Three Steps to Selecting ICD-10 Codes Accurately

March 5, 2014

Avoid disruptions in your practice’s reimbursement by following these three steps to submit the most accurate code the first time, every time.

The implementation date for ICD-10 is quickly approaching.  The new code set could be thought of as an enhancement of our current ICD-9 codes.  ICD-10 will allow for a more accurate story to be told about the condition(s) for which the patient is being treated. 

With nearly 70,000 codes, it will be virtually impossible to memorize codes as in the days of ICD-9.  The use of unspecified codes could be restricted by payers and the importance of proper look-up cannot be over emphasized. 

Here are three steps to ensure you select the proper ICD-10 codes:

Step 1: Find the condition in the alphabetic index.
Begin the process by looking for the main term in the alphabetic index.  After locating the term, review the sub terms to find the most specific code available.  Instructional notes in this section will help guide the reader with information such as “see,” “see also,” “with,”"without,” “due to,” and “code by site.” 

Step 2: Verify the code and identify the highest specificity.
The second step in the process is verifying the code in the tabular index.  This is the alphanumeric listing which organizes codes by disease and injury.   Additional detail is found here to create the most complete code.  For example, the default code for asthma in the alphabetic index is J45.909.  If is the reader selects this code without consulting the tabular index, an unspecified code would be reported. 

The tabular index identifies severity (intermittent, mild persistent, moderate persistent, or severe persistent) as well as complications such as an acute exacerbation or status asthmaticus.  Notes provide guidance for additional conditions which would need to be reported to identify exposure to tobacco smoke or use of tobacco. 

The tabular index also contains information identifying the length of a code; this is important since a code is anywhere from three to seven characters long.  This index includes additional information such as “Excludes 1” and “Excludes 2” status.  The exclude notes identify codes that you can never reported together (Excludes 1) and codes that you can never report at the same time (Excludes 2). 

An example of this is code J04.0 (acute laryngitis).  The information below the code has an entry for “Excludes 1” indicating it would be inappropriate to report J05.0 (acute obstructive laryngitis) since laryngitis is already included in J04.0.  An additional note is found for “Excludes 2” which instructs it could be appropriate to report J37.0 (chronic laryngitis) with J04.0 since a chronic condition and an acute exacerbation could occur at the same time.

Step 3: Review the chapter-specific coding guidelines. 
The final step in locating a code is a review of the chapter-specific coding guidelines found before the alphabetic index of the ICD-10 manual.  This index includes guidelines for specific diagnoses or conditions.  Some of the more complex diagnosis codes can be found here including HIV and sepsis. Without consulting this section, important sequencing guidelines would be missed. 

For instance, anemia sequencing varies when it is reported with neoplasm.  If you are treating a patient for anemia that is associated with a malignancy, the sequencing order is different than if you are treating a patient for anemia associated with chemotherapy, immunotherapy, and radiation therapy.   

Disruption in reimbursement could occur during the transition from ICD-9 to ICD-10.  One way to mitigate this is by ensuring the most accurate code is initially submitted.  Accomplish this by doing the three-step approach in finding the condition in the alphabetic index, verifying the code and looking for the highest specificity in the tabular index, and reviewing the chapter-specific coding guidelines for any additional guidance.