How can dermatology practices use ICD-10 Index and Tabular Lists to effectively meet conversion challenges?
The ICD-10 Index & Tabular List
The National Center for Health Statistics is the official repository of ICD-10-CM documents. The official source documents are: The ICD-10-CM INDEX TO DISEASES and INJURIES and The ICD-10-CM TABULAR LIST of DISEASES and INJURIES. The disease and injury index shares the same characteristics as most book and document indices. It provides a quick way of referencing code categories. The best way to use the index is to let it guide us as to where to look within the ICD-10-CM tabular list.
The tabular list is comprised of a comprehensive ICD-10 codes listing. Individual chapter breakdowns are typically based on body systems. An example in Dermatology is chapter 12. This is where Diseases of the skin and subcutaneous tissue can be found. This chapter is assigned the letter L, so all codes in this chapter will start with L.
At the beginning of chapter 12 there is an excludes 2 clause including such things as parasitic diseases (A00-B99), metabolic diseases (E00-E90) and viral warts (B07). Notes can provide clarification. Such notes include Includes Notes, Excludes Notes such as Excludes 1 and Excludes 2 and See Notes. The top level heading covering codes L00 to L99 is followed by an excludes 2 note. This Excludes 2 Note clarifies that the listed diagnoses aren’t part of the represented code, and can be made at the same time.
Types of Notes
Excludes1 notes indicate that coding the listed diagnoses together is invalid. Given a patient diagnosis of acquired epidermolysis bullosa (L12.3), it’s invalid for a congenital EB diagnosis to be given at the same time, as congenital and acquired are mutually exclusive. The Excludes1 note guides practitioners to select just one code.
Excludes2 notes indicate that differing codes can co-occur. Diagnoses that aren’t part of the code can be coded at the same time. Acne is in category L70. An Excludes2 note informs the practitioner that acne keloid is not found among L70 diagnoses so it can be listed as well.
See notes indicate places to look for related codes. Poison Ivy is a type of dermatitis. When checking in the Index, you might start at Dermatitis and then under Contact and Allergenic.
See Also notes provide alternative index locations when looking for a code. Looking in the index under papilloma, the index directs you to look under Neoplasms, Benign, or “by site”.
Use Additional Code indicates that an additional code is required. Given a patient with impetigo, (L01), the recommendation to use an additional code identifying the infectious agent (B95-B97) is given.
A Code First note urges the practitioner to use an additional code as the first code on the Superbill. Many Code First notes describe variations of a larger disease. In the L14 category of Bullous disorders in diseases classified elsewhere, a patient has a “bullous” subtype of Systemic Lupus Erythematosus(SLE), in which the lupus is causing blisters. The diagnosis associated with SLE (M32.8) is inadequate. Instead, the Code First note suggests using the M32.8 code for SLE, and then adding the L14 code to indicate “bullous changes”.
It’s clear that dermatology practices will make extensive use of ICD-10 Index and Tabular Lists to identify the correct ICD-10 codes for record keeping and claims processing after October 2015. These documents are a primary resource for locating and applying the correct code. Their use will help ensure that comprehensive and accurate medical information is available to help practitioners, patients and researchers.