Revenue Cycle Insider

Remember the quirkiness of the Index.

You probably know that a fear of confined spaces is known as claustrophobia. You might also know how to find the ICD-10 code for the condition by beginning with the entry “Fear of” in the ICD-10 Index. That directs you to another entry, “Phobia,” where you find a subsequent entry, “closed in spaces,” which then leads you to the correct code for the condition: F40.240 (Claustrophobia).

However, outside of behavioral health coding, when would you use that particular code? That was one of the questions posed by Anders Yanike, CPMA, CDIP, CCS, coding auditor/educator for Lifebridge Health in Baltimore and Covenant HIM in Georgia, in his HEALTHCON Regional 2024 presentation, “Fantastic Codes and Where to Find Them.”

In fact, the code could well be used to justify to insurance that a patient required open magnetic resonance imaging (MRI) rather than the standard, closed version due to the phobia. That’s why, Yanike argued, your ability to not only locate, but also to correctly use, codes that are unfamiliar to you is so important.

Here are some more of Yanike’s tips and tricks that you can implement the next time a particularly sticky scenario comes across your desk.

Don’t Be Afraid to Use Other Phobia Codes

Another code you should be familiar with is F40.231 (Fear of injections and transfusions). The code for this phobia, formally named trypanophobia, could come into play when justifying increased care for a patient when administering intravenous (IV) medications, according to Yanike.

In fact, other codes in the F40.23- (Blood, injection, injury type phobia) code group, including F40.230 (Fear of blood) and F40.232 (Fear of other medical care) are also worth keeping close at hand. They, too, could possibly help in justifying altered or prolonged medical care for patients above and beyond care normally associated with a particular condition.

Don’t Overlook These Chapters

Yanike also highlighted various ICD-10 chapters, including Chapter 17: Congenital Malformations, Deformations, and Chromosomal Abnormalities, because this chapter is “very inclusive” and “any possible anatomical site you can think of does have a code.” For example, “there’s a code for congenital malformation of the nails [Q84.6] or the hair [Q84.1 or Q84.2]; you might not think of that,” Yanike observed.

Similarly comprehensive, Chapter 18: Symptoms, Signs, and Abnormal Clinical/Laboratory Findings Not Elsewhere Classified provides a wealth of codes that you can turn to when your provider describes a condition as either possible or probable. So, a code such as R25.0 (Abnormal head movements) could be very useful in situations where a provider diagnoses a patient with possible Parkinson’s, Tourette’s, or even autism, but cannot offer a definitive diagnosis until the patient receives more testing or screenings.

Exercise Caution with Similar Descriptors

Yanike also advised exercising caution when using some codes, as assigning them can be more complex than it seems. As an example, Yanike offered Z91.02 (Food additives allergy status), which is a very specific food allergy to additives such as sulfites, preservatives, or dyes in foods. The allergy should not be confused with other food allergies, such as those to nuts or shellfish.

Similarly, Yanike highlighted Z91.82 (Personal history of military deployment) and noted its similarity to Z86.51 (Personal history of combat and operational stress reaction). Both look and sound similar, but both have distinct meanings and should be chosen cautiously. So, Z86.51 would, perhaps, be a more appropriate code to use with F43.1- (Post-traumatic stress disorder (PTSD)) than Z91.82, as the Z86.51 is more indicative of the patient’s having served in actual combat.

Allow for Index Quirks

Yanike concluded by shining a spotlight on some of the unusual issues associated with using the ICD-10 Index. For example, to find ascites, a condition where fluid builds up in the abdomen, you can simply look up the words Ascites (abdominal) in the index, which directs you to R18.8 (Other ascites). But Fluid à abdomen, Fluid à peritoneal, and Effusion à peritoneal also lead to R18.8. This acts as a reminder that you can find conditions by both direct and indirect methods, and that you sometimes need to get creative when assigning a code from provider documentation.

Another example of the odd nature of the ICD-10 Index occurs in assigning an intellectual disabilities code. “If a physician documents a patient has a specific IQ, according to the Alphabetic Index in the code book, you can actually take that to a specific intellectual disabilities code,” according to Yanike So, IQ à under 20 directs you to F73 (Profound intellectual disabilities); from 20-34 directs you to F72 (Severe intellectual disabilities); from 35-49 directs you to F71(Moderate intellectual disabilities); and from 50-69 directs you to F70 (Mild intellectual disabilities).

Last, Yanike pointed out that coders often overlook the terms “complaint,” “disturbance,” or “reaction,” in the provider’s notes and think there is nothing to code in the medical record. In fact, the terms “cross-reference over to main terms disease and disorder,” which are all codable. So, “suppose a patient comes in with a respiratory complaint, that takes you over to ‘Disease.’ There, you’re not going to get a great code, but you will find some kind of R code or J code you can use,” Yanike noted.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC