ICD-10-CM coding is a critical skill for medical coding professionals, especially those preparing for the Certified Professional Coder (CPC) exam.
Understanding the ICD conventions, general guidelines, and chapter-specific guidelines is paramount for accurate code assignment. Here’s a comprehensive summary of the essential guidelines
Alphabetic Index and Tabular List Division
The ICD-10-CM is divided into two main parts: the Alphabetic Index and the Tabular List.
The Alphabetic Index provides an alphabetical list of terms and corresponding codes, while the Tabular List organizes codes into chapters based on body systems or conditions.
Format and Structure
Codes are structured hierarchically with categories, subcategories, and codes.
Categories are three characters long and may have further subdivisions as subcategories. Codes may range from 3 to 7 characters. The indented format enhances readability and reference.
Use of ICD Codes for Reporting Purposes
Only codes, not categories or subcategories, are permissible for reporting purposes. Any applicable 7th character must be included where required.
Placeholder Character
The placeholder character “X” is used at certain codes to allow for future expansion, particularly in categories like poisoning and adverse effects.
7th Characters
Certain categories require 7th characters for specificity.
The 7th character must always occupy the 7th position in the data field, and if a code is less than 6 characters, a placeholder “X” must be used to fill the empty characters.
Abbreviations
Understand abbreviations like NEC (Not elsewhere classifiable) and NOS (Not otherwise specified) in both the Alphabetic Index and Tabular List.
Punctuation
Brackets, parentheses, and colons are used in both the Alphabetic Index and Tabular List for clarification and organization of information.
Use of “And”
The term “and” may imply either “and” or “or” in certain contexts, influencing code assignment.
Other and Unspecified Codes
“Other” codes are used when there’s no specific code for a detailed condition mentioned in the medical record.
They cover specific diseases without dedicated codes, often marked by “NEC” in the Alphabetic Index.
On the other hand, “unspecified” codes are chosen when there’s not enough information for a more specific code.
In cases where there’s no unspecified code available, the “other specified” code is used to represent both other conditions and those with unclear details.
“NEC” (Not elsewhere classifiable) and “NOS” (Not otherwise specified) are common abbreviations. They denote “other specified” and “unspecified” conditions, respectively.
Punctuation
Brackets [ ] enclose synonyms, alternative wording, or explanatory phrases.
Parentheses ( ) enclose supplementary words without affecting the code number.
Excludes Notes
Excludes1 notes indicate codes that should never be used together.
This note means “NOT CODED HERE!” It’s used when two conditions cannot occur simultaneously.
For example, if a code excludes a congenital form and an acquired form of the same condition, only one should be assigned.
Excludes2 notes denote conditions not included in the represented code but may coexist with it.
This note represents “Not included here.” It indicates that while the condition excluded is not part of the represented code, a patient may have both conditions simultaneously.
In such cases, it’s acceptable to use both the code and the excluded code together when appropriate.
In essence, Excludes1 notes prevent the assignment of two codes that cannot coexist, while Excludes2 notes indicate conditions that are not part of the represented code but may still occur alongside it.
Understanding and appropriately applying these notes ensure accurate coding and billing practices.
Etiology/Manifestation Convention
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.
For example Diabetes – Etiology (cause), Neuropathy, retinopathy, cataract are the manifestation (result of the cause).
The etiology/manifestation convention in ICD-10-CM mandates that underlying conditions be sequenced before their associated manifestations.
This convention ensures proper coding by indicating a “use additional code” note at the etiology code and a “code first” note at the manifestation code.
Manifestation codes usually contain “in diseases classified elsewhere” in the title, indicating their role in this convention.
These codes cannot be used as first-listed or principal diagnosis codes and must accompany an underlying condition code.
In cases where manifestation codes lack this title, the same sequencing rules apply.
Both conditions are listed in the Alphabetic Index, with the etiology code first followed by manifestation codes in brackets, ensuring accurate code sequencing.
Both conditions are listed in the Alphabetic Index, with the etiology code first followed by manifestation codes in brackets, ensuring accurate code sequencing.
An example of the etiology/manifestation convention is dementia with Parkinson’sdisease.
In the Alphabetic Index, code G20 is listed first, followed by code F02.80 or F02.81- in brackets.
Code G20 represents the underlying etiology, Parkinson’s disease, and must be sequenced first, whereas codes F02.80 and F02.81- represent the manifestation of dementia in diseases classified elsewhere, with or without behavioral disturbance.
Conclusion
Mastering the conventions of ICD-10-CM is essential for success in the CPC exam and in the field of medical coding.
To solidify your understanding of these concepts and prepare effectively for the exam, practice is key.
As a way to reinforce your learning and assess your readiness for the CPC exam, we’re offering a free practice exam.
We encourage you to take advantage of this valuable resource to enhance your preparation and increase your confidence in tackling the CPC exam.
Good luck, and happy coding!
