ICD-10 Fundamentals and Navigation

Editor's Notes

• #4: ICD-10 can be overwhelming, but, with some strategizing and planning it can be managed. In this presentation we will look at a few ICD-10 fundamentals, then familiarize ourselves with three methods for finding the right ICD-10 code. Each one is a different path, but all lead to the same destination: the right code.
• #14: Let’s see how this looks in a coding manual. This is the beginning of chapter 8, which covers Diseases of the Ear and Mastoid Process. Every code in this chapter begins with the letter “H”. It spans the range of H60 to H95. Notice all of the rules listed under the chapter heading. These guidelines apply to every code in this chapter, so it is important to come back to them from time to time to make sure your code is the right one.
• #16: A chapter is divided into blocks, or a range of three-digit categories. This one is Diseases of Middle Ear and Mastoid (H65-H75). If there were guidelines that pertained to the whole block, they would appear under this heading. The formatting here makes it easy to see when a new block begins.
• #18: Blocks are divided into three-digit categories. This one, H65.-, is for “nonsuppurative otitis media”. Notice that the formatting here makes it easy to spot when you are at the beginning of a new category because of the line above the three-character heading. Also notice that H65.- is followed by a hyphen, which indicates that this is not a complete code. All of the complete codes on this page lack a hyphen and are in bold. Some complete codes on this page have five and six characters.
• #20: Once you add a fourth or fifth character you have entered a subcategory. This one is ‘acute serous otitis media,’ which is a condition where fluid is trapped in the middle ear and can become infected. Notice that the subcategory is still not a complete code because it is not in bold and it has a hyphen, which tips off the reader that he or she needs to keep adding characters. However, there is a second diagnosis present under the subcategory description that indicates these codes also apply to patients diagnosed with ‘acute and subacute secretory otitis’ This is when thee fluid that has accumulated behind the eardrum, during the acute infection, remains after the infection resolves. The fifth character specifies laterality. We will come back and visit this code category in a minute.
• #22: A complete code may contain anywhere from three to seven characters. Complete codes are listed in bold print and do not have a hyphen. When a bolded, six-character code is followed by an underscore (_) in this book, it signifies a 7th and final character is required to complete the code.
• #23: The examples shown to you were from the InstaCode ICD-10 specialty books. There are 24 different specialties, each with their own customized ICD-10 guide and Tabular List. Come to our booth to see some examples and get a flyer. We have special pricing available for those who wish to order one today.
• #24: Extension 7th character is for obstetrics, injuries and external causes
• #25: Here is a real code that clearly demonstrates the additional detail available in ICD-10. The first three characters (M1A) represent the category, which is a group of related conditions. This one is chronic gout. The other gout category is M10 and it contains acute gout. The fourth character identifies the cause or etiology for this case of gout. There are actually six different digits that could go here, but we have selected the “3” for “renal impairment”. The fifth character identifies the location. Even though gout usually occurs in the big toe, there are ten choices for this character, each one a different joint where gout could occur. The sixth character is a “1” for right, “2” for left, or “9” for unspecified. This is one of the new features of ICD-10 that ICD-9 lacked: laterality. This category is one that offers a seventh character extension. It is a “0” or a “1” for without and with tophus, which is an accumulation of uric acid crystals in the joint. You can see that this seven character code tells quite the story. A third party is less likely to ask for documentation when all this detail appears on the claim form. It is interesting to note that there are 11 codes for gout in ICD-9, but 365 in ICD-10, just because of all of the extra detail available.
• #26: To illustrate to you just how detailed ICD-10 can be, we will take this ICD-9 code and translate it so that you can see how much information can be conveyed in the new codes. This a an actual ICD-9 code.
• #27: Here we see the first four characters of the ICD-10 equivalent. Not much new yet.
• #28: As we add the fifth character we see some detail, but the code does not really offer anything that the ICD-9 equivalent did not.
• #29: Now it gets interesting. The ampersand symbol offers the gender of the patient.
• #30: The greek letter, “mew”, describes the patient’s vertical stature.
• #31: The hashtag identifies the patient’s hair status
• #32: The dollar sign describes his or her fashion choice.
• #33: And the euro symbol identifies the phase of the moon at the time of the incident. So, if you have not already guessed, most of this is made up. Symbols are not used in ICD-10, just letters and numbers. And the codes can be up to seven characters long, not ten, like this silly code. However, the characters and description you see in blue, V97.33 are all part of a real code. Some ICD-10 naysayers suggest that the codes are useless because they provide detail that is not necessary. However, as you will see, much of the detail in real codes can actually be quite helpful in communicating the medical necessity of a claim to a third party payer.
• #47: Define the unfamiliar terms: Pertrochanteric and Subtrochanteric