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December 19, 2010

ICD-10 Coding Primer for Otolaryngologists

If you are a physician... you probably already know what I am talking about...

ICD is the "International Statistical Classification of Diseases and Related Health Problems" used by physicians to code a given medical problem whenever a patient sees a doctor. This "code" is what is submitted to insurance companies along with medical charges.

Periodically, ICD undergoes an update and in the United States, it is about to undergo a MAJOR update come October 1, 2013 to version ICD-10-CM. The current ICD being used in the Unites States is ICD-9-CM.

What are these changes as it relates to otolaryngolgists?

First the basics:

Differences in organization & structure, code composition, and level of detail.
ICD-9-CM ICD-10-CM
  • Consists of three to five characters
  • First digit is numeric or alpha (E or V)
  • Second, third, fourth, and fifth digits are numeric
  • Always at least three digits
  • Decimal placed after the first three characters
  • Consists of three to seven characters
  • First digit is alpha
  • All letters used except U
  • Second and third digits are numeric
  • Fourth, fifth, sixth, and seventh digits can be alpha or numeric
  • Decimal placed after the first three characters

ICD-10-CM codes may consist of up to seven digits, with the seventh digit extensions representing visit encounter or sequelae for injuries and external causes.


ICD-9-CM Code Format ICD-10-CM Code Format



SO... here are some examples of how the code changes from ICD-9-CM to ICD-10-CM:

Diagnosis ICD-9-CM ICD-10-CM
Right Earwax
380.4
H61.21
Left Earwax
380.4
H61.22
Bilateral Earwax
380.4
H61.23
Unspec Earwax
380.4
H61.20
Right Acute Otitis Externa
380.1
H60.311
Left Acute Otitis Externa
380.1
H60.312
Bilateral Acute Otitis Externa
380.1
H60.313
Unspec Acute Otitis Externa
380.1
H60.319

As you can see, what used to be a single code like 380.4 for earwax is now split into as many as 4 different codes based on side. Such increased specificity goes across the board for pretty much every diagnosis.

ICD-10-CM has numerous other new features allowing for a greater level of specificity and clinical detail.
  • Combination codes for conditions and common symptoms or manifestations
  • Combination codes for poisonings and external causes
  • Added laterality
  • Added extensions for episode of care
  • Expanded codes (injury, postoperative complications)
  • Expanded detail relevant to ambulatory and managed care encounters
  • Changes in timeframes specified in certain codes
  • External cause codes no longer a supplementary classification
ICD-10-CM also includes added standard definitions for two types of excludes notes. Excludes1 indicates not coded here. The code being excluded is never used with the code. The two conditions cannot occur together. For example, B06 Rubella [German measles] has an Excludes1 of congenital rubella (P35.0).

Excludes2 indicates not included here. The excluded condition is not part of the condition represented by the code. It is acceptable to use both codes together if the patient has both conditions. For example, J04.0, Acute laryngitis has an Excludes2 of chronic laryngitis (J37.0).

An additional feature is the expansion of codes for certain conditions like postoperative complication codes. Here's one if you accidentally leave behind a neuro paddy in the nose after sinus surgery causing nasal obstruction:

  • T81.524 codes for "obstruction due to foreign body accidently left in body following endoscopic examination"


Code extensions (seventh character) have been added for injuries and external causes to identify the encounter: initial, subsequent, or sequela. The extensions are:

  • A Initial encounter
  • D Subsequent encounter
  • S Sequelae
So that's a primer on how ICD-10-CM coding WILL affect otolaryngologists. A lot more time will be spent on coding than now.

The American Academy of Family Physicians has produced a superbill comparing ICD-9 and ICD-10. What took only 2 pages with ICD-9 will take up 9 pages once ICD-10 goes into effect. Sigh!

Click for ICD-9 and ICD-10 Superbill
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

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