After learning about ICD-10 coding assessments, it has been noted that approximately 65% of today’s documentation is actually ready for the transition from ICD-9 to ICD-10 coding. Insufficient documentation to support the specificity required for the new ICD-10 code sets will be one of the largest problems after the October 1st, 2015 implementation date goes into effect. If an office is fully prepared for ICD-10, but clinical documentation has not improved, accurate coding and proper payment will not be feasible. M-Scribe believes that for most providers, a behavioral change in documentation habits will be crucial — now is the time to start preparing.
With the transition to ICD-10, some documentation subjects will require physicians and providers to capture new information while others may be involved in updating, modifying and expanding documentation needs.
For instance, ICD-10 contains multiple combination codes — the documentation must reflect the association between conditions. For example, ICD-10 code K50.814 designates “Crohn’s disease of both small and large intestine with abscess.” The ICD-9 equivalent code would be “555.2, regional enteritis, small intestine with large intestine” and “569.5, Abscess of intestine.” In addition, laterality necessitates documentation.
Another example, ICD-10 code M05.271 designates “Rheumatoid vasculitis with rheumatoid arthritis of right ankle and foot.” The ICD-9 equivalent code would be “714.27 – Rheumatoid arthritis with visceral or systemic involvement, ankle and foot.”
The following conditions are potential problem areas related to insufficient documentation. Physicians and providers should be conscientious of necessary specificity levels, enabling clinical documentation to be better understood:
Diabetes Mellitus: ICD-9 features 59 codes for diabetes, while ICD-10 offers more than 200 codes. The expanded diabetes code set has added a provision of “poorly controlled” to categories of controlled or not controlled. There are multiple combination codes (e.g., ICD-10 code E09.11 designates “Type 1 diabetes mellitus with ketoacidosis with coma”).
Injuries: ICD-10 features an expanded category for injuries. A seventh character extension identifies the encounter type:
Coding professionals will be required to code the size and depth of the injury, which may not be captured in physician documentation. In addition to coding the type of injury, the cause of the injury should be documented and coded as well.
Drug Under-dosing: A new code for under-dosing has been added to the ICD-10 coding categories. It identifies situations in which a patient has taken less of a medication than prescribed by the physician.
Acute Myocardial Infarction (AMI)
ICD-10 contains additional diagnosis codes related to musculoskeletal conditions. For example, there are eight codes for pathologic fractures in ICD-9 but more than 150 codes in ICD-10.
Some codes require time frame documentation. For example, respiratory/ventilator codes are acknowledged based on the amount of time a patient has been on a ventilator. They are divided into three segments: less than 24 consecutive hours, 24-96 consecutive hours, or greater than 96 hours.
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