ICD-10: Getting Ready When You'd Rather Ignore It

Betsy Nicoletti, MS


January 08, 2014

In This Article

Actions That Will Help You Be Ready

Remove Inactive Problems From Problem Lists in Your EHR

Physicians often tell me that they spend considerable clinical time "cleaning up" the problem list. There can be incorrect or resolved problems on a problem list if all ICD-9 codes that have ever been assigned are imported into the problem list (not a recommended practice when transitioning to an electronic record) or when preloading of the patient's conditions was performed by someone without a strong clinical background. An accurate problem list will help the clinician to select accurate ICD-10 codes more quickly.

Review Your Use of Unspecified Codes

Every coder will tell you to code diagnoses to the highest degree of specificity. Using unspecified ICD-9 codes will make the transition to ICD-10 more difficult. However, some conditions are accurately described with an unspecified code in both ICD-9 and ICD-10. For example, acquired hypothyroidism in ICD-9 is code 244.9 and is the correct code. There are more specific codes for postsurgical, postablative, iodine, or other iatrogenic types of hypothyroidism. This translates exactly in ICD-10 to E03.9, hypothyroidism, unspecified. It is a code that may be used on a claim form and accurately describes the condition.

Other unspecified codes, however, will be problematic. The code 174.9 is the ICD-9 code for malignant neoplasm of the breast (female) unspecified. There are 8 more specific ICD-9 codes that identify the exact location of the malignancy in the female breast. In this case, using the more specific, known location of the malignancy would allow for accurate ICD-10 coding, while the nonspecific code does not. There are over 50 ICD-10 codes in category C50.- that are defined by laterality, sex of the patient, and more exact location.

How can you determine if your unspecified codes need to be more specific? Try to code them in ICD-10, using a search function and from the clinical documentation. Make a list of the additional clinical documentation that is needed and give that information to physicians. Develop a list of these and post them around the office.

Get a Demo From Your EHR or Practice Management System

Take a test drive in your EHR or practice management system. Compile a list of your 25 most frequently used diagnosis codes. In your test system, try to search for those codes in your EHR and assign them as a reason for the visit or an indication for a test.

Most systems will have a mapping or translation program. One-to-one mapping is mathematically impossible when moving from 14,000 codes to 69,000 codes. It is imperative that groups check the accuracy of the mapping program by looking at complete descriptions of the ICD-10 codes (not shortened versions) either in a book or using an online program distinct from your EHR system. The goal here is to test the accuracy of the mappings before relying on them for claims submission.


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