An introduction to ICD-10

What is ICD and ICD-10?

  • ICD is the international classification of diseases -10th edition
  • It was created in 1989 (26 years ago by the WHO to replace ICD-9.)
  • It allows for more specific diagnoses, laterality, and timing codes since ICD-9 ran out of numbers for codes
    • How many people would end up with this specific code, V97.33XD-subequent encounter for being sucked into a jet engine as opposed to the first (and final) encounter, V97.33XA

Why is this useful?

  • Aids scientists in being more specific with their research
  • Gives payors better information on patient illness and injury trends

What do I have to do to be compliant?

  • In most of our practices, the provider documents a diagnosis and a coder translates that into an ICD code. The provider will need to provide more specific documentation than they are used to in order to allow the coder to pick the correct ICD 10 code
  • Specific documentation includes specific locations or parts of the body involved and the acuity
    • Rather than Diagnosis: “sprain”, you would put “Acute left ankle sprain” and if you knew which ligament, you’d put that as well, “Acute talo-fibular ligament sprain”
    • Rather than “Abdominal pain unknown cause”, you’d put “Mild(moderate or severe) acute exacerbation of left lower quadrant pain in early pregnancy”
  • If you do your own coding, you’ll need to enter codes in ICD 10 starting with October 1, 2015 date of service

Where can I find the codes if I do my own coding?

When do I need to be compliant?

  • I’ll be sending out more examples and tips as the summer goes on in preparation for the change on October 1, 2015.

If I use a code or diagnosis that is not specific enough, will I get paid?

  • Medicare and its contractors will not withhold payment for codes that are not specific enough for the first year
  • Private payors will probably take advantage of lack of specificity to deny claims beginning October 1, 2015. We’ll send more updates out in November through January as we learn how the payers will penalize us so we can avoid that going forward
  • Some diagnostic examples of complications or how complicated
    • Dehydration with hypernatremia(not just dehydration)
    • Upper GI Bleed with profound anemia
    • Pressure ulcer and burn staging
    • Hypertension with end organ dysfunction(pulmonary edema)-no longer malignant hypertension
    • Chest pain with concern for coronary ischemia(not just chest pain)