How To Find The Right ICD-10 Code
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Here you will learn how to identify the right code for your diagnosis by applying different strategies that help reduce the probability of coding error and save time.
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How To Find The Right ICD-10 Code
- 2. ICD-10 Boot Camp Part 3 - Code Selection Strategies 2 Presented by Evan M. Gwilliam, DC MBA BS CPC CCPC NCICS CCCPC CPC-I MCS-P CPMA Chief Product Officer
- 3. Dr. Evan Gwilliam • Education • Bachelor’s of Science, Accounting - Brigham Young University • Master’s of Business Administration - Broadview University • Doctor of Chiropractic, Valedictorian - Palmer College of Chiropractic • Certifications • Certified Professional Coder (CPC) - AAPC • Nationally Certified Insurance Coding Specialist (NCICS) - NCCT • Certified Chiropractic Professional Coder (CCPC) - AAPC • ChiroCode Certified Chiropractic Professional Coder (CCCPC) - ChiroCode • Certified Professional Coder – Instructor (CPC-I) - AAPC • Medical Compliance Specialist – Physician (MCS-P) - MCS • Certified Professional Medical Auditor (CPMA) – AAPC, NAMAS • Certified ICD-10 Trainer - AAPC 3
- 4. Overview • Part 1 - ICD-10 fundamentals and navigation • Part 2 - Coding conventions and guidelines • Part 3 - ICD-10 code selection strategies • Part 4 - Documentation improvement 4
- 5. 1. Common codes list (but don’t stop there!) 2. GEMs code map (don’t stop here either!) 3. Alphabetic Index (still not safe!) Always confirm the code using the Tabular List 5 Find the code
- 6. 6
- 8. 2. GEMs 8
- 9. 9 2. GEMs General Equivalence Mappings (GEMs) o Created by the National Center for Health Statistics, part of the CDC o Forward maps from ICD-9 to ICD-10 o Backward maps from ICD-10 to ICD-9 o Approximations only
- 11. Example #1 Patient is an 18-month old fussy, white female with a three-day history of otalgia, runny nose and fever of 100. There is no exposure to tobacco smoke. Otoscopic examination reveals acute serous otitis media of the right ear. Assessment: Acute serous otitis media, right ear. On September 30, 2015, the diagnosis is 381.01 Acute serous otitis media. On October 1, 2015, it is: 11
- 12. 1. Common codes list (but don’t stop there!) 2. GEMs code map (don’t stop here either!) 3. Alphabetic Index (still not safe!) Always confirm the code using the Tabular List 12 Find the code
- 14. 1. Common codes list (but don’t stop there!) 2. GEMs code map (don’t stop here either!) 3. Alphabetic Index (still not safe!) Always confirm the code using the Tabular List 14 Find the code
- 15. 15 2. GEMs
- 16. 1. Common codes list (but don’t stop there!) 2. GEMs code map (don’t stop here either!) 3. Alphabetic Index (still not safe!) Always confirm the code using the Tabular List 16 Find the code
- 19. 1. Common codes list (but don’t stop there!) 2. GEMs code map (don’t stop here either!) 3. Alphabetic Index (still not safe!) Always confirm the code using the Tabular List 19 Find the code
- 20. 20 Tabular List
- 21. 21 Tabular List
- 22. Example #1 Patient is an 18-month old fussy, white female with a three-day history of otalgia, runny nose and fever of 100. There is no exposure to tobacco smoke. Otoscopic examination reveals acute serous otitis media of the right ear. Assessment: Acute serous otitis media, right ear. On September 30, 2015, the diagnosis is 381.01 Acute serous otitis media On October 1, 2015, it is: H65.01 Acute serous otitis media, right ear NOTE: • Common codes lists are just an expert guess • GEMs often leads to unspecified codes • Alphabetic Index often gives incomplete or multiple options 22
- 23. 1. Common codes list (but don’t stop there!) 2. GEMs code map (don’t stop here either!) 3. Alphabetic Index (still not safe!) Always confirm the code using the Tabular List 23 Find the code
- 24. The next step for converting to ICD-10 24 1. Go to the Tabular List o Look at the following: 1. Notes 2. Includes and alternative wording 3. Excludes1 4. Excludes2 5. Code Also, Code First, Use Additional 6. Seventh character extensions 2. Repeat at the level of the code, then the subcategory, category, block, and chapter 3. Reverse map for confirmation if necessary
- 25. 25 Tabular List
