ICD-10-CM – It’s all about the guidelines (part 1 of 3)

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.