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ICD-10 Coding for Contraceptives in Oregon

Posted By Rachel Linz, Friday, January 15, 2016
Updated: Tuesday, January 12, 2016
The Reproductive Health Program in Oregon is a little different than in most other states. Not only do we administer a Title X grant (Title X of the Public Health Services Act, signed into law by President Richard Nixon in 1970, is the only federal funding dedicated solely to family planning services), but we also administer a Section 1115 family planning demonstration waiver through the Centers for Medicare and Medicaid Services (CMS), despite being within our state’s Public Health Division rather than our state’s Medicaid office. Our waiver is called Oregon ContraceptiveCare, or CCare, and covers family planning and contraceptive management services for individuals who are U.S. citizens or lawful permanent residents with household incomes up to 250% of the federal poverty level and who are not enrolled in the state’s Medicaid program. The RH Program’s provider network includes all local public health departments in the state as well as Planned Parenthood health centers, university health centers, community health centers and School-Based Health Centers, totaling 150 clinics statewide. Through our entire provider network, we serve over 80,000 clients annually.
One area of focus for the Oregon RH Program has been to increase access to long-acting reversible contraceptives, or LARC methods. These include contraceptive implants and intrauterine devices, are effective for up to 3-10 years depending on type, and have failure rates similar to sterilization methods (see Figure 1). In fact, LARC methods are about 20 times more effective at preventing pregnancy than birth control pills! We provide technical assistance and training for clinicians and billing staff regarding insertion and removal of LARC devices, billing, reimbursement and maintenance of device stock on site, and best practices regarding client counseling techniques to increase client success with their methods, regardless of which method a client chooses.
As all readers of CSTE Features no doubt know, the United States transitioned to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) on October 1, 2015. For the Oregon RH Program, we are fortunate that our clinical data collection is narrowly focused and we only require diagnosis codes for visits under CCare, not for Title X (which covers a broader scope of services than CCare). Because of CMS requirements, CCare visits must include a primary diagnosis code indicating that contraceptive management was the primary purpose of visit (V25 codes under ICD-9, Z30 codes under ICD-10). To assist our provider network in managing the transition, we created a crosswalk that includes the ICD-9 codes for each contraceptive method alongside the appropriate ICD-10 code, as well as the Healthcare Common Procedure Coding System (HCPCS) supply codes associated with each method type (see Figure 2).
The biggest challenge with coding for the Oregon RH Program under ICD-9 has continued under ICD-10: several contraceptive methods do not have their own unique codes. We’ve all heard about new ICD-10 codes that have been created to document very specific types of injuries in specific locations, but what has not been in the news is the fact that the most effective LARC method, the hormonal implant (<0.5% failure rate) actually lost its unique codes that it had under ICD-9! Of the 18 different contraceptive methods available in the U.S., only four have their own specific diagnosis codes: intrauterine devices, oral contraceptives, injectable contraceptives, and natural family planning. Both female and male sterilization methods use the same diagnosis codes.
Our solution, which aligns with recommendations from national family planning and coding experts, is the following: for hormonal methods that do not have their own specific codes (the contraceptive implant, patch and ring), to use the codes for “unspecified” contraceptives (Z30.019 for initial encounter, Z30.40 for follow-up or surveillance encounters). For less effective methods that do not have their own specific codes (cervical cap, diaphragm, sponge, female and male condoms, and spermicide), we recommend using codes for “other” contraceptives (Z30.018 and Z30.49). This way, although we cannot determine specific contraceptive methods from diagnosis codes alone, we can determine the approximate level of effectiveness. The bottom line is that other information, such as HCPCS codes and National Drug Code (NDC) numbers, is required to determine exactly which contraceptive methods are dispensed. Additional ICD-10 codes may become available in the future, but for now, tracking ongoing use of certain long-acting methods remains a challenge.

Figure 1. Contraceptive method effectiveness. Most effective methods include the contraceptive implant, intrauterine devices, and sterilization methods. Moderately effective methods include injectables, pills, patches, rings and diaphragms.

Figure 2. A portion of the Oregon RH Program’s ICD-9/ICD-10 crosswalk. Under ICD-10, the hormonal implant lost its unique diagnosis codes while injectable contraceptives gained unique codes. Other methods such as the diaphragm have never had their own unique codes.

Rachel Linz, MPH is an Informatics Training in Place Program (I-TIPP) fellow and senior research analyst with the Reproductive Health Program at the Oregon Health Authority. To learn more about ICD-9 and ICD-10, join subcommittees in the Surveillance/Informatics Steering Committee.

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