Published 12/1/2014
Sarah Wiskerchen, MBA, CPC

Five Frequently Asked Questions About ICD-10

During the AAOS-sponsored ICD-10 education courses presented this year by KarenZupko & Associates, orthopaedic surgeons, practice managers, and staff had plenty of questions about ICD-10. Here are five that were frequently asked.

  1. If we’ve been using unspecified codes before, why can’t we use them now?

For orthopaedics, a key feature of ICD-10 is its expansion to include greater detail about the injuries and conditions treated. In ICD-9, an “unspecified” diagnosis code may have been the only option, but that will not often be the case in ICD-10.

If greater specificity exists within a code category for laterality, anatomic site, and other condition-specific descriptors, and these details are known, they should be reported in the diagnosis selected. Using unspecified codes when more specific descriptors could be applied leaves room for denials, payment delays, and more work by staff and physician when codes must be corrected.

  1. Must ICD-10 codes be used beginning Oct. 1, 2015, regardless of the date of service?

ICD-10 implementation is service-date specific; this means that information systems must be “bilingual” during the transition period. Physician claims for dates of service prior to Oct. 1, 2015, will be reported using ICD-9, and claims for dates of service after Oct. 1, 2015, will be reported using ICD-10.

The exception is surgeries that are scheduled before Oct. 1 but will occur after Oct. 1. In these situations, precertification must be completed using ICD-10 codes. This requires that staff and physicians understand the codes well in advance of the October deadline. The Centers for Medicare and Medicaid Services (CMS) and other payers are already expanding their medical necessity policies to include ICD-10 codes.

  1. ICD-10 doesn’t seem to have many bilateral code options. If the patient has the condition on both sides, how is it reported?

A few ICD-10 codes offer bilateral options for orthopaedic conditions, primarily for osteoarthritis and congenital disorders. If the patient’s injury or condition affects both sides of the body, the ICD-10 code requires laterality, and no bilateral option exists, report two ICD-10 codes—one for the right side and one for the left side. A new CMS claim form was implemented in April 2014 to accommodate the expansion of codes from four diagnosis codes to twelve.

  1. Why do billing staff have to know what the Gustilo classification is for diagnosis coding?

Physicians know that the Gustilo classification is a grading system that applies to open fractures, describing the degree of soft-tissue injury and the extent of contamination to determine fracture severity. A higher Gustilo grade refers to a more severe fracture. In ICD-10, an expanded set of 7th character options applies to fractures; for open fractures, the 7th character is determined in part by the Gustilo classification assigned. (See “When 7 Is Not a Lucky Number,” AAOS Now, November 2014) Not each Gustilo type is specified within ICD-10. The coder only needs to differentiate between low-grade fractures (Gustilo 1 or 2) and high-grade fractures (Gustilo 3A, 3B, or 3C).

  1. How will my information system help me assign the most specific ICD-10 code?

In many cases, this is an unknown. Ask your vendors now how their software will facilitate ICD-10 code selection. The Academy’s Code-X program is an essential adjunct tool for code identification. Code-X includes both Pick Lists (such as fracture, arthritis, spine, and osteomyelitis) as well as keyword search options to help users quickly identify appropriate ICD-10 codes. In just a few keystrokes, Code-X helps narrow the list from more than 91,000 orthopaedic codes to the right one. Understanding ICD-10’s requirements and documentation terms is key to efficient Code-X use.

The transition to ICD-10 is a planning and learning process. Take steps now to learn the system’s structure and code selection requirements, so your practice is ready for the transition. The next series of AAOS ICD-10 workshops begins in January 2015 in Dallas. For more information and to register, visit www.aaos.org/courses

Sarah Wiskerchen, MBA, CPC, is a senior consultant with KarenZupko & Associates, Inc. She is an instructor for the 2015 AAOS CPT and ICD-10 coding workshops.