A Funny Thing Happened on the Way to an ICD-10 Gap Analysis

October 25th, 2013 - Codapedia Editor
Categories:   Coding   Diagnosis Coding  

You’ve heard the scary facts, maybe even from me.  The number of diagnosis codes is increasing from about 16,000 in ICD-9 to 70,000 in ICD-10. The sky is falling.  I usually add, we won’t be able to memorize diagnosis codes any more. 

And then I did a gap analysis for a women’s health group.  My mission was to audit 60 records for accuracy in CPT/ICD-9 coding with the additional task of identifying any additional documentation that would be needed in the transition to ICD-10.   And the funny thing that happened: at note 42, I remembered an ICD-10 code without looking it up. 

Here’s the process: start with the documentation and compare the documentation with the ICD-9 code selected.  In this women’s health sample, the ICD-9 coding was accurate and there were few unspecified or non-specific codes.  (A review of oncology claims I did last month was dominated by ICD-9 codes ending in .9, and needless to say that group has work to do.  The first step in ICD-10 readiness is to clean up ICD-9 coding, and use specific codes whenever possible.  If the documentation doesn’t allow you to select a specific code, educate the clinician about what is missing.)  But, back to this group of claims, the ICD-9 coding was accurate and specific.  I used a free, internet-based crosswalk to find ICD-10 codes, keeping my paper ICD-10 book at the ready.   

  • Many codes had one-to-one direct matches, such as V25.11, encounter for insertion of intrauterine contraceptive device.
  • Some unspecified codes, accurately selected in ICD-9 by their alternative terminology will need to be reviewed.  625.9 is unspecified symptom associated with female genital organs.  The alternative terminology includes pain in female pelvis.  There are two suggestions for this code: N94.89 other specified conditions associated with female genital organs and menstrual cycle and R10.2 Pelvic and perineal pain.  N94.89 is the code to select if the source of the pain is known to be related to the GU system.  R10.2 is in the signs and symptoms chapter.  At the start of the section for R10.- the excludes notes states “Excludes1 symptoms referable to female genital organs.”  That is, if the patient in this sample had pelvic pain that was diagnosed as part of GU disease, use the more specific N94.89.  If the patient presented with pelvic pain but the clinician did not assess it as part of a GU problem, but perhaps sent the patient to a general surgeon for an assessment, use the symptom diagnosis of R10.2.  This example illustrates the drawback of a crosswalk program.  At first glance, R10.2 seems to be the correct match for pelvic pain.  But it is in the signs and symptoms chapter and the excludes notes clearly states it is not to be used for problems related to the GU system.
  • A commonly used code, V72.31 routine gynecological examination crossed to two codes and required the documentation to show if the results of the GYN exam were normal or abnormal.  Z01.411 encounter for gynecological examination (general) (routine) with abnormal findings or Z01.419 encounter for gynecological exam (general) (routine) without abnormal findings
  • In women’s health, supervision of pregnancy normal or high risk explodes to multiple codes.  For normal pregnancy, whether it is the first or subsequent pregnancy and the trimester need to be known to assign the correct code.  Although there are about twenty possible codes to describe types of high risk pregnancies in ICD-9, in ICD-10 there are seventy or eighty codes that describe the condition and trimester.  The ICD-9 codes are found under 648- other current conditions in the mother classifiable elsewhere but complicating pregnancy childbirth or the puerperium.  These conditions in ICD-10 are in the O09.- heading, list conditions and require the coder to know the trimester for accuracy.

You can do this analysis in your practice.  Of course, it’s easier in a single specialty group than in the ED or General Surgery where a range of problems are seen.  In that case, do the gap analysis repeatedly by system to facilitate learning.  Use a internet based program if it shows the includes/excludes notes or buy a book.  By the way, I suggest you buy a spiral bound book. I didn’t and pages are falling out of my book, and honestly, I haven’t used it that often. 

But, it was a funny thing: on note 42 I had memorized the two ICD-10 codes for an annual GYN exam.


Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.

Latest articles:  (any category)

Artificial Intelligence in Healthcare - A Medical Coder's Perspective
December 26th, 2023 - Aimee Wilcox
We constantly hear how AI is creeping into every aspect of healthcare but what does that mean for medical coders and how can we better understand the language used in the codeset? Will AI take my place or will I learn with it and become an integral part of the process that uses AI to enhance my abilities? 
Specialization: Your Advantage as a Medical Coding Contractor
December 22nd, 2023 - Find-A-Code
Medical coding contractors offer a valuable service to healthcare providers who would rather outsource coding and billing rather than handling things in-house. Some contractors are better than others, but there is one thing they all have in common: the need to present some sort of value proposition in order to land new clients. As a contractor, your value proposition is the advantage you offer. And that advantage is specialization.
ICD-10-CM Coding of Chronic Obstructive Pulmonary Disease (COPD)
December 19th, 2023 - Aimee Wilcox
Chronic respiratory disease is on the top 10 chronic disease list published by the National Institutes of Health (NIH). Although it is a chronic condition, it may be stable for some time and then suddenly become exacerbated and even impacted by another acute respiratory illness, such as bronchitis, RSV, or COVID-19. Understanding the nuances associated with the condition and how to properly assign ICD-10-CM codes is beneficial.
Changes to COVID-19 Vaccines Strike Again
December 12th, 2023 - Aimee Wilcox
According to the FDA, CDC, and other alphabet soup entities, the old COVID-19 vaccines are no longer able to treat the variants experienced today so new vaccines have been given the emergency use authorization to take the place of the old vaccines. No sooner was the updated 2024 CPT codebook published when 50 of the codes in it were deleted, some of which were being newly added for 2024.
Updated ICD-10-CM Codes for Appendicitis
November 14th, 2023 - Aimee Wilcox
With approximately 250,000 cases of acute appendicitis diagnosed annually in the United States, coding updates were made to ensure high-specificity coding could be achieved when reporting these diagnoses. While appendicitis almost equally affects both men and women, the type of appendicitis varies, as dose the risk of infection, sepsis, and perforation.
COVID Vaccine Coding Changes as of November 1, 2023
October 26th, 2023 - Wyn Staheli
COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M Services
October 11th, 2023 - Wyn Staheli
2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....

Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association