General Surgery Coding Alert

What you already know may surprise you.

You should have a growing familiarity with specific ICD-10 codes that you’ll need to know for your general surgery practice from reading briefs in this newsletter each month. But what else can you do to make sure you’re ready when ICD-10 goes into effect?

Solution: Peruse the codes online at www.cdc.gov/nchs/icd/icd10cm.htm#10update or use the crosswalk tool at https://www.aapc.com/codes/ to prep for specific diagnoses. But you can also start to familiarize yourself with some key coding conventions as you prepare for the ICD-10 codes.

Learn ICD-10 Precepts Now

Understanding the new codeset in a systematic way can stave off confusion once implementation rolls around. Look at the following ICD-10 principles to make sure you’re ready:

Seventh character: ICD-10 codes may have a seventh character that is a letter or number and provides more information about the condition being coded. For instance, check out T81.4xxD (Infection following a procedure; subsequent encounter).

Dummy placeholder: You don’t have a placeholder in ICD-9, but in ICD-10, it’s always the letter “x.” ICD-10 uses this dummy placeholder to:

• provide future expansion while keeping the six character structure (such as T65.0x2S), and
• meet the requirement of coding the highest level of specificity when a code has less than six characters and the code requires a seventh character (such as S17.0xxA).

Dash: When you see a dash at the end of a code, you should know that the code is incomplete. For instance, you might see M84.47- in the Tabular List, meaning you need to review the options to decide how to complete this code. “We use an ‘x’ in ICD-9 to show that more digits are required, however an ‘x’ is a placeholder in ICD-10, so the dash has taken its place,” says Lisa Selman-Holman, consultant and principal of Selman-Holman & Associates and CoDR — Coding Done Right in Denton, TX.

Abbreviations: You’ll find two abbreviations in ICD-10 that you already know from ICD-9:

• NEC (Not Elsewhere Classifiable): Like ICD-9, this abbreviation contains codes for “other” types of specified conditions that haven’t already been classified. An example is K38.8 (Other specified diseases of appendix).
• NOS (Not Otherwise Specified): When your physician doesn’t clearly specify the condition, you can use an NOS code — although payers usually frown upon this practice. An example is K38.9 (Disease of appendix, unspecified).

Punctuation: You’ll find some familiar punctuation in ICD-10, as follows:

• Parentheses: ICD-10 uses parentheses in both the Alphabetic Index and the Tabular List. This may include words that the physician might have stated in his or her documentation. For instance, you’ll find “Diabetes, diabetic (mellitus) (sugar)” in the Alphabetic Index. The parentheses indicate a non-essential modifier.
• Brackets: This punctuation encloses synonyms and alternative wordings in the Tabular List. When you find brackets in the Alphabetic Index, this identifies manifestation codes. For instance, you’ll find “Disease, Alzheimer’s G30.9 [F02.80]” in the Alphabetic Index.

Phrases: You’ll find that a few familiar phrases and their meanings move seamlessly from ICD-9 to ICD-10, including the following:

• “code first” notes, which instruct you to code another condition first
• “use additional code” notes that indicate the need for additional codes to add specificity
• “see” cross references to help you rule out related conditions
• “and,” which means “and/or”
• “with,” which means “associated with” or “due to”
• “code associated condition,” which means that both conditions should be coded, but sequencing does not matter.

Remember: ICD-10 codes will not be recognized/accepted on claims before October 1, 2014, according to Sarah Shirey-Losso, CMS Hospital Team Lead, Provider Billing Group.