Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

Getting Comfortable with the ICD-10 Code Set

Hourglass on computer keyboard
Hourglass on computer keyboard

While updates to your EHR and practice management systems are tasks best completed before the ICD implementation on October 1, 2015, and while properly coding claims that span the implementation date will need to be completed during or shortly after the transition, familiarizing yourself and your staff with the new code set will be an ongoing item on your to-do list for months to come.

But with almost 70,000 ICD-10 codes, where do you even start?

First, work with your in-house or outsourced coding team to determine your top 100 most-used ICD-9 codes. From that list, translate or “crosswalk” your common ICD-9 codes to ICD-10 codes. Likely, you will end up with a list of ICD-10 codes longer than 100 as you work through laterality, cause, occurrence, etc. Still, this will give you a place to start familiarizing yourself with the code set.

Then, expand from there, gathering a longer list of codes typically used in your specialty. CMS launched the ICD-10 Clinical Concepts Series for Specialties to help physicians and other providers get up to speed. Each guide in the series compiles key ICD-10 information for providers in that speciality, including common ICD-10 codes. Clinical Concepts packets are available for the following specialities:

If CMS has not covered your specialty, contact your specialty’s professional organizations to see what resources they have created, particularly those that break down the code set. Also, coding organizations like AAPC offer some resources by specialty. For instance, AAPC offers ICD-9 to ICD-10 Crosswalks at a small cost for various specialties. As well, both AHIMA andAAPC offers code-set training by specialty.

Next, familiarize yourself with unspecified codes and guidelines for their use. According to Mark Morsch, MS, Vice President of Technology at A-Life Medical, unspecified codes are simply valid ICD-10 codes with the term “unspecified” in their description. “In most cases, unspecified codes are used when more specific information is not present in the medical record,” he writes in a recent ICD-10 Monitor article. “A number of different aspects of a diagnosis code can be categorized as unspecified. These include laterality, body location, trimester, type of condition, severity, underlying organism, and others.”

Valid ICD-10 codes with “unspecified” in the description do fall within CMS’s grace period guidelines to accept codes from the same family as a correct code if a less specifica code is submitted. However, unspecified codes are not adequate substitutes for ICD-10 codes listed in the National and Local Coverage Deteminations (NCDs and LCDs) respectively.

CMS has a number of resources that explain unspecified codes and how they should be used in ICD-10-CM:

Which leads to our fourth recommendation: review all NCDs and LCDs that apply to your specialty and practice to see what ICD-10 guidelines are applied. Also, review information provided by your Medicare Administrative Contractor about LCD crosswalks or updates.

Finally, integrate the complete code set as a “dictionary” or “constants table” to prevent using an invalid ICD-10 code on or after October 1, 2015. CMS has posted a complete list of the 2016 ICD-10-CM valid codes and code titles on the 2016 ICD-10-CM and GEMs web page. The file is named icd10cm_codes_2016.txt. The codes are listed in tabular order (the order found in the ICD-10-CM code book). This list also can help you determine when and if additional characters are needed, such as the addition of a 7th character in order to arrive at a valid code.

The ICD-10 code set won’t be mastered in a day. Adopt a plan for continued training for you and your staff.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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