ICD-10-CM coding guidelines and Laterality (professional)

With the adoption of ICD-10-CM code set, we were introduced to diagnosis codes that now indicate the laterality of a condition.  At present, diagnosis code descriptions indicate whether the condition is present on the left, right or exists bilaterally.  A recent review of our claim denial trends has identified that many providers are not billing appropriately in regards to laterality.

 

As a reminder, if a condition currently exists on both sides, please refer to the ICD-10-CM Official Guidelines for Coding and Reporting FY 2019, specifically, the General Coding Guidelines Section and the Chapter Specific Sections; for specific guidance for reporting a diagnosis that designates a condition on the left and right versus a bilateral diagnosis.  Please carefully consider the information contained in the ICD-10-CM Coding Guidelines when trying to decide between reporting a condition using left diagnosis and right diagnosis codes versus a bilateral diagnosis code.