Brenda Edwards, CPC

In the first article of this series, we touched on the importance of the guidelines for proper coding, whether it is in ICD-9-CM or ICD-10-CM (chestphysician.org [in News From CHEST]). This article will dive into the conventions (1.A) for ICD-10-CM. The first important notation is at the start of the section. Sometimes a coder may be confused when the guidelines at the front of the manual state one thing, and the chapter instructions seem to state something else.

At the beginning of Section 1 it states, "The conventions and instructions of the classification take precedence over guidelines." So, if the Tabular Index gives an instruction that is different than the guidelines in the front of the manual, follow the Tabular Index guidelines.

Section 1.A contains the conventions describing the general rules. Some of the highlights include:

1.A.2: Characters for categories, subcategories, and codes may be either a letter or a number. Categories are three characters, but if there is no further breakdown, it may also be a code. For example, I10 Essential (primary) hypertension is a three-character code with no further breakdown. I11 Hypertensive heart disease is a category that needs additional characters to denote a valid code (I11.0 or I11.9).

1.A.3: For reporting purposes, only codes are permissible, not categories or subcategories, and any applicable seventh character is required. In other words, you have to continue until there are no more characters in the subcategory. As in the previous example, it would be invalid to just stop at I11, as there is a fourth character breakdown.

1.A.4 and 1.A.5: These guidelines refer to the seventh character extenders and placeholders. ICD-10-CM utilizes a placeholder "X" for future expansion and to fill in the empty characters for codes that requires a seventh character extender, when they are not six characters in length. For example, S09.21- is traumatic rupture of right eardrum, but this is not a complete code as it requires a seventh character. The partial code is five characters in length. In order to append the seventh character in the seventh character position, a placeholder "X" must be used. If this were an initial encounter, the appropriate seventh character would be "A." In this circumstance, the complete code would be S09.21XA Traumatic rupture of right

eardrum, initial encounter.

1.A.6 to 1.A.9 are familiar guidelines explaining abbreviations used in the code book (for example, not elsewhere classified [NEC], not otherwise specified [NOS], etc).

1.A.12.a and 1.A.12.b: These guidelines explain the new exclusions for ICD-10-CM: "Excludes1" and "Excludes2." Excludes1 is a true exclusion and indicates that the code(s) listed under the Excludes1 should never be coded with the code above the Excludes1 note. For example, type 1 diabetes has an Excludes1 list that includes type 2 diabetes, gestational diabetes, and secondary diabetes. None of these diagnoses would be reported with type 1 diabetes on the same patient encounter.

Excludes2 indicates that the conditions excluded are not part of the condition listed above them. If the documentation states both conditions exist together, both should be reported. This will be seen with some acute on chronic conditions for which ICD-10-CM does not have a combination code. For example, category J01, acute sinusitis, has an Excludes2 note for chronic sinusitis. If a patient has documented acute on chronic maxillary sinusitis, J01.00 (acute maxillary sinusitis) would be reported along with J32.0 (chronic maxillary sinusitis).

The remaining conventions cover sequencing of codes, other verbiage (the use of "and," "with," "see," and so on), and default codes.

It is important to take the time to become familiar with the guidelines now in order to ensure proper, efficient code assignment when we go live.

Brenda Edwards entered the coding and billing profession 25 years ago and has been involved in many aspects of the field. Her current responsibilities include chart auditing, coding and compliance education, and contributing articles to AAPC and industry publications. Brenda is an AAPC ICD-10-CM trainer and has presented for AAPC workshops, regional conferences, and local chapter meetings. She has also served on the AAPCCA local chapter board of directors.

In the first article of this series, we touched on the importance of the guidelines for proper coding, whether it is in ICD-9-CM or ICD-10-CM (chestphysician.org [in News From CHEST]). This article will dive into the conventions (1.A) for ICD-10-CM. The first important notation is at the start of the section. Sometimes a coder may be confused when the guidelines at the front of the manual state one thing, and the chapter instructions seem to state something else.

At the beginning of Section 1 it states, "The conventions and instructions of the classification take precedence over guidelines." So, if the Tabular Index gives an instruction that is different than the guidelines in the front of the manual, follow the Tabular Index guidelines.

Section 1.A contains the conventions describing the general rules. Some of the highlights include:

1.A.2: Characters for categories, subcategories, and codes may be either a letter or a number. Categories are three characters, but if there is no further breakdown, it may also be a code. For example, I10 Essential (primary) hypertension is a three-character code with no further breakdown. I11 Hypertensive heart disease is a category that needs additional characters to denote a valid code (I11.0 or I11.9).

1.A.3: For reporting purposes, only codes are permissible, not categories or subcategories, and any applicable seventh character is required. In other words, you have to continue until there are no more characters in the subcategory. As in the previous example, it would be invalid to just stop at I11, as there is a fourth character breakdown.

