ICD-10 CM: New Features & Common Coding Errors

January 7, 2015

As the deadline for the ICD-10-CM and –PCS approaches on October 1, 2015, home health agencies (HHAs) covered by HIPAA must be up to speed. Enlisting professional coders or at least well-trained billing personnel is paramount so as not lose out on billing revenue that rightfully belongs to your HHA.

In this blog, we’ll explore major changes between ICD-9 and ICD-10 coding practices for which you and your billing or coding staff should be in the know. We’ll also take a look at top coding errors based on outcomes from a study where coders made errors two-thirds of the time when enlisting ICD-10 coding.

New ICD-10 Features

In order to earn your full profit of changing to a new code currency, home health agencies must invest in the cost and time necessary to move to systems and software that utilize the new ICD-10 coding. HHAs must also educate their staff to successfully translate the meaning between the old ICD-9 codes and the new ones.

Rest assured, however, ICD-10-CM has the same categorical structure as ICD-9-CM. Some of the new features of ICD-10-CM include the following:

Combination codes for particular conditions and typical associated symptoms and disease manifestations, such as:

  • E11.341 – Type 2 diabetes mellitus with severe non-proliferative diabetic retinopathy with macular edema
  • K57.21 – Diverticulitis of large intestine and perforation abscess with bleeding

Some clinical concepts are non-existent in ICD-9-CM. These include:

  • Z67.40 – Type O blood, Rh positive
  • T45.526D – Under-dosing of antithrombotic drugs, subsequent encounter

Some codes have broadened significantly. Here are two examples:

  • E10.610 – Type 1 diabetes mellitus with diabetic neuropathic arthropathy
  • F10.182 – Alcohol abuse with alcohol-induced sleep disorder

Additional changes include a new discrepancy for coding between intra-operative complications and post-procedural disorders. Still more changes between ICD-9-CM and ICD-10-CM include:

  • Injuries are categorized by anatomical instead of injury type
  • Classifying specific disorders and diseases through restructuring categories and reorganizing codes
  • Some diseases are reclassified to different sections or chapters to replicate current medical knowledge
  • New code definitions have been enlisted
  • Modifications to codes that correspond to ICD-9-CM V codes and E codes
  • For V code, Factors Influencing Health Status and Contact with Health Services

External Causes of Injury and Poisoning have been incorporated into the main classification

  • For ICD-9-CM, they were separated into supplementary classifications

Changes to the Number of Numeric and Alpha Digits

There are specific changes to the new ICD-10-CM number of code digits. For ICD-9-CM, codes are three to five digits. The first digit is either numeric or alpha (the letters E or V only). All remaining digits are numeric. Here is the old way of coding (ICD-9):


In ICD-10-CM, however, codes can be up to seven digits. The first digit is always alpha (any letter but U), and the second digit is always numeric, with the last five digits of any combination. So by contrast to the above image, here’s how the ICD-10-CM coding will look:


The next image demonstrates an ICD-10-CM code for chronic gout due to renal impairment, left shoulder, without tophus:


For the ICD-9-CM code 599.7, Hematuria, the old system uses one code for all cases of hematuria which are documented in the patient’s medical record. Thus, it is connected to all ICD-10-CM hematuria codes. There are four of these codes in ICD-10, three of which are more specific than they were in the ICD-9-CM coding practices. Here’s an example of what I’m getting at here:


Finally, for fractures, ICD-10-CM coding captures left versus right side of body, initial versus subsequent encounter, routine versus delayed healing, and nonunion versus malunion.

These are just some of the more obvious coding changes between ICD-10 CM and ICD-9-CM. Now let’s take a look at some of the errors that your coding or billing staff are anticipated to make.

Frequent Coding Errors Using ICD-10-CM

A typical coding practice is to use the same code for two different diagnoses. Although this is considered acceptable from the billing perspective, it could leave a fair amount of reimbursement dollars by the wayside. An example would be if your coder used the same one or two diagnoses and severity codes for an orthopedic post-op rehab visit. This would result in no depiction of the co-morbid impact, leaving you with a flat value.

Another error your coding staff could make would be to use outdated codes. A recent code revision is that of the Hospice Debility NOS. Similar therapy code issues will create denials and costly consequences to your HHA.

Coders should not overlook OASIS and referral information to address possible inconsistencies. Reduced reimbursement and/or blatant payment rejection can occur due to disregarding any inconsistencies between the physician and hospital diagnosis. You should also make certain your HHA staff doesn’t just enter the most frequently used codes since not only will this not capture the most accurate codes, miscoding can result in more lost revenue.

Another mistake is if a billing staff person, for example, uses a reference manual to select the correct codes. Adequate training is imperative for your coders or billing staff to utilize the new ICD-10-CM codes and to be able to conduct a proper Oasis Review.

Pressure Not Just on Coders

The pressure isn’t just on coders. Precise medical documentation is also necessary for your agency to receive full compensation for its services. Caregivers must be educated as to the proper diagnoses for ICD-10-CM coding.

But the devil’s in the details, and oh, those poor coders.

In a 2013 pilot study conducted by the Healthcare Information and Management Systems Society (HIMSS) and the Workgroup for Electronic Data Interchange (WEDI), certified ICD-10 coders coded anonymous patient records as test cases.

Researchers found the following items as the coders’ most common errors:

  • Coders often confused the number “0” (zero) with the letter “O.”
  • They also mixed up the number “1” (one) with the letter “I.”
  • Some coders “went on auto pilot,” by relying on coding software rather than coding books.

Remember that there won’t be a grace period when this new coding system goes into effect, so you must get your home health agency prepared for using ICD-10 coding by the October 1st deadline. Just know that KanTime is here for you if you need any coding help.

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