Inpatient Facility Coding & Compliance Alert

Question: Are there are some codes that don’t have a bridge between the current system of ICD -9 and the new ICD-10 system?

Montana Subscriber

Answer: Unfortunately, some codes do not have a direct crosswalk between the ICD-9 system and ICD-10.

Example: ICD-10-CM code Y71.3 (Surgical instruments, materials and cardiovascular devices [including sutures] associated with adverse incidents) has no reasonable translation in ICD-9-CM; and ICD-9-CM procedure code 89.8 (Autopsy) has no reasonable translation in ICD-10.

Plus: If you can’t find an applicable code in ICD-10 that describes your patient’s condition, use an “other” or “unspecified” code and then explain the situation to your MAC if necessary. Reporting an ICD-10 code that’s “close” to your patient’s condition does everyone a disservice because it brands that patient with a condition he never had, and looks suspicious to auditors who might think you’re picking diagnosis codes that get the claim paid but don’t actually match the documentation.

In other words, you’ll use an “other specified” code when the doctor is specific in the record but no applicable code exists, and you’ll use an “unspecified” code when the physician does not provide you enough information to pinpoint the correct ICD-10 code.