1.A.4 and 1.A.5: These guidelines refer to the seventh character extenders and placeholders. ICD-10-CM utilizes a placeholder "X" for future expansion and to fill in the empty characters for codes that requires a seventh character extender, when they are not six characters in length. For example, S09.21- is traumatic rupture of right eardrum, but this is not a complete code as it requires a seventh character. The partial code is five characters in length. In order to append the seventh character in the seventh character position, a placeholder "X" must be used. If this were an initial encounter, the appropriate seventh character would be "A." In this circumstance, the complete code would be S09.21XA Traumatic rupture of right

eardrum, initial encounter.

1.A.6 to 1.A.9 are familiar guidelines explaining abbreviations used in the code book (for example, not elsewhere classified [NEC], not otherwise specified [NOS], etc).

1.A.12.a and 1.A.12.b: These guidelines explain the new exclusions for ICD-10-CM: "Excludes1" and "Excludes2." Excludes1 is a true exclusion and indicates that the code(s) listed under the Excludes1 should never be coded with the code above the Excludes1 note. For example, type 1 diabetes has an Excludes1 list that includes type 2 diabetes, gestational diabetes, and secondary diabetes. None of these diagnoses would be reported with type 1 diabetes on the same patient encounter.

Excludes2 indicates that the conditions excluded are not part of the condition listed above them. If the documentation states both conditions exist together, both should be reported. This will be seen with some acute on chronic conditions for which ICD-10-CM does not have a combination code. For example, category J01, acute sinusitis, has an Excludes2 note for chronic sinusitis. If a patient has documented acute on chronic maxillary sinusitis, J01.00 (acute maxillary sinusitis) would be reported along with J32.0 (chronic maxillary sinusitis).

The remaining conventions cover sequencing of codes, other verbiage (the use of "and," "with," "see," and so on), and default codes.

It is important to take the time to become familiar with the guidelines now in order to ensure proper, efficient code assignment when we go live.

Brenda Edwards entered the coding and billing profession 25 years ago and has been involved in many aspects of the field. Her current responsibilities include chart auditing, coding and compliance education, and contributing articles to AAPC and industry publications. Brenda is an AAPC ICD-10-CM trainer and has presented for AAPC workshops, regional conferences, and local chapter meetings. She has also served on the AAPCCA local chapter board of directors.

In the first article of this series, we touched on the importance of the guidelines for proper coding, whether it is in ICD-9-CM or ICD-10-CM (chestphysician.org [in News From CHEST]). This article will dive into the conventions (1.A) for ICD-10-CM. The first important notation is at the start of the section. Sometimes a coder may be confused when the guidelines at the front of the manual state one thing, and the chapter instructions seem to state something else.

At the beginning of Section 1 it states, "The conventions and instructions of the classification take precedence over guidelines." So, if the Tabular Index gives an instruction that is different than the guidelines in the front of the manual, follow the Tabular Index guidelines.

Section 1.A contains the conventions describing the general rules. Some of the highlights include:

1.A.2: Characters for categories, subcategories, and codes may be either a letter or a number. Categories are three characters, but if there is no further breakdown, it may also be a code. For example, I10 Essential (primary) hypertension is a three-character code with no further breakdown. I11 Hypertensive heart disease is a category that needs additional characters to denote a valid code (I11.0 or I11.9).

1.A.3: For reporting purposes, only codes are permissible, not categories or subcategories, and any applicable seventh character is required. In other words, you have to continue until there are no more characters in the subcategory. As in the previous example, it would be invalid to just stop at I11, as there is a fourth character breakdown.

1.A.4 and 1.A.5: These guidelines refer to the seventh character extenders and placeholders. ICD-10-CM utilizes a placeholder "X" for future expansion and to fill in the empty characters for codes that requires a seventh character extender, when they are not six characters in length. For example, S09.21- is traumatic rupture of right eardrum, but this is not a complete code as it requires a seventh character. The partial code is five characters in length. In order to append the seventh character in the seventh character position, a placeholder "X" must be used. If this were an initial encounter, the appropriate seventh character would be "A." In this circumstance, the complete code would be S09.21XA Traumatic rupture of right

eardrum, initial encounter.

1.A.6 to 1.A.9 are familiar guidelines explaining abbreviations used in the code book (for example, not elsewhere classified [NEC], not otherwise specified [NOS], etc).

1.A.12.a and 1.A.12.b: These guidelines explain the new exclusions for ICD-10-CM: "Excludes1" and "Excludes2." Excludes1 is a true exclusion and indicates that the code(s) listed under the Excludes1 should never be coded with the code above the Excludes1 note. For example, type 1 diabetes has an Excludes1 list that includes type 2 diabetes, gestational diabetes, and secondary diabetes. None of these diagnoses would be reported with type 1 diabetes on the same patient encounter.

