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

Betsy Nicoletti, MS


September 23, 2015

In This Article

More Coding Tips to Help With ICD-10

D: The Seventh Character Extender for Subsequent Trauma Care

The letter D is a seventh character extender for diagnosis codes from Chapter 19, "Injury, poisoning and certain other consequences of external causes."

The definition is found in its entirety at the start of the general guidelines. "[Seventh] character 'D' subsequent encounter is used for encounters after the patient has received active treatment of the condition and is receiving routine care for the condition during the healing and recovery phase." The guidelines give examples, such as cast change or removal, medication adjustment or other aftercare, and follow up visits following treatment of the injury or condition.

However, not all subsequent care is reported with D. For fractures, there are different seventh characters for fractures with delayed healing, nonunion, and malunion.

D is used on trauma codes for visits during the healing phase. Fracture care has more options.

Examination Coding

There are twice as many codes for annual gynecologic exam in ICD-10 as an ICD-9, increasing from one to two. And there are twice as many codes for a general medical exam.

That's because ICD-10 has codes for preventive exams with or without abnormal findings at the time of the visit. Does a provider need to wait for lab results in order to code the visit? No. The general guidelines section of ICD-10 states, "For example, if no abnormal findings were found during the examination, but the encounter is being coded before test results are back, it is acceptable to assign the code for 'without abnormal findings.'"

Let's say that at a well-child visit the clinician notes enlarged lymph nodes. Code the exam with abnormal findings and, in addition, add the code for enlarged cervical lymph nodes:

Z00.121—Encounter for routine child health examination with abnormal findings

R59.0—Localized enlarged lymph nodes.

There are also codes for with and without abnormal finding for general medical exams, vision exams, and hearing exams.

Reporting examination codes now requires the clinician to say whether it was with or without abnormal findings.

Fracture Coding

I could write books about fracture coding in ICD-10, but who would read them? When selecting a fracture code, first determine if the fracture is pathologic or traumatic. The clinician determines if the fracture is pathologic. A pathologic fracture is one in a patient with known osteoporosis who suffers a fracture, even if the patient had a minor fall or trauma, if that trauma would not normally break a bone in a healthy patient. A stress fracture is caused by repetitive rather than sudden trauma. Both of these types of fractures are in the musculoskeletal chapter and start with the letter M and require a seventh character extender.

Traumatic fractures are coded in the injury chapter and have multiplied like rabbits. Look for greater specificity in location (proximal, mid, distal), type (greenstick, torus), and episode of care. There are seventh characters for fractures with delayed healing, nonunion, or malunion, and some fractures also have seventh characters that describe the Gustilo classification.

Fractures are fraught with complexity in ICD-10.

Good Grief! (F43.21)

Mental health codes are found in Chapter 5, "Mental, behavioral, and neurodevelopmental disorders, F00-F99."

There are a few differences between coding for mental health disorders in ICD-9 and ICD-10. First there's a notation at the start of the intellectual disabilities category that states, "Code first any associated physical or developmental disorders."

Personal history of alcohol use is not in the last chapter along with other personal history codes. It is in the mental health chapter and is defined as alcohol dependence in remission F10.21. Substance-abuse codes are expanded greatly in ICD-10. Substance abuse codes are defined as use, abuse, or dependence, and many include "with" manifestations, such as with hallucination or with anxiety disorders. Use, abuse, and dependence are clinical terms—the clinician must define the patient's condition.

Coding for substance abuse has increased detail in ICD-10.


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