Inpatient Facility Coding & Compliance Alert

Capture the exact code, or else use “unspecified.”

Have you made up your mind when it comes to the taut ICD-9 codes that do not seem to have a match in ICD-10? 

Heads up: When ICD-10 goes into effect on Oct. 1, 2015, you will see that not all codes in ICD-9 have a direct crosswalk to ICD-10 codes. According to CMS, there are instances where there is not a translation between an ICD-9-CM code and an ICD-10 code.

Here are some examples: 

• The ICD-10-CM code Y71.3 (Surgical instruments, materials and cardiovascular devices [including sutures] associated with adverse incidents), which has no reasonable translation in ICD-9-CM; 
• The ICD-9-CM procedure code 89.8 (Autopsy), which has no reasonable translation in ICD-10-Procedure Coding System.

Aim for the most specific code: It is the all or none phenomena at work here. You cannot think of assigning a code from a code pool that best suits your case scenario. The code has to be the exactly befitting the documentation. In other words, reporting an ICD-10 code that’s “close” to your patient’s condition is not advisable. If you do so, you actually report a condition that the patient never had. You can only invite audits by adopting this practice. 

Use “other” or “unspecified” wisely: If you can’t find an applicable code in ICD-10 that describes the patient’s condition, you’ll be forced to use an “other” or “unspecified” code and then explain the situation to your MAC if necessary.

“Codes titled ‘other’ or ‘other specified’ are for use when the information in the medical record provides detail for which a specific code does not exist,” says the Centers for Disease Control & Prevention in its ICD-10-CM Official Guidelines for Coding and Reporting. “Codes titled ‘unspecified’ are for use when the information in the medical record is insufficient to assign a more specific code.”

Make sure a definitive code does not exist: You’ll use an “other specified” code when the doctor is specific in the record but no applicable code exists, and you’ll use an “unspecified” code when the physician does not provide you enough information to pinpoint the correct ICD-10 code.