Medical Coding: ICD-10 Official Guidelines

Plus, know the common facts and myths related to the new diagnosis system

What are ICD-9 rules and what are ICD-10 rules. And for a while, coders and anyone working with these ICD codes are going to be working with both systems as we do the transfer and the crossover. And so that's going to be one of the key points; it's to remember what are ICD-9 rules, what are ICD-10 rules.

One example is in the obstetrical coding. Every code has a trimester associated with it in ICD-10. And so that's one of the rules. There are multiple other medical coding rules that are specific to ICD-10 that are either in addition to or different from some of the guidelines you have in ICD-9.

ICD-10 PCS Procedure Coding: There is a list of approaches and a list of root operations and that's how all your procedure coding begins. Our expert pointed out in a recent healthcare event that once you become accustomed to this, you become familiar with this, you learn the definitions of some of these, you really don't have to use your index for this coding. You can go directly to the table for that specific body system.

In ICD-10 your procedures are all in tables. And you learn to use those tables and you have to be in the correct table to use the correct code.

The first digit is the medical and surgical section of the book as per the medical coding guidelines. The second digit is the heart and great vessels, so that's the anatomical section. And then the third digit, this particular one, this example says “bypass” and it gives you the definition.

There's are, 32 root operations. And an in-patient coder is going to have to become very familiar with this to code productively and so that you don't have to read the description of that root operation each time you're using those ICD codes.

But it does give that to you in the heading of your tables. So there is a quick reminder there. And then as you go through that, you go on down to the left-hand column, you go to the body part. Then you use the appropriate approach for your surgical procedure.

You can actually download and print the complete version of ICD-10 which would basically be the same as your current coding books.

For ICD-10 CM, the diagnosis, there are 2,038 pages so you probably don't want to print that unless you're really going to need to use it. That's a pretty thick book.

And on the Procedural Coding System, as you know in ICD-9, that's not a huge section right now. In ICD-10, it is 1,252 pages. So the volume is definitely increasing.

Facts and Myths

We've heard lots of comments. These are just a very few of them. People say there would be no hard copy ICD-9 code books and all coding will need to be done electronically.
Well, there are pages there. You can actually download it from the internet. You can purchase books. Yes, they will be larger than the one you're currently used to using. There's more coding and compliance information.

But there will be books available. There will be a lot of electronic systems. But there will be books available for purchase and there are now.

You can go ahead and purchase ICD-9 CM and PCS books now from the places you've purchased your ICD-9, from the AMA, from Ingenix and so on, some of the others, and they are available now.
Another fact or myth: unnecessarily detailed medical record documentation will be required. If your documentation currently is not detailed and you need some clinical documentation improvement, yes, that may be true.

But if your providers are currently providing good detailed documentation, there won't need to be any change. It will actually be easier for the coder because the information is all there to select the correct code.

And another one, the increased number of medical codes will make ICD-10 CM impossible to use. Actually, once you learn it, you make the transition, it's easier to use. It makes it much easier to select correct ICD 10 codes. There's no guessing as to what's included in that particular code description.

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