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Learning how to use the new ICD-10 codes prior to implementation will be just as important as learning the new codes.
As you prepare for next year’s ICD-10 implementation by studying the new codes, don’t forget to study how to use these codes.
The official guidelines for coding and reporting in the ICD-10-CM book are an invaluable resource for both physicians and coders.
The beginning of the book offers general conventions and guidelines to give overall instruction for using the book as a whole. Some of these guidelines mirror what’s written in ICD-9-CM (e.g., level of detail in coding, how to locate a code); while other guidelines are specific to the new codes (e.g., borderline diagnosis, laterality).
Chapter specific coding guidelines explain the finer points of some of the more complicated diagnoses, including anemia associated with other conditions, diabetes, hypertension with other diseases, injuries, HIV infections, sepsis, pressure ulcers, and pregnancy. These guidelines assist in determining sequencing, stages for some disease processes, and the hierarchy of certain codes.
Here are a few key areas to note:
• Anemia is sequenced as the principal diagnosis when associated with chemotherapy, immunotherapy, and radiation therapy. Anemia is sequenced as a second diagnosis when associated with a malignancy. This is also a case where the guidelines differ between ICD-10-CM and ICD-9-CM.
• Correctly applying the guidelines will also enable coding diabetes to the highest level of specificity. This should include the type of diabetes, insulin use, and diabetes with other conditions.
• Circulatory system diseases can be very intricate, but the guidelines explain the coding. Such is the case with hypertension with co-existing conditions. Information includes sequencing and use of additional codes when needed. Information and definitions are also included in the guidelines to explain acute myocardial infarctions (AMI). Again, there are significant changes from ICD-9-CM to ICD-10-CM; in this case the difference is in terms of the timeframe for current and old AMI.
• Coding injuries in ICD-10 brings many more code possibilities. The guidelines explain the seventh character requirements for both the treatment of a condition and the healing status of fractures.
Take a look at the conventions (1.A) for ICD-10-CM for starters. Note this important rule of thumb, right at the start of the section: "The conventions and instructions of the classification take precedence over guidelines." In other words, if the tabular index gives an instruction that differs from the guidelines in the front of the manual, follow the tabular index guidelines.
Highlights of the general conventions include:
1.A.4 and 1.A.5: Seventh character extenders and placeholders.
ICD-10-CM uses a placeholder “X” for two purposes:
• Future expansion
• Fill in the empty characters for codes that require a seventh character extender, but are not six characters in length.
Example: S09.21, traumatic rupture of right ear drum:
• Requires a seventh character
• The partial code is five characters in length
• A placeholder “X” must be used to append the seventh character
• An initial encounter would be S09.21XA.
1.A.12.a and 1.A.12.b: Exclusions
Excludes1: The code(s) listed under Excludes1 should never be coded with the code above the Excludes1 note.
Excludes 2. The conditions excluded are not a part of the condition listed above it (if the documentation states both conditions exist together, both should be reported).
Highlights of the general guidelines (Section 1.B) include:
If no bilateral code exists and the condition is bilateral, two codes must be assigned (one for right and one for left) to report the complete condition.
1.B.18: Signs/symptoms/unspecified codes
Unspecified codes have acceptable uses and are necessary at times, but each encounter should be coded to the level of certainty known. Example of appropriate use: When a definitive diagnosis has not been established by the end of the encounter.
You can never become too familiar with the guidelines. Study them and highlight the trickier areas for quick reference. This knowledge will prove to be incredibly helpful to you and your physician.
Brenda Edwards, CPC, CPMA, CPC-I, CEMC, entered the coding and billing profession 25 years ago, and has been involved in many aspects of the field. Her current responsibilities include chart auditing, coding and compliance education, and contributing articles to AAPC and industry publications. Brenda is an AAPC ICD-10 trainer and has presented for AAPC workshops, regional conferences, and local chapter meetings. She has also served on the AAPCCA Local Chapter Board of Directors.