- 26. Example #2 This 30-year old white male sustained a right knee injury while playing basketball on Saturday. He was seen in our urgent care clinic and sent for MRI of the right knee to rule out meniscal tear. MRI revealed right bucket-handle medial meniscal tear and tear of the anterior cruciate ligament (ACL). Patient will be scheduled for surgery on Tuesday. On September 30, 2015, the diagnosis is 836.0 Bucket handle tear, meniscus, knee On October 1, 2015, it is: 26
- 27. 1. Common codes list (but don’t stop there!) 2. GEMs code map (don’t stop here either!) 3. Alphabetic Index (still not safe!) Always confirm the code using the Tabular List 27 Find the code
- 29. 1. Common codes list (but don’t stop there!) 2. GEMs code map (don’t stop here either!) 3. Alphabetic Index (still not safe!) Always confirm the code using the Tabular List 29 Find the code
- 30. 1. Common Codes 30 2. GEMs
- 31. 31 Tabular List
- 32. 32 2. GEMs
- 33. 33 Tabular List
- 34. 1. Common codes list (but don’t stop there!) 2. GEMs code map (don’t stop here either!) 3. Alphabetic Index (still not safe!) Always confirm the code using the Tabular List 34 Find the code
- 36. 36 Tabular List
- 37. The next step for converting to ICD-10 37 1. Go to the Tabular List o Look at the following: 1. Notes 2. Includes and alternative wording 3. Excludes1 4. Excludes2 5. Code Also, Code First, Use Additional 6. Seventh character extensions 2. Repeat at the level of the code, then the subcategory, category, block, and chapter 3. Reverse map for confirmation if necessary
- 38. The next step for converting to ICD-10 38 1. Go to the Tabular List o Look at the following: 1. Notes 2. Includes and alternative wording 3. Excludes1 4. Excludes2 5. Code Also, Code First, Use Additional 6. Seventh character extensions 2. Repeat at the level of the code, then the subcategory, category, block, and chapter 3. Reverse map for confirmation if necessary
- 39. 39 Tabular List
- 40. 40 Tabular List
- 41. 41 Tabular List
- 42. 42
- 43. 43
- 44. The next step for converting to ICD-10 44 1. Go to the Tabular List o Look at the following: 1. Notes 2. Includes and alternative wording 3. Excludes1 4. Excludes2 5. Code Also, Code First, Use Additional 6. Seventh character extensions 2. Repeat at the level of the code, then the subcategory, category, block, and chapter 3. Reverse map for confirmation if necessary
- 45. 45
- 46. 46 Tabular List
- 47. Example #2 This 30-year old white male sustained a right knee injury while playing basketball on Saturday. He was seen in our urgent care clinic and sent for MRI of the right knee to rule out meniscal tear. MRI revealed right bucket-handle medial meniscal tear and tear of the anterior cruciate ligament (ACL). Patient will be scheduled for surgery on Tuesday. On September 30, 2015, the diagnosis is 836.0 Bucket handle tear, meniscus, knee On October 1, 2015, it is: S83.212A Bucket handle tear of medial meniscus, right knee 47
- 48. 34 specialty specific ICD-10 books • More than 70 pages which teach • Conventions • Guidelines • Implementation steps • Documentation strategies • Provider Documentation Guides • Specialty specific • GEMs mapping • Alpha Index • Abridged Tabular List Use “CureMD20” to save $20 at InstaCode.com
- 49. 49
- 50. 50
- 51. 51
- 52. 52
- 53. 53
Editor's Notes
- ICD-10 can be overwhelming, but, with some strategizing and planning it can be managed. In this presentation we will look at a few ICD-10 fundamentals, then familiarize ourselves with three methods for finding the right ICD-10 code. Each one is a different path, but all lead to the same destination: the right code.
- Finally, we are where the rubber meets the road. Here are the three strategies for finding the right ICD-10 code. They are [see above]. But the truth is that these methods are just step one of a slightly bigger process. Let’s say that you walk into the supermarket, looking for grape juice. You might ask a clerk where to find it and he could point you to aisle 3. Once you get there you might find exactly what you are looking for on the end cap. Or, you might have to wander up and down the aisle until you spot it. Then you might want to compare brands, or nutritional content, or look for the best price. In fact, you might realize that you really need apple-grape juice, or, after searching for a while, you decide you really wanted chocolate milk all along. These three strategies all get you to aisle 3. But often you have to do some investigating before you can be certain that you have chosen the right product (or code). You do this by digging through the Tabular List.
