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Issue #13 - July 13, 2011
AAPC ICD-10 Newsletter


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


Anatomy & Pathophysiology Online


Syracuse 7/21
Greensboro 7/21
Hartford 7/21
Chicago 7/28
Jackson 8/4
Boston 8/4
Nassau 8/11
Indianapolis 8/11
St. Louis 8/11


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.


Clinical Documentation Improvement

In the coming years as we move toward the "go-live" date for ICD-10-CM of October 1, 2013, you will hear the term CDI more frequently. Clinical documentation improvement (CDI) will be vital to every practice. In last month's article readiness assessments were discussed, which go hand in hand with CDI.

Following are a few examples of where changes may need to be made in documentation to follow the increased specificity of ICD-10-CM code assignment.

Most codes for diabetes are considered combination codes in ICD-10-CM. These codes require specific elements in the documentation to assign a code in ICD-10-CM.

Diabetes documentation requirements for ICD-10-CM include:

  • Type of diabetes
  • Body system affected
  • Complication or manifestation
  • For Type II diabetes a secondary code for long term insulin use is required if patient is using insulin

Example: Codes E11.51 and Z79.4 are used for a Type II diabetes mellitus patient with diabetic peripheral angiopathy without gangrene who has used insulin for many years.

Documentation requirements for neoplasms require specificity in both the site and laterality components. Documentation for neoplasms must include:

  • Type
    • Malignant (Primary, Secondary, Ca in situ)
    • Benign
    • Uncertain
    • Unspecified behavior
  • Location(s) (site specific)
  • If malignant, any secondary sites should also be determined
  • Laterality, in some cases

Example: Malignant neoplasm of the breast has 54 choices, and requires specification of male/female breast, the site of the neoplasm on the breast, and laterality. In addition, a code for estrogen receptor status is required, if known.

Code example: C50.411 Malignant neoplasm of upper-outer quadrant of the left female breast and Z17.1 Estrogen receptor status negative status [ER-].

Asthma codes in ICD-10-CM have been expanded to include the following concepts:

  • Severity of disease
    • Mild intermittent
    • Mild persistent
    • Moderate persistent
    • Severe persistent
  • Acute exacerbation
  • Status asthmaticus
  • Other types (exercise induced, cough variant, other)

Example: J45.41 Moderate persistent asthma with (acute) exacerbation.

As you can see from examples above, the documentation requirements for ICD-10-CM will vary from ICD-9-CM documentation requirements in many cases. Working with your providers on clinical documentation improvement for ICD-10-CM through readiness assessments and education will help ease the transition. Knowledge of the coding guidelines and preparation will be essential.


CMS logo The Centers for Medicare & Medicaid Services (CMS) hosted a national provider teleconference on CMS ICD-10 Conversion Activities. Subject matter experts discussed the ICD-10 conversion process currently taking place within CMS, including a case study from the CMS Coverage and Analysis Group on their transition to ICD-10 for the lab national coverage determinations (NCDs). A question and answer session followed the presentations. The written transcript and audio recording will be available soon; the slide presentation has already been released.

AAPCPS White PaperAAPC Physician Services, our sister company, published a free ICD-10 white paper entitled ICD-10-CM: The History, the Impact, and the Keys to Success. The white paper contains an executive summary, a short history of ICD-10, ICD-9 limitations, ICD-10-CM and ICD-10-PCS specifics, the benefits and impacts of ICD-10, and directions to successful transition. This is a useful resource to share with your providers, managers, and administrators.


Preoperative Diagnosis: Scheuermann thoracic kyphosis

Postoperative Diagnosis: Same.

Operation: Diskectomy at T10-11 and T11-T12 with interbody fusion cage insertion at T10-11 and T11-T12 with anterior plate placement at T10-11 and T11-T12.

Anesthesia: General.

Procedure: Tim, who is 12 years old, was brought to the Operating Room. Dr. Smith performed the approach, identifying the T10-11 and T11-T12 areas. This was confirmed on x-ray under C-arm guidance. We meticulously cleaned the disk spaces at T10-11 and T11-T12 using the Brantigan to distract them incrementally to open the space, particularly anterior. As we cleaned these with a bur and curved curettes back to the PLL we then smoothed them down to make them nicer for our cages. A large template cage was needed to reach lordosis. A medium plate was utilized at T10-T11 with good degree of lordosis. Screw holes were tapped into T10-T11. On both of these they came out towards the vessels which we recessed with a bur and placed a 15mm Ages plate, placing 20mm screws - two each into T10 and T11 and again two each into T11 and T12. Two separate plates were placed. We placed the T11-T12 plate laterally. We placed two screws in this plate as the vessels here were stuck down and we had to dissect under it and tap the cage in from a lateral position to get this safely placed and in this way we did not want the plate hitting back onto the vessels. After this was complete, intra-operative x-ray was taken to confirm good placement. Dr. Smith did the closure after irrigating.

ICD-9-CM Code: 732.0 Juvenile osteochondrosis of spine
ICD-10-CM Code: M42.04 Juvenile ostochondrosis of spine, thoracic region

Rationale: Scheuermann's kyphosis is a type of osteochondrosis. In ICD-10-CM, the codes require additional information. The spinal osteochondrosis code set is broken down by juvenile or adult, and vertebral level or levels. For the above scenario, to find the code, you would look under Osteochondrosis, juvenile, spine, thoracic region.

ICD-10 Implementation Strategies

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

Testing is an important step on the road to ICD-10 implementation. Internal and external testing of software and hardware to verify compatibility with upgrades and existing systems will be necessary. Testing will ensure that integrated changes into production systems have been accomplished. Complete testing of systems with clearinghouses, payors, and others should be included. Once new policies and procedures have been established, they should be tested to ensure they are both compliant and valid. Evaluation of clinical documentation improvement for ICD-10 readiness should continue during this time (Resource: ICD-10 Documentation Readiness Assessment). Test knowledge of staff to validate education for ICD-10 is on track (Resource: ICD-10 Proficiency Assessment).


The ICD-10 Implementation Tracker has been revised. This online application is used to track and graphically measure the ICD-10 implementation progress of an individual or organization. The tool lists tasks within key steps of the implementation process and then charts their completion against a recommended timeline/schedule to ensure minimal disruption to your organization. The tool is available exclusively to AAPC members and others participating in AAPC's ICD-10 Training.

ICD-10 Implementation Tracker

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