ICD-10-CM: Expanding Your Clinical Horizons

There are many new sections in ICD-10 that will require coders to “code outside the box.” Expanding knowledge of some basic clinical parameters will help coders capture the increased specificity of ICD-10-CM.

ICD-9 contains 10 codes for migraine headache, including 5th digit subclassifications to indicate status and intractability. ICD-10 has 39 codes which covers the category of migraine and variations, with increased specificity to a very detailed level, such as, “Short lasting unilateral neualgiform headache with conjunctival injection and tearing, intractable (SUNCT).” Coders will need to fine tune their clinical language skills as they probe deeper into the patient’s medical record and query the physician appropriately to obtain the required level of specificity.

Another example of a coding situation which may require coders to request more clinical information from providers is the correct code assignment for coma. ICD‐10‐CM has expanded the codes for coma and requires further information based on the Glascow Coma Scale (GCS). Documentation currently does not always give us this level of detail in the medical record and physicians will need to be educated on the new requirements.

Coders who work with neuro-intensivists, for example, may have information available to determine the comatose patient has a skull fracture. However, the documentation may not indicate how and when the GCS determination was made, which is necessary to complete the 7th character requirement. Currently, in ICD-9-CM, we do not code based on the coma scale, so additional documentation requirements will be challenging with ICD‐10‐CM.

The GCS codes are intended primarily for trauma registry and research, but may be utilized by all users of the classification who have a need for the information.


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