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Issue #2 - August 11, 2010
AAPC ICD-10 Newsletter


Featured Article
In the News
Coding Snapshot
I-10 Tips
ICD-10 Resource

Moving to ICD-10 CM/PCS will require a tremendous effort and incur incredible cost for health care organizations. Many health care organizations have not begun the implementation process and are expecting the date for implementation to be delayed. That is a misconception and could affect the health of the organization.

The countdown is now. Don't delay planning for implementation. The health of your organization depends on it!


AAPC and Ingenix have partnered to bring you 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.


ICD-10: Where do I begin?

Since the AAPC’s annual conference in Jacksonville, I have been wearing my “Ask me about ICD-10” button at chapter meetings. So, what is the most frequently asked question? “How and when should I begin learning about ICD-10?”

It is an obvious question and the answer varies depending on the individual. Those beginning their coding career are worried about learning something new so soon, and those nearer the end of their coding careers don’t think they can learn something new. Whichever group you belong to, I can assure you that if you code now, you will be able to code in ICD-10. You have time to prepare and the key to your success will be in the planning, and staying on track with your plan.  Here are five things you can do now to prepare for ICD-10.

  1. Decide where you want to be on October 1, 2013.

ICD-10 will give most of us an opportunity to expand or change our current roles. With the need for more detailed information in the patient’s medical record, there will be an increase to the queries we send to our providers. This will increase significantly the interaction between coders and the medical staff. Are you prepared for this? Training providers takes a different skill set, and if you have a desire to take up this new challenge you need to be prepared for it. Begin work on your communication practices now.

  1. Develop an action plan.

The action plan can be a simple excel spreadsheet with your ICD-10 goals and objectives. You also can use your benchmark tracker on the AAPC website to track your progress. Make sure you indicate timelines and have a space to note your progress. This will be a working document that may change over time, but having your goals in writing will not only help keep you focused, it will get you there!

  1. Assess your current skill level with medical terminology and anatomy.

ICD-10 represents a significant improvement over ICD-9. There are twice as many categories and currently 69,000+ codes consisting of up to seven alpha-numeric characters. Obviously this will increase the level of specificity required when coding.  If necessary, update your medical terminology and anatomy knowledge within the next year.  Having an in-depth knowledge of anatomy and terminology will help you ease the transition into ICD-10-CM and lessen productivity losses.

  1. Research and find useful websites

Look for websites that are providing useful, updated ICD-10 information.

This may be CMS, AMA or AAPC, for example. Don’t forget to search the top carriers in your region as well. Bookmark them and scan them at least monthly for updated information.

  1. Find an 1CD-10 partner

Find someone who is looking for the same thing as you. If it’s someone at work, plan to bring your lunch at least twice monthly to share your findings and discuss recent articles. In addition, you can go to the “find a chapter” section on the AAPC website and find local chapters in your region and consider attending their meetings if the topic is on ICD-10.  Find other coders to carpool with. Not only will it make the drive enjoyable, it will make you more comfortable having someone you know with you.

Although the idea of ICD-10 can be confusing and intimidating, it is manageable with proper planning, these five simple tips will help get you started on your journey to the October 1, 2013 implementation date. Remember this is a journey and not an event. By following these steps you will be ahead of the game and be ready to improve the success of your practice, which in turn will help you further your career.  By being prepared, you will find that ICD-10, rather than an object of fear, can be a tool to bring you success.


CMS Announced C&M Committee Meeting to Discuss ICD-9 and ICD-10 Crosswalk Revisions
On September 15, 2010 the ICD-9-CM Coordination and Maintenance (C&M) Committee is scheduled to share the proposed modifications to ICD-9. The committee meeting is a public forum where anyone can attend to learn about the proposed revisions and provide input to committee members regarding the crosswalk between the ICD-9 and ICD-10 for the purpose of making appropriate revisions. Those who are interested in attending and would like to provide input should come prepared to submit written comments and other relevant documentation at the meeting. If you are not attending CMS will accept written input no later than November 12, 2010.

The event will be held at CMS headquarters in Baltimore, MD. For more detail about the event or to register, visit the CMS website. Registration opens Friday, August 13.


CHIEF COMPLAINT: Left proximal humerus fracture, right distal radius fracture.
HISTORY OF PRESENT ILLNESS: A 59-year-old female returns today for reassessment. She is noting less wrist pain and less shoulder pain. She is currently utilizing a sling but is out of her wrist splint. She states that the pain in the wrist is diminished but she still has some weakness with lifting. She has been performing home Codman exercises for the shoulder. She utilizes Lortab for pain. 
PHYSICAL EXAMINATION: She is obese. She is intact to sensation through the bilateral upper extremities.  There is still some tenderness at the level of the distal radius but this is greatly decreased. The shoulder shows mild discomfort only with passive motion. Elbow and wrist remains supple.
ANCILLARY STUDIES: 3 view Radiographs of the left shoulder were ordered and interpreted in our office today, June 11, 2007, and show the fracture to be located. She has stable alignment of the fracture site; secondary to her pronounced soft tissue calluses, it is difficult to appreciate.
IMPRESSION: Healing right distal radius and left proximal humerus fracture.

In ICD-9-CM we coded this to V54.12 and V54.11, however in ICD-10-CM  in order to code this to the highest level of specificity we need to know what type of fracture, laterality and whether it was displaced or non displaced. We also need to know what stages of healing the fracture is in.

For S52.501 (unspecified fracture of the lower end of the right radius) our 7 digit extender choices are:

A   initial encounter for closed fracture
B   initial encounter for open fracture type I or II
     initial encounter for open fracture NOS
C   initial encounter for closed fracture with routine healing
D   subsequent encounter for closed fracture with routine healing
E    subsequent encounter for open fracture type I or II with routine healing
F    subsequent encounter for open fracture with type IIIA, IIIB or IIIC with routine healing
G   subsequent encounter for closed fracture with delayed healing
H   subsequent encounter for open fracture type I or II with delayed healing
J    subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
K   subsequent encounter for closed fracture with nonunion
M   subsequent encounter for open fracture type I or II with nonunion
N   subsequent encounter for open fracture type IIIA, IIIB, or IIIC with non union
P    subsequent encounter for closed fracture with malunion
Q    subsequent encounter for open fracture type I or II with malunion
R    subsequent encounter for open fracture type IIIA, IIIB, IIIC with malunion
S    sequel

You can see where good documentation of the patients healing process is necessary. In this case we would choose D.

For S42.202 (unspecified fracture of the upper end of the left humerus) our 7th digit extender choices are:

A   initial encounter for closed fracture
B   initial encounter for open fracture
D   subsequent encounter for fracture with routine healing
G   subsequent encounter for fracture with delayed healing
K   subsequent encounter for fracture with nonunion
P   subsequent encounter for fracture with malunion
S   sequel

In this case again we would use D. Working with physicians on complete documentation will be key to the coding of fractures in ICD-10-CM.


ICD-10 is coming and the Department of Health and Human Services (HHS) is not going to delay implementation. We will be sharing a number of steps to help any practice successfully implement ICD-10-CM.

Step #2: Develop the ICD-10 communications plan
Conduct regular meetings with staff on ICD-10 topics. A solid communication plan should include monthly meetings with the staff until six months prior to implementation, at which time communications efforts should be increased to biweekly. Share as much information about ICD-10 through articles, trade publications and other content to help staff stay informed and be prepared.


ICD-10 will change everything in your office. Find out how you will be affected:

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