- This is an example of a common codes list. This one is for diagnoses commonly seen in a family practice or urgent care setting. It can be helpful because the provider won’t need to search through all 70,000 ICD-10 codes. He or she can just browse this much shorter list, specific to the anatomical region of interest, and the provider’s specialty. Unfortunately, these lists are a little misleading because ICD-10 has not yet been used in the US, so no one really knows which codes are truly “common”. These lists will be produced by specialty associations and coding book publishers, but at this point in time, they are really just best guesses. Hence, they cannot be relied upon completely. Whatever path they lead us down, we must confirm with the Tabular List.
- Here is an example of a printed crosswalk based on GEMs forward mapping from ICD-9 to ICD-10. The ICD-9 codes are listed in numeric order in the left hand column and the ICD-10 equivalents are on the right. Many times there is only one ICD-10 code listed, but sometimes multiple options are offered, as you can see here. Unfortunately, GEMs frequently crosses to unspecified codes because the original ICD-9 code was not very specific. Unspecified codes are expected to be denied, or lead to delayed payment if more detail could have been reported by other codes. In this customized crosswalk, you’ll notice that unspecified codes do not appear. Rather, code categories and subcategories are provided. They are not in bold and end with a hyphen to encourage the reader to go to the Tabular List to research the detail needed to complete the code. If a complete code is available, it is bolded.
- Many providers will say, “Here is my old code. Just translate to the new one.” That is what GEMs does. GEMs is a government database that allows us to crosswalk from ICD-9 to ICD-10, or from ICD-10 to ICD-9. It seems like it could eliminate all the concern about finding the right code, but, unfortunately, it does not work like that. We have been warned by CMS that GEMs are only approximations and they should not be used to code. Codes should only be selected based on the key terms found in the provider documentation. Frequently, GEMs leads to unspecified ICD-10 codes, which are expected to be denied by payers. Nonetheless, GEMs can be helpful in identifying good prospects. Since GEMs was created by the government, it is in the public domain. You can obtain it for free, such as with the FindACode smart phone app.
- The third, and best, strategy for finding the right ICD-10 code is the alphabetic index. This is the method that CMS recommends. For this approach, you do not need to know what the ICD-9 code was. You just need to read the provider documentation, pick out the key terms, and look them up in the index. Sometimes the index will take you right to the correct code, which will be in bold (in this book anyway), but often it only provides the first three or four characters of a code. This is indicated by a hyphen (and no bold), which means that the reader needs to seek out the rest of the code in the Tabular List.
- Here is an example of a case. We will use all three methods to seek out the appropriate ICD-10 code, then confirm using the tabular list. [read the example] Note that, at this time, we have been instructed to report ICD-9 codes for dates of service that occur prior to October 1. There is no testing or dual reporting period. But there has been some movement among some healthcare provider’s organizations to create a sort of transition period where both codes could be accepted. Be sure to pay attention to notices from payers to be certain of your options.
- This common codes list contains code related to the ear. The only way to try to find our new code is to browse the list until we see something we like. Highlighted on the left, you can see ‘acute serous otitis media and the possible final code choices listed in bold print below. The options are based on laterality and whether the acute serous otitis media is recurrent or not. Since the note says nothing about recurrent and states the right ear, we can probably stick with H65.01. This could be the right code, and we might be done with our search. However, we should use the other two strategies, then confirm with the Tabular List, just to be sure.
- This is a GEMs based crosswalk or code map. As we scan the ICD-9 column, we come to 381.01, which is the code we were given in the example. This is a one-to-many map, because the category code followed by a hypen (-) indicates several options are available instead of just one or two. You must actually look through all of the options within H65.- to determine which is the most correct. We’ll have to go to the Tabular List to determine the final code selection. Before we go to the Tabular List, let’s use the third strategy.
