ICD-10 - Key Concepts for Radiology Practices

ICD-10: Key Concepts for
Radiology Practices
1
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ICD-9-CM vs. ICD-10-CM
ICD-10
Chapter #
ICD-10
Code
Range
# ICD-10
Codes ICD-10 Chapter Description
ICD-9
Chapter #
ICD-9 Code
Range
ICD-9
# of Codes
1 A00-B99 1,056 Certain Infectious and Parasitic Diseases 1 001-139 1,270
2 C00-D49 1,620 Neoplasms 2 140-239 988
3 D50-D89 238 Diseases Of The Blood and Blood-Forming Organs and Certain Disorders Involving The Immune Mechanism 4 280-289 123
4 E00-E89 675 Endocrine, Nutritional and Metabolic Diseases 3 240-279 335
5 F01-F99 724 Mental, Behavioral and Neurodevelopmental Disorders 5 290-319 477
6 G00-G99 591 Diseases Of The Nervous System 6 320-359 412
7 H00-H59 2,452 Diseases Of The Eye and Adnexa 6 360-379 795
8 H60-H95 642 Diseases Of The Ear and Mastoid Process 6 380-389 192
9 I00-I99 1,254 Diseases Of The Circulatory System 7 390-459 474
10 J00-J99 336 Diseases Of The Respiratory System 8 460-519 255
11 K00-K95 706 Diseases Of The Digestive System 9 520-579 596
12 L00-L99 769 Diseases Of The Skin and Subcutaneous Tissue 12 680-709 204
13 M00-M99 6,339 Diseases Of The Musculoskeletal System and Connective Tissue 13 710-739 892
14 N00-N99 591 Diseases Of The Genitourinary System 10 580-629 389
15 O00-O9A 2,155 Pregnancy, Childbirth and The Puerperium 11 630-679 1104
16 P00-P96 417 Certain Conditions Originating In The Perinatal Period 15 760-779 281
17 Q00-Q99 790 Congenital Malformations, Deformations and Chromosomal Abnormalities 14 740-759 421
18 R00-R99 639 Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified 16 780-799 372
19 S00-T88 39,869 Injury, Poisoning and Certain Other Consequences Of External Causes 17 800-999 2,587
20 V00-Y99 6,812 External Causes Of Morbidity 18 V01-V91 1,291
21 Z00-Z99 1,178 Factors Influencing Health Status and Contact With Health Services 19 E000-E999 1,109
69,853 14,567
14,567  68,953 Codes
2

ICD-10
Chapter #
ICD-10
Code
Range
# ICD-10
ICD-9
Chapter #
ICD-9 Code
Range
ICD-9
# of Codes
2 C00-D49 1,620 Neoplasms 2 140-239 988
69,853 14,567
Majority of added codes relate to injury,
poisoning and external causes
2,587  39,869 codes 3

ICD-10
Chapter #
ICD-10
Code
Range
# ICD-10
ICD-9
Chapter #
ICD-9 Code
Range
ICD-9
# of Codes
2 C00-D49 1,620 Neoplasms 2 140-239 988
69,853 14,567
The two other areas with significant code count increases--MS and
Eye--can be mostly attributed to new concepts for ICD-10 such as
laterality, episode of care and use of clinical scales 4

What Does ICD-10 Mean For Radiology?
5

• Many of the new, highly-specific codes are
for things you are unlikely to encounter in
practice.
– Burns from waterskis on fire (V91.07)
– Struck by orca, initial encounter (W56.22)
– Prolonged stay in weightless environment (X52)
– Hurt at the opera (Y92.253)
– Sucked into jet engine (V97.33)
ICD-10 and Radiology
6

• More specific documentation is often
needed, but the basic concepts are the same
– You don’t need an in-depth understanding of
ICD-10 coding to document properly.
– ICD-10 does account for scenarios in which a
radiologist may not have specific information
(e.g. Pneumonia, organism unspecified).
ICD-10 and Radiology
7

– A suspected diagnosis cannot be coded. If a
study was ordered to rule out a condition,
document the signs/symptoms that caused the
study to be ordered.
– Coders cannot assume the location of pain,
injury or swelling based on the study being
performed.
– It is always better to provide more history than
not enough.
What hasn’t changed…
8

– Many generic signs and symptoms (e.g. cough,
shortness of breath, dizziness) do not require
more specific documentation in ICD-10.
– It is always better to provide more history than
not enough.
What hasn’t changed…
9

Report Review Findings
10
Type of Study Impacted Documentation Concerns
CT and MRI of brain
For non-traumatic intracerebral hemorrhage, in ICD-9 there only one
code (431). In ICD-10, there are area specific codes for brain stem,
cerebellum, hemisphere, cortical and subcortical. Please be sure to
specify hemorrhage location in patient history or dictated report (if
visualized on current study).
Lumbar spine studies Sciatica - must specify laterality to code in ICD-10.
Breast US and MR Breast cancer - need to specify which quadrant of the breast is affected.
Pelvic US, CT or MR
For fibroid uterus, please specify the location of the tumor (subserosal,
intramural, etc.)
Abdominal/Pelvic studies, dialysis
vein mapping
Renal failure - must specify acute or chronic, including staging
information for chronic cases.
Abdominal/Pelvic studies Hematuria - Need to specify gross hematuria vs. microscopic

