ICD-10: 26 Tips You Absolutely Want to Know!

Betsy Nicoletti, MS

Disclosures

September 23, 2015

In This Article

Important Coding Tips From A to Z

The 10th edition of the International Classification of Diseases (ICD-10) is almost upon you! Chances are you've been preparing, but the magnitude of the changes coming seems overwhelming to many physician practices. To help you manage the transition more easily, we've come up with an A to Z of 26 tips that can help you become more comfortable and more efficient with ICD-10.

A Is for Active Treatment

A is used for active treatment of an injury, not only the initial encounter. Injuries require a seventh character extender in ICD-10 that defines the episode of care and, for fractures, the healing status of the fracture. The diagnosis code for the injury remains constant throughout the care of the injury, but the seventh character extender changes.

This significant change can be confusing because of the short descriptor of A—initial care, D—subsequent encounter, and S—sequela. When does initial care stop and subsequent care begin? The general guidelines that introduce the 2015 ICD-10 book clarified this: Don't just use the seventh character solely on the first service with the patient; continue to use the A seventh character on follow-up visits while the patient is still receiving active treatment. Switch to D for subsequent care when the patient is receiving routine care in the healing or recovery phase.

When you see the A, don't think initial, think A for Active.

Bilateral Diagnosis Codes

The eye and ear chapters in ICD-10 are filled with the word "bilateral." Does the patient have otitis in the right ear, left ear, both ears, or an unspecified ear? (Unspecified ear is obviously the wrong choice here.) Both the musculoskeletal chapter and the injury chapter also have laterality in code descriptions. Does the patient have right knee pain, left knee pain, or pain in an unspecified knee?

If the patient has pain in both knees and there isn't a bilateral code, report two codes, right and left knee pain. Having a bilateral diagnosis code, however, doesn't change how we report the CPT code for procedure performed bilaterally. Continue to use modifier 50 on the CPT code and select a bilateral diagnosis code or report the condition twice using the diagnosis code for right and left.

Using a bilateral diagnosis code doesn't change CPT reporting.

Causes of Injury

How did the patient get hurt? What was the cause of the injury?

ICD-10 (like its predecessor, ICD-9) has an index of external causes that describe how the patient was injured. In both code sets, these codes are optional, although some payers may require external cause codes or slow down payment without them. The external cause codes in ICD-10 are detailed, sometimes funny, and difficult to search. If a worker's compensation or insurance company requires their use, plan on extra time to code the services. There are also three optional occurrence codes as part of the external cause code set. Look for a description of these under tip "Y."

Collect more detailed information about the cause of injury if payers require external cause codes.

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