By Tom Maher, President and CEO


By now, ICD-10 is likely fully operational in your practices.  Practicefirst’s offers you the following tips while using the new code set:

  1. BE SPECIFIC-the layers in ICD-10 are deep. Accurate reporting is a CMS expectation.
    1. Tell us if a motor vehicle accident happened in a car, suv, pickup truck or van
    2. Cellulitis vs. Abscess
      1. ICD-10 gives different codes for each whereas they were combined in ICD-10.
      2. Do NOT use the term CELLULITIS & ABSCESS in your documentation interchangeably.
    3. Sprain vs. Strain:
      1. ICD-10 classifies these as different.
      2. Specify STRAIN vs. SPRAIN
      1. More specificity, please! See the fracture section of your ICD-10 manuals for elaboration.  This is a highly expanded section containing much detail.

Diagnosis Coding Tips:

  • Always code each health care encounter to the level of certainty known for that encounter. All providers are expected to code correctly and have sufficient documentation to support the codes selected.
  • Medicare did not require external cause reporting in ICD-9-CM and does not require external cause reporting in ICD-10-CM. Similar to ICD-9-CM, there is no national requirement for mandatory ICD-10-CM external cause code reporting. Unless you are subject to a state-based external cause code reporting mandate or these codes are required by a particular payer, you are not required to report ICD-10-CM codes found in Chapter 20 of the ICD-10-CM, External Causes of Morbidity.
  • In both ICD-9-CM and ICD-10-CM, sign/symptom and unspecified codes have acceptable, even necessary, uses. While you should report specific diagnosis codes when they are supported by the available medical record documentation and clinical knowledge of the patient’s health condition, in some instances signs/symptoms or unspecified codes are the best choice to accurately reflect the health care encounter.
  • If a definitive diagnosis has not been established by the end of the encounter, it is appropriate to report codes for sign(s) and/or symptom(s) in lieu of a definitive diagnosis. When sufficient clinical information is not known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate unspecified code (for example, a diagnosis of pneumonia has been determined but the specific type has not been determined). In fact, you should report unspecified codes when such codes most accurately reflect what is known about the patient’s condition at the time of that particular encounter. It is inappropriate to select a specific code that is not supported by the medical record documentation or to conduct medically unnecessary diagnostic testing to determine a more specific code.

If you are not currently a coding client of Practicefirst, call us to find out how you can become one!

If you would like more information about how we can tailor our services to meet your needs, please contact Practicefirst at 716.834.1193 or

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