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Issue #7 - January 12, 2011
AAPC ICD-10 Newsletter


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


Phoenix - Feb 17
Charlotte - Feb 17
San Antonio - Feb 24
San Diego - Feb 24



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How to Weather the Implementation Storm

ICD-10 implementation is still a couple years away, but it's time to think about the changes that we will face and the strain it will bring to our work environment. Although some still choose not to believe it, everything I have read indicates the change will take place on October 1, 2013.

Coders need to face the fact that the transition from ICD-9-CM to ICD-10-CM will take a toll on our working environment and we need to plan for some stressful times. What can you do to help keep yourself strong and on target?

  • Maintain a positive attitude during the transition
  • It will be beneficial to your success and well-being to maintain a positive outlook. No one wants to work with someone who has a negative attitude. You can usually find at least one good thing that will result from a change. Find that one thing and embrace it.

  • Communicate
  • Openly share your knowledge and ideas. Remember, this may require some personal sacrifice and sometimes risk, but it will also increase your credibility and establish yourself as an expert within your organization.

  • Be organized
  • There will be a lot of moving parts during the transition. Taking good notes and keeping them organized will help you be prepared and understand the "why" behind the the different elements. After attending a meeting, compare your notes with someone else's. This will ensure that you've captured everything and it will discontinue any misunderstandings you may have.

  • Be part of a team
  • ICD-10-CM will be a huge undertaking and will require employees that can embrace teamwork. Ask to observe an already established team's meeting, or find a book or a class to research team-building skills. Being an expert on specific subject matter is important to a team. However, it is more important to have the necessary interpersonal skills, accept joint accountability, and work with others toward a common goal.

  • Find time to reward yourself
  • You should develop a list of things you want to accomplish and reward yourself for each achievement along the way. For example, you may determine that you need to upgrade your knowledge base and decide to take an anatomy class. Treat yourself to your favorite restaurant if you get an "A" on the midterm, or post your grade on the refridgerator.

    Change is stressful and at times very difficult. But the change from ICD-9-CM to ICD-10-CM is coming regardless. We can choose to embrace the changes and be prepared for them by focusing on their positive aspects, especially as they relate to our patients and the overall health care delivery system.


    The Centers for Medicare and Medicaid Services (CMS) posted the new, revised, and deleted ICD-10-CM codes on the CMS website on December 22, 2010. A total of 487 new codes were added, 220 codes were deleted and 2,858 codes were revised. The total number of ICD-10-CM codes went from 69,101 to 69,368. Keep in mind the codes are still in draft format and will not be finalized until the freeze. Many of the code changes, additions, and deletions were a result of the ICD-9-CM Coordination and Maintenance Committee meeting with input from the health care industry. The new codes may be found on the CMS website.


    PREOPERATIVE DIAGNOSIS: Displaced both-bone forearm fracture, right arm.

    POSTOPERATIVE DIAGNOSIS: Displaced both-bone forearm fracture, right arm.

    OPERATIONS PERFORMED: Closed reduction and casting, right forearm fracture.

    ANESTHESIA: IV sedation.

    DESCRIPTION OF PROCEDURE: The patient was brought to the operating room via the emergency room and placed on the operating table in the supine position. The arm was removed from the splint and placed into a fingertrap suspension. He was given some intravenous sedation, and seven pounds of traction was applied to the proximal arm. A closed reduction of the forearm fracture was accomplished. The adequacy of the reduction was checked with a mini C-arm, which showed good alignment of the fracture fragments to both AP and lateral views. A long-arm plaster cast was applied. After appropriate time was allowed for hardening, the patient was transferred back to stretcher and returned to the recovery room in satisfactory condition. He tolerated the procedure well.

    ICD-9-CM Code:
    ICD-10-CM Code:

    Rationale: Unspecified fracture of forearm, right forearm initial encounter.

    Note: In ICD-10-CM most fracture codes include displaced and non displaced choices. In addition you must include 7th digit character for stage of healing. For this encounter the reduction and casting qualifies for A (Initial Encounter). Examples of initial encounter include ED encounters, first time seeing a physician, surgery, etc. It is for use while the patient is receiving active care.

    ICD-10 TIPS

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

    Step #7: Develop a training plan
    Training will be essential. Coordinate your plan to occur in two phases (discussed in greater detail in future tips). The first will be a general overview of guidelines, different code format, etc. The second will be focused on your practice's specific relevant code sets. All staff members in the practice will need some form of training, based on their role within the practice.


    AAPC has offered a reference sheet to compare the ICD-9 and ICD-10 code sets.  Click for a free PDF.

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