EM Coding Alert
Focus Your ED ICD-10 Prep on These Top-9 Codes, Part 2
According to the latest news, ICD-10’s official implementation date will be Oct. 1, 2015, and you should stop hoping for a delay. Like many medical practices, the American Medical Association (AMA) had been holding out for another delay, but they’re finally on board with the October start date. That means you need to be ready.
Last month, you learned how ICD-10 will change your diagnosis coding for four of the top diagnosis codes to support your emergency department (ED) visit codes. Now, here’s the scoop on the next five, including helpful guidance from Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, chairman, Edelberg & Associates.
5. Identify Epilepsy and Seizures Specifics
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):
6. Simplify Headache and Migraine Challenges
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 table below lists two common ICD-9 codes and their crosswalk to the comparative codes in ICD-10.
7. Check Location for 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), as well as 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 versus 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, and your physicians should start adding these details to their documentation now.
8. Move Beyond Chapter 7 for 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 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). For diseases of the ear, code first the condition followed by the code for the external cause of the condition, adds Edelberg.
9. Learn the Ear and Mastoid ‘Blocks’
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:
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