ICD-10: Working Through the Basics

ICD-10 is 19 months away. Is your practice ready? Insert ominous tone here.

Ok, so maybe we still have some time to prepare. However, CMS recommends that medical practices take several years to prepare for implementation of the new code set, even though the deadline for ICD-10 has been pushed back repeatedly.

“It’s safe to say that ICD-10 will have a huge impact on healthcare administration.  Computer systems will require considerable adaptation and clinicians and staff will need a great deal of education prior to the transition,” said Alex Johnson, HIT Consultant and Founder of CredentialedCare.

With the ICD-10 transition scheduled to come into effect on October 12014, Power Your Practice wants to make sure your staff is fully aware of some of the most important ICD-10 basics.

“ICD-10 demands significantly more specificity in diagnosing and coding, something the healthcare landscape isn’t accustomed to or skilled in effecting at this time,” added Johnson. ” In the short-run, this could be highly disruptive to reimbursement patterns.  However, in the long run, the coding specificity will enable the public health system to target health promotion strategies in a more effective way and we predict that claims data will be more meaningful.”

So with no further delay, here are the basic guidelines for the ICD-10 transition:

  • The switch to ICD-10 does not affect Current Procedural Terminology (CPT) coding for outpatient procedures. Like ICD-9 procedure codes, ICD-10-PCS codes are for hospital inpatient procedures only. CPT coding is similar to ICD-9 and ICD-10 coding, except that it identifies the services rendered rather than the diagnosis on the claim.
  • ICD-10-PCS codes are composed of seven characters. Each character is an axis of classification that specifies information about the procedure performed. Within a defined code range, a character specifies the same type of information in that axis of classification.
  • ICD-10-PCS will not be used in the outpatient or office setting; CPT codes will continue to be used in these settings.
  • ICD-10-CM (CM = clinically modified) is a disease classification system that will be used by ALL healthcare providers in ALL settings when ICD-10 is implemented. ALL diagnosis codes will be created using ICD-10-CM conventions including both the inpatient and outpatient/office setting.
  • In ICD-10-CM, you will find that injuries are grouped by the body part rather than by categories of injury.
  • ICD-10-CM codes will work as the following: Characters 1-3 (the category of disease); 4 (etiology of disease); 5 (body part affected), 6 (severity of illness) and 7 (placeholder for extension of the code to increase specificity).
  • One of 34 possible values can be assigned to each axis of classification in the seven-character code: they are the number 0 through 9 and the alphabet (except 1 and 0 because they are easily confused with the number 1 and 0). The number of unique values used in an axis of classification differs as needed.

Now, let’s take a look at how a medical practice would code an initial encounter with a patient who sprained their right ankle using ICD-10-CM standards:

First off, the documented statement of “ankle sprain” leads us to ICD-10 Chapter 19 Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88). The ICD-10CM code for an ankle sprain is S93.4.

Next, we must specify what part of the body the injury occurred in digits 5 and 6.

  • S93.4- Sprain of ankle
    • S93.401- Sprain of unspecified ligament of right ankle
    • S93.402- Sprain of unspecified ligament of left ankle
    • S93.409- Sprain of unspecified ligament of unspecified ankle

The final 7 character is reserved for identifying the patient encounter.

  • A – Initial
  • D – Subsequent
  • S – Sequela

In this instance, the final ICD-10-CM code would be: S93.401A

See? Pretty simple. Well not really. That’s why coding experts recommend preparing for the transition by improving your clinical documentation, strengthening the relationship between clinicians and coders, implementing vigorous training, and locating resources for help. And of course, it’s better to do it sooner rather than later – you don’t want to be caught off guard when the deadline hits.

The ICD-10-CM, ICD-10-PCS code sets, and the ICD-10-CM official guidelines are available free of charge at www.cms.gov/ICD10.

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