Report Review Findings
11
Type of Study Impacted Documentation Concerns
All modalities/body areas Contusion - need to mention specific location of injury
Chest x-ray
"Screening" or "pre-op" not specific enough to code, need to
specify reason for screening (positive PPD?) or procedure for
pre-op cases.
X-Ray of hand/ fingers, injections Trigger finger - please specify which finger(s) are affected.
X-Ray of hand/ fingers, injections
For injury of finger(s), we need to know specifically which
finger was injured (e.g. "left 4th finger").
Orthopedic studies
To code fractures in ICD 10, we need documentation on the
encounter type (initial vs. subsequent). Please document
whether the patient is in active treatment for fracture or this is
a follow up study.
Abdomen/pelvis studies, head
injury studies, chest x-rays
Vomiting - In ICD-10 we have separate codes for vomiting with
vs. without nausea. Please specify whether the patient also
experienced nausea or not when vomiting is a symptom.

Changes to documentation requirements are
focused in a few key areas (TILES):
• Timing
• Intent of Injury
• Laterality/Location
• Episode of Care
• Status/Complications (for chronic conditions)
Key Concepts
12

• For OB diagnoses, ICD-10 coding generally
requires the trimester and also allows for
coding weeks of gestation.
• For pain, swelling and other symptoms, note
the duration when possible.
• When applicable, state whether the patient’s
condition is acute or chronic.
Timing
13

• There are three categories for intent of injury
in ICD-10
– Accident
– Assault
– Self Harm
• If known, this should be documented in the
radiology report.
Intent of Injury
14

ICD-10 codes get much more specific than ICD-9
about the location of pain, swelling, injury, etc.
• For extremity study history, be sure to include
laterality and specific area affected.
• “Injury to right 5th finger”
• “Pain in left forearm”
• “Swelling of right ankle”
Location and Laterality
15

• Abdominal pain
 Specify quadrant/region affected if possible.
 ICD-10 does allow for general/unspecified abdominal
pain when no further information is available.
• Chest pain
 Specify precordial pain/painful respiration if
documented.
 ICD-10 has a code for general/unspecified chest pain
in the event that further information is not available.
16

• Back and neck pain
• Specify level/area of pain.
• Sciatica requires documentation of laterality.
• Indicate if pain is radiating to other areas.
• Fibroid Uterus
• Specify location of tumor(s)
17

• There are three categories for episode of care in
ICD-10. These apply to accident and injury
diagnoses.
– Initial
– Subsequent
– Sequela
• It is not necessary to use these terms as long as
documentation allows the coder to assign the
correct category (e.g. date of injury)
Episode of Care
18

Initial episode of care means that the patient is in the
initial encounter for diagnosis and being actively treated
for the condition. Nearly all ED cases will be initial
episode of care.
Documentation examples would include:
– Wrist x-ray for ED patient with injury that day
– Head CT on an inpatient recently admitted after trauma
from motor vehicle accident.
– Intraoperative x-ray to assist with fracture fixation.
Episode of Care
19

Subsequent care indicates that the patient is
receiving follow up care during the healing/recovery
phase.
Documentation examples would include:
– X-ray to assess healing of a tibial fracture at four weeks.
– X-ray to check status of fracture non-union/malunion
Episode of Care
20

Fracture follow up studies must describe healing
status as one of four categories:
– Routine healing
– Delayed healing
– Malunion
– Non-union
Episode of Care
21

Symptoms relating to old injuries would be
coded as sequela.
– Pain from meniscal tear 5 years ago
– Gait disturbance related to old hip fracture
Episode of Care
22

For chronic conditions, the number of codes has
increased dramatically. We need additional
documentation of:
– Specific type/features of the condition
– Staging or disease status
– Any current, acute complications
Status and Complications
23

Common examples:
– Stage of disease for renal failure
– Diabetic complications such as circulatory issues,
diabetic ketoacidosis, etc.
– Whether an asthma patient is experiencing an
asthma attack
Status and Complications
24

Other documentation concerns:
– Hematuria must be specified as gross vs.
microscopic
– Current cerebral infarction – specify area/artery
affected
– CHF – specify systolic or diastolic, acute, chronic or
acute-on-chronic
Miscellaneous
25

The good news: Some of the most common
diagnoses for chest x-ray will not require
additional documentation.
– Shortness of breath
– Cough
– Dizziness
– Syncope
– Enlarged heart
ICD-10 Tips: Chest X-ray
26

ICD-10 does allow for common situations in
which detailed information is not readily
available:
– Unspecified chest pain remains a valid code, may
be used in the absence of further detail (ER)
– Unspecified pneumonia may be used when the
specific origin/organism has not yet been
identified
27

Other common codes have only split into two
categories:
– Pulmonary collapse: atelactasis vs. other
– Altered mental status: disorientation vs. other
– Pleural effusion: malignant vs. other
28

Routine screening exams have minor changes:
– For pre-operative studies, specify what procedure
the patient will be having
– For fitting/adjustment of device, specify device
type and associated complications (if any)
– Positive PPD does not require additional
documentation
29

Areas with significant changes include:
– Respiratory failure: specify if acute or other,
document hypoxia/hypercapnia status
– Asthma, COPD, emphysema, etc. – Provide as
much detail as possible about the patient’s
disease and any current complications
30

ICD-10 - Key Concepts for Radiology Practices

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