- As we look up the key term, “otitis” in the Alphabetic Index, we are led to a few options. Under the main term of ‘otitis’ scroll down through the subterms to locate ‘media,’ followed by the next subterm from our diagnosis of ‘serous.’ Here we are presented with instructions to “see Otitis, media, nonsuppurative, acute, serous.’ As you can see, with this particular book, there is a gray column just left of the subterms that helps to keep you lined up with the subterm associated with the main term you are looking under. With these instructions, go back to the first subterm of media and continue to look for another subterm, further down the page of ‘nonsuppurative.’ We are presented with yet another subterm ‘acute or subacute NEC’ and options under it. ‘Serous H65.0-’ is presented (which fits our diagnosis) but there is another subterm of ‘recurrent H65.0-’ under it. We can see from this exercise in the Alphabetic Index that subcategory H65.0- is our starting point in the Tabular List. Let’s go to the Tabular List.
- As we look up the key term, “otitis” in the Alphabetic Index, we are led to a few options. Under the main term of ‘otitis’ scroll down through the subterms to locate ‘media,’ followed by the next subterm from our diagnosis of ‘serous.’ Here we are presented with instructions to “see Otitis, media, nonsuppurative, acute, serous.’ As you can see, with this particular book, there is a gray column just left of the subterms that helps to keep you lined up with the subterm associated with the main term you are looking under. With these instructions, go back to the first subterm of media and continue to look for another subterm, further down the page of ‘nonsuppurative.’ We are presented with yet another subterm ‘acute or subacute NEC’ and options under it. ‘Serous H65.0-’ is presented (which fits our diagnosis) but there is another subterm of ‘recurrent H65.0-’ under it. We can see from this exercise in the Alphabetic Index that subcategory H65.0- is our starting point in the Tabular List. Let’s go to the Tabular List.
- The three strategies have all led us here, to the Tabular List. The first option we found, using a commonly codes list, was H65.01. The GEMs and Alphabetic Index let us to H65.0-. If we look at the most complete code we were offered, from the Common Code List we can see that H65.01 is reported for acute serous otitis media, right ear. This matches our documentation. However, additional choices in this category include ‘recurrent, right ear H66.04.’ The question must be asked as to whether or not the providers are accustomed to documenting recurrence and as a coder, understanding what ‘recurrent’ means. Bring that information to your providers. Let them understand that this may affect authorizations for tube placement if recurrent isn’t documented and properly coded. Next, read any instructional notations associated with the code. Here we see instructions at the chapter level and instructions at the category level. For this particular code, there is one instructional note that states if the patient has a perforated tympanic membrane, an additional code of H74.- should be reported and if the patient is exposed to tobacco smoke (environmentally or in the perinatal period) or uses tobacco additional codes should also be reported. Referencing the note, the patient has not been exposed to tobacco smoke. Final code selection would be correct at H65.01 Acute serous otitis media, right ear.
- The three strategies have all led us here, to the Tabular List. The first option we found, using a commonly codes list, was H65.01. The GEMs and Alphabetic Index let us to H65.0-. If we look at the most complete code we were offered, from the Common Code List we can see that H65.01 is reported for acute serous otitis media, right ear. This matches our documentation. However, additional choices in this category include ‘recurrent, right ear H66.04.’ The question must be asked as to whether or not the providers are accustomed to documenting recurrence and as a coder, understanding what ‘recurrent’ means. Bring that information to your providers. Let them understand that this may affect authorizations for tube placement if recurrent isn’t documented and properly coded. Next, read any instructional notations associated with the code. Here we see instructions at the chapter level and instructions at the category level. For this particular code, there is one instructional note that states if the patient has a perforated tympanic membrane, an additional code of H74.- should be reported and if the patient is exposed to tobacco smoke (environmentally or in the perinatal period) or uses tobacco additional codes should also be reported. Referencing the note, the patient has not been exposed to tobacco smoke. Final code selection would be correct at H65.01 Acute serous otitis media, right ear.
- Here is an example of a case. We will use all three methods to seek out the appropriate ICD-10 code, then confirm using the tabular list. [read the example] Note that, at this time, we have been instructed to report ICD-9 codes for dates of service that occur prior to October 1. There is no testing or dual reporting period. But there has been some movement among some healthcare provider’s organizations to create a sort of transitionary period where both codes could be accepted. Be sure to pay attention to notices from payers to be certain of your options.
- We don’t have time to go through all of the ICD-10 conventions and guidelines, but be sure to get educated on these rules so that you can become “fluent” in ICD-10. Just like you need to study French in order to become fluent, you need to get familiar with the “rules of grammar” in ICD-10 coding so that you can speak with the natives, or rather, avoid interruptions to your reimbursement.
