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

Betsy Nicoletti, MS

Disclosures

September 23, 2015

In This Article

More Complex Coding Requirements

History of a Condition

Like its predecessor ICD-9, ICD-10 has codes for family history or personal history of certain conditions. In the index, the history codes are divided into family history and personal history.

The family history codes are in categories Z80 to Z84 and include neoplasms, heart disease, nervous system disorders, mental health disorders, digestive disorders, and other conditions.

The personal history codes are in categories Z85-Z99. In addition to personal history of neoplasms, endocrine disorders, mental health issues, circulatory conditions, digestive conditions, and musculoskeletal conditions, there are codes to report ostomy status, acquired absence of a limb, noncompliance, and presence of an artificial medical device. All of these codes are in the last chapter of the ICD-10 book titled, "Factors influencing health status in contact with health services."

Report personal and family history codes when these are relevant to the patient's treatment.

Injuries Are Going to Hurt

Be kind to orthopedists, trauma surgeons, and emergency department physicians in October. The largest expansion in ICD-10 is in Chapter 19, the S and T codes, titled "Injury, poisoning and certain other consequences of external causes." These codes make up over 50% of all ICD-10 codes.

How did they get so big? Location, laterality, and the seventh character extender. The locations of injuries described in ICD-10 are much more specific and, when relevant, include codes for the right and left body part. If there's a sprained ankle or broken bone, it defines which ligament or which part of the bone is injured. And the seventh character extender—discussed in other tip entries in this article—defines the episode of care, for fractures healing status, and for a limited number of codes the Gustilo classification.

Clinicians: Use detailed descriptions for injuries. Coders: Be prepared to code from x-ray and procedure notes.

Joints, Bones, and Muscles

Chapter 13, "Diseases of the musculoskeletal system and connective tissue," is the chapter in which we find conditions related to joints, bones, and muscles.

Codes from this chapter are used for patients who have conditions that are a result of a previous injury or trauma or are recurrent conditions and conditions that are a result of the healed injury. A current, acute injury should be coded from Chapter 19. This chapter does include codes for pathologic fractures or stress or fatigue fractures. There is a code for osteoporosis without pathologic fracture and specific codes for osteoporosis with a current pathologic fracture. These codes frequently have laterality in their descriptions. For some conditions, such as osteoarthritis, there is a single code to report that the patient has the condition in multiple sites.

Use codes from the musculoskeletal chapter for nontraumatic conditions related to the bone, joint, or muscle.

Knowing When to Stop

The Centers for Medicare & Medicaid Services (CMS) recently released guides describing patient conditions and the associated ICD-10 codes.

One in the internal medicine scenario was a typical post-hospital follow-up visit, and CMS selected nine ICD-10 codes for the encounter. Physicians raise their eyebrows because of the sheer number of codes CMS suggested for an office visit (probably at a 99214 level). Because many medical practitioners are selecting their own codes in the electronic health record, submitting nine diagnosis codes will certainly slow the provider down.

Begin slowly in October when reporting ICD-10 codes and updating a patient's problem list. In the first months, two accurate codes are better than nine unspecified codes. As the patient's problem list is updated, gradually report more conditions on the claim form.

Know when to stop.

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