Health Information Management

Don't let fear prevent coders from learning ICD-10

JustCoding News: Inpatient, August 1, 2012

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Editor’s note: This article is part two of a two-part series. Click here to read the first article in the series.

If ICD-10 seems to be a bit of a nightmare, then think again. Although ICD-10 includes more codes than ICD-9-CM, that doesn’t mean the transition needs to be impossible, painful, or frightening.

“Most of the fear that coders are feeling is based on perception and not reality,” says Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, president of Safian Communications Services, Inc. in Orlando. “Fear based on perception then becomes this insurmountable reality. Coders become convinced that they can’t learn ICD-10.”

How can coders overcome their fears and forge ahead into the unknown territory of ICD-10?

Safian and Robert S. Gold, MD, CEO of DCBA, Inc. in Atlanta provide several mental strategies that can help psyche coders up for the change and calm any anxiety they may feel:

The coding process won’t change. The coding process for ICD-10-CM is virtually the same as the one that coders currently use for ICD-9-CM, says Safian. This includes:

  • Reading the documentation
  • Abstracting the key terms
  • Finding the key terms in the Alphabetic Index
  • Using the Tabular List or tables to confirm the suggested code

Although ICD-10-PCS codes are structured differently than their ICD-9 Volume 3 counterparts, ICD-10-PCS will permit coders to use the knowledge they already possess to build the correct code, she adds.

Memorization isn’t necessary. Even though ICD-10 includes a greater number of codes, this doesn’t mean that coders must memorize every code as soon as ICD-10 goes into effect or even at all. Coders can—and should—use reference books and coding manuals to look up new codes, says Safian. Over time, coders may find that they do inadvertently memorize certain codes, but that’s certainly not an expectation or a goal that they should set for themselves, she adds.

Likewise, although coders may need to take an anatomy and physiology refresher course, they certainly won’t be expected to know everything about the human body. Just as coders can research ICD-10 codes, they can also research disease processes and anatomy, says Safian.

Information is likely already in the record. Although the volume of codes will increase in ICD-10-CM, much of the information needed to assign those expanded codes is already in the medical record, says Safian. “Most of the information is already there. We just haven’t been paying attention to it because we didn’t need it before,” she adds.

Consider these examples:

  • Cysts of eyelids: ICD-9-CM code 374.84 translates to ICD-10-CM codes H02.821 (cysts of right upper eyelid), H02.822 (cysts of right lower eyelid), H02.824 (cysts of left upper eyelid), and H02.825 (cysts of left lower eyelid). Physicians are already documenting the laterality and location of the cyst, says Safian. This means coders already have the detail they need.
  • Carpal tunnel syndrome: ICD-9-CM code 354.0 translates to ICD-10-CM codes G56.00 (carpal tunnel, unspecified upper limb), G56.01 (carpal tunnel syndrome, right upper limb), and G56.02 (carpal tunnel syndrome, left upper limb). Physicians already document the specific limb affected by the carpal tunnel syndrome, Safian adds.

The medical record will likely include the information that coders need for ICD-10-PCS as well ICD-10-CM, says Safian. For example, in ICD-10-PCS, coders must assign one of the codes in the 0BB range for a lung biopsy. Each code specifies laterality, a specific section of the lobe from which the physician took the biopsy, and the approach—all of which the physician typically documents, she adds. For instance, ICD-10-PCS code 0BBD4ZX denotes a diagnostic, percutaneous endoscopic biopsy of the right middle lung lobe.

ICD-10 codes aren’t all that different. The idiom ‘Don’t judge a book by its cover’ holds true for ICD-10; although ICD-10-CM codes may appear to be different, a closer look reveals that they are very similar to their ICD-9-CM equivalents, says Gold.

For example, ICD-10-CM codes for strokes differ from their ICD-9-CM counterparts in several ways, says Gold. For example, ICD-10-CM:

  • Includes codes for stoke are in the I60-I65 code category.
  • Separates embolic from locally occlusive strokes.
  • Specifies ‘nontraumatic’ for certain bleeds. This helps remind coders that codes for traumatic bleeds are located in the trauma section.
  • Identifies the intracerebral arteries when arteries are blocked (e.g., middle cerebral artery stroke).
  • Identifies parts of the brain involved in an intracerebral bleed (e.g., cortical bleed, intraventricular bleed).
  • Includes laterality, when appropriate. For example, laterality identifies on which side of the brain the embolic stroke occurred and whether that side corresponds to the patient’s dominant or non-dominant side.
  • Categorizes subdural strokes as acute, subacute, or chronic.

Another example pertains to heart failure. ICD-10-CM codes for heart failure differ from their ICD-9-CM counterparts in the following ways, says Gold. For example, ICD-10-CM:

  • Includes codes for heart failure are in the I50.1-I50.9 code category.
  • Includes the nonessential modifier ‘congestive’ in codes for systolic heart failure, diastolic heart failure, combined systolic and diastolic heart failure, and unspecified heart failure. Thus, coders don’t need to report the added unspecified code (428.0) as they do now.
  • Uses the same fourth and fifth digits for left ventricular failure as ICD-9-CM.
  • Includes a fifth digit of ‘9’ instead of ‘0’ For unspecified heart failure.
  • Deletes the ‘excludes’ note for rheumatic heart failure. In ICD-10-CM,when patients have rheumatic heart failure, coders can identify the specificity of acute, chronic, systolic and diastolic left heart failure just as they would for non-rheumatic heart failure cases.

Visualizing how the ICD-9-CM codes will map to ICD-10 can also help calm coders’ fears, says Safian. CMS’ General Equivalence Mappings (GEM) can help. The ICD-10-CM GEM is devoted entirely to diagnosis codes, and the ICD-10-PCS GEM focuses on procedural codes.

The GEMs are a helpful tool to better understand the depth and breadth of the changes, says Safian. Rather than trying to look at all of the GEMs at once, consider creating a personalized GEM based on the codes most often reported in your office, hospital, or department.

Another option is to start small by focusing on the more manageable changes, says Safian. First, look at GEMs that show a simple one-to-one translation. For example, ICD-9-CM code 427.69 (other premature beats) translates directly to ICD-10-CM code I49.3 (ventricular premature depolarization). Likewise, ICD-9-CM Volume 3 procedure code 48.36 (endoscopic polypectomy of rectum) translates directly to ICD-10-PCS code 0DBP8ZZ (excision of rectum via natural or artificial opening, endoscopic).

Next, create a GEM that includes examples of how several ICD-9-CM codes (e.g., 010.90-010.96) translate to only one ICD-10 code (e.g., A15.7). Third, create a GEM that includes examples of how multiple ICD-9-CM codes (e.g., 995.92 and 785.52) translate to one ICD-10-CM combination code (e.g., R65.21). These examples are particularly important to note because they demonstrate instances in which coders will need to report fewer codes than they currently do in ICD-9-CM, says Safian. Coders can gradually start to digest other changes over time and will likely realize that, overall, the changes are certainly manageable, she adds.

Editor’s note: Lisa A. Eramo is a freelance writer and editor in Cranston, RI who specializes in healthcare regulatory topics, health information management, and medical coding. You may reach her at

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