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Issue #23 - May 9, 2012
AAPC ICD-10 Newsletter


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


Boot Camps:

Cincinnati, OH 5/17
Baltimore, MD 5/17Charlotte, NC 5/17
San Antonio, TX 5/31
Boston, MA 5/31
Portland, ME 6/7
San Francisco, CA 6/7
Minneapolis, MN 6/14
Morgantown, WV 6/14

Anatomy & Pathophysiology Online


What's Your EyeQ?

In the coming ICD-10 Connect newsletters, we will be taking time to refresh anatomy and pathophysiology (A&P) in reference to ICD-10-CM, with a spotlight on a particular condition. The eyes have been described as the most complex organ in our body. Comparative to its size, there are a myriad of parts that all work together to allow us the gift of sight.

The human eye acts like a camera. Light comes in through the cornea (the glass of a camera's aperture), with the amount of light coming in controlled by the pupil that opens and closes (camera shutter). The light focuses on the retina, a series of light-sensitive cells lining the back of the eye. The retina (camera film) reacts to the incoming light and sends a record of the image, via the optic nerve, to the brain.

The eye also contains vitreous humor and aqueous humor. The vitreous humor is in the back of the eye and is more gel-like. The aqueous humor is located in the anterior chamber of the eye and is a clear fluid that provides nutrients to the cornea and lens. Aqueous humor leaves the eye through the anterior chamber angle. When the flow of this fluid is blocked, it causes a build-up of intraocular pressure (IOP) in the eye. This may lead to glaucoma.

Glaucoma is defined as an increase in the IOP, causing pathologic changes in the optic disk and defects in the field of vision. It is the second most common cause of blindness in the United States. The codes for glaucoma are found in categories H40-H42 in ICD-10-CM. They are broken down to include laterality (in some cases), type (open angle, pigmentary), and for certain subcategories, stage (mild, moderate, severe, indeterminate, or unspecified).

The more we understand A&P, the better we will understand ICD-10-CM. Future articles will feature other organ systems and ICD-10-CM references.


Comment Period Still Open for Possible ICD-10 Delay
There is still time to submit a comment to the Department of Health and Human Services (HHS) regarding the proposed delay of ICD-10. All comments are due to HHS no later than 5 p.m. ET on May 17. Comments can be submitted in the following ways:

  • Electronically by following the "Submit a comment" instructions on the website
  • By regular mail sent to:
    • Centers for Medicare & Medicaid Services
      Department of Health and Human Services
      Attention: CMS–0040–P
      P.O. Box 8013
      Baltimore, MD 21244–8013

More information about the proposed rule can be found in the One-Year Delay of ICD-10 Compliance Date fact sheet, which outlines the background of the ICD-10 compliance date and highlights provisions of the proposed rule and standards compliance date.


A patient presents herself today for a follow-up for her hypertension. At the last visit, she was complaining of swelling in her feet and ankles, back pain, trouble sleeping, and having to get up at night to urinate. She has a family history of CKD. She presents herself today for results of her GFR test.

ROS: As above, otherwise negative.

PFSH: As above. She does not drink or smoke.

Her GFR was 50. We discussed the fact that she is at stage 3 CKD. We discussed a referral to the nephrology department for recommendations and a treatment plan. She is positive about her diagnosis as she has had family members with CKD that take care of themselves and function very well. She wants to see the nephrologist as soon as possible. Calls were made to his office today and an appointment was made for her before she left our office. Dr. Jones will send me back his recommendations and we will move forward from there.

ASSESSMENT: Hypertension. CKD, stage 3.

The visit today was strictly counseling and coordinating care and a total face-to-face time of 40 minutes was spent with the patient discussing her condition, prognosis, outcomes, and referral to nephrology.

ICD-10-CM Codes:
I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
N18.3 Chronic kidney disease, stage 3

Rationale: According to the 2012 ICD-10-CM Official Guidelines/Reporting (C.9.a.2) assign codes from category I12 when both hypertension and a condition classifiable to category N18, Chronic kidney disease (CKD) are present. Unlike hypertension with heart disease, ICD-10-CM presumes a cause-and-effect relationship and classifies CKD with hypertension as hypertensive chronic kidney disease. The appropriate code from category N18 should be used as a secondary code with a code from category I12 to identify the stage of chronic kidney disease.

NOTE: The GFR test measures how well your kidneys are filtering a waste called creatinine, which is produced by the muscles. When the kidneys aren't working as well as they should, creatinine builds up in the blood. Levels below 60 mL/min/1.73 m2 for 3 or more months are a sign of chronic kidney disease.

ICD-10 Implementation Strategies

In this section, we share strategies to help your practice successfully implement ICD-10-CM. Please remember to track your progress in your ICD-10 Implementation Tracker on AAPC's website.

Gap Analysis
A gap analysis is an effective tool that can be used to assess where you are on the road to transition, what obstacles are in your way, and what you need to do to overcome them to achieve your goal of successful ICD-10 implementation. You will use the gap analysis to assess your strengths in helping to reach the goal (staff, education, software, etc.), your weaknesses (skill sets, new code sets, etc.), the opportunities available (boot camps, online training, chapter meeting offerings, etc.), and the obstacles that may potentially slow down your progress.

A gap analysis is a process that allows you to take a look at your "as is" state and outlines the plan to get to your desired "to be" state. With each step that is taken on the road to implementation, the gap analysis may be repeated to assess how the "gap" has been reduced. This can be used as a good marker on keeping track of your ICD-10 implementation.


ICD-10 Documentation Example
In this sample note, you can see the opportunity to indicate a higher degree of specificity in ICD-10-CM. In many cases, the documentation may already contain much of the necessary information to assign ICD-10-CM codes with higher granularity. Also keep in mind, the external cause codes listed may not be required by all payers.

ICD-10 Documentation Example

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