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Building Blocks of ICD-10-CM - PAHCOM · Principles of ICD-10-CM Coding; AMA; Deborah J. Grider ICD-10-CM, The Complete Official Draft Code Set; Ingenix Understanding ICD-10-CM and

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  • Building Blocks of ICD-10-CM

    Norma A. Panther, CPC, CPC-I, CIRCC, CEMC, CCS-P, ICDCT-


  • Objectives

    Comparison of ICD-9 & ICD-1Ø 5 digits vs. 7 Alphanumeric New conventions, such as:

    Excludes 2 Placeholder x

    General coding rules Coding

    We’ll use pages from the Ingenix® 2013 ICD-1Ø- CM Draft to code using building blocks. The example codes will include at least one placeholder x.


    PresenterPresentation NotesToday we will be focusing on the differences between I-9 and I-10. This is not a review of the I-10 guidelines which should be reviewed in detail before coding and billing with this code set. ICD-9 did have some Alphanumeric codes however, all of I-10 is alphanumeric. Remember the first character will always be a letter. While you may see I10 as a diagnosis the second character should not be confused as another I.

  • The same!

    Alphabetic Index & Tabular Index External Causes Index Codes arranged by chapter, now 21 in the tabular index Neoplasm and Drugs and Chemicals Tables Brackets, Code First, Colon, Excludes, Includes, In diseases classified elsewhere, Parentheses, See, See Also, Use Additional Code


    PresenterPresentation NotesIf you have been using ICD-9 you can take comfort in the familiar and adjust to the new. Note that the Neoplasm is in the middle of the book just prior to the Drugs and Chemicals Table, not alpha as in ICD-9.

  • I-9 vs. I-10 Diseases of the Musculoskeletal System and Connective Tissue

    M84. Disorder of continuity of bone

    M84.5 Pathological fracture in neoplastic disease

    M84.56 Pathological fracture in neoplastic disease, tibia and fibula

    M84.561 Pathological fracture in neoplastic disease, right tibia

    M84.561A Pathological fracture in neoplastic disease, right tibia, initial encounter for fracture

    Musculoskeletal System and Connective Tissue

    733. Other disorders of bone and cartilage

    733.1 Pathologic fracture

    733.16 Pathologic fracture of tibia or fibula


    PresenterPresentation NotesOn your left we have the I-9 path to the code for pathological fracture in neoplasm of the right tibia and on the right the same path for I-10. (I-10 flies in) M84.56, who thinks we are done?As you can see by the final 7 character I-10 code we have granularity, neoplastic disease and laterality, right tibia and finally more granularity with extension A=initial encounter.

  • Steps to coding: 1. Review conventions and guidelines 2. Locate and look up mainterm in the Alphabetic Index 3. Note nonessential modifiers 4. Follow instructions such as: see, see also, see

    category, with/without, omit code, due to 5. Verify code choice in the Tabular Index 6. Review instructions in the Tabular Index, such as:

    includes, excludes, code also, character requirements 7. Are there guidelines for the chapter you are coding? 8. Confirm and assign code

    PresenterPresentation NotesGenerally the step to coding for I-10 and I-9 are very similar. On the next few slides we will explore some of the differences in I-10. First lets talk about general coding rules.

  • General Coding Guidelines Medical Necessity

    Reasonable and necessary for the diagnosis and/or treatment of an illness or injury, or to improve function of a deformed member

    Borderline Diagnosis

    Code as confirmed unless classification provides specific entry (e.g., borderline diabetes)

    First Listed Diagnosis The most important reason for the care provided to the patient


    Assignment of 4th. 5th, 6th or 7th character to further specify or classify a diagnosis Special Characters Use of placeholder x

  • General Coding Guidelines Impending or Threatened Condition

    At discharge if diagnosis occurred code it otherwise refer to impending or threatened in the index


    If no bilateral code for bilateral condition assign both left and right

    Signs & Symptoms What prompts a patient to seek treatment. Code when diagnosis is not confirmed. Also code when not routinely associated with disease process.

  • I-10- CM Differences

    Point dash - Excludes 2 notes Extensions- Alphabetic and Numeric Placeholder x


    PresenterPresentation NotesLet’s review some of the differences we will encounter in I-10. If you consider yourself and I-9 expert then all you need to do is add these building blocks to your playing field. Might want to turn the book right side up.

