NOW THAT ICD-10 IS OFFICIAL, it’s time to get the right tools to make sure you don’t experience any revenue interruption for submitting incorrect codes. Despite the misleading title of this article, you will not actually find any quick fixes to ICD-10 described here. Th is article is actually an exposé on the dangers of using shortcuts when selecting ICD-10 codes. Sorry if you feel misled, but please read on. A valuable lesson awaits.
Let’s suppose you wanted to learn to speak French. If there was a shortcut, a way to communicate effectively without years of study, you would want to know it. How about one of these?
CHEAT SHEET: A concise list of the most important phrases in French. All you need to do is memorize them. Sure, you might not have the flexibility to say what you really mean, but at least you will be able to get by when you need a standard phrase such as, “Where is the bathroom?”
- TRANSLATOR TOOL: A list of the English phrases you use now along with the translations to the French equivalents. Instead of somebody else’s list, this one will be customized for you. To go a step further, this could even be a magical translator device that changes each word you speak from English to French the moment the words come out of your mouth.
The first option of commonly used phrases or words seems easy. No need to study French for years. Instead you just get to what you really need. Some expert picked the most important phrases that you need to know. But what if the detail you need is missing? What if you are looking for a bathroom, but your cheat sheet forgot to specify if you need the ladies' room instead of the men’s room? That could lead to an embarrassing situation.
The second option appears to be a little safer, since it starts with phrases you already commonly use. It seems that you will be more likely to have the right words available to you when you need it. Unfortunately, if each word is translated the moment it leaves your mouth, it won’t be able to take into account the syntax or the rules of grammar to form a cohesive sentence. In many languages, the sequence of the adjectives relative to the nouns is not the same in English. Other languages have words that must match in gender or have special rules about verb conjugations. Without considering the context, the sentence might have some of the correct words in it, but it just won’t sound right in French.
What Does This Have to Do With ICD-10?
You could be offered the same two options to help you take the easy road to ICD-10, hoping that it will allow you to avoid time-consuming and expensive training. The two options include:
• CHEAT SHEET: A list of the top codes that some expert came up with for your specialty. All you need to do is select one from the list. You just need to hope that your expert did not overlook anything, such as instructional notes that pertain to each code.
• TRANSLATOR TOOL: A magical device that will take your existing ICD-9 codes and convert them over for you. The translator does all the work for you. Just hope that the matches are one-to-one, rather than some complex decision tree algorithm.
The problems with these options are the same whether the subject is French or ICD-10. A cheat sheet may not include the codes you really need. Many ICD-10 codes are entirely new or include multiple options. If every option were included, the cheat sheet might take up three, four or five pages, thus decreasing its value as a quick reference. A translator is likely to use the government’s (CMS) GEMs (General Equivalence Mappings) database to give you an equivalent ICD-10 code. Frequently, GEMs leads to unspecified codes, which payers are likely to deny, and it overlooks many new codes that have no approximate match to an ICD-9 code.
In either case, the description of the code suggested could still turn out to be a pretty good match. In that scenario, you are still not done because these tools can’t take into consideration the “rules of grammar.” In other words, lists do not provide guidance on coding conventions and guidelines. Without intimate knowledge of the “rules of grammar,” you will never sound like a native speaker.
Learn to Speak Like a Native
Here is a seemingly simple example: 723.1 is the ICD-9 code for cervicalgia, or neck pain. There is an ICD-10 code that matches almost perfectly and either of the tools mentioned above would probably include M54.2 cervicalgia, as a choice for your consideration. However, in order to ensure that it is really the correct code, you should look for instructional notes within the tabular list for M54.2, and you must understand how to apply them. Next to M54.2, it says, Excludes1: cervicalgia due to intervertebral cervical disc disorder (M50.-). Shortcut lists don’t have space to include notes like this.
A “fluent” ICD-10 speaker would know that “Excludes1” means that these codes are mutually exclusive. The codes should not be billed at the same encounter. And, of course, that makes sense, because there is no need to report cervicalgia twice. One of the codes will do it just fine.
And that is still not the end of the journey. The cheat sheet or translator also forgets to tell you that the M54 category has an Excludes1 note for every code that begins with those three characters. It says Excludes1: psychogenic dorsalgia (F45.41), which means that code cannot be used with any code that begins with M54. And yet, a little further up in the Tabular List you will learn that the block of codes from M50-M54 have yet another exclusion: Excludes1: current injury – see injury of spine by body region discitis NOS (M46.4).
An extensive list of Excludes2 notes and instructions for the use of external cause codes appear at the beginning of chapter 13 of the CMS' ICD-10 Tabular List of Diseases and Injuries. These rules apply to all of the codes that begin with the letter “M.” A native speaker would tell you that Excludes2 means that you should consider adding those codes if they apply, because they are not automatically included in any codes in the whole chapter.
Familiarity with the general ICD-10 guidelines, which appear in their own section in the text, and apply to every code in the book, could come in handy as well. For example, they state that signs or symptoms should not be reported when a more definitive diagnosis is known. If something more specific is the cause of the cervicalgia, then it would be reported instead. The very first Excludes1 note that was identified, regarding M50.– cervicalgia due to intervertebral disc disorder, is a good example of a more specific code that would be used if the criteria are met.
Shortcuts and cheat sheets are appealing, and they can be helpful, but there is no substitute for a thorough understanding of the language and rules you must follow. For each code that these tools point out for you, it would be wise to go to the Tabular List and look at the following:
2) Includes and alternative wording
5) Code Also, Code First, Use Additional
6) Seventh character extensions
Repeat at the level of the code, then the subcategory, category, block and chapter.
Instructions on how to do this can be found in the ACA ICD-10 Toolkit at www.acatoday.org/ ICD-10 and the ChiroCode ICD-10 Book, Section Edition, at http://bit.ly/1J9ycjD, which is endorsed by ACA. Members even get special pricing. If you take the time to get the proper training, you can become fluent in ICD-10 before the Oct. 1, 2015 implementation date, thereby minimizing miscommunication with the payers and other parties who will no longer “speak” ICD-9. When the livelihood of your practice is at stake, don’t cut corners. Study hard and learn the rules of the system so that you can blend in with the natives.
ACA, ICD-10 and You
ACA HAS RESOURCES on ICD-10 Coding available at www.acatoday.org/ICD10. Here are two useful articles to help you sort through the issues:
• Dual Coding – Friend or Foe? – www.acatoday.org/ICD-10/documents/DualCoding.pdf
• ICD-10 Matters – www.acatoday.org/UserFiles/ICD10MattersApril2015.pdf
Dr. Gwilliam graduated from Palmer College of Chiropractic and later added credentials such as certified professional coding instructor, medical compliance specialist and certified professional medical auditor. He provides expert witness testimony, medical record audits, consulting and online courses for health care providers. He is a sought after seminar speaker. He is the vice president of the ChiroCode Institute and chief product officer of Find-A-Code; both provide coding, documentation and reimbursement guidance and education to physicians and coders. He has an MBA, is on the post-graduate faculty for National University of Health Sciences and is one of the few clinicians who became a certified ICD-10 instructor through the American Academy of Professional Coders.