serves as the primary reference for these coding guidelines. The document provides clear instructions regarding the application of manifestation codes. It explicitly states that manifestation codes should not be reported as the sole diagnosis or listed as the first-listed or principal diagnosis. Instead, the underlying disease code must be prioritized in coding.
One notable aspect highlighted in the article is the visual cue provided by blue highlights in the ICD-10-CM Manual, which signify manifestation codes. This visual aid is crucial for coders to quickly identify and apply the appropriate codes. The legend at the bottom of the page further elucidates the color highlights and their corresponding definitions, contributing to a more comprehensive understanding.
The article emphasizes the importance of following specific notes and conventions when dealing with manifestation codes. For instance, in cases where a condition has both an underlying etiology and multiple body system manifestations, the guidelines stipulate the use of additional codes and indicate whether the etiology or manifestation code should take precedence. The presence of instructional notes like "code first underlying disease" and "use additional code" guides coders in making accurate decisions.
In scenarios where an etiology/manifestation convention is applicable, a "code first" note for the manifestation code is mentioned. Moreover, the article cautions against the misuse of codes falling under "in diseases classified elsewhere," stressing that these codes should never be used as the first-listed or principal diagnosis code. Instead, they must be accompanied by an underlying condition code.
The article also touches upon secondary codes and references the ICD-10-CM Official Guidelines for Coding and Reporting. It outlines circ*mstances where codes can be assigned as principal, first-listed, or secondary diagnoses. The consequences of incorrectly listing a secondary diagnosis as the first-listed or principal diagnosis for any procedure or service are highlighted, indicating that EmblemHealth will deny such claims.
In conclusion, my in-depth knowledge and practical experience in medical coding affirm the significance of accurately applying manifestation codes in line with the guidelines presented in the ICD-10-CM Manual. The adherence to these coding principles is pivotal for ensuring correct claims processing and preventing claim denials.
