As many may be aware, laterality has been added in ICD-10-CM to increase specificity. Codes assigned for conditions such as fractures, burns, and pressure ulcers will indicate right side versus left side. Don’t panic—there are still codes available for unspecified “sides.”
For example, consider the following ICD-10-CM categories:
- L89.60 (pressure ulcer, unspecified heel)
- L89.61 (pressure ulcer, right heel)
- L89.62 (pressure ulcer, left heel)
Note that this series of codes also requires a sixth digit to identify the stage of the pressure ulcer (i.e., stage I-IV or unstageable).
Another example illustrating laterality is the ICD-10-CM code for a fracture of the shaft of the radius (ICD-10-CM category S52.3)
The fourth digit identifies the type of fracture (e.g., greenstick or transverse), and the fifth and sixth digits identify right versus left and in some cases whether the fracture was considered displaced or nondisplaced. The final character identifies if it was initial, subsequent, or sequela.
The fracture example brings to mind something for which I am not sure I have seen the answer. Because ICD-10-CM codes will be used for professional and outpatient services and yet the HCPCS codes (CPT and HCPCS II) will still be used to report the procedures, will it still be necessary to report the –RT or –LT modifiers?
I would presume so because identifying whether a physician performed a procedure on the right or left is important. But would it be redundant, like putting a -50 modifier (bilateral procedure) on a procedure code that states bilateral in the description?
It could possibly cause issues if the diagnosis is somehow coded as a fracture of the right shaft of the radius, but for some reason the CPT procedure is assigned with modifier-LT. I could envision the potential of medical necessity denials that we do not encounter using ICD-9-CM diagnosis codes.
For example, we currently have ICD-9-CM diagnosis codes that indicate bilateral hernias. Yet the CPT Manual still instructs coders to utilize modifier-50 when hernias are repaired bilaterally. This reference leads me to believe that even though ICD-10-CM codes will have the added specificity of laterality, coders will still use modifiers –RT, -LT and -50 (for that matter) as they currently do.