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Issue #11 - May 11, 2011
AAPC ICD-10 Newsletter


Featured Article
In the News
Coding Snapshot
ICD-10 Strategies
ICD-10 Resource


Portland 5/19
New York 5/19
Birmingham 5/26
Kansas City 5/26
Sacramento 6/2

Detroit 6/9
Minneapolis 6/9


This e-Newsletter offers the most up-to-date and essential news and information about the transition to ICD-10. If you would prefer not to receive these monthly updates, you can change your email preferences in your account.


Anatomy and Physiology in ICD-10

The tenth revision of the International Classification of Diseases (ICD-10) brings many changes to coding in the United States. It not only increases the amount of codes available for use, it will also require, among many things, an in-depth understanding of anatomy and pathophysiology. Code selections may be based on the site of the condition or injury (anatomy) or by the disease process (pathophysiology), and the stages of healing. Without an understanding of these, the user will find it difficult to select the appropriate code.

Take a look at the injury section as an example, many of these codes require 7 characters and it may be necessary to know the type of injury, site, laterality, and episode of care. For example, in ICD-9-CM there is one choice for closed fracture of the shaft of the radius (813.21). In ICD-10-CM there are 270 code choices for this injury. The code is assigned based on:

  • Type of fracture (greenstick, transverse, spiral, etc.)
  • Displaced or nondisplaced
  • Right, left, or unspecified side
  • Episode of care (initial, subsequent, or sequela)
  • Stage of healing (for subsequent encounters)
    • Delayed healing
    • Nonunion
    • Malunion

You can see that without an understanding of the various types of fractures, and the healing process involved, the user may have a difficult time with code selection. There may be temptation to use the unspecified code if the information is omitted from the note; however, the requirement is to always use the code that most accurately describes the injury.

ICD-10-CM has an increased amount of combination codes compared to ICD-9-CM. Knowledge of anatomy and pathophysiology in the areas where combination codes exist will help to user to understand the relationship between the two conditions. In ICD-9-CM two codes were required to report coronary atherosclerosis of autologous vein bypass graft with intermediate coronary syndrome (unstable angina) – 414.02 and 411.1. In ICD-10-CM the same condition would be reported with the combination code I25.710 – Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris.


The Centers for Medicare & Medicaid Services (CMS) and AAPC held a free ICD-10 "Code-A-Thon" webinar on Tuesday, April 26. The webinar featured presentations on ICD-10 from CMS and AAPC personnel. During the Code-A-Thon, more than 250 questions were answered. A quick sample of the hot topic questions:

  • Q: If we want to form an ICD-10 implementation committee, who are the key people to recruit for it?
  • A: Look for people with different areas of expertise, so that it is less likely that something might get overlooked. For example, a physician, coder, billing representative, IT specialist, manager, nurse, and an ancillary staff person could be part of the committee to bring different perspectives to the table.
  • Q: What is GEMs?
  • A: GEMs stands for General Equivalence Mappings. The GEMs act mainly as a crosswalk of ICD-9 and ICD-10 codes. You can look up an ICD-9 code and be provided with the most appropriate ICD-10 matches and vice versa. More information is available on the CMS website.

Presentation materials, including a list of questions and answers, and a recording and transcript of the event, will be posted to the CMS ICD-10 website in the next two weeks.


POSTOPERATIVE DIAGNOSIS: Sebaceous cyst, scalp. – per pathology report
PROCEDURE PERFORMED: Excision of mass, scalp with excised diameter of 1.8 cm and complex repair of 2.8-cm wound.
ANESTHESIA: Local using 5 cc of 1% lidocaine with epinephrine.
SPECIMENS: Mass, scalp for permanent pathology.
INDICATIONS FOR SURGERY: The patient is a 43-year-old woman with a mass on her scalp. I marked the area for elliptical excision and I drew my best guess the resultant scar. The patient observed these markings with two mirrors, so that she can understand the surgery and agree on the location, and we proceeded.
DESCRIPTION OF PROCEDURE: With the patient prone, the area was infiltrated with local anesthetic. The scalp and face were prepped and draped in sterile fashion. I incised an ellipse over the top of the mass as I had drawn it and dissected the mass away from its attachment to the skin and underlying soft tissue. Hemostasis was achieved using the Bovie cautery. I felt we were able to get the mass completely removed. Defects were created at each end of the wound to optimize the primary repair and because of this, I considered it a complex repair. I had given her some more local even before we started just to make sure she was completely numb at her request and the wound was closed in layers using 4-0 Monocryl, 5-0 Prolene, and the skin stapler. Loupe magnification was used. The patient tolerated the procedure well.

ICD-9-CM Diagnosis: 214.1
ICD-10-CM Code: L72.1

Rationale: With ICD-9-CM for the diagnosis of Sebaceous Cyst the coder is directed to 706.2, Cyst, skin. If the cyst is sebaceous or epidermal the ICD-9-CM code is the same.

With ICD-10-CM the coder is directed to cyst, and then documentation will have to support the choice of the L72.0 – L72.9. Epidermal cyst of the skin is L72.0, where Sebaceous Cyst of the skin is coded with L72.1.

ICD-10 Implementation Strategies

We will be sharing a number of strategies to help your practice successfully implement ICD-10-CM. They are also found in your ICD-10 Implementation Tracker on AAPC's website.

Performing a business process analysis
You will need to assess the impact ICD-10 will have on all business processes. For example, conduct a review of your communications between departments (e.g., lab and radiology orders). Analyze your practice management, billing systems, registration processes, and contracts with health plans.

Perform a baseline ICD-10 readiness audit. Look at each business process that addresses or uses ICD-9-CM, and evaluate the impact of ICD-10-CM on that process. Be sure to include your payer contracts in this analysis. Keep in mind that because the level of specificity is greater in ICD-10-CM, documentation must meet the level of detail to submit a claim on or after October 1, 2013.


The Coder's Roadmap to ICD-10 is a full curriculum to prepare coders for the Oct. 1, 2013 implementation of ICD-10. All AAPC members and industry coders are strongly encouraged to consider all steps in the plan as each one provides the foundation for the next.

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