ICD-10 2.0: An Evolving Data Set

One year after the official go-live of the International Classification of Diseases, 10th revision (ICD-10), the coding language is scheduled to undergo an evolution, with nearly 1,975 additions, more than 300 deletions and 425 revisions. This brings the total set of diagnosis codes to more than 71,480. The new and revised clinical modification codes (ICD-10-CM) take effect on Oct. 1, 2016, and should be used for all discharges and patient encounters as of that date.

Code Set Changes
Newsworthy changes to the code set include additions for the Zika virus (A92.5) to the chapter on “Certain infectious and parasitic diseases” and the addition of transsexualism (F64.0) to the chapter on “Mental, behavioral, and nutritional diseases.” Codes that pertain to rheumatology practices include adjustments in Chapter 13: “Diseases of the musculoskeletal system and connective tissue” (M00-M99). The eight-page list is compiled in the ICD-10-CM tabular addenda 2017 and includes the following:

• Additions under M25.5: Pain in joint (M25.54: Pain in joints of hand; M25.541: Pain in joints of right hand; M25.542: Pain in joints of left hand; and M25.549: Pain in joints of unspecified hand);
• Additions to M26.61: Adhesions and ankylosis of temporomandibular joint for laterality (M26.611: Right; M26.612: Left; M26.613: Bilateral; and M26.619: Unspecified side); and
• Deletions under M50.92: Cervical disc disorder with myelopathy, mid-cervical region (C4–C5, C5–C6, C6–C7 with myelopathy) with corresponding additions for increased specificity, M50.920 (unspecified level), M50.921 (C4–C5), M50.922 (C5–C6), and M50.923 (C6–C7).

What You Can Do to Prepare
Some steps physicians can take to help prepare for the expanded code set before it takes effect, according to Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, include the following:

Run a data report on diagnosis code frequency from October 2015 through July 2016. Then review the top 20–25 codes that were used most frequently in the practice. “This should represent the majority of encounters,” says Ms. Bryant, who has more than 30 years of experience as a coding and health information management professional and leader and is an American Health Information Management Association ICD-10-CM/PCS trainer.

The list of most frequently used codes will help you identify any “unspecified” codes. “Look carefully at the ICD-10-CM tabular listings for other possible options [for these codes],” says Ms. Bryant. “Also, review or audit at least 50 encounters for those unspecified [diagnosis] codes and determine if there were other options based on the documentation.”

Additionally, Ms. Bryant says, practices should get a denial report on diagnosis codes for October 2015–July 2016. “Compare this to your above information and findings,” she says. “For the first three months of using the new FY2017 codes, ensure the practice has in place a review process that is pre-bill for any unspecified code that would be billed.”