- The three strategies have all led us here, to the Tabular List. The first option we found, using a commonly codes list, was H65.01. The GEMs and Alphabetic Index let us to H65.0-. If we look at the most complete code we were offered, from the Common Code List we can see that H65.01 is reported for acute serous otitis media, right ear. This matches our documentation. However, additional choices in this category include ‘recurrent, right ear H66.04.’ The question must be asked as to whether or not the providers are accustomed to documenting recurrence and as a coder, understanding what ‘recurrent’ means. Bring that information to your providers. Let them understand that this may affect authorizations for tube placement if recurrent isn’t documented and properly coded. Next, read any instructional notations associated with the code. Here we see instructions at the chapter level and instructions at the category level. For this particular code, there is one instructional note that states if the patient has a perforated tympanic membrane, an additional code of H74.- should be reported and if the patient is exposed to tobacco smoke (environmentally or in the perinatal period) or uses tobacco additional codes should also be reported. Referencing the note, the patient has not been exposed to tobacco smoke. Final code selection would be correct at H65.01 Acute serous otitis media, right ear.
- Here is an example of a case. We will use all three methods to seek out the appropriate ICD-10 code, then confirm using the tabular list. [read the example] Note that, at this time, we have been instructed to report ICD-9 codes for dates of service that occur prior to October 1. There is no testing or dual reporting period. But there has been some movement among some healthcare provider’s organizations to create a sort of transition period where both codes could be accepted. Be sure to pay attention to notices from payers to be certain of your options.
- This common codes list contains code related to the ear. The only way to try to find our new code is to browse the list until we see something we like. Highlighted on the left, you can see ‘acute serous otitis media and the possible final code choices listed in bold print below. The options are based on laterality and whether the acute serous otitis media is recurrent or not. Since the note says nothing about recurrent and states the right ear, we can probably stick with H65.01. This could be the right code, and we might be done with our search. However, we should use the other two strategies, then confirm with the Tabular List, just to be sure.
- This common codes list contains code related to the ear. The only way to try to find our new code is to browse the list until we see something we like. Highlighted on the left, you can see ‘acute serous otitis media and the possible final code choices listed in bold print below. The options are based on laterality and whether the acute serous otitis media is recurrent or not. Since the note says nothing about recurrent and states the right ear, we can probably stick with H65.01. This could be the right code, and we might be done with our search. However, we should use the other two strategies, then confirm with the Tabular List, just to be sure.
- The three strategies have all led us here, to the Tabular List. The first option we found, using a commonly codes list, was H65.01. The GEMs and Alphabetic Index let us to H65.0-. If we look at the most complete code we were offered, from the Common Code List we can see that H65.01 is reported for acute serous otitis media, right ear. This matches our documentation. However, additional choices in this category include ‘recurrent, right ear H66.04.’ The question must be asked as to whether or not the providers are accustomed to documenting recurrence and as a coder, understanding what ‘recurrent’ means. Bring that information to your providers. Let them understand that this may affect authorizations for tube placement if recurrent isn’t documented and properly coded. Next, read any instructional notations associated with the code. Here we see instructions at the chapter level and instructions at the category level. For this particular code, there is one instructional note that states if the patient has a perforated tympanic membrane, an additional code of H74.- should be reported and if the patient is exposed to tobacco smoke (environmentally or in the perinatal period) or uses tobacco additional codes should also be reported. Referencing the note, the patient has not been exposed to tobacco smoke. Final code selection would be correct at H65.01 Acute serous otitis media, right ear.
- This is a GEMs based crosswalk or code map. As we scan the ICD-9 column, we come to 381.01, which is the code we were given in the example. This is a one-to-many map, because the category code followed by a hypen (-) indicates several options are available instead of just one or two. You must actually look through all of the options within H65.- to determine which is the most correct. We’ll have to go to the Tabular List to determine the final code selection. Before we go to the Tabular List, let’s use the third strategy.
