ICD-10 will be one of the largest healthcare changes since 1979 in the United States. This coding method describes your medical diagnoses, inpatient procedures and practice verified with clinical documentation. Many of the guidelines for ENTs will not change with the new ICD-10 codes. However, new codes are being added that have never been used before.
Some of the guidelines that you may not recognize are:
Determine How Serious the Condition Is and Prove Medical Necessity
The patient’s condition will now be listed as a code determined by the physician data on the ICD-10. The term used, Severity of Illness, is often listed in the inpatient hospital setting. This term defines how serious the illness is and what complications have occurred along the course of treatment. What this basically means is that “Severity of Illness” states how sick the patient is. Generally the sicker patients cost more money to treat as they use more resources and are at a higher risk for complications. ICD-10 codes will support Severity of Illness documentation and reporting because they are much more descriptive. These codes are much more descriptive than the ICD-9 codes. These specific codes may eliminate appeals, saving the physician and staff time and speed up the receipt of payments.
Acute and Chronic Conditions
Code any separate subentries that are found in the Alphabetic Index at the same indentation level. You will also need to sequence the subacute/acute code first.
Impending or Threatened Condition
When your patient is discharged, code the condition as “impending” or “threatened”. Code confirmed diagnosis if it occurred. If it did not happen; you will then check the Alphabetic Index to find out if there is a sub-entry term for “impending” or “threatened”. There is also the main term direction to check for the codes on “impending” or “threatened”. If you are able to find sub-terms use the listed code.
Laterality
In the ICD-10-CM, the final character of the code refers to laterality. There is also an unspecified side code in case the side is not known in the medical records. When you cannot find a bilateral code and that is the condition, use separate codes to identify the left and right sides.
Coding of Injuries
Give separate codes when coding injuries for each separate injury. If there is a combination code available this can be assigned. In the ICD-10-CM there are multiple codes given for multiple injuries; however you should not use them unless you cannot find a more specific code. Do not use the traumatic injury code (SOO-T14.9) for regular healing of surgical wounds. Do not use this code for surgical wounds that are experiencing complications either. The focus of the treatment, that which is identified by the physician as the most serious, should be the first one coded.
What’s Not Affected By ICD-10 Transition
The transition to ICD-10 will have to be followed by anyone covered under HIPAA (Health Insurance Portability Act). It will not affect CPT coding on procedures for outpatients. With the right information and tools you will be able to transition smoothly without any revenue loss.
