Pathology/Lab Coding Alert

Question: We’ve observed that some codes we commonly used under ICD-9 don’t have a one-to one translation to ICD-10, but instead direct to a code definition that states “other specified” or “unspecified.” What do those terms mean, and how will they impact our code selection under ICD-10?

Codify Subscriber

Answer: You are correct that not all codes in ICD-9 have a direct crosswalk to ICD-10 codes. That’s one of the reasons you should not still be relying on general equivalency mappings (GEMs) now that ICD-10 has gone into effect. Instead, you should code directly from the medical record using first the alphabetic index, and then the tabular list to find the correct ICD-10 code.

Other specified versus unspecified: You should use codes titled “other” or “other specified” when the information in the medical record provides detail for which a specific code does not exist, according to the ICD-10 Official Guidelines for Coding and Reporting. On the other hand, you should use codes titled ‘unspecified” when the information in the medical record is insufficient to assign a more specific code.

Do this: In other words, 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.