ICD-10 Training Camp: A Closer Look at the New Guys in Town

Nancy Maguire, ACS, PCS, FCS, HCS-D, CRT February 6th, 2012

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I guess people are nervous about ICD-10 codes because the thought of alphanumeric codes and 7 characters is a far cry from ICD-9 numerical three to five digit codes.  Actually, there is a lot more to these codes.  Detailed description of body parts will require detailed documentation by the provider.  For example, a non-displaced transverse fracture of shaft of right fibula (S82.424-) requires a 7th character to describe status of an open or closed fracture.  If the diagnostic statement was a subsequent encounter for closed fracture with malunion, the full code assignment would be S82.424P.  This information must be documented in the medical record; it is never assumed by the coding professional.  The anatomy of the bones in chapter 19 (Injuries and Poisoning) is very specific and anyone coding these encounters should have advanced knowledge of the musculoskeletal system.

In the case mentioned above, you must know the difference between a displaced versus a non-displaced fracture.   Displaced and non-displaced fractures refer to the way the bone breaks.  In a displaced fracture, the bone snaps into two or more parts and moves so that the two ends are not lined up straight. In a non-displaced fracture, the bone cracks either part or all of the way through, but does not move and maintains its proper alignment.  A transverse fracture is a fracture at a right angle to the bone’s axis.  The fibula is a slender bone that is located posterolaterally to the tibia. Isolated fibular shaft fractures often present after the description of a direct blow to the lateral leg and the patient will usually report pain and swelling.  A malunion is a broken (fractured) bone that has healed in an unacceptable position that causes significant impairment–this is a complication of a fracture.

There are several new terms and categories in ICD-10-CM that are not in the ICD-9 classification. Primarily, changes in ICD-10-CM are in its organization and structure, code composition, and level of detail. ) New features include the inclusion of clinical concepts that do not exist in ICD-9-CM (e.g., underdosing, blood type, blood alcohol level, as well as laterality).

Underdosing is a new term in ICD-10

Underdosing is a new term in ICD-10.  An “underdosing” code is also found in chapter 19 to describe taking less of a medication than is prescribed or instructed by the manufacturer, whether inadvertently or deliberately.  Categories T36-T50, have subcategories for underdosing of drugs.  These codes require a 7th character extensor to describe an initial encounter (A), subsequent encounter (D), or sequela encounter (S).   It is important to remember the underdosing codes are always a secondary code assignment.  An example would be underdosing of tetracyclines, initial encounter code T36.4x6A.  The first-listed code would be the event triggered or prolonged due to this circumstance; for example, bacterial pneumonia (J15.9).  The underdosing code, T36.4x6A, would be the secondary code assignment.

Blood type is a new category (Z67) to describe a specific blood type.  Type A blood, Rh positive is code Z67.10.  Type A- blood, Rh negative is assigned code Z67.11.  There are additional codes to describe Type B, AB, and Type O blood, whether positive or negative.  Codes Z67.90 and Z67.91 describe unspecified blood type, positive or negative. These codes (Z67.-) are always a secondary code assignment.

Blood alcohol level measurements are found in chapter 20, External Causes of Morbidity.  Category Y90.-  “Evidence of alcohol involvement determined by blood alcohol level”,  is used to describe supplementary information concerning causes of morbidity.  These codes are not to be used for single-condition coding.  There is a note under the Y90 descriptor to “Code first any associated alcohol related disorders (F10”).

Laterality is a new concept used in ICD-10-CM code assignment

Laterality is a new concept used in ICD-10-CM code assignment.  Most of the codes within chapter 13 have site and laterality designations.  Chapter 13 covers diseases of the musculoskeletal system and connective tissues (M00-M99).  All codes that have laterality requirements require you to identify if the disease, injury, or diagnoses is located on the right or left side or unspecified.  Laterality codes can be found in the eye (Hoo-H59) and ear (H60-H95) chapters as well as neoplasm (C00-D49) and skin codes (L00-L99).  The nervous system, chapter 6 (G00-G99) also has codes with laterality regions.  For example, G57.61 describes a lesion of plantar nerve, right side.  This is just an example, there are more chapters that include laterality in the code descriptors and the coder must be aware of this concept and physicians educated on documentation requirements of site and laterality.

This article has looked at several new and wonderful changes we can expect with implementation of ICD-10-CM.  It is best to take a positive approach to learning how these new guys function because they are here to stay.  As you live with them on a daily basis they will become user-friendly, you just have to give them a chance!  ICD-9 survived for 30 years but it’s time to move on and allow new blood into our coding lives with greater functionality and data gathering abilities.

Nancy Maguire discusses several new and wonderful changes we can expect with implementation of ICD-10Nancy Maguire, ACS, PCS, FCS, HCS-D, CRT, author of The Nancy Maguire GPS to ICD-10-CM Planning and Implementation Guide, is a nationally-renowned procedural and diagnostic coding instructor, bootcamp trainer, and workshop leader. She has spent more than 30 years as a hands-on coder and has authored countless coding articles and presentations. She served the first two terms as president of AAPC in the early 1990s.

Hear Nancy speak in two complimentary archived webinars on ICD-10 presented by Kareo medical billing software: How to Prepare for ICD-10/5010 to Reduce F41.1 (Anxiety Reaction) or Preparing for ICD-10-CM: The Nitty-Gritty of Diagnosis Coding. You can also read her entire series of articles on ICD-10.

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