It’s all about the guidelines (part 2 of 3)

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.