Home Health ICD-9/ICD-10 Alert

Watch Injury/Poisoning codes and E codes transform.

The Centers for Medicare & Medicaid Services has pushed off the ICD-10 transition deadline to October 1, 2014, but you'll still need to prepare for the change. Happily, you will find that your ICD-10-CM coding manual is similar to your ICD-9-CM one, which means you likely already know how to use it. However, don't miss these subtle differences in your Alphabetic Index and Tabular List.

Just as is true in your ICD-9 manual, in the Alphabetic Index of your ICD-10 manual, you'll find diagnoses divided alphabetically with a list of terms and their corresponding code. This is also where you'll find the Index of Diseases and Injury, Index of Eternal Causes of Injury, the Table of Neoplasms, and the Table of Drugs and Chemicals. The Table of Neoplasms is separate in the ICD-10-CM manual instead of within the alphabetical index.

Here is an example of how atrial fibrillation appears in the Alphabetic Index.

• atrial or auricular (established) I48.91
• chronic I48.2
• paroxysmal I48.0
• permanent I48.2
• persistent I48.1

ICD-10 Differences: Here are a couple changes you'll notice in the ICD-10-CM Alphabetic Index:

• You won't find morphology codes listed alongside descriptors and standard codes. Morphology codes no longer have a separate appendix either.
• The Table of Drugs and Chemicals contains an under-dosing column.

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).

ICD-10 Differences: 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 Chapter 19 (Injury, Poisoning And Certain Other Consequences of External Causes) organizes injury codes by body region, starting with the head and ending with the foot. For instance, you'll find the S75 category for Injury of blood vessels at hip and thigh level followed by S76 for Injury of muscle, fascia and tendon at hip and thigh level.
• ICD-10-CM divides up the ICD-9-CM codes for E Codes (External Causes of Injury and Poisonings) into V, W, X and Y codes. These codes are found in Chapter 20 (External Causes of Morbidity). Chapter 20 codes specifically capture:
• what caused the injury or health condition,
• the intent behind it (such as unintentional or intentional),
• the place where an event occurred,
• what the patient was doing at the time, and
• the patient's status (such as civilian or military).
• But as a home health coder, you will only be responsible for coding what caused the injury or health condition. This will be a requirement -- not an optional code. As far as the other types of external codes, home health agency coders will not be required to use them.
• Some chapters are reordered.

All categories In ICD-10 begin with the base 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.

Here's an example of how Alzheimer's disease appears in the Tabular Index:

You'll notice that each code includes an entire title. You will no longer have to reference the category title to determine the complete title for a specific code. For example, if you were coding for Alzheimer's disease with early onset in ICD-9-CM (if this code existed), the fourth digit would state With early onset and you would have to reference the category title to get the rest of the code title -- Alzheimer's disease.