General Surgery Coding Alert

Hint: Don’t rely on GEMs.

Maybe you’re still struggling with your transition to ICD-10, even though you’ve been at it for over a month. 

Check out these five pointers to solidify your ICD-10 coding skills.

Tip 1: Learn Relevant Combination Codes

Under ICD-10, you have more combination codes for certain conditions and their associated common symptoms or manifestations, said Sue Bowman, MJ, RHIA, CCS, FAHIMA, senior director of coding policy and compliance for the American Health Information Management Association (AHIMA) in a recent CMS tutorial.

These combination codes eliminate the need for reporting two codes for a condition with a specific manifestation, but you may find it more difficult to “crosswalk” from an ICD-9 code to an ICD-10 combination code. You should not use two or more codes when a single combination code captures the diagnostic information.

Do this: Get familiar with combination codes for conditions that your surgeon routinely treats. For instance you might need to know combination codes such as K50.013 (Crohn’s disease of small intestine with fistula) or K80.67 (Calculus of gallbladder and bile duct with acute and chronic cholecystitis with obstruction), depending on the conditions and procedures that your general surgeons deal with.

Tip 2: V Codes Change to Z Codes

“ICD-10 eliminates the use of the [therapy] V codes due to the fact that they provide no clinical information about the patient other than the fact that therapy services are being provided,” noted Kris Mastrangelo, president and CEO of Harmony Healthcare International in a recent company blog posting. “ICD-10 requires much more specificity related to the medical condition resulting in the need for the therapy encounter.”

You’ll still be able to report the circumstances you previously explained with V code, but under ICD-10, you’ll use Z codes instead, according to Karen Kostick, RHT, CCS, CCS-P in a recent Journal of AHIMA article.

For instance: If your general surgeon performs a screening colonoscopy in the absence of signs or symptoms of disease, you should report the procedure using ordering-diagnosis ICD-10 code Z12.11 (Encounter for screening colonoscopy NOS).

Note: ICD-10 “z” codes include “aftercare codes,” which identify specific types of continuing care that your surgeon might perform after the initial treatment of an injury or disease.

Tip 3: Beware GEM Shortcomings

CMS, AHIMA, and other industry organizations joined together to develop the General Equivalence Mappings (GEMs) to help providers understand how ICD-9 codes relate to the new ICD-10 codes and code categories.

Downside: “Unfortunately, there are no perfect crosswalks to convert from ICD-9 to ICD-10,” Mastrangelo pointed out. “GEMs provide plausible conversions, not equivalent conversions. GEMs do not provide an exact match, and in most cases transition may require the selection of the best alternative code from among all plausible coding options.”

When you’re “forward-mapping” from ICD-9 to ICD-10, expect only about 5 percent of all codes to accurately map one-to-one, according to Mastrangelo. Beware of software that gives you the ICD-9 and the ICD-10, because often those codes are more generic than most payers will allow.

Resources: You can find a treasure trove of ICD-10 resources at www.roadto10.org, a website that CMS has created specifically for ICD-10 transition-related training, tools, and information.