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Deb Grider

ICD-10 will be challenging for everyone, but in particular practitioners. Many physicians in all specialties are moving to electronic health records now or will transition in the next year.

Selecting the appropriate specificity of an ICD-10 code may be challenging. How do you assist practitioners with documentation improvement to allow them to be able to select the appropriate ICD-10 code? My experience working with physicians for years is that they in the past have used “superbills” or “charge tickets,” with their most common diagnoses listed on these forms. They typically either would begin by checking a diagnosis themselves or by writing the diagnosis on the form by hand.

From there, a coder or data entry staff member would enter the charges into the practice management system. With the migration to electronic records, however, the process has changed. The practitioner will select the diagnosis code from a “pick list,” in most cases, and with the increased number of codes, which will they select?

My guess is the first code on the list, or the unspecified code. One of the purposes of moving to ICD-10 is specificity. If using the General Equivalency Mappings (GEMs) files, many ICD-9 codes do not map in linear fashion, but instead map to several ICD-10 codes (with many ICD-9-CM codes also mapping to an unspecified code). So relying on the GEMs files is not a real solution. One option is using computer-assisted coding (CAC), but in order to do so, the practitioner will need to use “smart” phrases or specific language within the patient encounter in order for it to work.

So what’s the bottom-line solution? Many practitioners will not have the time or desire to learn the new coding system in its entirety, so it is our job to retrain them on how to document for ICD-10 in order for the transition to be successful.

The best way to accomplish this is to keep it simple. Run a utilization report on their top 25-30 diagnosis codes, reporting by specialty. You then can review the ICD-10 codes relative to the common ICD-9-CM codes and build your education and training around the conditions each practitioner typically manages. Provide your physicians information based on the common conditions they treat and what needs to be documented for those particular conditions. For example, for a diagnosis of Alzheimer’s, it is important to document the following:

  • Early onset
  • Late onset
  • Any behavioral disturbances or delirium

Consider this comparison between ICD-9-CM and ICD-10-CM:



331.0 – Alzheimer’s disease

G30 – Alzheimer’s disease

G30.0 – Alzheimer’s disease with early onset

G30.1 – Alzheimer’s disease with late onset

G30.8 – Other Alzheimer’s disease

G30.9 – Alzheimer’s disease, unspecified

Another example of where specificity comes into play is in the diagnosis of glaucoma:

  • Documentation must include:
    • Type of glaucoma (angle-closure, congenital, open angle, etc.)
    • Eye affected (laterality)
    • Stage of glaucoma

A few suggestions:

Create presentations for each of your medical specialties comparing the common ICD-9 codes they use today with the codes that will be applicable when ICD-10 is implemented, identifying what needs to be documented for each condition. Begin training physicians on what they need to document for the common conditions they treat. Follow this up in a few weeks with a documentation review for ICD-10 readiness. Then train those practitioners who are struggling.

Another suggestion is that you might want to create “documentation flash cards” with conditions listed on the front and documentation requirements on the back. Practitioners even can begin carrying the cards around in their pockets and can pull them out when they are documenting. This could be cumbersome with some specialties such as primary care since there are so many diagnoses involved, so I don’t recommend this method for everyone. But in that case you instead might create an easy-to-use comparison sheet listing diagnoses and corresponding documentation requirements, making for something they can hang in their offices to review as they are documenting.

Also begin looking for affordable software programs that will interface with your electronic health records to assist with the selection process if your EHR does not have the capability to “drill down” to more specific codes quickly. Keep in mind that practitioners do not have a lot of time to make coding decisions, as they routinely are busy performing their primary function, which is treating patients.

Finding easy tools that will assist practitioners is imperative to beginning to get ready for ICD-10. Do not wait until 2014 to begin familiarizing those practitioners with the documentation requirements.

You might find by waiting that it will be difficult for them to select codes based on specificity if they are not familiar with the documentation requirements for the conditions they commonly treat.

And this inevitably will slow down the claims submission process, which ultimately can affect reimbursement or trigger a carrier audit.

About the Author

Deborah has been a national speaker for various organizations the last 23 years including the American Academy of Professional Coders, The Indiana and Illinois State Medical Associations, The American College of Surgeons, The Coding Institute, Karen Zupko and Associates, The American Medical Association, Contexo Media, the NHCAA-National Health Care Anti-Fraud Association, Indiana and Kentucky Hospital Associations, Indiana and Indiana & Kentucky HFMA, as well as other national organizations.  Deborah is a former member of the United Healthcare’s Physician Administration Advisory Committee and the American Medical Association CPT Editorial Panel.

Deborah is a former administrator in a surgical specialty practice in a university setting, and a health care consultant for seventeen years prior to joining Blue and Company as a Senior Manager in Healthcare Revenue Cycle and heads up the ICD-10 consulting team. Deborah has continued to provide consulting and educational services to physicians and hospitals nationally.

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