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ICD-10-CM Guidelines for Coding and Reporting
 
 

ICD-10-CM Guidelines for Coding and Reporting

 

Guidelines for coding and reporting with ICD-10-CM are provided by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS). These guidelines have been approved by the four organizations that make up the Cooperating Parties for the ICD-10-CM: the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), CMS, and NCHS. The conventions of ICD-10-CM take precedence over these guidelines, however.

Basic ICD-10-CM Coding Steps

Step 1: Locate the Code

To locate the code, the coder must find the diagnosis, condition, or reason for visit in the Alphabetic Index and verify the provided code in the Tabular List. The coder has to follow all instructional notes (Leon-Chisen, 2011).

Step 2: Assign Code to the Highest Level

For maximum reimbursement and to prevent claim denials, the coder must assign the code to the highest level of detail. This is accomplished by:

  • Assigning a three-character code only if there are no four-character codes listed.

  • Assigning a four-character code only when there are no five-character codes in that subcategory.

  • Assigning a five-character code only when there are no six-character codes in that subcategory.

  • Assigning a six-character code when one such subclassification is provided.

  • Assigning a seven-character code extension when provided (Leon-Chisen, 2011). 

Step 3: Assign Residual Codes

The use of NEC and NOS (residual codes) as appropriate involves using the main term entry in the Alphabetic Index that is followed by a code number for the unspecified condition. This code is never used when subterms exist that allow for use of a more specific code (Leon-Chisen, 2011).

Step 4: Assign Combination Codes

If available, the coder should assign combination codes, which are codes used to classify either two diagnoses with associated secondary process or a diagnosis with an associated complication. Combination codes are listed in the Index and contain connecting words such as "due to," "with," and "associated with" (Leon-Chisen, 2011).

Step 5: Assign Multiple Codes

Multiple coding is the use of more than one code for the identification of certain elements of a complex diagnostic or procedural statement. These statements connect words and phrases by using "with," "incidental to," and "secondary to." Special circumstances related to multiple coding include:

  • Mandatory multiple coding – This type of coding is used for "dual classification," which describes the required assignment of two codes to give information about manifestations and/or characteristics and the associated underlying condition, disease, and/or etiology. These codes are found in the Alphabetic Index by the use of a second code listed in brackets.

  • Discretionary multiple coding – This type of coding involves "code first" notes that appear in the Tabular List. These notes are under certain codes that are not specifically manifestation or characteristic codes, but codes in which the condition may be due to the underlying condition, disease, illness, or cause. The underlying condition should be always sequenced first with these codes.

Example: Malignant ascites (R18.0) has a note that specifies "code first" the malignancy, such as malignant neoplasm of ovary (C56.-). For this encounter, code C56.- would be listed first, followed by code R18.0.

  • Indiscriminate multiple coding – The coder should avoid indiscriminate coding of irrelevant information, such as codes for characteristics of the diagnosis and codes based on findings of diagnostic tests unless confirmed by the physician (Leon-Chisen, 2011).

Step 6: Code Unconfirmed Diagnosis

For inpatient admissions that are listed as "possible," "probable," or "questionable," the coder should report as though the diagnosis was established. The exception to this step is when coding HIV infection and influenza due to certain identified viruses, such as avian flu or H1N1 virus (Leon-Chisen, 2011).

General Equivalence Mappings

CMS and the CDC created a national version of the General Equivalence Mappings (GEMs) to ensure that there is national data consistency. The GEMs are a tool that coders use to convert data from the ICD-9-CM to ICD-10-CM and ICD-10-PCS (forward mapping), as well as to convert the ICD-10-CM and ICD-PCS to ICD-9-CM (backward mapping). The GEMs are basically a comprehensive translation dictionary used for accurate and effective translation of any ICD-9-CM-based data used for tracking quality, calculating reimbursement, recording morbidity and mortality, or for converting applications (Davis, 2011).

ICD-10-CM and ICD-9-CM Chapter Comparison

ICD-10-CM Chapter

ICD-10-CM Code Categories

ICD-9-CM Code Categories

Certain Infectious and Parasitic Disease

A00-B99

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001-139

Neoplasms

C00-D49

140-239

Disease of the Blood and Blood-Forming Organs and Certain Disorders involving the Immune Mechanism

D50-D89

280-289

Endocrine, Nutritional, and Metabolic Diseases

E00-E89

240-279

Mental and Behavioral Disorders

F01-F99

290-319

Disease of the Nervous System

G00-G99 

 

320-389

Disease of the Eye and Adnexa

H00-H59

320-389

Disease of the Ear and Mastoid Process

H60-H95

320-389

Disease of the Circulatory System

I00-I99

390-459

Disease of the Respiratory System

J00-J99

460-519

Disease of the Digestive System

K00-K94

520-579

Disease of the Skin and Subcutaneous Tissue

L00-L99

680-709

Disease of the Musculoskeletal System and Connective Tissue

M00-M99

710-739

Disease of the Genitourinary System

N00-N99

580-629

Pregnancy, Childbirth, and the Puerperium

O00-O0a

630-677

Certain Conditions Originating in the Perinatal Period

P00-P96

760-779

Congenital Malformations, Deformations, and Chromosomal   Abnormalities

Q00-Q99

740-759

Symptoms, Signs, and Abnormal Clinical Laboratory Findings, Not Elsewhere Classified

R00-R99

780-799

Injury, Poisoning, and Certain other Consequences of External Causes

S00-T98

800-999

External Causes of Morbidity

V00-Y98

E800-E999

Factors Influencing Health Status and Contact of Health Services

Z00-Z99

V01-V83

 

 
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