ICD-10 documentation requirements

Do you know how much documentation you will need to accurately assign an ICD-10-CM code? ICD-10-CM uses three to seven alpha and numeric digits and full code titles, even though the format is very much the same as ICD-9-CM (e.g., ICD-10-CM has the same hierarchical structure as ICD-9-CM).

The changes in ICD-10-CM are in its organization and structure, code composition, and level of detail. This new ICD-10-CM structure will allow for further expansion that was previously not possible with ICD-9-CM because more positions in more chapters are left open and available for future modifications.


                ICD-10-with-extrv.jpg Click on the images above for an expanded view of ICD-10 examples.

Let’s take look at acne, one of the most frequently reported conditions in a dermatology practice. In ICD-9-CM we code acne as 706.1, whereas in ICD-10-CM we need to have enough information provided in the patient medical record to define which type of acne the patient is presenting.

For example:

ICD-10-CM has eight codes for acne, as follows:
 L70 Acne
     Excludes 2 acne keloid (L73.0)
 L70.0 Acne vulgaris
 L70.1 Acne conglobata
 L70.2 Acne variolifornis
   Acne necrotica miliaris
 L70.3 Acne tropica
 L70.4 Infantile acne
 L70.5 Acn’ excorl’e des jeunes filles
   Picker’s acne
 L70.8 Other scne
 L70.9 Acne, unspecified
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ICD-10 crosswalk Link the most frequently used ICD-9-CM codes to corresponding ICD-10-CM codes.
dialogues_logo Dialogues in Dermatology: The Road to ICD-10 features Mark Kaufmann, MD, and Murad Alam, MD, co-chairs of the ICD-10 Workgroup, giving ICD-10-CM background information as well as tips for a successful, seamless ICD-10-CM transition.
ICD_10_ebook 2015 ICD-10-CM Coding for Dermatology eBook: Prepare for a successful transition to the new ICD-10-CM coding system with this easy-to-use ICD-10 coding resource, complete with official coding guidelines and reporting instructions.
For more information, or for answers to specific coding and reimbursement questions, email AAD's Manager of Coding and Reimbursement Faith McNicholas, RHIT, CPC, CPCD, PCS, CDC, at fmcnicholas@aad.org.

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