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

Betsy Nicoletti, MS

Disclosures

September 23, 2015

In This Article

Coding Becomes Much More Precise

Location, Location, Location

Who hasn't heard a realtor describe the location of an apartment or house as a key factor? But, "location, location, location" could also be an ICD-10 rallying cry.

There aren't any additional parts of the human body, but ICD-10 defines them in more detail. Was the skin ulcer on the left upper back or the right upper back? Which lid (or lids) suffered from conjunctivitis? Which ligament of the ankle did the patient sprain? The increase in location codes is most notable in chapters related to eyes, ears, skin, the musculoskeletal chapter, and trauma. Clinicians may find that their coders are asking them for more detail, and coders may find that it takes more time to code certain conditions and may require review of diagnostic reports for accuracy.

One of the key changes in ICD-10 is increased specificity for location.

Mapping

Medical practitioners see ICD-10 codes in their electronic health record next to the ICD-9 codes and think, "I'm done here, right? My system already has the ICD-10 codes in it."

But accept those mapped codes with a grain of salt. Or maybe a salt shaker worth of salt. Not all mapped codes are created equal. Some were essentially mapped automatically while others were cross walked by a knowledgeable human being.

Also, if the code is unspecified in ICD-9, and it is mapped, it doesn't get any more specific in ICD-10. For some conditions, there was an explosion of codes, and so accurate mapping is impossible. For example, in ICD-9 there were about a dozen codes for gout, but there are hundreds of codes for gout in ICD-10, making accurate mapping impossible.

Verify mapped codes by reviewing the complete ICD-10 description.

Neoplasms

Experienced coders will find that coding neoplasms is easy and familiar in ICD-10. The neoplasm chart moved from the "N" section of the index to the back of the index, but its utility remains the same.

When selecting a neoplasm code, start with histology if known or with the location or organ in the neoplasm table. The neoplasm table is organized by location and by type of neoplasm—malignant primary, malignant secondary, in situ, benign, uncertain, and unspecified behavior. Then turn to the tabular listing to select the code. Some cancers have additional codes for location. Breast cancer in male patients expands from two codes to many by including location, and both male and female breast cancer have different codes for neoplasms of the right and left breast.

Experienced coders will find coding neoplasms straightforward.

Obstetric Coding

Codes in Chapter 15, "Pregnancy, childbirth, and puerperium" begin with the letter O, not to be confused with the number 0. Codes for supervision of normal pregnancy are found in the last chapter of ICD-10.

However, when a pregnancy or delivery is complicated by a maternal condition, just like in ICD-9, there are disease-related codes to describe the condition. Codes from this chapter are only used on the mother's record, never on the baby's record.

Some codes in this chapter are defined by trimester—a new feature of ICD-10. Also, there's a note to use an additional code from the final chapter category Z3A to identify the specific week of the pregnancy. In another change, if the mother is carrying more than one fetus, there are delivery codes that use a seventh character extender to identify the fetus.

Some pregnancy-related conditions are defined by the specific trimester.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....