6 Key ICD-10 Changes for Primary Care

Lea Chatham October 28th, 2013

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By Lisa A. Eramo

ICD-10 resources

The transition to ICD-10-CM isn’t without twists and turns; however, the ‘pot of gold’ at the end of the journey (i.e., more accurate data that can lead to better patient care) will surely be worth it. ICD-10-CM will allow primary care specialists to more accurately depict chronic conditions as well as other commonly reported diagnoses.

Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, CPEDC, CENTC, vice president of ICD-10 training and education at the American Academy of Professional Coders reviews some diagnoses to which primary care specialists should pay attention. Note that this is certainly not an all-encompassing list. Practices should examine their own top diagnoses and compare how those codes will change once ICD-10-CM goes into effect.

ICD-10-CM includes a whole slew of codes for headaches. For example, when a patient presents with a migraine (code G43), physicians must specify whether it’s common, hemiplegic, persistent, chronic, ophthalmologic, abdominal, or menstrual.

Cluster headaches and other trigeminal autonomic cephalgias (code G44.0) are grouped into episodic, chronic, episodic paroxysmal hemicrania, chronic paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache with conjunctival injection and tearing.

There are also codes for vascular headaches (G44.1), tension-type headaches (G44.2), post-traumatic headaches (G44.3), drug-induced headaches (G44.4), as well as a variety of other headache syndromes.

Many of the codes in the headache section also require the following documentation:

  • With or without aura
  • Intractable vs. not intractable
  • With or without status migrainosus

According to the Centers for Disease Control and Prevention, an estimated one in 10 adults reports depression. Depression codes have been greatly expanded in ICD-10-CM. When a patient presents with major depression (codes F32-F33), physicians must document the following:

  • Single episode vs. recurrent
  • Mild, moderate, or severe
  • With or without psychotic features
  • In partial or full remission

Ear infections
ICD-10-CM includes various codes to denote specific forms of a middle ear infection. These codes are grouped in H65-H67 and distinguish between the following forms of otitis media:

  • Serous
  • Allergic
  • Mucoid
  • Nonsuppurative
  • Suppurative
  • Tubotympanic suppurative
  • Atticoantral suppurative

Physicians must also document the following information for many of the codes in this section:

  • Acute vs. chronic
  • Laterality (left vs. right vs. bilateral)
  • Any associated perforated tympanic membrane

ICD-10-CM code I10 denotes essential (primary) hypertension. There are separate codes for hypertension involving vessels of the brain (codes I60-I69) and hypertension involving vessels of the eye (code H35.0).

ICD-10-CM also includes codes for hypertensive heart disease with or without heart failure (code I11), hypertensive chronic kidney disease (code I12, Note that physicians must document the stage of the chronic kidney disease), hypertensive heart and chronic kidney disease (code I13), and secondary hypertension (code I15).

Diabetes (codes E08-E13) has greatly expanded in ICD-10-CM. Physicians must document whether the diabetes is Type 1, Type 2, drug- or chemical-induced, or due to an underlying condition. They must document the specific underlying condition, the specific drug or toxin, as well as the use of any insulin. ICD-10-CM requires very specific details regarding any complications or manifestations of the diabetes. For example, code E08.341 denotes diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema. A careful review of diabetes codes is required to ensure compliance.

Asthma (code J45) is another diagnosis that was expanded in ICD-10-CM. Physicians must document whether the asthma is:

  • Mild intermittent
  • Mild persistent
  • Moderate persistent
  • Severe persistent

They must also specify whether the asthma is uncomplicated, with acute exacerbation, or with status asthmaticus.

Other interesting codes
Chapter 21 of the ICD-10-CM Manual includes a whole slew of codes related to factors that influence health status and contact with health services. For example, primary care physicians may be interested in codes Z55-Z65, which pertain to health hazards related to socioeconomic and psychosocial circumstances. Codes in the Z68 category denote specific data related to body mass index. Codes in the Z72 category denote problems related to lifestyle (e.g., tobacco use, lack of exercise, and high-risk sexual behavior).

This chapter also includes codes for preventive care, such as Z01.3 (encounter for examination of blood pressure), Z01.4 (encounter for gynecological exam), and more.

About the Author

Lisa Eramo Freelance

Lisa A. Eramo (leramo@hotmail.com) is a freelance writer and editor based in Cranston, RI who specializes in healthcare regulatory topics, health information management, and medical coding.

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