20 Jul 0
One of the best things you can do for ICD-10 is be as prepared as possible. There are many free ICD-10 web trainings available and Capstone will be providing its own ICD-10 webinar series beginning July 23, 2015. Please check your email regarding information to register for these webinars making sure to check junk and spam mail.
Some of the changes from ICD-9 to ICD-10:
Specificity- ICD-10 will provide more specificity, thus increasing the code structure from ICD-9’s 3 to 5 characters to 5 to 7 characters and adding over 50,000 additional codes.
Examples: Moderate persistent asthma with COPD, History of tobacco use- J45.40 and J44.9 and Z87.891
Asthma- should include scales or stages such as:
- Mild intermittent
- Mild persistent
- Moderate persistent
- Severe persistent
Also clarify the relationship between COPD, Bronchitis and Asthma- Asthma with Chronic obstructive bronchitis or Asthma with COPD, then add the tobacco exposure
Fractures: Hip fracture
- First include right or left hip
- Then include open/closed
- Then include with routine healing or with delayed healing
- Then include malunion or non-union
- Then include encounter type- initial, subsequent or sequela
A subsequent encounter for a closed fracture of the right femur with routine healing is coded- S72.001D (note the 7 characters)
Laterality– ICD-10 includes laterality, right and left account for >40% of the codes.
Example: Hearing loss, right ear- H91.91
Hearing loss-must include:
Combination codes– ICD-10 includes for more combination codes to better capture complexity.
Example: Diabetes type 2 with chronic kidney disease- E11.22, use additional code to identify the stage of CKD (N18.1-N18.6)
Diabetes- documentation should include:
- Type 1 or 2
- Due to drugs or chemicals
- Due to underlying condition
- Other specified
Then document any complications such as:
And be sure to link the complications to the diabetes. A relationship must still be documented.
Controlled and uncontrolled is no longer classified, now hyper or hypoglycemia
For the providers, ICD-10 is most likely going to require a change in your current documentation practices. Additional codes and an increase in specificity only mean there will be more to document. Best practice is to begin evaluating your documentation now. Is your documentation ready for ICD-10?