ICD-10 Coding Overview
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The document provides an overview of the structure and guidelines of ICD-10 diagnosis coding. It explains that ICD-10 codes have 3 to 7 characters representing different levels of clinical detail. The first 3 characters indicate the category, while additional characters specify etiology, anatomical site, or other information. It also outlines required additional codes, excludes notes, chapters within ICD-10, and transition dates from ICD-9 to ICD-10 for medical claims.
ICD-10 Coding Overview
- 1. ICD-10 Overview Prepared by Advanced Billing Consultants Advanced Billing Consultants, Inc. Copyright 2015
- 2. Minimum of 3, maximum of 7 characters 6th and 7th are not optional if required X may serve as a place holder for 4th and 5th character for future use Example of X place holder: other specified spondylopathies, cervical region is M48.8X2 Code Structure Advanced Billing Consultants, Inc. Copyright 2015
- 3. Represent the category 1st: Capital Letter (any except U) 2nd: number 3rd: number Example: The category for pain, not elsewhere classified is G89 Characters 1-3 Advanced Billing Consultants, Inc. Copyright 2015
- 4. Represent the etiology, anatomical site, severity, or other clinical detail Can be number or letter- capital or lowercase Characters 4-6 Advanced Billing Consultants, Inc. Copyright 2015
- 5. For obstetrics, musculoskeletal injuries, and external causes of morbidity encounter type, or extension, stages, LT/RT/bilateral/unspecified OR: A: initial D: subsequent S: Sequela (complications) Character 7 Advanced Billing Consultants, Inc. Copyright 2015
- 6. Collapsed vertebra, not elsewhere classified is M48.50- M48.58, but it requires a 7th digit A= initial encounter for fracture B= subsequent encounter for fracture with routine healing G= subsequent encounter for fracture with delayed healing S= sequela of fracture Correct diagnoses for the initial encounter for collapsed vertebra not elsewhere classified, site unspecified is: M48.50A Example Character 7 Advanced Billing Consultants, Inc. Copyright 2015
- 7. Excludes1: the two codes cannot be billed together Excludes2: both codes can be used Excludes Notes Advanced Billing Consultants, Inc. Copyright 2015
- 8. Many ICD-10 require additional diagnosis codes Additional Codes Required Advanced Billing Consultants, Inc. Copyright 2015
- 9. in diseases classified elsewhere= a manifestation code Can never be listed first May say: use additional code or code first Again, can never be listed first Code in brackets means it must be coded also, and second Etiology/Manifestation Codes Advanced Billing Consultants, Inc. Copyright 2015
- 10. 1. Certain Infectious and Parasitic Diseases (A00-B99) 2. Neoplasms (C00-D49) 3. Disease of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89) 4. Endocrine, Nutritional, and Metabolic Diseases (E00-E89) 5. Mental, Behavioral, and Neurodevelopmental Disorders (F01-F99) 6. Chronic pain syndrome (G89) 7. Diseases of the Eye and Adnexa 8. Diseases of the Ear and Mastoid Process (H60-H95) **not yet used 9. Diseases of Circulatory System (100-199) 10. Diseases of Respiratory System (J00-J99) 11. Diseases of Digestive System (K00-K95) **not yet used Chapters Advanced Billing Consultants, Inc. Copyright 2015
- 11. 12. Diseases of the Skin and Subcutaneous Tissue (L00-L99) 13. Diseases of Musculoskeletal System and Connective Tissue (M00-M99) 14. Diseases of Genitourinary System (N00-N99) 15. Pregnancy, Childbirth (O00-O9A) 16. Certain Conditions Originating in the Prenatal Period (P00-P96) 17. Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99) 18. Symptoms, signs, and abnormal clinical and laboratory findings (R00-R99) 19. Injury, Poisoning, and Certain other Consequences of External Causes (S00-T88) 20. External Causes of Morbidity (V00-Y99) 21. Factors Influencing Health Status and Contact with Health Services (Z00- Z99) ***The new V-codes*** Chapters Contd Advanced Billing Consultants, Inc. Copyright 2015
- 12. Use ICD-10 for DOS 10/1/2015 and forward. Continue use of ICD-9 for DOS 9/30/15 and before (even for corrected claims) Date Transition Advanced Billing Consultants, Inc. Copyright 2015
- 13. Many software systems provide crosswalks and conversions at the encounter or charge entry level. Ensure you have the most recent updates for your system. Specialty specific cheat sheets can be purchased from many vendors AAPC offers a free ICD-9 to ICD-10 conversion tool at: https://www.aapc.com/icd-10/codes/ Conversions and Crosswalks Advanced Billing Consultants, Inc. Copyright 2015
- 14. We appreciate any feedback. Please contact us at info@abcbilling.net Thank You! Advanced Billing Consultants, Inc. Copyright 2015