ICD-10: Exact Symptom Location Becomes a Huge Deal

Betsy Nicoletti, MS


July 02, 2015

In This Article

Where Does It Hurt?

Location, location, location. It's the realtors' mantra in home sales. But it could also be an International Classification of Diseases, 10th edition (ICD-10) rallying cry. Increased specificity about location and the addition of laterality are key reasons that diagnosis coding increases from about 16,000 ICD-9 codes to almost 70,000 in ICD-10. In ICD-10, many conditions are specifically defined as occurring in the right, left, or bilaterally. This quick tour around the chapters of the ICD-10 will locate the conditions and diseases that are defined more specifically by location.

Many neoplasms are already well defined in ICD-9, and there are not significant changes in ICD-10, such as malignant neoplasms of the tongue or lip or gum. Neoplasms of the breast do increase, particularly for breast cancer in males. In ICD-9 there are only two codes, but in ICD-10, malignant neoplasms of the breast in males have all of the location choices as those in females. Both now have different codes for right, left, and unspecified. That has increased the number of male breast neoplasms from two codes to 27 codes.

In ICD-10, codes for eye diseases and ear diseases each have their own chapter. With the rare exception, the conditions in these two chapters have different codes for a condition on the right, the left, bilaterally and, of course, an unspecified code. ICD-10 always provides an unspecified code, in case the physician has not indicated if the condition was in, for example, the right knee, the left knee, or both knees. Groups should avoid using a diagnosis code such as "pain in knee, unspecified." Besides laterality, there are additional codes for conditions of the eyelid, defining if the condition affects the upper lid, the lower lid, or both.

The human body only has one heart, but many conditions in the circulatory chapter have new codes for the condition on the right, the left, bilaterally, or unspecified. Codes for atherosclerosis, embolism, and varicose veins all have increased specificity for location, laterality, and complications.

When coders want to sound alarm bells about implementing ICD-10, they often use skin codes as examples. Cellulitis explodes from 10 codes to over 40 codes. It is defined as cellulitis or acute lymphangitis, with laterality and with more specific locations. There are more than 125 nonpressure ulcer codes in ICD-10, with greater location specificity and laterality and one new feature: The stage of the pressure ulcer is built into the code.

Naturally, codes in the musculoskeletal chapter have increased greatly from increased specificity of location and laterality. Pain, arthritis, gout—all of these conditions have more code options than in ICD-9. Gout is a good example, going from less than a dozen codes in ICD-9 to more than 100 codes in ICD-10. How? First, it is defined by the type of gout, including chronic gout, lead-induced chronic gout, drug-induced chronic gout, chronic gout to due renal impairment, and other secondary chronic gout.

There are also codes for gout not defined as chronic. Chronic gout is further defined by the affected joint, such as shoulder, knee, elbow, toe, and many others, with a choice for multiple locations. And for chronic gout, a seventh character extender denotes if the gout is with or without tophus (tophi).

Conditions of the breast remain in the genitourinary chapter; some, like cyst, have a right/left choice and some, like breast mass, do not.


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