EM Coding Alert

Just because the book is thicker, doesn’t mean it is harder to use.

Flipping through your ICD-9 manual to find the right diagnosis code was probably second nature after so many years using that code-set. Now’s the time to get familiar with the ICD-10 code-set, so you can confidently choose the right code just as fast as you did before.

Follow these tips to help you to navigate the ICD-10 manual so your comfort level grows.

Check Out the Alphabetic Index

In the Alphabetic Index, you’ll find chapters divided up by letter with a list of terms and their corresponding code. This is where you’ll find the Index of Diseases and Injury, Index of External Causes of Injury, the Table of Neoplasms, and the Table of Drugs and Chemicals.

The obvious difference between the ICD-9 and ICD-10 manuals is how in-depth the coding options are under ICD-10. Here’s an example of an entry for “butted” in the Index of External Causes of Injury sections of both books:

ICD-9:

• Butted by animal: E906.8

ICD-10:

• Butted by animal: W55.82
• Bull: W55.22
• Cow: W55.22
• Goat: W55.32
• Horse: W55.12
• Pig: W55.42
• Sheep: W55.32

The differences between the two coding systems means that you’ll need very thorough documentation to choose the correct ICD-10 code. If you’re adding the “W” code to describe the cause of a patient’s injury, you’ll want to delve deeper if the doctor writes “The patient presents today for review of a head injury after being butted by an animal.” Instead, you’ll want to ask what specific animal was involved.

“Although in our infancy, the coding and auditing experts are already seeing where the providers’ documentation must improve,” says Suzan (Berman) Hauptman, MPM, CPC, CEMC, CEDC, director of PB Central Coding at Allegheny Health Network in Pittsburgh, Pa. “The specificity must be there as the unlisted, unclassified, or not otherwise specified codes will only go so far.”

Don’t Miss This Big ICD-10 Alphabetic Index Change

One of the biggest changes to your ICD-10-CM Alphabetic Index includes what ICD-9-CM currently terms Injury/Poisoning codes.

In Chapter 19: Injury, Poisoning And Certain Other Consequences of External Causes of the ICD-10 manual, you’ll find your injury codes are organized by body region, starting with the head and ending with the foot. For instance, you’ll find the S85 category for “Injury of blood vessels at lower leg level” followed by S86 for “Injury of muscle, fascia and tendon at lower leg level.”

Now Check out the Tabular List and Chapters

In the Tabular List, you’ll find 21 chapters, organized either by body/organ system (such as Diseases of the Circulatory System) or the etiology/nature of the disease process (such as Certain Infectious and Parasitic Diseases).

In addition, here are some differences to your chapters in ICD-10-CM:

• ICD-9-CM's chapter for the Diseases of the Nervous System and Sense Organs transforms into three separate chapters in ICD-10-CM.
• ICD-10-CM does not divide up the diagnosis codes for E Codes (External Causes of Injury and Poisonings) and V Codes (Factors Influencing Health Status and Contact with Health Services).
• Some chapters are reordered.
• These chapters are full of categories, subcategories, and codes. Remember, characters may be a letter or a number.

How to Decipher Code Categories

All categories are three characters. If a three character category doesn’t have any subdivisions, then this is a complete code.

Subcategories can have either four or five characters. These subcategories have codes listed underneath them that can expand up to seven digits. Some of these codes require a seventh digit and are invalid without them.