As we continue to look at the ICD-10-CM Chapter 18 codes for symptoms, signs, and ill-defined conditions, in this article we will consider particular ICD-9-CM codes that are used regularly in the Emergency Department setting, and the changes that ICD-10-CM will bring for those codes.
Clinical documentation will be an enormous determinate in the accurate coding of all ICD-10-CM patient visits. Should the documentation lack specificity, coders are faced with possible physician queries that will prove arduous for both the providers and coders. Our goal is to be proactive in the improvements that the ICD-10 Environment will demand so that we avoid some of these obstacles at transition time.
Let’s begin by looking at the ICD-9-CM code 782.0, Disturbance of Skin Sensation. Currently in ICD-9-CM there exists a single code for any disturbance of skin sensation, but ICD-10-CM will specifically identify the skin sensation disturbance on a granular level. Below illustrates what this code change looks like in ICD-10-CM:
- R20.0 Anesthesia of skin
- R20.1 Hypoesthesia of skin
- R20.2 Paresthesia of skin
- R20.3 Hyperesthesia
- R20.8 Other disturbances of skin sensation
- R20.9 Unspecified disturbances of skin sensation
Anesthesia of skin is the complete absence of any sensation in the skin; hypoesthesia is decreased sensation in skin; parasthesia refers to abnormal sensation such as tingling; hyperesthesia is an increased sensitivity or exaggerated sensitivity in sensation. In addition, there are codes available for “other specified” disturbances of skin sensation and “unspecified disturbance” of skin sensation.
Another patient presentation to the ED we might see is abnormal involuntary movement, for example head jerking, shrugging of the shoulders, or tremors as the sign or symptom described either by the patient subjectively or seen by the physician objectively.
In ICD-9-CM, again there is one code to represent all abnormal involuntary movements, and that code is 781.0. Moving into ICD-10-CM, we have an entire category of codes to describe in detail the type of abnormal involuntary movements:
- R25.0 Abnormal head movements
- R25.1 Tremor, unspecified
- R25.2 Cramp and Spasm
- R25.3 Fasciculation
- R25.8 Other abnormal involuntary movements
- R25.9 Unspecified abnormal involuntary movements
Again, careful review of the documentation is required to ensure that the abnormal movements cannot be assigned a more specific code. For example, muscle spasms would not be coded under R25.2; a code from subcategory M62.83- in the musculoskeletal chapter would be assigned.
Coders will need to carefully review the physician’s documentation in order to extract this information and code to the highest level of specificity . These detailed lists of codes will allow for greater granularity for purposes such as research and data mining, both of which are part of the impetus for the implementation of the new code set classification.
Continue to follow this series focusing on the ICD-10-CM, Chapter 18 codes for Symptoms, Signs and Abnormal Clinical Findings, Not elsewhere classified (R00-R99). For earlier installments, click on a link below.
ICD-10-CM Coding for Symptoms, Signs, and Abnormal Clinical Findings – Part 1
For more ICD-10 articles, please visit our ICD-10 Updates page.
— Compiled by former CIPROMS ICD-10 Coordinator, Angela Hickman, CPC, CEDC, AHIMA-Approved ICD-10 CM/PCS Trainer, AHIMA Ambassador. All rights reserved. For use or reprint in your blog, website, or publication, please contact us at firstname.lastname@example.org.