ICD-10-CM: Myths Gone Wild

As the ICD-10-CM implementation date nears, it seems that the buzz has heightened and along with the buzz comes half-truths and misconceptions.   A recent online article in Forbes’s magazine focused on coding.  The article, “Doctors Lag Far Behind On New Medicare Diagnosis Codes,” implies that ICD-10-CM codes are Medicare codes.  Because the United States uses ICD-9-CM (and eventually ICD-10-CM) in the billing process, we have ventured away from real reason we code:  to have an efficient, consistent system of capturing data that supports healthcare decision making in our country.   Do we care that some experts say that diabetes is an epidemic or organisms’ resistance to antibiotics is a grave concern?  Are we concerned that incidence of asthma is on the increase in children?  Do we want to know why the U.S. continues to have more fetal deaths than many other countries?  The inability to collect reliable, consistent, granular data with the use of internationally accepted codes is the key to research and improving healthcare outcomes. 

The article continues to explain that providers must convert to 140,000 new codes in order to bill.   The other part of the story is that over ⅓ of the new codes have included laterality (left, right, bilateral), which is not a major change.  Severity stratification and new terminology have been incorporated to reflect modern medicine.  ICD-10-CM is a revision of an international classification system that has been in existence for over 100 years.  The system was developed to collect healthcare data, not support billing systems. 

Unspecified Codes

A new myth has emerged concerning use of unspecified codes.  The message was “payers are not going to accept unspecified ICD-10-CM codes!”  This caused experienced coders to pause, knowing that the use of unspecified codes cannot be avoided and are appropriate in many cases.  For example, if a patient is seen for pneumonia but due to recent prolonged antibiotic usage, there is no organism and no further specification is available from the physician; therefore, the diagnosis is simply Pneumonia, unspecified.  It is acceptable in ICD-9-CM and should be in ICD-10-CM.

On the other hand, an “unspecified site” code for a sprain may be denied.  The practice of selecting codes from a “pick list” populated with unspecified codes will not support an accurate healthcare data collection system and may potentially result in a delay or denial of payment for the provider.

ICD-10-CM is an international classification system designed to collection data for healthcare decision-making.

Japsen, B. (2013, June 15). Doctors Lag Far Behind On New Medicare Diagnosis Codes. Forbes.

 by Gail I. Smith Coding Advisory Board Member