Part B Insider (Multispecialty) Coding Alert

We've got the tips you need to make sense out of the new diagnosis coding system.

Good news! You'll 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, which will help you when ICD-10 goes live (the current proposed date is Oct. 1, 2014.)

Check Out the Alphabetic Index

In the Alphabetic Index, you'll have chapters divided up by letter with a list of terms and their corresponding code. This is 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.

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

• - cerebellar G31.9
• - face, facial, progressive (Romberg) G51.8
• - tongue K14.8

ICD-10 Differences: Here are a few changes to your Alphabetic index in ICD-10-CM:

• 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.

Don't Miss This Big ICD-10 Alphabetic Index Change

One of the biggest changes to your ICD-10-CM Alphabetic Index includes what ICD-9-CM currently terms Injury/Poisoning codes and E codes.

In Chapter 19: Injury, Poisoning And Certain Other Consequences of External Causes, you'll find your injury codes are organized 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."

In Chapter 20: External Causes of Morbidity contains what ICD-9-CM currently terms E codes (as well as some in Chapter 19). 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).

For instance, check out W21.03xA (Struck by baseball, initial encounter), Y92.320 (Baseball field as the place of occurrence of the external cause), Y93.64 (Activities involving other sports and athletics playing as team or group: baseball), and Y99.8 (Other external cause status [recreation or sport not for income or while a student]).

Now Check Out the Tabular List

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 does not divide up the ICD-9-CM codes for E Codes (External Causes of Injury and Poisonings) and V Codes (Factors Influencing Health Status and Contact with Health Services).
• Some chapters are reordered.

These chapters are full of categories, subcategories, and codes. Remember, characters may be a letter or a number.

How to Decipher Code Categories

All categories are 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 acute appendicitis appears in the Tabular Index:

K35.2 Acute appendicitis with generalized peritonitis Appendicitis (acute) with generalized (diffuse) peritonitis following rupture or perforation of appendixAppendicitis with peritonitis NOSPerforated appendix NOSRuptured appendix NOS

K35.3 Acute appendicitis with localized peritonitisAcute appendicitis with localized peritonitis with or without rupture or perforation of appendixAcute appendicitis with peritoneal abscess

K35.8 Other and unspecified acute appendicitis

K35.80 Unspecified acute appendicitisAcute appendicitis NOSAcute appendicitis without (localized)(generalized) peritonitis

K35.89 Other acute appendicitis