Despite the urgings of the American Medical Association (AMA) for Congress to stop the implementation of ICD-10, ICD-9 updates have ceased (other than those necessary to accommodate new technology), and the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS) is focusing its energy on ICD-10. Most recently, the agency, under authorization by the World Health Organization (WHO), updated its ICD-10-CM Official Guidelines for Coding and Reporting for 2012.

Although these codes are not currently valid for any purpose or use in the United States, with an ICD-10 implementation date of Oct. 1, 2013, now is a good time to become familiar with these new guidelines for diagnosis coding and reporting.

As you review the manual, take note of the recent revisions for 2012: Bold text indicates a narrative change from 2011 guidelines; italicized text indicates a heading change; and text that is underlined has been moved in the guidelines since the 2011 version.

You’ll find notable changes in the following locations:

Section I, B, 16: Documentation of Complications of Care

This revised paragraph reminds the coder that code assignment should be based on the provider’s documentation of the relationship between the condition and the care or procedure. “There must be a cause-and-effect relationship between the care provided and the condition … query the provider if the complication is not clearly documented.”

Section I, C, Chapter 1: Certain Infections and Parasitic Diseases (A00-B49)

Under Sepsis, Severe Sepsis, and Septic Shock, the guidelines clarify that, “Septic shock generally refers to circulatory failure associated with severe sepsis, and therefore, it represents a type of acute organ dysfunction.”

Code T81.12 Postprocedural septic shock is added as a code that can be sequenced after the code for the systemic infection, and a reminder has been added that “the code for septic shock cannot be assigned as a principal diagnosis.”

Additional changes can be found in this chapter, including those for methicillin resistant staphylococcus aureus (MRSA) conditions.

Chapter 2: Neoplasms (C00-D49)

Look to this chapter to find a number of changes regarding general guidelines for neoplasm coding.

Chapter 5: Mental, Behavioral, and Neurodevelopmental Disorders (F01-F99)

Here, NCHS clarifies that “a code from category G89 [Pain, not elsewhere classified] should not be assigned with code F45.41,” which is used to indicate “pain that is exclusively related to psychological disorders.” Instead report code F45.2 Pain disorders with related psychological factors, provided “there is documentation of a psychological component for a patient with acute or chronic pain.”

Chapter 7: Diseases of the Eye and Adnexa (H00-H59)

The section on glaucoma in this chapter has been completely revised to clarify the assignment of codes for glaucoma in general and in various stages.

Chapter 18: Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99)

In this chapter, under Coma Scale, you’ll find new guidance stating, “Assign code R40.24, Glasgow coma scale, total score, when only the total score is documented in the medical record and not the individual score(s).”

Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes (S00-T88)

Under Adverse Effects, Poisoning, Underdosing and Toxic Effects, item 5 clarifies, “When coding an adverse effect of a drug that has been correctly prescribed and properly administered, assign the appropriate code the nature of the adverse effect followed by the appropriate code for the adverse effect of the drug (T36-T50). The code for the drug should have a 5^th or 6^th character “5” (for example T36.0X5-).

Guideline changes for coding adult and child abuse, neglect, and other maltreatment can also be found in this chapter.

Chapter 21: Factors Influencing Health Status and Contact with Health Services (Z00-Z99)

Lastly, check out this chapter for new guidance regarding encounters for obstetrical and reproductive services, and the use of code Z3A Weeks of gestation.

5 Responses to “ICD-10 Guidelines for 2012 Offer Insight to Future”

1. j myers Says:
   February 2nd, 2012 at 11:53 am

   After the debaucle that 5010 has become we will be in a money crunch for 6 moths with icd10. We will have doctors on the verge of bankruptcy in a few months with no relief.

2. C Radcliff Says:
   February 4th, 2012 at 6:36 am

   I started studying ICD-10 guidelines and coding it last year. But, with all of the new guidelines I now have to restudy. I think they should make 2012 the last updates for ICD-10 until 2014. This is another extreme change in the healthcare world, and you need to give coders time to get used to the regulations before they go into effect.

3. Brandi Tadlock Says:
   February 6th, 2012 at 11:13 am

   This is probably a stupid question, but…
   Are the ICD-10′s guidelines longer than ICD-9′s? It’s hard to tell…I was a little shocked to see 113 pages in the PDF, since the conventions in ICD-9 only take up 20 pages, but the print in ICD-9 is much smaller, and it’s condensed into 2 columns, so I thought that probably accounts for most of the size difference. It seems odd to issue the rules for how to use something, several years before the product is available to use. It’s even stranger to amend the rules several times, before the release date. For me, these guidelines are extremely hard to grasp in abstract form. It’s a lot easier for me to understand the rules, if I can see them in action.
   I don’t agree with the whole ‘ripping off a band-aid’ strategy, that CMS has adopted, in implementing ICD-10; it’s too much change at once. Some people think it’s just a new code-set; the more I see of ICD-10, the less I think it has much resemblance to ICD-9 at all; some of the guidelines appear to overlap, and both code sets represent diagnosis codes, but that appears to be near the extent, of their similarities. They’ve re-organized it, and added a ridiculous amount of detail to the code descriptions – sure, in the long run, that will probably have benefits. But it’s going to take a while to get used to, before anyone starts to see benefits from it.
   Everyone seems to forget that all coverage criteria – ALL medical necessity determinations – are based on diagnostic information. Right now, whether or not your procedure codes are covered, depends almost entirely upon the diagnosis code(s) linked to them. ICD-9 codes represent a condition/problem, for which the CPT/HCPCS codes must be clinically appropriate to diagnose or treat, in order for the service to be considered ‘medically necessary’ by a payer. It’s naive to believe that such a drastic change in a crucial code set, will only have a minimal impact on operations – it’s even more naive to believe that the bulk of the problems will occur on the front-end, through productivity and training costs, alone.

   When you fundamentally change the structure and descriptions of diagnosis codes, you fundamentally change the way that services are considered for payment. Coverage criteria will almost certainly be affected by the new, more extensive level of detail available. How will payers amend their policies? Will they simply crosswalk the previously-covered codes, to the new code set, or will they completely redefine their coverage criteria, to require more specificity? Will they take into account some of the new details encompassed in the codes, such as ‘initial’ or ‘subsequent encounter’ designations? Will providers get to learn about the changes ahead of time, or will it happen post-implementation?

   I’ve been through some of the coding changes that have happened over the past few years – most notably the new pediatric vaccine admin codes, from 2011. I can assure you – no change, no matter how slight, is implemented with smooth-sailing, when there is so little consistency between payers, across the board. Prepare all you want; learn the new code sets and guidelines, test your systems, and train everyone around you. You won’t prevent hang-ups in payer-readiness, glitches in claim processing, ignorance from provider services reps, or dramatic changes to coverage criteria, which may or may not already be in the works. Those who will be best prepared, will be able to respond to those hurdles, appropriately, as they arise. October 1st, 2013 is not the end of the implementation nightmare; it’s the beginning. Just wait and see.

4. Lux Says:
   February 7th, 2012 at 7:31 am

   I guess ICD10 is not for lazy people or who doesn’t like to read.
   Looks very challenging but t the same time I am glad Doctors will need to slow down and improve documentation.

5. Brandi Tadlock Says:
   February 7th, 2012 at 11:50 am

   CODING is not for lazy people, or those who dislike reading. And yes, doctors will need to slow down and provide better documentation, but that doesn’t mean it’s going to happen. If their documentation hasn’t been good enough to meet the requirements in the past, what makes anyone think that they’ll suddenly decide to start documenting enough to meet the requirements, when the rules change? I just don’t see it happening.

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