Health Information Management

Keep ICD-10-CM training momentum by reviewing orthopedic changes

APCs Insider, May 23, 2014

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The added specificity for reporting diagnoses with ICD-10-CM affects the majority of codes, but some of the most significant changes involve coding for orthopedic injuries.
The changes can sound challenging, at first. For example, ICD-9-CM contains two codes to report patella fractures, with only a distinction to code it as open or closed. ICD-10-CM features nearly 500 options.
Many of the additions simply have to do with laterality, with left, right, and unspecified options available for each code. ICD-10-CM also has codes to report the type of fracture (e.g., longitudinal, transverse) and whether it's displaced or nondisplaced.
ICD-10-CM injury codes also require a seventh character to specify the encounter. The characters show whether the patient is being seen for an initial encounter, subsequent encounter, or sequela. For open fractures, the seventh character incorporates the Gustilo-Anderson open fracture classifications. The result is 16 possible seventh characters for each patella fracture code.
The good news is that providers are likely already documenting most of this information. However, those who aren't will need to be educated on the additional documentation requirements and coders will need to know what information to look for in documentation.
The recent implementation delay allows HIM/coding departments additional time to refine their ICD-10 education in an effort to reduce productivity declines.
“I hope that organizations will stay their course and keep the faith by continuing to refresh and renew knowledge related to ICD-10 and not be pessimistic about its eventual implementation,” says Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, director of HIM and coding for HCPro, a division of BLR, in Danvers, Massachusetts.  
“Those who have already learned the fundamentals of ICD-10 know that without exercising some practical application in the next 18 months it will feel like starting over again. Keep ICD-10 concepts in the forefront of documentation and coding efforts, because I’ve never seen anyone penalized for over-documenting.”
To help maintain training momentum and help coders get a handle on the orthopedic changes, we’ve teamed with expert speakers and AHIMA-approved ICD-10-CM/PCS trainers and ambassadors Kim Carr, RHIT, CCS, CDIP, CCDS, and Kristi Stanton, RHIT, CCS, CPC, CIRCC, for a two-hour webcast devoted to orthopedic coding in ICD-10-CM. Kim and Kristi will review guidelines for coding orthopedic injuries, explain the seventh character, and identify documentation challenges, including capturing loss of consciousness.
The webcast will take place Thursday, June 5, from 1 to 3 p.m. Eastern. For more information, visit the HCPro Healthcare Marketplace.


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