- The three strategies have all led us here, to the Tabular List. The first option we found, using a commonly codes list, was H65.01. The GEMs and Alphabetic Index let us to H65.0-. If we look at the most complete code we were offered, from the Common Code List we can see that H65.01 is reported for acute serous otitis media, right ear. This matches our documentation. However, additional choices in this category include ‘recurrent, right ear H66.04.’ The question must be asked as to whether or not the providers are accustomed to documenting recurrence and as a coder, understanding what ‘recurrent’ means. Bring that information to your providers. Let them understand that this may affect authorizations for tube placement if recurrent isn’t documented and properly coded. Next, read any instructional notations associated with the code. Here we see instructions at the chapter level and instructions at the category level. For this particular code, there is one instructional note that states if the patient has a perforated tympanic membrane, an additional code of H74.- should be reported and if the patient is exposed to tobacco smoke (environmentally or in the perinatal period) or uses tobacco additional codes should also be reported. Referencing the note, the patient has not been exposed to tobacco smoke. Final code selection would be correct at H65.01 Acute serous otitis media, right ear.
- As we look up the key term, “otitis” in the Alphabetic Index, we are led to a few options. Under the main term of ‘otitis’ scroll down through the subterms to locate ‘media,’ followed by the next subterm from our diagnosis of ‘serous.’ Here we are presented with instructions to “see Otitis, media, nonsuppurative, acute, serous.’ As you can see, with this particular book, there is a gray column just left of the subterms that helps to keep you lined up with the subterm associated with the main term you are looking under. With these instructions, go back to the first subterm of media and continue to look for another subterm, further down the page of ‘nonsuppurative.’ We are presented with yet another subterm ‘acute or subacute NEC’ and options under it. ‘Serous H65.0-’ is presented (which fits our diagnosis) but there is another subterm of ‘recurrent H65.0-’ under it. We can see from this exercise in the Alphabetic Index that subcategory H65.0- is our starting point in the Tabular List. Let’s go to the Tabular List.
- The three strategies have all led us here, to the Tabular List. The first option we found, using a commonly codes list, was H65.01. The GEMs and Alphabetic Index let us to H65.0-. If we look at the most complete code we were offered, from the Common Code List we can see that H65.01 is reported for acute serous otitis media, right ear. This matches our documentation. However, additional choices in this category include ‘recurrent, right ear H66.04.’ The question must be asked as to whether or not the providers are accustomed to documenting recurrence and as a coder, understanding what ‘recurrent’ means. Bring that information to your providers. Let them understand that this may affect authorizations for tube placement if recurrent isn’t documented and properly coded. Next, read any instructional notations associated with the code. Here we see instructions at the chapter level and instructions at the category level. For this particular code, there is one instructional note that states if the patient has a perforated tympanic membrane, an additional code of H74.- should be reported and if the patient is exposed to tobacco smoke (environmentally or in the perinatal period) or uses tobacco additional codes should also be reported. Referencing the note, the patient has not been exposed to tobacco smoke. Final code selection would be correct at H65.01 Acute serous otitis media, right ear.
- We don’t have time to go through all of the ICD-10 conventions and guidelines, but be sure to get educated on these rules so that you can become “fluent” in ICD-10. Just like you need to study French in order to become fluent, you need to get familiar with the “rules of grammar” in ICD-10 coding so that you can speak with the natives, or rather, avoid interruptions to your reimbursement.
- We don’t have time to go through all of the ICD-10 conventions and guidelines, but be sure to get educated on these rules so that you can become “fluent” in ICD-10. Just like you need to study French in order to become fluent, you need to get familiar with the “rules of grammar” in ICD-10 coding so that you can speak with the natives, or rather, avoid interruptions to your reimbursement.
- The three strategies have all led us here, to the Tabular List. The first option we found, using a commonly codes list, was H65.01. The GEMs and Alphabetic Index let us to H65.0-. If we look at the most complete code we were offered, from the Common Code List we can see that H65.01 is reported for acute serous otitis media, right ear. This matches our documentation. However, additional choices in this category include ‘recurrent, right ear H66.04.’ The question must be asked as to whether or not the providers are accustomed to documenting recurrence and as a coder, understanding what ‘recurrent’ means. Bring that information to your providers. Let them understand that this may affect authorizations for tube placement if recurrent isn’t documented and properly coded. Next, read any instructional notations associated with the code. Here we see instructions at the chapter level and instructions at the category level. For this particular code, there is one instructional note that states if the patient has a perforated tympanic membrane, an additional code of H74.- should be reported and if the patient is exposed to tobacco smoke (environmentally or in the perinatal period) or uses tobacco additional codes should also be reported. Referencing the note, the patient has not been exposed to tobacco smoke. Final code selection would be correct at H65.01 Acute serous otitis media, right ear.
