Inpatient Facility Coding & Compliance Alert

Whether you’re coding dyspnea or encounters with turtles, specificity rules the process.

Facility coders are focusing on ICD-10-PCS implementation in October 2014 (as they should be), but don’t forget about ICD-10-CM itself. Those changes will affect ED coding across the board, so read on advice on easing the transition, straight from certified ICD-10 instructor Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC; AHIMA, president of Edelberg Compliance Associates in Baton Rouge, La.

Remember Basic Differences Between ICD-9 and ICD-10

Both ICD-9 and ICD-10-CM codes are used to document a patient’s diagnosis. ICD-9 codes are 3-5 digits in length, and you currently have more than 14,000 code choices. ICD-10 codes, by comparison, are 3-7 characters in length. When ICD-10 goes into effect, you’ll be selecting from 68,000 code choices.

The following charts illustrate the differences in how ICD-9 and ICD-10 codes are structured:

ICD-9-CM Diagnosis Code Format

ICD-10-CM Diagnosis Code Format

 Also: The ICD-10-PCS codes represent procedures. They are alphanumeric, 7 characters in length, and total approximately 87,000.

Get ED Physicians Ready for These Specifics

ICD-10 implementation will primarily impact IT systems and coding professionals, but the dramatic change in code descriptions will mean physicians must upgrade their documentation practices at all levels. Providers will be required to look differently at how differential diagnoses, final diagnoses, operative notes, diagnostic interpretations and more are documented, says Edelberg.

For a sneak peek at what’s coming ED coding, compare these common ED diagnosis statements and the associated codes in ICD-9 and ICD-10:

Documentation pointer: Don’t let the complexities of the new system throw you. Because so many conditions are combined into one ICD-10 code where they were previously identified individually, you will see complex statements like those below bundled into one specific code:

Anatomy rules: Providers will be required to provide a higher level of anatomical detail in notes and note conditions such as "stabbing," "visible," "extreme" and a more specific and exact location of problem.

Coma Scale? Make sure you know it: Documentation of a Glasgow Coma Scale will be required for coding many neurologic complaints and will require that coders clearly understand how the Coma Score translates to conditions recognized for coding (such as motor response, verbal response, eye opening). Expanding documentation "macros" and templates will be a significant component of the transition to ICD-10, Edelberg says.

Humor helps: Although preparation for ICD-10 is serious business, to provide some comic relief for what promises to be a bumpy road ahead, consider the following conditions that will be addressed by ICD-10 External Causes of Morbidity:

 These might not be the typical conditions your physicians see in the ED, but they do illustrate how thorough ICD-10-CM will be in addressing possible causes of injury.