ED Coding and Reimbursement Alert
Fast Track Your ICD-10 Prep With 9 Strategies for ED Priority Diagnoses
Your choice of pain code will depend on the system where the pain occurs After much discussion about a possible implementation delay, ICD-10 is ready to go on October 1 of this year. As your ED coding team makes final preparations for go-live, you’ll benefit from reviewing these coding priorities for emergency medicine that your coding staff will need to successfully manage. Check in: By now your coding team should be proficient in ICD-10 and demonstrate that proficiency by coding parallel to ICD-9 on live charts that go through an internal audit process, advises Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, Chairman, Edelberg & Associates. This gives each coder an opportunity to fine-tune any areas that require additional focus and remediation. Streamline your ICD-10 prep with this helpful instruction from Edelberg on these top emergency medicine diagnosis areas: 1. Sepsis - When an infection is the principle diagnosis, report it first, followed by the non-infectious condition such as burn, trauma, etc. This chart summarizes your choices: 2. Dementia - Dementia is characterized by the development of multiple cognitive deficits such as memory impairment and cognitive disturbances, including aphasia, apraxia and agnosia which are coded to the Mental, Behavioral and Neurodevelopmental disorders (FXX) code set, says Edelberg. Alzheimer’s (G30) and Parkinson’s disease (G20) related dementia are coded first as the underlying disease, followed by the type of impairment, e.g. Dementia at F02.8. Dementia classified in subcategory F02.8 is due to direct physiological effects of a general medical condition, she confirms. If the patient has wandered off, Z91.83 would be assigned to the F02.81 or F03.91. 3. Hemiplegia and Hemiparesis - When identifying hemiplegia and hemiparesis, you should note whether the dominant or non-dominant side is affected, advises Edelberg. The official ICD-10-CM coding guidelines indicate that should the affect side be documented, but not specified as dominant or non-dominant, and the classification system does not indicate a default, your code selection should be considered as follows; 4. Pain - If the definitive diagnosis is known, do not report pain unless the reason for the encounter is pain control or management of pain and not treatment for the underlying condition, says Edelberg. The site of the pain is coded from Chapter 18, Signs, Symptoms and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified. If the pain is documented as acute or chronic, category G89 us appropriate, she notes. Codes from G89 are generally reported first, followed by the site if the encounter is specifically for pain management, says Edelberg. If the encounter is for other than pain control or pain management without a definitive diagnosis, assign a code for the site of the pain first followed by a code from the G89 category. Chronic pain is reported with G89.2x. It requires specific documentation that the pain is, indeed, chronic. There is no time frame for classifying pain as chronic, says Edelberg. The terminology for epilepsy has been updated, with terms to classify the disorder such as: Neoplasm related pain is coded with G89.3 and can be coded without acute or chronic status documented. 5. Epilepsy and Seizures - Within these various categories, more specificity is possible than with ICD-9, such as identifying seizures of localized onset, complex partial seizures, intractable and status epilepticus, Edelberg says. A note within category G40, Epilepsy and recurrent seizures, provides the following terms to be considered equivalent to intractable (this note also applies to category G43, Migraine): Epilepsy example, G40.909 (Epilepsy, unspecified, not intractable, without status epilepticus) and G45.9 (Transient cerebral ischemic attack, unspecified). 6. Headaches and Migraines - Headaches and migraines are common to the emergency department and will present somewhat of a challenge to ED coding professionals due to the level of specificity required in ICD-10, notes Edelberg. For example, the following table lists two common ICD-9 codes and their crosswalk to the comparative codes in ICD-10. 7. Musculoskeletal Pain/Injuries. Perhaps one of the more challenging sections of ICD-10 for physicians and coders is Chapter 13, says Edelberg. Diseases of the Musculoskeletal System and Connective Tissue will require a much higher level of specificity for documentation of location and type disorder and external causes of problems. (Fractures and dislocations are addressed in the Injury, Poisoning and External Cause section of ICD-10.) For example, patients who present with severe joint pain from arthritis will require additional documentation and coding of type of infection, where known and whether or not infection is direct or indirect, says Edelberg. Pain in joints or limbs without known cause (e.g., fracture, dislocation, foreign body) will be identified from this section of ICD-10, she adds. Some of the more common musculoskeletal disorders treated in the emergency department will include: Emergency physicians will need to document type of condition, location and type (infectious, chronic); causation (chronic, traumatic, post-procedural, infectious, initial, subsequent, sequela, etc.). Best practice: Design a form for providing feedback to physicians when too many “non-specified” conditions are coded due to incomplete documentation of details surrounding treatment of the disorder, recommends Edelberg. Back pain is a common complaint of patients seen in the emergency department. When possible, physicians should provide clarification of exact location and cause of back pain, says Edelberg. Also, if other areas are involved, be sure to identify them as well. For example, neck and back pain vs. back pain only. More specific detail provides a higher level of medical necessity to support the need for diagnostic testing. For patients that are admitted, a higher level of detail will support the appropriate DRG, she adds. Pain in a limb requires documentation of the exact location of the pain, e.g. The bottom line: Physician documentation will be critical to coding of the correct location and type of pain. 8. Diseases of the Eyes and Adnexa - Eye injuries and wounds are coded to the type of disorder injury (open wound of eyelid, superficial injury of eyelid or, for diseases of the ear, code first the condition followed by the code for the external cause of the condition, says Edelberg. However, not all not all eye problems appear in Chapter 7, she warns. Burns to the eye (T26-T28) and corneal abrasions without foreign body (S05.0xx), corneal and conjunctival abrasions with foreign body (T15.xxx) are defined in other chapters of ICD-10. For example, codes from the S05.0xx categories require a 7th characters to identify initial encounter (A); subsequent encounter (D); or sequela (S). Be sure to documentation of the exact location, type of injury, disease or underlying disease and exact location of the area being treated. Injuries and wounds are coded to the type of disorder injury (open wound of eyelid, superficial injury of eyelid or, for diseases of the ear, code first the condition followed by the code for the external cause of the condition, adds Edelberg. 9. Diseases of the Ear and Mastoid - Take note that Chapter 8 is an entirely new chapter in ICD 10 CM. It differs in that the conditions classified in this chapter are located in Chapter 6: Diseases of the Nervous System and Sense Organs. Diseases of the ear and mastoid process have been arranged into “blocks” making it easier to identify the types of conditions that would occur in the external ear (block 1), middle ear and mastoid (block 2), and inner ear (block 3). Block 4 is used for other disorders of the ear. Block 5 contains the codes for intraoperative and post procedural complications, which are grouped at the end of the chapter rather than scattered throughout different categories, warns Edelberg. Other changes are greater specificity added at the fourth-, fifth-, and sixth-character levels; the delineation of laterality; and the addition of many more ‘code first underlying disease’ notes. For example: The 5th character for H65.0 (Acute serous otitis media) is available to report the laterality as seen in the example below: One classification change in the chapter is that ICD 9 CM category 381 (Non suppurative otitis media and Eustachian tube disorders), has been split into two categories in ICD 10 CM; Diseases of the ear common to the emergency department include the following, she notes:
ED Coding and Reimbursement Alert
- Preparing for ICD-10 Implementation:
Fast Track Your ICD-10 Prep With 9 Strategies for ED Priority Diagnoses
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