Excludes2 indicates that the conditions excluded are not part of the condition listed above them. If the documentation states both conditions exist together, both should be reported. This will be seen with some acute on chronic conditions for which ICD-10-CM does not have a combination code. For example, category J01, acute sinusitis, has an Excludes2 note for chronic sinusitis. If a patient has documented acute on chronic maxillary sinusitis, J01.00 (acute maxillary sinusitis) would be reported along with J32.0 (chronic maxillary sinusitis).

The remaining conventions cover sequencing of codes, other verbiage (the use of "and," "with," "see," and so on), and default codes.

It is important to take the time to become familiar with the guidelines now in order to ensure proper, efficient code assignment when we go live.

Brenda Edwards entered the coding and billing profession 25 years ago and has been involved in many aspects of the field. Her current responsibilities include chart auditing, coding and compliance education, and contributing articles to AAPC and industry publications. Brenda is an AAPC ICD-10-CM trainer and has presented for AAPC workshops, regional conferences, and local chapter meetings. She has also served on the AAPCCA local chapter board of directors.

Where is the best place to find information on how to use the ICD-10-CM codes? The answer is in the ICD-10-CM Official Guidelines for Coding and Reporting. The guidelines are beneficial for both the provider and coder to ensure the most accurately described diagnosis is reported to represent the documentation of the service performed. The guidelines are used to give additional instruction when used with the conventions and instructions. Following the guidelines is required under the Health Insurance Portability and Accountability Act (HIPAA).

The general guidelines are provided to give overall guidance for the ICD-10-CM code book. There are some similarities between ICD-9-CM and ICD-10-CM (eg, How to Locate a Code, Level of Detail in Coding), and some different guidelines are specific to ICD-10-CM (eg, Laterality, Borderline Diagnosis).

The chapter-specific coding guidelines explain nuances found with some of the more complex diagnoses. These include HIV infections, sepsis, anemia associated with other conditions, diabetes, hypertension with other diseases, pressure ulcers, pregnancy, and injuries.

The guidelines will assist in sequencing rules, stages for some disease processes, and the hierarchy of certain codes. For example, anemia is sequenced as the principal diagnosis when associated with chemotherapy, immunotherapy, and radiation therapy. It is sequenced as a second diagnosis when anemia is associated with a malignancy (which would be sequenced first). This is an example of where the guidelines are different in ICD-10-CM when compared with ICD-9-CM.

Diabetes can be coded to the highest level of specificity when using the guidelines. This includes the types of diabetes, use of insulin, and diabetes with other conditions. Diseases of the circulatory system can be very complex, but by utilizing the guidelines, explanations are given on coding, such as hypertension with coexisting conditions. Information includes sequencing and use of additional codes when needed.

Information and definitions also explain acute myocardial infarction (AMI). This is important because there are significant changes from ICD-9-CM to ICD-10-CM in the timeframe for current and old AMI.

Injury coding will see a tremendous increase in the number of code possibilities. The additional information given in the guidelines explains the 7th character requirement for both treatment of a condition and healing status of fractures.

Whether you are just diving into ICD-10-CM or you have already have taken the plunge, you cannot become too familiar with the guidelines. Read and reread them, and highlight those trickier areas for quick reference. The provider and coder must work together to successfully implement this expansive change. The extra knowledge you can gain from the coding guidelines will be helpful not only to you but can be an educational tool when training others.

Ensure proper code assignment in ICD-10-CM by studying the conventions and guidelines in greater detail. Watch for part 2 in the January 2014 issue of CHEST Physician.

Brenda Edwards entered the coding and billing profession 25 years ago and has been involved in many aspects of the field. Her current responsibilities include chart auditing, coding and compliance education, and contributing articles to AAPC and industry publications. Brenda is an AAPC ICD-10-CM trainer and has presented for AAPC workshops, regional conferences, and local chapter meetings. She has also served on the AAPCC local chapter board of directors.

Where is the best place to find information on how to use the ICD-10-CM codes? The answer is in the ICD-10-CM Official Guidelines for Coding and Reporting. The guidelines are beneficial for both the provider and coder to ensure the most accurately described diagnosis is reported to represent the documentation of the service performed. The guidelines are used to give additional instruction when used with the conventions and instructions. Following the guidelines is required under the Health Insurance Portability and Accountability Act (HIPAA).

The general guidelines are provided to give overall guidance for the ICD-10-CM code book. There are some similarities between ICD-9-CM and ICD-10-CM (eg, How to Locate a Code, Level of Detail in Coding), and some different guidelines are specific to ICD-10-CM (eg, Laterality, Borderline Diagnosis).

The chapter-specific coding guidelines explain nuances found with some of the more complex diagnoses. These include HIV infections, sepsis, anemia associated with other conditions, diabetes, hypertension with other diseases, pressure ulcers, pregnancy, and injuries.

