At last, the secret to ICD 10 Guidelines is revealed

Last night I was in a Medical coding webinar and lot my students are keep on asking me that ICD 10 Guideines very hard how can we learn them in simple way, They desparately want to know about the secrets of ICD 10 Guidelines, I Clarified all the doubts of my students in that particular webinar

After the webinar I was thinking like this is the not problem of just my students, there are lot of Medical coders who feels ICD 10 Guidelines are much difficult and unable to make the good grip on them, please make a note that these are not ICD 10 Guidelines 2021, all the details we mention in this post are ICD 10 Guidelines 2022

I am writing this blog post just to make the concepts in ICD 10 Guidelines clear and every has to understand in a more professional way, That is why I decided to explain the all ICD 10 Guidelines with examples, ICD 10 Guidelines for coding plays a major role and most of the part will be depending up on ICD 10 CM Only

In this futuristic blog post I explain all the ICD 10 Guidelines, after the reading this post you completely feel good authority over ICD 10 CM

What is ICD :

ICD stands for International Classification of Diseases

It is an International standard diagnostic tool in which all the diseases are categorised, nothing but Diseases and symptoms classified into alpha numeric numbers

ICD has a major in medical coding to get the right E&M and specific diagnosis in short time with accuracy

Present we are using ICD 10 CM,  it means it is the 10TH  revision of Whole set of ICD’S that resemble with “ 10” and CM Means Clinical modifications,  every year on Oct 1st ICD has undergoes some changes this resembles with clinical modifications “ CM”

Origination of ICD :

Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics(NCHS) two departments within the U.S. Federal Government’s Department of Health and Human Services (DHHS) provide the following guidelines for coding and reporting using the International Classification of Diseases

These guidelines have been acceptd by the four organizations are AHIMA, AHA, CMC and NCHS, HIPAA plays major role in ICD

Conventions for ICD-10-CM:

The conventions for the ICD-10-CM are the general rules to code ICD’S.

The ICD 10 CM  is divided into Alphabetic index and tabular list .

Alphabetic index:

It is an alphabetical list of terms and their respectable code.

        It consist of 4 parts

The index of diseases and injuries

The index of external causes of injuries

The table of neoplasms

The table of drugs and chemicals.

b) Tabular list:

The list of codes divided into chapters based on body system or condition.

Locating and Level of Detail in Coding :

Step 1 : Read and understand the diagnosis carefully

Step 2 : Search the code in alphabetic index first

Step 3 : Refer the code in tabular list ( because A.I doesn’t provide full code always )

Step 4 : Check if any 4,5,6,7 digits are required

Step 5 : Read the notations that are present in Excludes ,code first, use additional code etc

Step 6: Check whether ICD needs to place holder “ X”

Step 7 : Confirm any need of 4,5,6,7 characters if the code is 7 characters then we should report it

             By this way we can locate a code with detail coding

Leading Mechanism of ICD 10 :

If any diagnosis has been confirmed by the provider we should code that condition

Lets say if provider documented that the patient is having ASTHMA, we have to find the ICD 10 CM Code for the condition asthma,

The ICD 10 CM Leading process includes 2 steps

Step 1 : We have to search the condition in ICD 10 Alphabetic index just like the term we are looking at dictionary ( In our case Asthma is our condition we have to search that In alphabetic index)

Note : The code we find in the Alphabetic index is not complete, in order to get the complete code we have to confirm our code in Tabular list

Step 2:  Based on the code results that we found in the Alphabetic index we have to search this code in tabular list in order to find the full and complete code

Format and structure:

ICD-10-CM tabular list contains categories, subcategories and codes.

Eg : S52.011A Torus fracture of upper end of right ulna, initial encounter for closed fracture

    S52 : Fracture of forearm

    01   : Torus fracture of upper end of Ulna

    1A   : Right side initial encounter

Characters for categories, subcategories and codes may be either a letter or a number.

A three character category that has no further subdivision is taken as a complete code.

Some times the ICD code doesn’t further divided to sub category or code at that time 3 character code can be Considered as complete code

     Ex : Hypertension, The code of HTN is  I10

Etiology/manifestation convention: (“code first”, “use additional code” and “in diseases classified elsewhere” notes)

Etiology : it means Root cause, It is the main condition that develops other complications

Manifestation :  it means Because of underlying Etiology some other conditions occurs these are  called as manifestation

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology

In such scenarios etiology should be sequenced first followed by manifestation

Wherever such a combination exists, there is a “use additional code” note at the etiology code, and a “code first” note at the manifestation code

“In diseases classified elsewhere” :

In most cases the manifestation codes will have in the code title, “in diseases classified elsewhere.”,  Codes with this title are a component  of the etiology/ manifestation convention.

“In diseases classified elsewhere” codes are never permitted to be used as first-listed or principal diagnosis codes

They must be used in conjunction with an underlying condition and  the underlying condition should be coded as primary diagnosis

Eg : Patient is having Dementia in disease classified elsewhere and Parkinson’s disease

We have already discussed that in disease classified elsewhere codes as never permitted as primary diagnosis

WITH :

The word “with” or “in” should be used to mean “associated with” or “due to”

The classification presumes a causal relationship between the two conditions linked by

 these terms in the Alphabetic Index or Tabular List.

Lets say if you are searching a condition and that is linked with another condition by the term “ WITH”, Then we should take a casual linkage between these two terms

These conditions should be coded as related even in the absence of provider documentation

When the documentation clearly stating that these two conditions are unrelated to each other then only we don’t take the linkage

Eg : Diabetes and Hypertension have some WITH terms in that we find casual linkages that  Should we take in the absence of provider linkage

Default codes :

A code listed next to a main term in the ICD-10-CM Alphabetic Index is referred to as a default code.

The default code represents that condition that is most commonly associated with the main term, or is the unspecified code for the condition

Lets say if you are searching a condition A code present next that searching condition is known Default code

Eg : Appendicitis is documented without mention of as acute or chronic the default code should be assigned

Excludes : 

It has 2 types

Excludes 1

Excludes 2

Excludes 1  : “ Not coded here “

Notations are very important in ICD 10CM, While searching a code in ICD 10 CM if you find Excludes 1 notation bellow to that code, that it means we never code these 2 conditions at the same time

Lets say we are not allowed to code a congenital form versus an acquired form of the same condition together

b) Excludes 2 :  “Not included here.”

While searching a code in ICD 10 CM if you find Excludes 2 notation bellow to that code, that it means we can code both the conditions together

Eg: Patient is having Hypertension and HTN involving vessels of brain

All  the above ICD 10 Guidelines are termed as ICD 10 CM Conventions, In our future blog post we also going to explore the ICD 10 Chapter wise guidelines if you are interested in our post Bookmark our blog Krishnatejacpc.com

In our future post we cover most important topics like neoplasm icd 10 guidelines, diabetes mellitus icd 10 guidelinese etc

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Commonly asked questions :

Conclusion :

ICD stands for International Classification of Diseases, AHA, AHIMA, CMS, NCHS has authority over ICD CM

ICD is a process of transforming diagnosis to alphanumerical numbers

ICD 10 CM has alphabetic index and tabular list

ICD 10 CM conventions are the general coding guidelines which helps us to know the coding the process

ICD 10 Conventions includes Leading mechanism, Format and structure, level in detailed coding, WITH convention, Etiology and manifestation conventions, Excludes 1, 2 and finally default codes

ICD 10 CM further divided to ICD 10 CM Chapter wise guidelines