ICD-10 Guidelines Include Several Changes

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  • October 7, 2015
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ICD-10 Guidelines Include Several Changes

Now that ICD-10-CM is implemented and the 2016 ICD-10-CM code book has been released, it’s time to take a look at changes.
In the General Coding, Section 1.B.10 Sequela (Late Effects), a paragraph was added to provide examples.  These examples include scar tissue after a burn, a deviated septum due to a nasal fracture, and infertility due to tubal occlusion from old tuberculosis. The sequencing of the codes still states the condition or nature of the late effect is sequenced first using the injury or healed/old condition as the secondary code.
Descriptions have been added for clarification of the 7th characters extensions for Chapter 13 and Chapter 19.

  • Initial encounter utilizing “A” for active treatment revised the examples in the guidelines to read:

Examples of active treatment are:  surgical treatment, emergency department encounter, and evaluation and continuing treatment by the same or different physician.”

  • Subsequent care definition is edited and adds wording that includes “an X-ray to check on healing of a fracture” to the current examples.
  • A paragraph is added for Section 1.C.19.c.1 that states 7th character assignment for Initial encounter is assigned for delayed treatment of malunion/nonunion.

Several changes are noted in Chapter 1 Guidelines.
Chapter specific guidelines for Sepsis (Section 1.C.5) deleted the words “and post procedural septic shock” from the guideline.  Example of T81.4 Infection following a procedure, or O86.0 Infection of obstetrical surgical wound should be coded first; followed by code R65.21 Severe sepsis without septic shock.  A code for the systemic infection should also be assigned.

  • There is an error in the secondary code. R65.21 is “with” septic shock; for “without,” the correct code is R65.20.
  • A new paragraph is added for post procedural shock showing sequencing of T81.4, Infection following a procedure, or O86.0, Infection of obstetrical surgical wound as the first listed code, followed by T81.12- Postprocedural septic shock. Also code for the systemic infection.

Chapter 20 contains a Coding Guideline for External cause, which states the selection of the required 7th character must match the 7th character assigned to the associated injury. Guidelines for place of occurrence do state generally the place of occurrence is reported only once at the initial encounter, but adds language for that rare instance when a new injury code occurs during hospitalization, a second POA can be used (Section1.C.20.b and Section 1.C.20.d).
In Chapter 21 (Section 1.C.21.16) a list of Z codes that can only be used as Principal/First-listed Diagnoses. Under Z00 Encounters for general examination without complaints, suspected or reported diagnosis an exception is added  “Except: Z00.6.”
Section II.E is a guideline that was deleted effective October 1, 2014.

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Rhonda Buckholtz
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Rhonda Buckholtz, CPC, CPMA, CRC, CDEO, CMPE, CHC, COPC, AAPC Approved Instructor, is owner of Coding and Reimbursement Experts. She spends her time helping physician practices achieve operational excellence, compliance, education, and Lean Six Sigma through her consulting. Buckholtz has more than 30 years of experience in healthcare management, compliance, and reimbursement/coding sectors. She was responsible for all ICD-10 training and curriculum at AAPC during the transition from ICD-9. Buckholtz has authored numerous articles for healthcare publications and she has spoken at numerous national conferences for AAPC and others. She is past co-chair for the WEDI ICD-10 Implementation Workgroup, Advanced Payment Models Workgroup, and she provided testimony for ICD-10 and standardization of data for National Committee on Vital and Health Statistics. Buckholtz is on AAPC’s National Advisory Board.

No Responses to “ICD-10 Guidelines Include Several Changes”

  1. Tiffany says:

    I cannot find a satisfactory answer to this question, no mater who I ask. At what point would you code an adverse effect from a medication as a sequela? If the adverse effect takes place when the patient is no longer actively taking the medication?

  2. Mary Stuart says:

    Could you help me? If a patient is recerted in the end of September for an episode starting October 1, 2015, what codes need to be on the CARE PLAN. The recert OASIS will be in ICD 9. Do we need to redo the codes for the care plan because it starts in OCT? Guidelines that say the RAP, final bill and POC all need to match for dx…does that mean the codes must all be in the same ICD 9/10? Thanks!!

  3. Judy Breuker says:

    These changes are listed in the FY 2015 Official Guidelines for Coding and Reporting.

  4. K. Rosales says:

    •Initial encounter utilizing “A” for active treatment revised the examples in the guidelines to read:
    Examples of active treatment are: surgical treatment, emergency department encounter, and evaluation and continuing treatment by the same or different physician.”
    Little confused – I have a discharge summary dictated by the admitting physician. The traumatic hip fracture has already been repaired the previous day by surgeon. Will the ICD-10 code 7th character be a “A” or “D”? After reading above statement I think it should be an “A”
    Thank you

  5. lisa says:

    Thanks for taking the time and getting all the changes out to us. Thanks for always being professional and polite in your responses.