The Anatomy of an ICD-10 Code

An ICD-10 code is one thing you can't assemble without consulting the instruction volume.

Fam Pract Manag. 2012 Jul-Aug;19(four):27-29.

Article Sections

  • Introduction
  • Coding sequelae
  • Exclusions
  • The placeholder: Ten
  • It's complicated

In the fading era of ICD-ix, you tin can probably get along with a minimal agreement of the ICD-9 arrangement – at least as long as you have a good billing staff and a superbill (or the electronic equivalent) on which you lot tin merely check a code. But the coming era of ICD-10 seems likely to pull you more than fully into the process of diagnosis coding. Fifty-fifty with a billing staff good plenty to deduce the correct code from your annotation, y'all'll demand to know what documentation they need. And to know that, y'all'll demand to be familiar with the structure of the codes and the rules for using them, which is the field of study of this article, the second in our orientation to ICD-ten (see "Other articles in FPM's 'Inaugural to ICD-x' series").

The current version of ICD-10-CM is available from the National Center for Health Statistics website (look for a PDF of the "Guidelines" and a compressed annal of the other files). Browsing through the files tin can help orient you. Information technology may as well be helpful to wait upwards the codes described throughout the article.

The ICD-10 manual begins with "ICD-10-CM Official Guidelines for Coding and Reporting" and is then divided into two primary parts: offset, the alphabetic index of terms with corresponding codes (subdivided into an index of diseases and injuries, an index of external causes, and tables of drugs and neoplasms) and second, the tabular list of codes divided into capacity based on body systems or conditions. Yous'll want to become familiar with the instructions at the chapter and section levels, since these apply to numerous code categories.

Equally with ICD-ix, ICD-10 has iii basic instructions:

  1. Consult the alphabetic index kickoff and and then refer to the tabular list.

  2. Read all pertinent instructions in both the alphabetic alphabetize and the tabular list.

  3. In the tabular list, check for instructions at the iii-character category level in improver to the lawmaking level.

IT'S COMING, BUT WHEN?

Back in April, the U.S. Department of Health and Human Services published a proposed dominion that would delay the date when you'll demand to start using ICD-10 from Oct. one, 2013, to Oct. i, 2014. The comment period for the proposed rule airtight May 17, and and then far there's no reason not to expect the 2014 compliance date to hold. Stay tuned, and do what you lot can to be set whenever the time comes.

Coding sequelae

  • Abstract
  • Coding sequelae
  • Exclusions
  • The placeholder: Ten
  • It's complicated

Many instructions in ICD-10, such as "Code first" and "Utilize boosted lawmaking," may exist familiar from ICD-9. Others are new. Tardily effects are handled somewhat differently. They are referred to as sequelae in ICD-10; they are reported in some cases with codes specifically intended to draw sequelae and in others by adding a 7th graphic symbol to the lawmaking for the condition that caused the sequelae. An case of each follows:

I69 Sequelae of cerebrovascular disease. Codes in category I69 are used to identify sequelae of cerebrovascular diseases, which are themselves coded in categories I60–I67. For instance, I69.022 is dysarthria post-obit nontraumatic subarachnoid hemorrhage, while codes for nontraumatic subarachnoid hemorrhage itself are institute in a dissimilar category, I60.

S83 Dislocation and sprain of joints and ligaments of articulatio genus. This is ane of the lawmaking categories that requires the addition of a seventh grapheme – one of 3:

  • A: initial encounter,

  • D: subsequent run into,

  • S: sequela.

And then, for instance, S83.104S would lawmaking unspecified dislocation of correct knee, sequela.

Exclusions

  • Abstract
  • Coding sequelae
  • Exclusions
  • The placeholder: X
  • It's complicated

ICD-10 offers two different types of exclusions. Both indicate that the current category or code excludes some specified condition, which is described elsewhere in the lawmaking set. "Excludes1" indicates that the code for the excluded condition should not exist reported with the current code, while "Excludes2" indicates that the lawmaking for the excluded condition may be reported with the current code, assuming that both conditions are present. For instance, category C43, malignant melanoma of peel, specifies exclusions of both kinds:

  • Excludes1: melanoma in situ (D03.-),

  • Excludes2: malignant melanoma of skin of genital organs (C51-C52, C60.-, C63.-), Merkel jail cell carcinoma (C4A.-), and sites other than skin.

A code from category C43 should not exist used to code melanoma in situ, nor should a code from category C43 exist submitted with a lawmaking for melanoma in situ. On the other hand, both a category C43 lawmaking and a code listed in the Excludes2 instruction could be reported on the same date, for instance when multiple sites are involved.

The placeholder: 10

  • Abstract
  • Coding sequelae
  • Exclusions
  • The placeholder: X
  • Information technology's complicated

Like the code from category S83 that we looked at earlier, many codes are vii characters long, with the 7th character representing condition or boosted clinical information (see "Code construction: ICD-ten style"). With the specified seven-character length comes the biggest structural change from ICD-nine to ICD-10, the use of placeholders. The placeholder grapheme, X, stands for a character that has not been assigned a meaning but must be filled in to achieve the specified code length.

