FLASH: Claims Processing Changes for Laterality Coding

Effective January 3, 2022, Health Alliance™ will be updating their coding system that will change the way ICD-10 laterality claims are processed. This will affect all claims submitted once the edit is turned on and is not date of service driven.

The UNSL rule identifies when an ICD-10-CM code(s) reported on the claim line defines an unspecified ICD-10-CM code which has an equivalent code for right or left, an equivalent code for unilateral or bilateral.

ICD-10 guidelines indicate you code to the highest level of specificity. While we understand there may be situations where an unspecified laterality code must be used, the majority of the time the rendering provider knows which site is being examined/treated. An example would be reporting diagnosis code H52.229, regular astigmatism, unspecified eye, when laterality codes exist to indicate left, right or bilateral, for example: H52.221 REGULAR ASTIGMATISM, RIGHT EYE, H52.222 REGULAR ASTIGMATISM, LEFT EYE, H52.223 REGULAR ASTIGMATISM, BILATERAL.

As noted in the ICD-10 manual, unspecified codes should be used in limited circumstances, when neither the diagnostic statement nor the documentation provides enough information to assign a more specific, diagnosis code. Practitioners providing clear, concise documentation enabled coders to code to the highest level of specificity benefiting all involved.

If you have any questions surrounding this, please contact your provider relations specialist.