Are there tricks and shortcuts to make the process easier?
If you were hoping that this article was going to offer shortcuts for ICD-10 coding, you will be sorely disappointed. Instead, this is an overview of the dangers of using shortcuts when selecting ICD-10 codes. But even if you feel misled, do read on; a valuable lesson awaits.
Learning a foreign language
Suppose you wanted to learn Chinese. If there were a shortcut, a way to communicate effectively without years of study, you would want to know about it. Consider the following options:
- Cheat sheet: A concise list of the most important phrases in Chinese. All you need to do is memorize them. Sure, you might not have the flexibility to say what you want in all cases, but at least you’ll be able to get by when you need a standard phrase such as “Where is the bathroom?”
- Translator tool: A list of the common English phrases you use now, translated to their Chinese equivalents. Instead of somebody else’s list, this would be customized for you. This could even be a device that changes each word you speak from English to Chinese the moment the words come out of your mouth.
The first option, a list of commonly used phrases or words, seems straight-forward. No need to study Chinese for years—rather you can cut right to the chase. An expert has already selected the most important things you need to know. But what if a detail you need is missing? What if you are looking for a bathroom, but your cheat sheet forgot to specify the difference between a ladies’ room instead of a men’s room? That could lead to an embarrassing situation.
The second option appears somewhat safer, as it contains the phrases you already use. It would seem you would be more likely to have the right words available to you when you need them. Unfortunately, if each word is translated the moment it leaves your mouth, the tool won’t be able to account for syntax or the rules of grammar for forming a cohesive sentence.
In many languages, the sequence of adjectives relative to nouns is not the same as in English. Other languages have words that must agree in gender with complex rules for conjugating verbs. Devoid of context, a sentence might contain the correct words but still won’t sound right in the target language.
ICD-10 is a language too
It’s natural to look for ways to more easily transition to ICD-10, in the hope of avoiding time-consuming and expensive training. The two options discussed here are:
- Cheat sheet: A list of the top codes that an expert has devised for your specialty. Theoretically, all you need do is select a code from the list. Hopefully, the expert didn’t overlook anything.
- Translator tool: A software program that takes your existing ICD-9 codes and converts them to ICD-10 versions. All the work involved in converting codes is done for you.
The problems with these options are the same whether the subject is Chinese or ICD-10 coding. A cheat sheet may not include the codes you need. Many ICD-10 codes are new or include multiple options. If every option were included, the cheat sheet might take a dozen or more pages, decreasing its value as a quick reference.
A translator tool is likely to use the government’s General Equivalence Mappings (GEMs) database to give you an equivalent ICD-10 code. Frequently, however, GEMs lead to unspecified codes, which payers are likely to deny, and they overlook the many new ICD-10 codes that have no approximate match to ICD-9 versions.
In either case, the description of the code suggested could turn out to be a pretty good match. But you still would not be done because these tools can’t take into consideration the “rules of grammar.” In other words, lists are unlikely to provide assistance on coding conventions and guidelines. Without an intimate knowledge of the rules of grammar, you will never be fluent.
Speaking like a native
Here is a deceptively simple example: In ICD-9, code 723.1 is for cervicalgia (neck pain). There is an ICD-10 code that matches it, and either of the tools mentioned above would probably include “M54.2 cervicalgia” as a choice for consideration.
To ensure that this is the correct code, however, you need to look for instructional notes in the tabular list for M54.2, and you must understand how to apply them. Next to M54.2, it says, “Type 1 Excludes: cervicalgia due to intervertebral cervical disc disorder” (M50). Shortcut lists won’t have space to include notes like this.
A fluent ICD-10 speaker would know that “Type 1 Excludes” means that this other code category should be considered instead of M54.2. The codes are mutually exclusive and should not be billed for the same encounter. And that makes sense, because there is no need to report cervicalgia twice. One of the codes will suffice.
But there’s more: A cheat sheet or translator tool would fail to tell you that the M54 category has a Type 1 Excludes note for every code that begins with those three characters. For example: Type 1 Excludes: psychogenic dorsalgia (F45.41), means this code cannot be used with any code that begins with M54.
A little further up in the tabular list, you will find that the block of codes from M50 to M54 has yet another exclusion: “Type 1 Excludes: current injury—see injury of spine by body region discitis NOS” (M46.4).
An extensive list of Type 2 Excludes notes and instructions for the use of external cause codes appear at the beginning of chapter 13. These rules apply to all codes that begin with the letter M. A native speaker could tell you that “Type 2 Excludes” means you should consider adding those codes if they apply, because they are not automatically included in any codes in this chapter.
Familiarity with the general ICD-10 guidelines, which appear in their own section in the text and apply to every code in the book, could come in handy as well. For example: Signs or symptoms should not be reported when a more definitive diagnosis is known. If something more specific is the cause of the cervicalgia, then it should be reported instead. The first Type 1 Excludes note, regarding “M50: cervicalgia due to intervertebral disc disorder,” is an example of a more specific code that would be used if the criteria are met.
Shortcuts and cheat sheets are appealing—and they can be helpful—but there is no substitute for a thorough understanding of ICD-10. If you take the time to get proper training, you can become fluent before the October 1, 2015, implementation date, thereby minimizing miscommunication with payers and other parties who will no longer “speak” ICD-9. With your practice and livelihood at stake, don’t cut corners. Study hard and learn the rules of the system so you can blend in with the natives.
Evan M. Gwilliam, DC, MBA, CPC, NCICS, CCPC, CCCPC, CPC- I, MCS-P, CPM, is a vice president and director of education and consulting for the ChiroCode Institute and is the only chiropractor certified by the AAPC as an ICD-10 trainer. He teaches chiropractors and other health professionals how to prepare for ICD-10 and can be contacted at firstname.lastname@example.org.