ICD-10 Training Camp: ICD-10-CM Changes You Can’t Afford To Miss!

ICD-10-CM is quickly becoming a reality as the Oct. 1, 2013 deadline looms just beneath the horizon.  There are a number of skills that are critical to this transition.  All coding professionals, hospitals, health care facilities, and, physician offices will be impacted.  The impact will be felt both financially and in time and staff allocation.  We are stepping into territory that is completely new to the delivery of patient care.  This does not have to be a feared experience; it can actually be a fun, rewarding, and even relatively easy transition.  Motivation is within each of us but we must recognize and act on this opportunity in a positive manner.

First, let’s discuss the skills required for this transition; they include Cognitive, Perceptual, Associative, and Autonomous learning skills.

Cognitive skills are intellectual skills that involve thought processes.  During the cognitive phase we identify and develop the component parts of this learning process.  It involves forming a mental picture of the skill.

Perceptual skills are how we interpret the presented material.  This can be a landmine because we are used to the rules and conventions of ICD-9-CM, which are entirely different from  its replacement classification (ICD-10-CM).  You will be learning new concepts and code structure as well as new conventions and guidelines.  You must have an open mind and a positive attitude to weather this storm.  You must be motivated.  Prior knowledge can be at odds with the new material and you must be careful not to distort new material as related to ICD-10-CM implementation.  ICD-10 will refine prior knowledge in a long-term learning process involving interaction with peers and physicians.  Each step is a short-term experience (incremental part) in a long-term learning process.

Associative phase allows us to link the component parts into a smooth action.  This phase involves practicing the skill and using feedback to perfect the skill.  Perfect practice makes perfect (Vince Lombardi).  Conversation and peer interaction is essential.

The final phase is the autonomous phase.  The autonomous phase of  learning develops the learned skill so that it becomes automatic, not all coders will reach this stage of learning.

You must have strategies (plans) prepared in advance of a new learning experience, which you hope will place the practice in a winning position.  Tactics are then used to put the strategies into action.  To develop strategies and tactics, you need to know the strengths and weaknesses of all involved in the process.  There must be buy-in from the top down.

This new concept in learning is necessary to enhance, strengthen, and introduce what is new and vital in the coding profession. In this age of rapid technological change and knowledge creation, a coder must continue to learn throughout her career and to be able to readily adopt and navigate new paradigms.

Changes in the ICD-10 code structure

The purpose of this article is to highlight several changes in the ICD-10 code structure and the rules that could be missed when learning this new system.  One of the most essential life skills a person can have is the ability to adapt to change.  An adaptive individual is one who is able to refocus the mind in new directions and make choices based on his or her desired outcomes.

However, adapting to change is difficult for most people due to the fact that humans are creatures of habit and change can be annoying and usually is.  Why is there fear today about ICD-10 implementation?  One reason may be because it is an unknown and many think this will cause a loss of control.  Others may fear the commitment or even potential for failure.  You control how you think about and perceive change.  Think positive and your reaction to this change will be positive.

Be aware of the following changes (Part 1):

ICD-10 introduces the seventh extender of “S” on many code options listed in specific chapters of the tabular list.  A 7^th digit or character requirement must be in the 7^th place of the code selected (when a 7^th character is required).  The 7^th character of “S” means it is a sequela encounter with the patient due to a late effect.  This extender is used for complications or conditions that arise as a direct result of an injury or a healed condition with complication or residual condition.  When using extension “S”, it is necessary to use both the injury code that precipitated the sequela and the code for the sequela itself. The “S” is added only to the injury code, not the sequela code. The “S” extension identifies the injury responsible for the sequela. The specific type of sequela (e.g. traumatic arthritis) is sequenced first, followed by the injury code (example, fracture).

Sequela is the new terminology in ICD-10-CM for late effects in ICD-9-CM and using the sequela extension replaces the late effects categories (905–909) in ICD-9-CM.  There is no time limit on when a late effect code can be used.  The residual may be apparent early, such as in cerebral infarction, or it may occur months or years later, such as that due to a previous acute injury. An example of a residual and a sequela encounter is as follows: M12.572 (Arthropathy, traumatic, ankle), S92.002S (Fracture, traumatic, tarsal bone, calcaneous), sequele encounter, the arthropathy is the first-listed code.

Another circumstance that will be a reversal from ICD-9 coding rules is coding for “adverse effects”.  ICD-10-CM lists the adverse effect codes in Chapter 19: Injury, poisoning and certain other consequences of external causes (S00-T98).  Chapter 19 is the largest chapter in the Tabular list and most codes require a 7^th character extender.  For example: T43.015- Adverse effect of tricyclic antidepressants.  This code requires a 7^th character extender of A, D, or S.  If the encounter is the initial treatment by the physician, the 7^th character will be “A”.  If the encounter is a subsequent visit, the 7^th character will be “D”.  If the patient presents for a sequela condition, the 7^th character is “S”.  In the ICD-9-CM classification, you code the manifestation condition as first listed followed by the E code for adverse effect. In ICD-10-CM, the adverse effect code must be first-listed (T43.015-(A, D or S) followed by the manifestation (for example, drowsiness, anxiety, emotional blunting).  If this was the initial encounter, the full code for this encounter would be T43.015A.

Conditions classified by severity

ICD-10-CM classifies some conditions by severity.  An example is Asthma (J45.-).  Instead of asthma being described as extrinsic or intrinsic, it is described as mild intermittent, mild persistent, moderate persistent, and severe persistent.  Subcategory J45.2 is listed as follows:

J45.2-   Mild intermittent asthma

J45.20…… uncomplicated

J45.21…… with (acute) exacerbation

J45.22…… with status asthmaticus

You must have 5 digits to complete a code assignment in subcategory J45.2.

Remember, we can always know more, understand better, or improve how we do something.  ICD-10-CM learning is a new challenge but with perfect practice comes perfect coding.   Stay focused and do not lose the momentum.  Preparation and planning leads to success, it doesn’t just happen.

Nancy Maguire, ACS, PCS, FCS, HCS-D, CRT, author of The Nancy Maguire GPS to ICD-10-CM Planning and Implementation Guide, is a nationally-renowned procedural and diagnostic coding instructor, bootcamp trainer, and workshop leader. She has spent more than 30 years as a hands-on coder and has authored countless coding articles and presentations. She served the first two terms as president of AAPC in the early 1990s.

Hear Nancy speak in two complimentary archived webinars on ICD-10 presented by Kareo medical billing software: How to Prepare for ICD-10/5010 to Reduce F41.1 (Anxiety Reaction) or Preparing for ICD-10-CM: The Nitty-Gritty of Diagnosis Coding. You can also read her entire series of articles on ICD-10. In her next installment, Nancy will review coding changes easily missed in ICD-10-CM.