ICD-10 Updates: A Burn May Be Corrosion Under the Soon-To-Go-Into Effect Code Set

The new diagnosis coding system will allow your surgeon to make a distinction.

When you start using ICD-10 in October 2013, reporting burns by body site/ ‘degree’ plus an additional code for total body surface area (TBSA) won’t change. However, reporting the cause of the burn will.

Changes ICD-10 will bring to burn source

In ICD-9, a burn is a burn; however under ICD-10, a burn may be a corrosion, which is a chemical burn and the new diagnosis coding system will allow your surgeon to make a distinction.

Here’s an Instance:

A patient has a second degree burn of the right thigh from accidentally spilling boiling water. Under the present code system, you would report the condition as 945.26 whereas under ICD-10, you need to list T24.211.

Now let us say you have the exact scenario, except the burn is from an accidental spill of a strong acid. With the present code system, you’d still go for 945.26. However, you’ll use T24.611- (Corrosion of second degree of right thigh) for ICD-10.

ICD-10 helps you zoom in on body site more specifically than the current code set. ICD-10 provides distinct codes for you to report bilateral body sites as right, left or unspecified.

Additional codes

Just like ICD-9, you will need to list a distinct ICD-10 code pointing to the extent of burns (or corrosions) using a unique TBSA code.

Say for instance in ICD-9, you would go for 948.10. But after 2013, you will have two TBSA choices based on the burn/corrosion distinction: T31.10, T32.10.

Corrosion codes in ICD-10: After 2013, not only do you have different corrosion codes in the soon-to-go-into effect ICD-10 code set , you also need to report a unique code to determine the cause of the chemical burn. ICD-10 provides this instruction: Code first: (T51-T65) to identify chemical and intent preceding the corrosion codes.

Make Your Doctors ICD-10 Ready

Where have you reached as far as your ICD-10 preparation is concerned? If you're still lagging behind, it's time you geared yourself up for it because irrespective of where you work (hospital, ambulatory surgical center, physician practice, clinic, etc), the ICD-10 deadline applies to you.

D-Day: Oct. 1, 2013 will be the date that everyone will begin to use ICD-10. After this date, CMS will not accept ICD-9 codes for any dates of service on or after Oct. 1, 2013; however the agency will continue to process claims for services prior to that date for a still-unannounced period of time.

Transition: The more familiar you are with the changes, the easier the transition will be. Even though you should not start your intensive, in-depth ICD-10 training until six to nine months prior to implementation, you can gear yourself up in other ways now. Obtain education and understand early on so that you will be well equipped.

Gear up your doctors:

Popular thinking: One of the major worries pertaining to ICD-10 is the increased number of codes making the new system impossible to use. However, the truth that it should not be the case. While your physician's documentation will need to be detailed and clear, the diagnosis code set will not be more difficult to use. Presently, the agency publishes about 14,000 ICD-9 codes, but there will be over 69,000 ICD-10 codes. The additional codes will allow you to give more detail in describing diagnoses and procedures. Since ICD-10 codes will often be more detailed and specific than the ICD-9 codes you and your surgeon are used to, you may need to persuade your physician to start being more detailed in his documentation.

ICD-10 will need some improvement in physician documentation; the higher the quality of your documentation now, the easier it'll be to stay away from unspecified codes, and the quicker you will find the accurate ICD-10 code. Begin by speaking with your doctors now about improving their clinical documentation detail which will be the most important aspect for them and should be started prior to the change. With the increased granularity of ICD-10 code descriptions, payers may make use of this opportunity to develop increased pay for performance incentives and more specific medical necessity requirements that were not possible earlier. In this direction, accurate and specific code selections will be required however only possible if physicians have improved their ability to pain a clear and more detailed picture of the patient's clinical conditions.

Focus On Drug Dependence versus Abuse to Assign Diagnosis

ICD-9 does not provide a specific code for a urine drug test. The same is the case with ICD-10 too. The proper diagnosis code for billing a lab drug test depends on the signs, symptoms, patient condition, or other reason for the test, say for instance screening.

Example: The physician orders a drug screen for a patient diagnosed with Cannabis dependence who uses the drug intermittently. Code the ordering diagnosis as 304.32 (Cannabis dependence, episodic use) with ICD-9.

Cross walking from ICD-9 to ICD-10: Even though ICD-10 provides more detail than ICD-9, leading to more code choices for ICD-10, the opposite is correct in this instance. The subsequent three ICD-9 codes crosswalk to a single ICD-10 code (F12.20, Cannabis dependence, uncomplicated):

304.30 -- Cannabis dependence, unspecified use

304.31 -- Cannabis dependence, continuous use

304.32 -- Cannabis dependence, episodic use.

Report different codes for abuse or use

Both ICD-9 as well as ICD-10 differentiates between drug dependence versus drug abuse. For example, 304.3x identifies Cannabis dependence while 305.2x (Non-dependent Cannabis abuse) identifies Cannabis abuse.

Likewise, ICD-10 provides F12.20 for Cannabis dependence, and F12.10 (Cannabis abuse, uncomplicated) for Cannabis abuse.

Article Source :- http://www.supercoder.com/coding-newsletters/my-icd-10-coding-alert/reader-question-focus-on-drug-dependence-vs-abuse-to-assign-diagnosis-108833-article

What's more, ICD-10 provides separate codes for drug use when the doctor does not specify whether the use constitutes dependence or abuse. For example, you would code Cannabis use as F12.90 (Cannabis use, unspecified, uncomplicated).

Post ICD-10, Osteoarthritis Will Require Heightened Documentation

In 2013, as we all know, ICD-9 will become ICD-10. After this, you'll not always have a simple one-to-one relationship between old codes and the new ones. often, you will have more options that may need tweaking the way your doctor documents a service and a coder reports it.

Read on for some common osteoarthrosis diagnoses that will help you find out what you will report post October 1, 2013.

Normally a patient with osteoarthritis might start with his primary care physician, who then refers him to a rheumatologist. The rheumatologist has been tending to the patient with conservative measures such as NSAIDS (nonsteroidal anti-inflammatory drugs). Owing to increasing symptoms, now poorly controlled by the use of NSAIDS, the rheumatologist requests an orthopedic consultation. He diagnoses osteoarthrosis(715.xx-716. xx) and these codes specify location, primary, or secondary.

ICD-10 difference: For these codes, you should look at the following:

M15 (Polyosteoarthritis)

M16 (Osteoarthritis of hip)

M17 (Osteorthritis of knee)

M18 (Osteoarthritis of first carpometacarpal joint)

M19 (Other and unspecified osteoarthritis).

Just like ICD-9 codes, these codes are broken down into location, primary and secondary. However they also sometimes specify unilateral, bilateral and post-traumatic indications.

Documentation: In order to submit the most detailed diagnosis, the orthopedic physician will need to maintain osteoarthrosis documentation but expand it to unilateral, bilateral, and/or post-traumatic specification. Some important terms are "oestoarthritis," "arthritis," "athrosis," "DJD," "arhtorpathy," "post traumatic arthritis," and "traumatic arthritis."

Tips for coders: See how codes M19.01--M19.93 entail unspecified locations. Now ICD-10 code(http://www.supercoder.com/coding-newsletters/icd-10-coding-alert)
  does not group unspecified locations alongside the specific locations for each type (as in, the familiar .9 code in most ICD-9 codes categories). You'll find them at the end of the code grouping (M19.90--"M19.93) for each specific type but in an unspecified location.

That apart, traumatic osteoarthritis is now more appropriately indexed and described as post-traumatic osteoarthritis, the true condition.