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Managing ICD-10 conversion for Your Medical Practice

September 30, 2015

ICD_10_checklistYour specialty medical practice’s coding usage will soon morph from several hundred of your most commonly used codes to seemingly thousands overnight, thanks to the ICD-10 code changes that must be in place by October 1st, 2015. While adding 68,000 codes may be stretching things a bit for most practices, your coders will have a lot more work ahead as they will need to choose the modifiers, as well as the specifics about cause, frequency of occurrence, and more.

Examples of some code changes for specialty practices:

Cardiologists – In ICD-10 there are now two categories describing myocardial infarction:

  • 121– ST elevation (or STEMI) and non-ST elevation (NSTEMI) myocardial infraction
  • 122 – Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction

Endocrinologists – For Diabetes Mellitus, the ICD-9 descriptions “uncontrolled” and “not stated as uncontrolled” have been discontinued. They have been replaced with ICD-10 descriptive codes indicating “with complications” or “without complications.”

Family practitioners – As with other practices, the changeover will complicate things a bit: the ICD-9 code V70.0 for ”routine exam” converted to ICD-10 now has additional modifiers specifying the type as well as other considerations as shown below:

  • Z00.00 – “adult exam without abnormalities”
  • Z00.01 –“adult exam with abnormalities

Yes, it sounds complicated – and it is, but even if your office is still grappling with the changeover at this late date, don’t panic. If your coders know the steps to begin the familiarization process they’ll be more likely to get things right the first time.

1. Your coding team (in-house or outsourced) needs to decide on which ICD-9 codes are most-used – for example, the 100 most commonly-used. From there, your team will need to “crosswalk” or translate the most common codes into the new ICD-10 codes. More likely than not, your team will come up with more than 100 once they delve into the additional modifiers, causes, frequency, and so on, but at least it’s a starting point.

2. Once your initial list is developed, expand it from there to include more codes unique to your specialty. CMS has created a Clinical Concepts Series for Specialties to help ease the transition for specialties of all types. Some of these include Family Practice,CardiologyOB/GYNInternal MedicineOrthopedics and Pediatrics.

3. The next step is to become familiar with unspecified codes as well as the guidelines for their correct use. Mark Morsch, VP of Technology at A-Life Medical describes “unspecified” codes as valid ICD-10 codes with the word “unspecified” as a description. He writes that these are properly used when more specific information is unavailable in the patient’s medical chart. He added that a diagnosis code can have various aspects such as laterality, trimester, location, severity and so on that could place it in the “unspecified” category.

Note: Physicians (and their coders and billers) will be relieved to know that valid ICD-10 codes containing the description “unspecified” will be included within the grace period guidelines as correct with the submission of a less specific code. After the grace period expires, no invalid ICD-10 codes will be allowed.

4. Physicians should then review all NCDs and LCDs within their specialty and overall practice to understand which ICD-10 guidelines will be applicable. This review should include Medicare-approved information about crosswalks and other

5. Now it’s time to integrate the code sets in the form of a ‘dictionary’ or other table to avoid use of invalid ICD-10 codes on or following October 1, 2015.

If your back office is having coding and billing issues including ICD-10 readiness, M-Scribe Technologies, LLC can help. As a national leader in medical claims billing, coding and auditing, call us at 888-727-4234 or email for a free analysis of your practice’s needs. 


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