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Three Steps to Selecting the Right ICD-10 Codes

April 3, 2014

ICD-10 code selectionThe October 1, 2015 deadline for implementing ICD-10 codes is sneaking up behind you. Is your practice ready to make the transition from ICD-9 to ICD-10?

If not, your practice faces some rough times ahead. The 2015 ICD-10 contains nearly 70,000 codes, providing ample room for error when selecting codes. Almost none of the code numbers remained the same from ICD-9 to ICD-10, and it is not as easy as translating the old ICD-9 codes into new codes.

A poor transition from ICD-9 to ICD-10 has real consequences for any practice, whether it is a large hospital or single practitioner practice. Selecting the wrong ICD-10 codes will result in disruption of reimbursements, low reimbursements, and claim denials. Ill-prepared coders will likely grow frustrated with returned claims, denied claims, and requests for more information.

Fortunately, you can select the right ICD-10 codes in just three easy steps.

Step 1: Use the ICD-10 alphabetical index

Locate the main term in the alphabetical index. Review the list of sub-terms and select the most appropriate sub-term specific to the case. Read the instructional notes about how to add terms like “see,” “see also,” “with,” “without,” “due to,” and “code also.”

The “see” and “see also” instructions in the alphabetical index mean you should reference another term to find the correct code. The “code also” note describes a case where you will need to enter two codes to describe the situation fully.

Step 2: Verify the code with the tabular list

Use the tabular list to verify the code. The tabular list groups the ICD-10 codes according to chapter, categories, and subcategories. Be sure to review the notes appearing at the top of the tabular list, as that information can help you select the correct code.

The tabular list allows you to provide more information about the visit. Use the tabular index to describe the severity of the patient’s condition and any complications associated with the case.

The tabular list helps you reduce your selections to only the appropriate codes. Use the tabular list to describe “Excludes 1” and “Excludes 2” rules that identify codes you should never use together and at the same time, respectively. Excludes 1 would prohibit you from entering J05.0 with J04.0, for example, because both describe acute laryngitis.

Furthermore, the tabular index contains information that determines the length of the code, which can be anywhere from three to seven characters long.

Step 3: Review coding guidelines

Read over those coding guidelines at the top of the alphabetical listing. It includes specific information for some of the more complex codes, such as sepsis and HIV. Miss this section and you might miss vital sequencing guidelines. The sequencing order for a patient with anemia resulting from malignancy, for example, is completely different from a case where chemotherapy, radiation or immunotherapy caused anemia.

You can reduce confusion, frustration and loss of reimbursements by preparing your practice for the ICD-10 transition now. Encourage all staff members to learn how to implement the new ICD-10 codes into your practice. Teach these three easy steps to every worker who records information about patient care and ease the tension in your office when October rolls around.


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