For example, codes for fatigue fracture of vertebra, in subcategory M48.iv, require a placeholder for the sixth character because the base codes are merely five characters long and require ane of the following every bit a seventh character:

  • A: initial encounter for fracture,

  • D: subsequent encounter for fracture with routine healing,

  • G: subsequent encounter for fracture with delayed healing,

  • S: sequela of fracture.

To lawmaking the initial meet for a fatigue fracture of a cervical vertebra (M48.42), and so, a placeholder X must be added to arrive at code M48.42XA. If yous miss the instruction regarding the seventh character and report only M48.42 or M48.42A, your claim will likely be rejected because your code is incomplete.

Placeholders are also built into some codes at the fifth character, every bit in S06.0, the subcategory for concussion. Hither, the sixth character specifies the duration of loss of consciousness, and the required seventh character is A, D, or S – but the fifth character has not been assigned a significant. So, for instance, S06.0X0A codes concussion without loss of consciousness, initial see.

Another example where the placeholder is needed is code W04, fall while being carried or supported by other persons. In this case, the three-character category is tantamount to a code, because it has no subdivisions. Only since the instructions require that the appropriate seventh character (A,D, or South) be added, to make a complete code of W04 requires multiple placeholders (e.g., W04.XXXA).

Code CONSTRUCTION, ICD-x Mode

Consummate ICD-10 codes tin can range in length from iii characters to seven. Mostly speaking, every grapheme to the right of the decimal point adds its own element of meaning, and that pregnant tin vary from code to code. As you tin can see from the five- and seven-graphic symbol examples below, each character to the correct of the decimal place can bespeak something well-nigh complications, cause, torso part involved, etc. Consequently, code selection depends heavily on familiarity with the instructions given at the affiliate, category, and code levels. Compare the longest versions of these codes and codes discussed elsewhere in the commodity to get a sense of the pattern variation you tin can expect in ICD-ten codes: Although they await quite different from one another, I10, E11.42, M1A.0721, and even W04.XXXA are all consummate, valid codes. There seems to be no easy way with ICD-10.

A three-grapheme code

Base of operations lawmaking (category)

I10

Essential (master) hypertension

Building a five-character code

Base lawmaking (category)

E11

Type 2 diabetes

Four characters

E11.4

Type 2 diabetes with neurological complications

Five characters

E11.42

Blazon ii diabetes with polyneuropathy

Building 7-character codes

Base code (category)

M1A

Chronic gout

Four characters

M1A.0

Idiopathic chronic gout

Five characters

M1A.07

Idiopathic chronic gout, ankle and foot

Half dozen characters

M1A.072

Idiopathic chronic gout, left ankle and human foot

Seven characters

M1A.0721

Idiopathic chronic gout, left talocrural joint and foot, with tophus

It's complicated

  • Abstract
  • Coding sequelae
  • Exclusions
  • The placeholder: X
  • It's complicated

Clearly, ICD-10 codes tin convey more than specific information than ICD-9 codes. If you aren't directly involved in code selection, and even if your electronic health record arrangement suggests ranges of possible codes, you'll demand to make certain that your documentation includes all the information needed to make up one's mind a code – information such as which side of the patient's trunk is involved, whether this was the first or a subsequent see for the problem, what condition gave rise to a sequela, whether healing is progressing as expected, and then on. Now is the time to consider whether your current documentation is sufficient and whether your coding resource will support complete ICD-10 code pick. If either is lacking, you'll have fourth dimension to consider options for achieving an optimal result.

Articles IN FPM'S ICD-10 SERIES

You tin access the following articles in FPM'southward ICD-ten topic collection:

"ICD-10: Major Differences for V Common Diagnoses," FPM, September/October 2015.

"ICD-x Sprains, Strains, and Automobile Accidents," FPM, May/June 2015.

"Digesting the ICD-10 GI Codes," FPM, Jan/February 2015.

"Coding Common Respiratory Problems in ICD-10," FPM, Nov/December 2014.

"ICD-10 Simplifies Preventive Care Coding, Sort Of," FPM, July/August 2014.

"ICD-10 Coding for the Undiagnosed Problem," FPM, May/June 2014.

"How to Document and Code for Hypertensive Diseases in ICD-x," FPM, March/April 2014.

"x Steps to Preparing Your Office for ICD-10 – Now," FPM, January/February 2014.

"Getting Ready for ICD-10: How Information technology Will Affect Your Documentation," FPM, November/December 2013.

"The Beefcake of an ICD-x Code," FPM, July/Baronial 2012.

"ICD-10: What You Need to Know Now," FPM, March/Apr 2012.

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About the Writer

Cindy Hughes is a coding and compliance consultant with Medical Acquirement Solutions, Oak Grove, Mo., and a contributing editor to Family Practice Management. Author disclosure: no relevant financial affiliations disclosed.

Send comments to fpmedit@aafp.org.

Copyright © 2012 past the American Academy of Family unit Physicians.
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