    The point dash replaces the box with a check in it, at least for the Ingenix version, that indicated additional digits were required. This place marker appears in both the alpha index and the tabular list.Excludes 2 notes in order to fully understand excludes 2 notes we first must understand that Excludes 1 notes are still used and mean “NOT CODED HERE”, simply if you are coding Chronic tonsillitis (J35.0) and you arrive at J36 Peritonsillar abscess, J36 is the wrong code and excludes chronic tonsillitis “it’s not coded here”. Excludes 2 notes on the other hand will indicate “Not included here” so code it separately. Extensions the 7th character extensions in I-10 give further detail as the timing of the patient encounter, is this the first visit, a follow up or a late effect (or sequela). S a q EE laPlaceholder x sometimes in order to use the 7th character extension we must insert a placeholder x into the code, we’ll look at an example in a moment.So, using all that we know and all these new guidelines, physician coders have to find the “first listed dx”.

  • Point dash - Placeholder for additional digits

    Alphabetic Index


  • Point dash - Placeholder for additional digits

    Tabular List


  • Excludes 2

    “Code this 2”


    PresenterPresentation NotesThe opposite of Excludes 1, the Excludes 2 rule states if the condition listed is documented code it to. Ironically hypertension is coded to I10. There are two additional conditions that if applicable we would code too.

  • Alphabetic Extensions

    A through S No: I, L, O Most common:

    A- initial encounter D- subsequent encounter S- sequela plural se·quel·ae

    Definition of SEQUELA \si-ˈkwe-lə\ 1: an aftereffect of disease, condition, or injury 2: a secondary result Origin of SEQUELA New Latin, from Latin, sequel First Known Use: circa 1793 14

    PresenterPresentation NotesAlphabetic and numeric extensions add granularity to may codes in I-10. Alpha extensions range from A-S, however, you will not see I, L or O as a choice. Zero is used and will be “crosshatched”, however some concern over O and zero must remain.

  • Alphabetic Extensions


    PresenterPresentation NotesHere’s an example of Alpha extension use. The extensions are actually listed on the previous page.(they fly in) here they are. In I-9 a healing fracture was coded using a V code, in I-10 you will use the fracture code and append the appropriate extension (see D).

  • Numeric Extensions

    Number of fetuses Stage of disease Time frame


  • Placeholder x

    Used as 4th, 5th and/or 6th character Must be used or code is invalid Use when you see this symbol



    PresenterPresentation NotesCertain I-10 code categories utilize an extension character, but have not yet been expanded to 7 characters, so a placeholder is necessary. Sometimes these category codes are only 4 characters, but utilize a 7th place extension, in these cases two placeholders will be need one in the 5th and one in the 6th character position. Utilize however many it take to make a 7 character code .

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    PresenterPresentation NotesYou can see the teal colored 7th character symbol on this page starting with S35.00 so our final code for an initial encounter would be S35.00XA.



  • Coding Exercise


    PresenterPresentation NotesNow with a little help from your fellow table mates you will code using I-10. The bags being handed out contain a page from the Alpha Index, a page from the Tabular List and the building blocks to build the appropriate code. When you are done please have someone at the table raise their hand and I will tell you how to find the answer.

    (The Answer will be in the envelope the coding scenario is written on)

  • Disclaimer: The information provided in this presentation was obtained from third party sources and is subject to change without notice. It is intended to provide general information for illustrative purposes only. Presenter specifically disclaims liability or responsibility for the results or consequences of any misapplication(s)

    of the statements, opinions, or suggestions, in this presentation. Sources:

    Principles of ICD-10-CM Coding; AMA; Deborah J. Grider ICD-10-CM, The Complete Official Draft Code Set; Ingenix Understanding ICD-10-CM and ICD-10-PCS A Worktext; Mary Jo Bowie & Regina Schaffer CMS; various web sources and presentations


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    Slide Number 1Building Blocks of ICD-10-CMObjectivesThe same!I-9 vs. I-10Steps to coding:General Coding GuidelinesGeneral Coding GuidelinesI-10- CM DifferencesSlide Number 10Point dash -Point dash -Excludes 2Alphabetic ExtensionsAlphabetic ExtensionsNumeric ExtensionsPlaceholder xSlide Number 18DETERMINATIONSlide Number 20Slide Number 21Coding ExerciseSlide Number 23Slide Number 24