ICD-10 Code Assignments

Question: I know that there are going to be significantly more codes with ICD-10, but will the rules change regarding how codes are assigned?

Answer: Good question, and one that I'm sure a lot of people want to know the answer to. In terms of how codes are assigned, the general guidance, and ICD-10 coding guidelines, the rules are not all that different from ICD-9.You still have the same guidance for assignment of the first-listed (primary) diagnosis code, selection of secondary diagnosis codes, injuries and accidents, late effect codes, and infections.

Many specific areas of coding such as diabetes and HIV have essentially the same rules. They have new codes, but the same governing rules. Your Volume II still has the general alphabetic index, the Neoplasm table, the Table of Drugs and Chemicals, and the Index of External Causes. There is currently no Hypertension Table in I-10, but that doesn't mean there won't be one. You no longer have sections in the back of Volume I (Tabular) for your E-codes and V-codes because these have each now been assigned their own chapters in the Tabular section. Your old E-codes are now in Chapter 20 (V01 – Y99) and the old V-codes are now Chapter 21 (Z00 – Z99).

You will still find familiar instructions and conventions throughout the manual. For example, brackets are still used in the index to indicate secondary codes that should be reported, and the Tabular will contain sequencing instructions such as "code first underlying disease" and "code xx as an additional code."

There are some new concepts such as place holders, but in the main, once you become familiar with the appearance of the codes and their organization, it should not be a difficult transition for a coder.

Bill Dacey, CPC, MBA, MHA, is principal in the Dacey Group, a consulting firm dedicated to coding, billing, documentation, and compliance concerns. Dacey is a PMCC-certified instructor and has been active in physician training for more than 20 years. He can be reached at billdacey@msn.com or editor@physicianspractice.com.

This article originally appeared in the March 2011 issue of Physicians Practice.