What to expect when using the new ICD-10-CM codes

By Faith McNicholas

Q: What changes can I expect when using the new ICD-10-CM codes?

A: ICD-10-CM is not just an update of ICD-9-CM codes. It is a restructuring of the diagnosis classification system with a significant increase in the number of codes, expanded code lengths, and narrative descriptions, allowing for greater granularity. Dermatology alone is moving from 9,000+ ICD-9-CM codes to more than 22,000+ codes in ICD-10-CM.

Q: When is the ICD-10-CM compliance deadline?

A: The compliance deadline for ICD-10-CM is Oct. 1, 2014. All Health Insurance Portability and Accountability Act (HIPAA)-covered entities with transactions that have dates of service on or after Oct. 1, 2014 must be submitted using ICD-10-CM.

Q: Is there a way to report severity for conditions in ICD-10-CM?

A: Just like in ICD-9-CM, codes that do not contain severity as part of the code descriptor are the same in ICD-10-CM.

For now, reporting of severity for some conditions can be captured by the CPT code reported. For example, psoriasis would be described by reporting the appropriate affected area in CPT code 9692x — Laser treatment of inflammatory skin disease (psoriasis); total area, which defines the total area that is covered by the lesions. Note: There are three code choices available, all based on total treated area.

Q: How do I report more than one diagnosis code?

A: In certain circumstances, documenting the severity of a condition requires looking out for several distinctions when reporting. Some dermatology conditions will have to be reported with more than a single ICD-10-CM code to identify the underlying cause and/or manifestation, which conveys the complicating issues of the condition or severity, where applicable.

Q: How do I use combination codes?

A: Some dermatology codes require what is called a combination code to identify the site and stage of a condition. For example, when coding for pressure ulcers (L89.xxx), providers will need to use combination codes, which identify the site of the pressure ulcer and the stage of the ulcer. Guidelines recommend that one codes any associated gangrene (I96) first. These codes are based on severity, which is designated by stages 1 to 4 as the sixth character, and 0 and 9 as the sixth character for unstageable and unspecified stages, respectively. Unstageable and laterality is indicated by the fifth character (1 for the right side and 2 for the left side).

For more information, or for answers to specific coding and reimbursement questions, email the Manager of Coding and Reimbursement, Faith McNicholas, RHIT, CPC, CPCD, PCS, CDC, at fmcnicholas@aad.org.

Email the Member to Member editor at members@aad.org.

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