he AAP Pediatric Coding Newsletter™ is a
monthly newsletter from the American Academy of Pediatrics. Along with
providing solutions to the most urgent pediatric coding questions, the
Newsletter also features “Transitioning to 10,” a monthly column with
practical advice on the upcoming ICD-10-CM transition.
Transitioning to 10: Finding Codes
In general, locating a code in International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) is very similar to how a code is located in International Classification of Diseases, Ninth Revision, Clinical Modification. After locating a term for the diagnosis in the alphabetic index, finding the code to which you are directed in the tabular list of codes is easy. For instance, codes in category A02 are found immediately following codes in category A01. However, when an alphabetic character is found in the third through fifth characters, you may have to look a little further.
In a classification that uses a standard format, you might expect that each character would follow a pattern of 0–9 and then A–Z. However, in the creation and continued refinement of ICD-10-CM, this type of sequencing was
overridden by the need to add codes to more specifically identify a condition in an existing category without re-sequencing existing codes. This is true for subcategories of childhood absence epilepsy (G40.A) and juvenile myoclonic epilepsy (G40.B). These conditions were previously categorized in subcategory G40.3, generalized idiopathic epilepsy and epileptic syndromes, but are distinct entities and so were determined to require separate subcategories. Subcategories G40.A and G40.B were added between subcategories G40.3 and G40.4 to accommodate appropriate placement within the category.
Codes may also appear out of order where codes have been deleted and replaced to more accurately categorize a condition. An example of this is the index reference for J09.X, influenza due to identified novel influenza A virus. You might expect this would follow a set of other alphanumeric codes in category J09. However, this is especially easy to locate, as it is currently the first and only subcategory of category J09, influenza due to certain identified influenza viruses. This is because J09.X was added to accommodate a change in categorization of influenza due to identified avian influenza virus (previously J09.0) into a new subcategory of identified novel influenza A virus, which includes bird, swine, and influenza of other animal origin (now J09.X). Also changed was categorization of influenza due to identified novel H1N1 influenza virus (previously J09.1) to category J10, influenza due to other identified influenza virus.
Beyond these explanations of why ICD-10-CM codes may not follow the 0–9 and then A–Z pattern, the takeaway of this article is that when an alphabetic character appears in the third through fifth character of an index entry, the tabular index entry is placed according to its clinical relationship to other categories and subcategories. While familiarity with the tabular list will make these exceptions to the general code format recognizable and more easily located, use of electronic coding products that offer search functionality makes cross-referencing from the alphabetic index to the tabular list an easier task. For many coders, the move from using code books to electronic products does not come easily. However, this transition may be best undertaken in conjunction with learning to use the ICD-10-CM code set so that 2 transitions are accomplished at once.
Ready to give coding without books a try? There are several online products that already include the ICD-10-CM code set, or you can download PDF files of the ICD-10-CM code set without charge from the Centers for Disease Control and Prevention Web site at www.cdc.gov/nchs/icd/icd10cm.htm
. The PDF files are large, but once downloaded, they provide the complete official code set with added features such as internal links to make navigation easier and to accommodate keyboard shortcuts, sticky notes, and highlighting. Change can be hard, but when making a change as big as ICD-10-CM, we may benefit from not only learning the new code set but also new ways to access and use it.
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