What You Should Know About ICD-10-CM Codes

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Author(s): 
Barbara Aung, DPM

   Although this may seem like a daunting task, it appears we now have an additional 24 months to get this done. The old saying of how do you eat an entire elephant — one bite at a time — seems most appropriate for the task at hand. If we have a plan and we work the plan in small bites each week, month and year, we should be ready to hit the starting line — or in this case, the finish line — running rather than trying to leap a massive distance in a single bound.

A Few Case Scenarios Of Coding Changes

Let us take a look at a few case scenarios to see what our coding might look like. I would like to direct your attention at how the wording of the documentation will help or hinder how we now need to choose the ICD-10 codes.

   Case one. A 40-year-old male presents for an initial visit with an injury to his right great toe, which occurred as an object crushed the toe. The past medical history is without significant findings.

Appropriate ICD-10-CM code: S97.111A
S97.111 = right hallux, crush injury
This base code S97 requires a seventh character so:
A = initial encounter
D = subsequent encounter
S = sequelae

   Case two. A patient presents to the office with a history of type 2 diabetes. He has been taking insulin for many years. There is a midfoot ulcer of the right foot. The examination reveals that the ulcer is superficial in which only the skin is injured.

Appropriate ICD-10-CM codes: E11.621, L97.411, Z79.4
E11.621 = type 2 diabetes with foot ulcer
L97411 = ulcer on the right midfoot. This code is needed in addition to the diabetes code to identify the site of the ulcer and that it is superficial.
Z79.4 = long-term use of insulin

   You might ask why it matters that the patient is using insulin. This history can explain the complexity of the patient’s medical status and the risk level of complications as they relate to the foot ulcer.

   Case three. A 72-year-old male presents to the wound care center with a stage 4 pressure ulcer on the left heel. His past medical history is significant for severe peripheral artery disease and cerebrovascular accident without residual complications.

Appropriate ICD-10-CM codes: L89.624, Z86.79, Z86.73,
L89.624 = pressure ulcer to the left heel
Z86.73 = history of stroke without residual complications
Z86.79 = history of peripheral arterial disease

   Case four. A 65-year-old male presented to your partner with ulcers to the lower legs of six years’ duration. The patient weighs 450 lbs. His past medical history includes hypertension, deep vein thrombosis, venous insufficiency, coronary artery disease and chronic anemia. Your partner has performed split thickness skin grafts on these venous insufficiency ulcers. You are seeing this patient while your partner is on vacation. This is the eighth visit for this patient, who now presents with a healed graft.

Appropriate ICD-10-CM code: Z48.817

   This encounter is for surgical aftercare of the skin and subcutaneous tissue.

   It does appear the Z code section is somewhat equivalent to the V code section in ICD-9, which covers factors influencing the health status of the patient during an encounter with the health system.

In Conclusion

I am suggesting to all practitioners to start looking at or auditing current patient notes/documentation so they can identify areas where improvements are required as part of the implementation plan to convert to the ICD-10-CM coding system.

   Dr. Aung is in private practice in Tucson, Ariz. She is a Certified Professional Medical Auditor, a Certified Surgical Foot and Ankle Coder and member of the American Association of Professional Coders. She is also a panel doctor at Carondelet St. Mary’s Advanced Wound and Hyperbaric Center. Dr. Aung serves on the Examination Committees for both the American Board of Wound Management and the American Board of Podiatric Medicine.

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