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Issue #36 - June 12, 2013

AAPC ICD-10 Tips and Resources


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


FINAL Implementation
Boot Camps:
Richmond, VA 6/20
Chicago, IL 6/20
Dallas/FW, TX 6/27
Philadelpha, PA 6/27
Seattle, WA 6/27

Code Set Boot Camps:
Pittsburgh, PA 7/11
Sacramento, CA 7/11
Honolulu, HI 7/18

Implementation Boot Camps

Anatomy & Pathophysiology Online

Code Set Training


ICD-10 Implementation to Continue - CMS Part 1
By Faith C. M. McNicholas, CPC, CPCD, PCS, CDC, RHIT

In December 2012, the American Medical Association (AMA) requested that the Centers for Medicare & Medicaid Services (CMS) halt implementation of the International Classification of Diseases Version 10 (ICD-10). In response, Acting CMS Administrator Marilyn Tavenner reiterated that the deadline for ICD-10 conversion would not be postponed.

On February 6, 2013, she wrote, "Halting this progress midstream would be costly, burdensome, and would eliminate the impending benefits of these investments. Many private and public sector health plans, hospitals and hospital systems, and large physician practices are far along in their ICD-10 implementation and have devoted significant funds, resources and staff to the effort." She further explained, "We believe the one-year extension to September 30, 2014, offers physicians adequate time to train their coders, complete system changeovers, and conduct testing. Staying the course with ICD-9 is not sustainable in an electronic health environment."

Since Tavenner's statement, CMS has continued urging all healthcare providers to continue planning for ICD-10 transition and implementation. Claims for healthcare services provided on or after October 1, 2014, must contain ICD-10 codes.

As healthcare providers and coders, we understand that preparing for ICD-10 presents many challenges, including the inevitable increase in claim denials, potential cash-flow disruption, increased pressure on cash-on-hand, and scrutiny of operating margins. Besides training staff on the new code set, restructuring data, and managing the risks associated with ICD-10, conversion programs reach far deeper into the facility cash flow and budget.

Healthcare providers and coders must note that the switch from ICD-9 to ICD-10 will impact all aspects of the facility/practice. Most importantly, there will be a huge impact on clinical documentation and coding resources. In the days leading up to the ICD-10 implementation deadline, healthcare providers and coders should begin reviewing and assessing whether the current ICD-9 documentation will meet the coding requirements and specificity required to have their claims paid once we begin reporting those exact same services in ICD-10. Such assessment will assist in identifying what changes and staff (both clinical and coding) education will be required to be ready for the implementation.

Watch for Part 2 of this article next month with plans to mitigate risk for a smooth transition to ICD-10.


ICD-10-PCS Code Updates
The 2014 ICD-10-PCS (procedure) files are now available and posted on the CMS website. ICD-10-PCS will be used for coding inpatient procedures when the U.S. transitions to ICD-10 on October 1, 2014. ICD-10-PCS will replace ICD-9-CM, Volume 3. CPT® codes will continue to be used for outpatient procedures and services.

The new ICD-10-PCS files include:

  • Updated "Official ICD-10-PCS Coding Guidelines" with guidance from the ICD Cooperating Parties: CMS, the Centers for Disease Control and Prevention, the American Hospital Association, and the American Health Information Management Association
  • The 2014 ICD-10-PCS code tables and index, which add four procedure codes created to capture new technologies

To find out more about the 2014 ICD-10-PCS files, see the accompanying "What's New" document. The 2014 General Equivalence Mappings (GEMs) and 2014 Reimbursement Mapping files will be released in October 2013.


PREOPERATIVE DIAGNOSIS: Left Achilles tendon rupture (nontraumatic)
POSTOPERATIVE DIAGNOSIS: Left Achilles tendon rupture (nontraumatic)
PROCEDURE PERFORMED: Repair of left Achilles tendon rupture
DESCRIPTION OF PROCEDURE: After informed consent was obtained, the patient was taken to the operating room and placed on the table in the supine position. The patient had received 1 g of Ancef preop and a tourniquet was applied to the left proximal thigh. Once satisfactory general anesthesia was accomplished, the patient was then turned to the prone position. The left lower extremity was then prepped and draped in the usual sterile fashion. After several minutes of elevation and exsanguination using a 6-inch ACE wrap, the tourniquet was inflated to 300 mmHg. A sterile marking pen was then used to outline a posteromedial longitudinal incision to the left Achilles tendon. This incision measured approximately 12 cm in length. Great care was taken to avoid placing the incision midline to avoid Chou counter strikes at a later date. Sharp dissection was carried down through skin. Full-thickness flaps were developed. The patient was noted to have a complete frayed rupture of Achilles tendon at the musculotendinous junction. This rupture was approximately 7 cm proximal to the calcaneus. The tendon sheath with subcutaneous tissue was incised exposing the ruptured proximal and distal ends of the tendon. The frayed tendon was gently freshened to a smooth edge. The proximal tendon was then sutured using #2 FiberWire using a whip stitch technique. The distal end was also repaired using #2 FiberWire. The wound was irrigated with saline. PRP was injected around the tendon and the 2 columns of #2 FiberWire were then approximated with the foot in 5 degrees of equinus. The para Tenon and subcutaneous tissue was closed with 4-0 absorbable sutures. The repair was noted to be secure upon testing. The patient was placed in a sterile dressing and short leg fiberglass cast with the foot in 5-8 degrees of equinus. The patient tolerated the procedure well and was taken to recovery in stable condition. Sponge and needle count were correct. The patient received 1000 mL of crystalloid.

ICD-10-CM Codes:
M66.372 Spontaneous rupture of flexor tendon, left ankle and foot

Rationale: In ICD-10-CM, codes for tendon rupture are broken down by site, type of muscle, laterality, and whether the rupture is traumatic or nontraumatic. In the case above, the postoperative diagnosis is stated as a nontraumatic rupture of the left Achilles tendon. The Achilles tendon is in the ankle and is part of the gastrocnemius muscle, which is a flexor muscle. Therefore, it is a nontraumatic rupture of a flexor muscle of the left ankle.


We will be sharing a number of 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.

Budget Assessment and Reassessment
To ensure that funds are available when needed, a complete budget must be planned. The budget should be based on the areas identified in the practice as being impacted, including:

  • IT systems
  • Software/hardware
  • Implementation/code deployment
  • Cross-walking
  • Staff training and education
  • Documentation readiness audits
  • Overtime during the transition
The budget will need to be reassessed multiple times during all phases of transition to ICD-10 to enable necessary adjustments to be made to keep the project on task.


OB/GYN Quick Reference Guide
OB/GYN Quick Reference GuideAn OB/GYN Quick Reference guide has been developed to assist with the new concepts in ICD-10-CM as they relate to codes in Chapter 15, Pregnancy, Childbirth, and the Puerperium (O00-O9A) and the Chapter 21 codes that relate to the weeks of gestation. It is a two-page PDF document that can be printed and shared with the entire office and used as a training tool with your providers.

ICD-10 Tips and Resources is offered as a benefit to AAPC members and we hope you find the information useful. If you'd rather not receive future issues of ICD-10 Tips and Resources, please log in to your account and change your email preferences.

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CPT copyright 2012 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse or interpretation of information contained in this product.