- The three strategies have all led us here, to the Tabular List. The first option we found, using a commonly codes list, was H65.01. The GEMs and Alphabetic Index let us to H65.0-. If we look at the most complete code we were offered, from the Common Code List we can see that H65.01 is reported for acute serous otitis media, right ear. This matches our documentation. However, additional choices in this category include ‘recurrent, right ear H66.04.’ The question must be asked as to whether or not the providers are accustomed to documenting recurrence and as a coder, understanding what ‘recurrent’ means. Bring that information to your providers. Let them understand that this may affect authorizations for tube placement if recurrent isn’t documented and properly coded. Next, read any instructional notations associated with the code. Here we see instructions at the chapter level and instructions at the category level. For this particular code, there is one instructional note that states if the patient has a perforated tympanic membrane, an additional code of H74.- should be reported and if the patient is exposed to tobacco smoke (environmentally or in the perinatal period) or uses tobacco additional codes should also be reported. Referencing the note, the patient has not been exposed to tobacco smoke. Final code selection would be correct at H65.01 Acute serous otitis media, right ear.
- The three strategies have all led us here, to the Tabular List. The first option we found, using a commonly codes list, was H65.01. The GEMs and Alphabetic Index let us to H65.0-. If we look at the most complete code we were offered, from the Common Code List we can see that H65.01 is reported for acute serous otitis media, right ear. This matches our documentation. However, additional choices in this category include ‘recurrent, right ear H66.04.’ The question must be asked as to whether or not the providers are accustomed to documenting recurrence and as a coder, understanding what ‘recurrent’ means. Bring that information to your providers. Let them understand that this may affect authorizations for tube placement if recurrent isn’t documented and properly coded. Next, read any instructional notations associated with the code. Here we see instructions at the chapter level and instructions at the category level. For this particular code, there is one instructional note that states if the patient has a perforated tympanic membrane, an additional code of H74.- should be reported and if the patient is exposed to tobacco smoke (environmentally or in the perinatal period) or uses tobacco additional codes should also be reported. Referencing the note, the patient has not been exposed to tobacco smoke. Final code selection would be correct at H65.01 Acute serous otitis media, right ear.
- We don’t have time to go through all of the ICD-10 conventions and guidelines, but be sure to get educated on these rules so that you can become “fluent” in ICD-10. Just like you need to study French in order to become fluent, you need to get familiar with the “rules of grammar” in ICD-10 coding so that you can speak with the natives, or rather, avoid interruptions to your reimbursement.
- The three strategies have all led us here, to the Tabular List. The first option we found, using a commonly codes list, was H65.01. The GEMs and Alphabetic Index let us to H65.0-. If we look at the most complete code we were offered, from the Common Code List we can see that H65.01 is reported for acute serous otitis media, right ear. This matches our documentation. However, additional choices in this category include ‘recurrent, right ear H66.04.’ The question must be asked as to whether or not the providers are accustomed to documenting recurrence and as a coder, understanding what ‘recurrent’ means. Bring that information to your providers. Let them understand that this may affect authorizations for tube placement if recurrent isn’t documented and properly coded. Next, read any instructional notations associated with the code. Here we see instructions at the chapter level and instructions at the category level. For this particular code, there is one instructional note that states if the patient has a perforated tympanic membrane, an additional code of H74.- should be reported and if the patient is exposed to tobacco smoke (environmentally or in the perinatal period) or uses tobacco additional codes should also be reported. Referencing the note, the patient has not been exposed to tobacco smoke. Final code selection would be correct at H65.01 Acute serous otitis media, right ear.
- Here is an example of a case. We will use all three methods to seek out the appropriate ICD-10 code, then confirm using the tabular list. [read the example] Note that, at this time, we have been instructed to report ICD-9 codes for dates of service that occur prior to October 1. There is no testing or dual reporting period. But there has been some movement among some healthcare provider’s organizations to create a sort of transition period where both codes could be accepted. Be sure to pay attention to notices from payers to be certain of your options.
- The examples shown to you were from the InstaCode ICD-10 specialty books. There are 24 different specialties, each with their own customized ICD-10 guide and Tabular List. Come to our booth to see some examples and get a flyer. We have special pricing available for those who wish to order one today.