When It Comes to ICD-10 Codes, It Pays to Be Specific

Last Updated: Oct 5, 2017

The 2018 ICD-10-CM Official Guidelines for Coding and Reporting took effect on Oct. 1, 2017, and will apply through Sept. 30, 2018. In addition to the new guidelines, there are also 363 new codes and numerous deletions and revisions.

As the health care community transitions to 2018 codes and guidelines, it is a good time to underscore how important specificity is to successful coding and ensuring that claims are not rejected.

Physicians and practices can avoid the costly, time-consuming process of resubmitting certain denied claims by keeping these two points in mind:

  1. Be as specific as possible: ICD-10-CM diagnosis codes contain a minimum of three characters, with some diagnoses requiring specificity of up to the maximum of seven characters. "Diagnosis codes are to be used and reported at their highest number of characters available," according to the ICD-10-CM Official Guidelines for Coding and Reporting FY 2018. A code will be considered invalid if it has not been coded to the full number of characters required for the diagnosis in question.
  2. Don't forget to document: As the guidelines note, "The importance of consistent, complete documentation in the medical record cannot be overemphasized." It is recommended that the entire record be reviewed to determine the specific reason for the encounter and the conditions treated.

Pennsylvania Medical Society (PAMED) has heard from members who have had claims rejected for lack of specificity or other improper usage. In the cases we reviewed, we found that insurers are adhering to a strict interpretation of guidelines.

Other Resources

CMS offers online resources on 2018 ICD-10-CM on its website here. This page includes a number of resources, including a copy of the 2018 Coding Guidelines.

PAMED members with questions can also contact our Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.

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