ICD-10-CM and Chapter 15 Pregnancy, Childbirth and the Puerperium (O00-O9A)
This article will present an overview of the changes to specific disorders classified to Chapter 15 of ICD-10-CM. Not all revisions will be identified here, but certain conditions are highlighted to point out certain concepts that represent terminology, organizational and classification modifications. ICD-10-CM allows coding for increased specificity in the reporting of diseases and recently recognized conditions.
The first hurdle is to recognize that ICD-10-CM codes in Chapter 15 – Pregnancy, Childbirth and the Puerperium (O00-O9A) begin with the alpha character “O” – not to be confused with the numerical character “0”. Remember that the first character in ICD-10-CM is always an alpha character. Chapter 15 – Pregnancy, Childbirth and the Puerperium (O00-O9A) includes the categories arranged in the following blocks: Read more >>
Structural Differences: ICD-9-CM vs. ICD-10-CM
From Octo-mom to Nonuplets!
Diagnosis coding will go from 3-5 characters in ICD-9-CM to 3-7 characters in ICD-10-CM. While many components of the code in ICD-10-CM remain the same as ICD-9-CM the user will note differences in ICD-10-CM structure, code composition, and level of detail.
Just like ICD-9-CM, all of the codes with the same first three characters have common traits. Each character beyond the first three adds more specificity.
Let’s look at the ICD-10-CM example of S04.02xA – Injury of optic chiasm initial encounter….Read more >>
ICD-10CM – Musculoskeletal System: Ankle Sprain
Today we look at the female 26-year-old patient who presents to her physician’s office with “ankle sprain.” No other information is offered about the injury or how it happened. In ICD-9CM we code this statement as:
- 845.00 sprains and strains of ankle, unspecified site
This code comes from ICD-9CM Chapter 17 Injury and Poisoning (800-999). The beginning of ICD-9CM Chapter 17 instructs us to “use additional code for retained foreign body, if applicable” and also to “use E code(s) to identify the cause and intent of the injury or poisoning (E800-E999)”. Our documented statement does not give us an indication of retained foreign body or how the ankle was sprained.
In ICD-10CM you will find that injuries are grouped by the body part rather than by categories of injury. The documented statement of “ankle sprain” leads us to Chapter 19 Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) ICD-10CM code S93.4- Sprain of ankle. Instructions provided ask us to code any associated open wound, and to also use a secondary diagnosis code from Chapter 20 External causes of Morbidity (V00-Y99) to indicate the cause of injury. If this is the initial encounter a place of occurrence code is used after other external cause codes.
ICD-10CM: S93.4- Sprain of ankle
This block instructs us to use a fifth, sixth, and seventh digit:
- S93.4- Sprain of ankle
- S93.401- Sprain of unspecified ligament of right ankle
- S93.402- Sprain of unspecified ligament of left ankle
- S93.409- Sprain of unspecified ligament of unspecified ankle
- Required 7th digit to identify the encounter:
- A – Initial
- D – Subsequent
- S – Sequela
Coding professionals may be tempted to code as unspecified when the physician’s documentation does not give us the specifics needed to select a more specific code but I would caution against this. It is true that in our case of the “ankle sprain” that there is an unspecified code to choose from in ICD-10CM (S93.409_). This is an action that you may regret in a few years when you review your severity and risk scores assigned to you by government and third party payer plans. Your coded files will not have the specificity needed to justify higher levels and better reimbursement.
Our documented statement of “ankle sprain” will require a written inquiry to the physician for additional information:
- Which ankle, right or left?
- Is this the initial, subsequent or sequela encounter?
- How did this injury happen?
- Where did this injury happen?
The following week we receive the inquiry back from the physician with the information that is needed to select an ICD-10CM code for the encounter. The physician indicates that this is the first encounter for this right ankle sprain, leading us to code ICD-10CM as S93.401A. The physician also tells us that the patient slipped in the driveway on the ice while going to the mailbox. This is coded in ICD-10CM as W00.0xxA fall on same level due to ice and snow, initial encounter. The seventh character “A” indicates that this is the initial encounter. You may notice that code W00.0xxA describes how the injury happened and that this code includes two “xx” placeholders. We will discuss the role of placeholders in a future article.
Don’t Let ICD-10 Raise Your Blood Pressure
In ICD-9, we have the Hypertension Table in the alphabetic index. Rarely do we have enough information documented to code anything more than 401.9 Unspecified essential hypertension. In order to code more specifically in ICD-9, we need documentation that states either “benign HTN” to code 401.1 or “malignant HTN” to code 401.0. The Hypertension Table also gives us many other options to choose from when the hypertension is linked to heart disease and/or kidney disease. In ICD-10, we have one code for hypertension. Ironically, the code is I10 Essential (primary) hypertension. Hopefully, ICD-10 doesn’t make your blood pressure rise! [Note: The letter “I” will always be used in the first character place and should not be confused with the number 1 which will always be used in the second character place.] This code includes benign and malignant hypertension or high blood pressure. As with ICD-9, there are additional codes for hypertensive heart disease and hypertensive kidney disease.
"Uhhhhh…What Happened to Gout?"
Currently in ICD-9-CM, Chapter 3 Endocrine, Nutritional and Metabolic Diseases and Immunity (240-279) physicians would choose category 274 Gout and select one of 15 different codes to describe the encounter. In ICD-10-CM, this chapter has been renamed to Chapter 4, Endocrine, Nutritional and Metabolic Diseases (E00-E89). Gout has been removed from this category and placed in Chapter 13 Diseases of Musculoskeletal System and Connective Tissue. In ICD-10-CM, physicians will choose from the category M10 Gout, and select a code from 162 choices. In order to select the appropriate code, your documentation will need to describe all of the following elements that most accurately describe the encounter:
- Anatomical area affected
- Lead-induced (also identify the toxic effects of lead and its compounds)
- Drug induced (also identify the drug)
- Renal impairment (also code the associated renal disease)
- Other secondary (coding first the associated condition)
- an additional code to identify certain diseases and/or disorders classified elsewhere
Are you ready for ICD-10?
The time to begin preparation for clinical documentation improvement is now. Do not waste the opportunity to improve on current diagnosis documentation in ICD-9-CM. Learning how to improve your documentation now will make the transition into ICD-10-CM much easier. Contact us for more information on what you or your physicians need to document now to be ready for ICD-10.