EM Coding Alert

ICD-10:

Review the Changes to Your Most Common Diagnoses

Make sure your provider’s documentation will lead you to the right code.

Hopefully your practice is starting to see payment on claims you’ve submitted using ICD-10 codes. If you’re seeing some denials on those claims, you should take a deeper review of your practice’s most commonly billed diagnoses and ensure your providers are up to speed on the documentation you’ll need to select the right ICD-10 code.

CMS provides a good resource on its “Road to 10” website (www.roadto10.org) that illustrates some of the most commonly used codes and their ICD-10 changes by specialty. Here is just a sampling of the most-used codes in family practice that will experience significant changes in ICD-10:

1. Hypertension: In ICD-10, the concept of “benign or malignant” relating to hypertension no longer exists, and hypertension is defined as essential (primary), according to CMS. When documenting hypertension, you will need to include: 1) type (e.g., essential, secondary, etc.) and 2) causal relationship (e.g., renal, pulmonary, etc.). You will also need to document tobacco use or exposure.

2. Asthma: ICD-10 has updated the terminology used to describe asthma to reflect the current clinical classification system, CMS says. When documenting asthma, you must include:

A. Cause — Exercise induced, cough variant, smoking-related, chemical or particulate cause, or occupational.

B. Severity — For persistent asthma patients, choose one of thefollowing:

  • Mild persistent
  • Moderate persistent
  • Severe persistent

C. Temporal factors — Acute, chronic, intermittent, persistent, status asthmaticus, or acute exacerbation.

3. Underdosing: This is a new concept and term in ICD-10, allowing you to identify when a patient is taking less of a medication than prescribed, CMS says. When documenting underdosing, you must include:

  • Intentional, Unintentional, Noncompliance — Is the underdosing deliberate (e.g., patient refusal)?
  • Reason — Why is the patient not taking the medication (e.g., financial hardship, age-related debility)?

4. Diabetes: Coding for diabetes mellitus has more specificity, with a combination of ICD-10 codes that include the type of diabetes mellitus, the body system affected, and the complications affecting that body system, according to CMS. ICD-10 no longer uses the concept of “secondary diabetes mellitus,” but instead provides specific secondary options.

When documenting diabetes mellitus, include:

  • Type — e.g., Type 1 or Type 2 disease, drug or chemical induced, due to underlying condition, gestational, etc.
  • Complications — What (if any) other body systems are affected by the diabetes condition (e.g., foot ulcer related to diabetes mellitus)?
  • Treatment — Is the patient on insulin?

In ICD-10, the concepts of “hypoglycemia” and “hyperglycemia” have changed. You can now document and code these conditions without using “diabetes mellitus” and specify if the condition is due to a procedure or other cause, CMS notes.

5. Injuries: When it comes to increased specificity under ICD-10, the new coding for injuries takes the cake. While ICD-9 used separate “E codes” to record external causes of injury, ICD-10 more thoroughly incorporates these codes and expands sections on poisonings and toxins, CMS notes. When documenting injuries, you should include:

  • Episode of care — e.g., Initial, subsequent, sequelae.
  • Injury site — Be as specific as possible.
  • Etiology — How was the injury sustained (e.g., sports, motor vehicle crash, pedestrian, slip and fall, environmental exposure, etc.)?
  • Place of occurrence — e.g., School, work, etc.
  • For initial encounters, you may also need to include (where appropriate):
  • Intent — e.g., Unintentional or accidental, self-harm, etc.
  • Status — e.g., Civilian, military, etc.