Author Archive for Joe Rivet

A coding tip that will make your ears perk up

This is just one of hundreds examples of changes coming with ICD-10. Every family practice regardless of size should identify a person(s) to be the designated ICD-10 expert. To develop appropriate education, every practice should take the time to recognize areas upon which ICD-10 will have a significant impact. As we get closer to the October 1, 2013, ICD-10 implementation date, take your current encounter form and convert it to ICD-10. The ICD-10 codes published today may not be exactly the same in 2013, but this conversion could be a good tool to show senior leaders in your practice how specific this new coding system can be.

For example, ear wax removal currently has one code. But this will expand to four codes in ICD-10:

Diagnosis: Impacted Cerumen

ICD-9

• 380.4 Impacted cerumen

ICD-10

• H61.20 Impacted cerumen, unspecified ear
• H61.21 Impacted cerumen, right ear
• H61.22 Impacted cerumen, left ear
• H61.23 Impacted cerumen, bilateral

Excludes notes get a makeover in ICD-10

Excludes notes in ICD-10 will have a slightly different look.

Currently in ICD-9, there are simply excludes notes listed below codes in italic font. In ICD-10, there are two types of exclude notes:

• Excludes1: A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE!” An Excludes1 note indicates that the code excluded should never be reported with the code above the Excludes1 note. An Excludes1 is used to indicate when two conditions cannot occur together, such as a congenital form and an acquired form of the same condition.
• Excludes2: A type 2 Excludes note is used to indicate ”not included here.” An Excludes2 note means that the condition excluded is not part of the condition under which it is listed, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to report both the code and the excluded code together.

Consider the following ICD-10 code:

F11.2 Opioid dependence

Excludes1: opioid abuse (F11.1x) opioid use, unspecified (F11.9x)

Excludes2: opioid poisoning (T40.0x-T40.2x)

Note changes for OB codes in ICD-10

Even though it’s still early to start studying and learning ICD-10 codes, at this point you should at least take a look at codes you commonly assign to get a sense of the changes and to see whether there are any significant differences regarding coding conventions.

For example, note Chapter 11 in the ICD-9 Manual, “Complications of Pregnancy, Childbirth, and the Puerperium.” This chapter will be Chapter 15 in ICD-10. Rather than reporting codes according to the episode of care, coders will report pregnancy codes by trimester in ICD-10.

Currently under ICD-9, pregnancy coding is defined by the following episodes of care:

• Unspecified
• Delivered
• Antepartum

However, coders will report pregnancy codes in ICD-10 based on the stage of pregnancy:

• First trimester
• Second trimester
• Third trimester

According to ICD-10 guidelines, trimesters are counted from the first day of the last menstrual period, and they are defined as follows:

• First trimester: Fewer than 14 weeks, zero days
• Second trimester: Fourteen weeks, zero days to fewer than 28 weeks, zero days
• Third trimester: Twenty-eight weeks, zero days until delivery

Have you taken a look at the codes you will most frequently report for your specialty in ICD-10? Share your quick tip for your specialty codes.  Did any of the new codes or the code descriptions surprise you? What interested you most about the changes?

ICD-10 is more specific than ICD-9 most of the time, but not always

It is widely known that ICD-10 is going to be much more specific than ICD-9. While that is true, there are some ICD-9 codes that will not be as specific in ICD-10. Here are two examples:

ICD-9 codes:

• 010.90 Primary tuberculous infection, unspecified
• 010.91 Primary tuberculous infection, bacteriological/histological exam not done
• 010.92 Primary tuberculous infection, bacteriological/histological exam unknown (at present)
• 010.93 Primary tuberculous infection, tubercle bacilli found by microscopy
• 010.94 Primary tuberculous infection, tubercle bacilli found by bacterial culture
• 010.95 Primary tuberculous infection, tubercle bacilli confirmed histologically
• 010.96 Primary tuberculous infection, tubercle bacilli confirmed by other methods

ICD-10 code:

• A15.7 Primary respiratory tuberculosis

ICD-9 codes:

• 635.50 Legally induced abortion, complicated by shock, unspecified
• 635.51 Legally induced abortion, complicated by shock, incomplete
• 635.52 Legally induced abortion, complicated by shock, complete
• 636.50 Illegal abortion, complicated by shock, unspecified
• 636.51 Illegal abortion, complicated by shock, incomplete
• 636.52 Illegal abortion, complicated by shock, complete

ICD-10 code:

• O04.81 Shock following (induced) termination of pregnancy

Have you accessed the General Equivalence Mapping (GEM) tool on the CMS Web site to assist in converting policies, edits, and trend data from ICD-9-CM to ICD-10-CM/PCS? Did you think the GEM was useful?

Compare commonly used codes in ICD-9 vs. ICD-10

Since we have talked and read globally about ICD-10, I thought we should turn the pages a little deeper and look at some commonly used codes and see what they will look like October 1, 2013, when the new ICD-10 coding system takes effect. I selected codes for essential hypertension and elevated blood pressure reading.

There are some significant changes. The terms “benign, malignant, and unspecified” will no longer be used in defining the code selection. Also, another big change is that it appears the hypertension table is not used in ICD-10.

I took the codes in the current 2009 ICD-9 Manual and compared them to the most recent ICD-10-CM codes available. I created a table to illustrate the breakdown of this comparison.

Alleviate fears with ICD-10 fact sheet

Discussions are starting regarding ICD-10, and there are many rumblings in the coding community. Just like anything else, something new and different can bring on feelings of being overwhelmed. Yes, ICD-10 does have a different look and feel, but it is not as challenging as many may believe. Many people have expressed to me their fears about this new coding system, conveying that they have heard how difficult it will be to use ICD-10. I am posting an ICD-10 fact sheet CMS published that will hopefully alleviate some fears and end some of the myths generated in the coding community.

AHIMA will require CEUs to reflect ICD-10 proficiency

Currenty, the American Health Information Management Association’s (AHIMA) Council on Certification (COC) has made the following recommendations regarding how credentialed members (and certified nonmembers) would demonstrate proficiency in ICD-10.

• CEUs on ICD-10 will be required per credential. The COC has not yet determined the number of required CEUs per credential.
• These ICD-10 CEUs will be in addition to mandatory CEUs reported during a 2 year cycle.
• Credentialed members will need to report CEUs by October 1, 2013.