Key Steps for Coders to Select the Right ICD-10 Codes

by | Published on Oct 14, 2019 | Medical Coding

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From 68,000 codes in 2014, ICD-10 has now reached a grand total of 71,932 codes in 2019. Choosing a relevant code from these alphanumeric categories is no doubt a time-consuming task for coders. Professional medical coding companies provide regular training for their coders to improve their performance and ensure the best services to physicians and other providers. In the ICD list, an alphanumeric system is used for assigning specific codes for every disease, injury, and all imaginable health conditions. But they’re not just used for diagnosis: physicians, coders, health IT managers, nurses, and other healthcare professionals also rely on them to assist in the storage and retrieval of patient information.

Here are some easy steps you can consider to find the correct ICD-10 codes.

Check the alphabetic index for the condition

The first step is to find the condition in the alphabetic index. Once the term is located, check the sub terms available to find the specific code.

For instance, the code “M00.0” is Staphylococcal arthritis and polyarthritis. You should also check for sub- terms and related codes such as –

  • M00.011 Staphylococcal arthritis, right shoulder
  • M00.012 Staphylococcal arthritis, left shoulder
  • M00.021 Staphylococcal arthritis, right elbow
  • M00.042 Staphylococcal arthritis, left hand
  • M00.061 Staphylococcal arthritis, right knee

Remember that using the correct term is crucial for identifying the correct code, which will help to report accurate diagnosis in bills and medical claims.

Verify the Code in the Tabular List

Once you find the ICD-10 code, the next step is to check whether this code in the Tabular List has any special instructions you need to follow. For example, check whether a sixth character has to be added to further specify the patient’s condition. Additional detail helps to create the most complete code.

The code “H25.04” refers to Posterior subcapsular polar age-related cataract.

By adding a sixth character, this code indicates laterality, such as –

H25.041 Posterior subcapsular polar age-related cataract right eye

H25.042 Posterior subcapsular polar age-related cataract left eye

The tabular index identifies severity such as intermittent, moderate persistent or severe persistent as well as complications. It also includes information identifying the length of a code and includes additional information such as “Excludes 1” and “Excludes 2” status. The exclude notes identify codes that you can never report together and those that you can never report at the same time.

Read and understand specific coding guidelines

Certain codes have guidelines and instructions for specific diagnoses or conditions. Missing out these guidelines may lead to coding errors and thus claim denials.

An example is that while using the code H25.819 (Combined forms of age-related cataract, unspecified eye), it has been instructed that this code is grouped within Diagnostic Related Group(s) (MS-DRG v36.0):

  • 124 Other disorders of the eye with mcc
  • 125 Other disorders of the eye without mcc

Another instance is that when it comes to broken arm, there are notes on what the code does and does not cover including -a fracture not indicated as displaced or non-displaced should be coded to displaced and a fracture not indicated as open or closed should be coded to closed.

Add a Seventh Character for Injury or Trauma

ICD-10-CM has the provision of assigning a seventh character to codes in certain categories. These characters are found predominantly in two chapters: Chapter 19 (Injury, Poisoning and Certain Other Consequences of External Causes) and Chapter 15 (Pregnancy, Childbirth and the Puerperium).

Use one of the following characters to indicate that this particular injury or trauma has been experienced before:

  • A to indicate the initial encounter
  • D for a subsequent encounter
  • S for sequela

While this character provides information about episodes of care for injuries, poisonings and other external causes, it provides information about the fetus for pregnancy, childbirth and the puerperium. However, instructions in each category should be reviewed for any exceptions.

For some glaucoma diagnoses, the Tabular List instructs to add a seventh character for glaucoma staging codes:

  • 0 for stage unspecified
  • 1 for mild
  • 2 for moderate
  • 3 for severe
  • 4 for indeterminate

Make sure to always code to the highest degree of accuracy and completeness.

Along with following such coding practices, it is also vital for all coding professionals, coding auditors, and consultants to be up to date with the changing coding standards.

Julie Clements

Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.

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