INSIGHTS FOR HEALTH CARE 

AUG. 31, 2016   
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Celebrate the Anniversary of ICD-10-CM & ICD-10-PCS: Changes You Need to Know 

By Susan Roehl

Buy new code books! Update your encoders! To celebrate the end of our first year utilizing the ICD-10 coding system, approximately 1,990 new ICD-10-CM (diagnoses) codes are being added, 422 codes revised and 305 codes deleted. There are 3,651 new PCS (surgical) codes alone. The code freeze that's been in place since 2011 expires this year, and these changes are the first major additions to ICD-10. 
 
Here's what you need to know: 
  • The ICD-10-CM code changes include pertinent additions to the diabetes, fractures, myocardial infarction and hypertension categories. There is now a specific code for the Zika virus.
  • The majority of the changes for surgical codes are procedures of the cardiovascular system. Remember, the PCS codes are only utilized in the inpatient setting.
  • Guideline 1.A.19, effective Oct. 1, is receiving attention because many facilities rely on the coding staff, in conjunction with the clinical documentation improvement staff, to ensure all codes assigned and reported are done with the clinical integrity of the documentation at the forefront (i.e., the provider documentation of the patient's condition and treatment supports reporting the diagnosis code).
    The guideline states that the assignment of a diagnosis code is based on the provider's diagnostic statement that the condition exists. Code assignment is not based on clinical criteria used by the provider to establish the diagnosis.
  • The second noteworthy change is an addition to the instructions regarding the term "with" when it appears in a code title. The classification presumes a causal relationship between the two conditions linked by these terms in the Alphabetic Index or Tabular List. These conditions should be coded as related, even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated. For conditions not specifically linked by these relational terms, provider documentation must link the conditions to code them as related. 
  • The grace period of "flexibility" in code assignment to the physician community that was granted for fiscal year 2016 expires. Physician claims were not audited for code completeness or specificity during the first year of ICD-10-CM. Beginning Oct. 1, incomplete codes will not be allowed on claim submissions, so accuracy is much more important moving forward. 
The first year of ICD-10 implementation has gone remarkably well. The code system will continue to evolve as health care evolves. It is a joint responsibility between coders, providers and health systems to ensure all staff are provided the resources and educational opportunities to ensure compliant code assignments. 
 
Congratulations on a job well done in FY 2016!

 
Susan Roehl, RHIT, CCS   
Health Care Consultant Manager  
701.476.8770
 sroehl@eidebailly.com

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