The guidelines will assist in sequencing rules, stages for some disease processes, and the hierarchy of certain codes. For example, anemia is sequenced as the principal diagnosis when associated with chemotherapy, immunotherapy, and radiation therapy. It is sequenced as a second diagnosis when anemia is associated with a malignancy (which would be sequenced first). This is an example of where the guidelines are different in ICD-10-CM when compared with ICD-9-CM.

Diabetes can be coded to the highest level of specificity when using the guidelines. This includes the types of diabetes, use of insulin, and diabetes with other conditions. Diseases of the circulatory system can be very complex, but by utilizing the guidelines, explanations are given on coding, such as hypertension with coexisting conditions. Information includes sequencing and use of additional codes when needed.

Information and definitions also explain acute myocardial infarction (AMI). This is important because there are significant changes from ICD-9-CM to ICD-10-CM in the timeframe for current and old AMI.

Injury coding will see a tremendous increase in the number of code possibilities. The additional information given in the guidelines explains the 7th character requirement for both treatment of a condition and healing status of fractures.

Whether you are just diving into ICD-10-CM or you have already have taken the plunge, you cannot become too familiar with the guidelines. Read and reread them, and highlight those trickier areas for quick reference. The provider and coder must work together to successfully implement this expansive change. The extra knowledge you can gain from the coding guidelines will be helpful not only to you but can be an educational tool when training others.

Ensure proper code assignment in ICD-10-CM by studying the conventions and guidelines in greater detail. Watch for part 2 in the January 2014 issue of CHEST Physician.

Brenda Edwards entered the coding and billing profession 25 years ago and has been involved in many aspects of the field. Her current responsibilities include chart auditing, coding and compliance education, and contributing articles to AAPC and industry publications. Brenda is an AAPC ICD-10-CM trainer and has presented for AAPC workshops, regional conferences, and local chapter meetings. She has also served on the AAPCC local chapter board of directors.

Where is the best place to find information on how to use the ICD-10-CM codes? The answer is in the ICD-10-CM Official Guidelines for Coding and Reporting. The guidelines are beneficial for both the provider and coder to ensure the most accurately described diagnosis is reported to represent the documentation of the service performed. The guidelines are used to give additional instruction when used with the conventions and instructions. Following the guidelines is required under the Health Insurance Portability and Accountability Act (HIPAA).

The general guidelines are provided to give overall guidance for the ICD-10-CM code book. There are some similarities between ICD-9-CM and ICD-10-CM (eg, How to Locate a Code, Level of Detail in Coding), and some different guidelines are specific to ICD-10-CM (eg, Laterality, Borderline Diagnosis).

The chapter-specific coding guidelines explain nuances found with some of the more complex diagnoses. These include HIV infections, sepsis, anemia associated with other conditions, diabetes, hypertension with other diseases, pressure ulcers, pregnancy, and injuries.

The guidelines will assist in sequencing rules, stages for some disease processes, and the hierarchy of certain codes. For example, anemia is sequenced as the principal diagnosis when associated with chemotherapy, immunotherapy, and radiation therapy. It is sequenced as a second diagnosis when anemia is associated with a malignancy (which would be sequenced first). This is an example of where the guidelines are different in ICD-10-CM when compared with ICD-9-CM.

Diabetes can be coded to the highest level of specificity when using the guidelines. This includes the types of diabetes, use of insulin, and diabetes with other conditions. Diseases of the circulatory system can be very complex, but by utilizing the guidelines, explanations are given on coding, such as hypertension with coexisting conditions. Information includes sequencing and use of additional codes when needed.

Information and definitions also explain acute myocardial infarction (AMI). This is important because there are significant changes from ICD-9-CM to ICD-10-CM in the timeframe for current and old AMI.

Injury coding will see a tremendous increase in the number of code possibilities. The additional information given in the guidelines explains the 7th character requirement for both treatment of a condition and healing status of fractures.

Whether you are just diving into ICD-10-CM or you have already have taken the plunge, you cannot become too familiar with the guidelines. Read and reread them, and highlight those trickier areas for quick reference. The provider and coder must work together to successfully implement this expansive change. The extra knowledge you can gain from the coding guidelines will be helpful not only to you but can be an educational tool when training others.

Ensure proper code assignment in ICD-10-CM by studying the conventions and guidelines in greater detail. Watch for part 2 in the January 2014 issue of CHEST Physician.

Brenda Edwards entered the coding and billing profession 25 years ago and has been involved in many aspects of the field. Her current responsibilities include chart auditing, coding and compliance education, and contributing articles to AAPC and industry publications. Brenda is an AAPC ICD-10-CM trainer and has presented for AAPC workshops, regional conferences, and local chapter meetings. She has also served on the AAPCC local chapter board of directors.