Get Ready for More!

on July 22nd, 2011   by Kim Felix

In this blog we will start to illustrate some of the differences in I-10 by using specific coding examples; ones that coders and coding teams can use every day. These examples are meant to give you some background in I-10 coding as well as the opportunity to do some honest self-assessment of your educational needs.

More Extensions and Documentation
The first example we’ll discuss is extensions; using fractures to demonstrate the point. In I-10, there are additional extensions to further categorize each fracture. For example, coders will need to identify if a fracture is:

• Initial or subsequent encounter
• Open or closed
• With routine or delayed healing
• With malunion or nonunion
• Sequela

In order to code fractures correctly, coders must understand each of these descriptors, how they are identified in the record and where to find the supporting documentation. And as you have heard before, more specific documentation will be needed in ICD-10.  Take the time NOW to educate your physicians on documentation changes so that October 1, 2013 is just another date on the calendar for them.

More Laterality
Laterality is also very important in I-10 and something coders must not overlook. Not accustomed to coding laterality, this will be a new, additional step for the inpatient coders —but a critical one!  CPT coders already use laterality in procedure coding.  Many CPT coders like I-10 because of the similarities and level of detail to CPT.  For example, in I-9 coding of malignant neoplasm of the ovary the code is 183.0, regardless of side. In I-10 there are three different codes as follows:

• C56.0 Malignant neoplasm of right ovary
• C56.1 Malignant neoplasm of left ovary
• C59.9 Malignant neoplasm of ovary, unspecified side

More Combinations
I-10 also has more combination codes, a lot more! For example, additional digits are used to describe a granular level of specificity that we simply don’t have in I-9. Crohn’s disease of the small intestine, coded 555.0 in I-9, now has up to seven possible combinations.

• K50.00 without complications
• K50.011 with rectal bleeding
• K50.012 with intestinal obstruction
• K50.013 with fistula
• K50.014 with abscess
• K50.015 with other complication
• K50.016 with unspecified complications

These examples should help give you and your coding team a flavor for the variety and types of changes you’ll see in I-10. Over the coming months, we’ll discuss more of these cases in detail. We’re all in this together, and IOD looks forward to helping you along every step of the journey.