ICD 10 Coding Alert

Anatomy skills key to ICD-10-CM coding success.

So now that you've had an ICD-10-CM overview, have a look at some specific examples to help you apply the coding fundamentals, courtesy of Suzanne Leder, BA, M. Phil., CPC, COBGC, Certified AHIMA ICD-10 Trainer, executive editor with The Coding Institute.

Example 1: The physician sees a Medicare patient with osteoporosis who has a pathological humerus fracture.

ICD-9: You would report 733.11 (Pathological fracture of humerus) and 733.01 (Senile osteoporosis).

ICD-10: You would report M80.021d (Subsequent encounter for fracture with routine healing, postmenopausalosteoporosis with current pathologic fracture, right humerus). So this is a situation where ICD-10 consolidates these codes.

Example 2: A patient presents to your office with a prolapse of the anterior vaginal wall, which is commonly called a cystocele.

ICD-9: You would report 618.01 (Prolapse of vaginal walls without mention of uterine prolapse; cystocele, midline) or 618.02 (... cystocele, lateral).

ICD-10: When your diagnosis code system changes: Code 618.01 will become N81.10 (Cystocele, unspecified) or N81.11 (Cystocele, midline). Code 618.02 will become N81.12 (Cystocele, lateral).

Those are different looking codes, but their definitions aresimilar.

Example 3: Your physician treats a patient for a lower back pressure ulcer.

ICD-9: You should report 707.03 (Pressure ulcer; lower back) and an additional code from 707.20-707.25 (Pressure ulcer stages ...) to identify the pressure ulcer stage:

• 707.20 -- Pressure ulcer, unspecified stage
• 707.21 -- Pressure ulcer stage I
• 707.22 -- Pressure ulcer stage II
• 707.23 -- Pressure ulcer stage III
• 707.24 -- Pressure ulcer stage IV
• 707.25 -- Pressure ulcer, unstageable.

Note: If you look at those definitions, you'll see how the descriptor specifies the stage.

ICD-10: You don't have enough information. You need to know whether the ulcer is on the left or right. You'll report a single code. Some options will be (but are not limited to): L89.131 (Pressure ulcer of right lower back, stage I) L89.141 (Pressure ulcer of left lower back, stage I).

Bottom line: You'll need additional anatomic details when you start using ICD-10 in 2013. For instance, for the same lower back pressure ulcer, choosing the proper ICD-10 code will depend on whether the ulcer is on the left or right. Did your physician probably already document this? Yes. That information didn't matter for ICD-9. But ICD-10 will allow you to be more specific.

Also, note that rather than using two codes as you do under ICD-9, a single ICD-10 code will represent both the anatomic location and the stage, such as L89.131 (Pressure ulcer of right lower back, stage I) or L89.141 (Pressure ulcer of left lower back, stage I).