ED Coding and Reimbursement Alert

From extreme epistasis to dolphin bites, specificity is all important with ICD-10

How specific? You'll need to know if that spacecraft collision injuring an occupant was an initial or subsequent encounter!

Although continued efforts are underway to postpone this implementation, you should move forward assuming that the official startup on Oct. 1, 2013 will not be delayed, says certified ICD-10 instructor Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC; AHIMA, President, Edelberg Compliance Associates, Baton Rouge, LA. Read on for Edelberg's instruction on how ICD-10 will affect ED coding and tips for a smooth transition.

Brush Up on Basic ICD-9, ICD-10 Differences

ICD-10-CM codes are the ones designated for use in documenting diagnoses. They are 3-7 characters in length and total 68,000, while ICD-9-CM diagnosis codes are 3-5 digits in length and number over 14,000. The ICD-10-PCS are the procedure codes and they are alphanumeric, 7 characters in length, and total approximately 87,000, while ICD-9-CM procedure codes are only 3-4 numbers in length and total approximately 4,000 codes.

Take a look at the following format diagrams that illustrate the differences in code structure between ICD-9 and ICD-10:

The number of codes has increased significantly, and the reformatting of the number of characters per code and the demands for increased code specificity require significant planning, training, software/system upgrades/replacements. The move to ICD-10 impacts other coding and billing systems as well. As of January 1, 2012, the HIPAA transaction standards known as "5010" requires revision to accommodate ICD-10 codes, says Edelberg.

Get ED Physicians Ready for These Specifics

Although the major impact with be on IT systems and coding professionals, the dramatic change in ICD-10 code descriptions will mean your physicians will need to upgrade their documentation practices at all levels. Providers will be required to look differently at how differential diagnoses, final diagnoses, operative notes, diagnostic interpretations and more are documented, says Edelberg.

For a sneak peek at what's coming ED coding, compare these common ED diagnosis statements and the associated codes in ICD-9 and ICD-10:

Documentation pointer: Don't let the complexities of the new system throw you. Because so many conditions are combined into one ICD-10 code where they were previously identified individually, you will see complex statements like those below bundled into one specific code:

Anatomy rules: Providers will be required to provide a higher level of anatomical detail in notes and note conditions such as "stabbing", "visible", "extreme" and a more specific and exact location of problem.

Coma Scale? Make sure you know it: Documentation of a Glasgow Coma Scale will be required for coding many neurologic complaints and will require that coders clearly understand how the Coma Score translates to conditions recognized for coding, (e.g. motor response, verbal response, eye opening). Expanding documentation "macros" and templates will be a significant component of the transition to ICD-10, says Edelberg.

Humor helps: Although preparation for ICD-10 is serious business, to provide some comic relief for what promises to be a bumpy road ahead, consider the following conditions that will be addressed by ICD-10 External Causes of Morbidity: