Icd-10 essentials for busy physicians who would rather be doing something else -- diabetes and chf
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ICD-10 essentials for busy physicians who would rather be doing
something else -- Diabetes and CHF
March 26, 2012 | Rhonda Butler - ICD-10, 3M 
As promised, I am going to talk about chronic conditions that are common enough that most physicians see patientswho have them. And that means dealing with the documentation needs for coding the patient encounter in ICD-9now and ICD-10 in the future. In this blog I am going to highlight the similarities and differences between ICD-9 andICD-10 documentation and coding needs for diabetes and congestive heart failure (CHF).
Diabetes coding wil actual y be easier and more efficient in ICD-10, which should translate into fewer queries from
coders. There are two basic changes in ICD-10 diabetes classification:
No more coding and documentation hassles with uncontrol ed diabetes.
Complex diabetes cases that required multiple ICD-9 codes can be coded with one ICD-10 code.
Like hypertension, diabetes classification in ICD-9 was unnecessarily complex because it used terminology that didnot reflect the real world. In diabetes classification the culprit was a sub-category called uncontrolled diabetes
Physicians don’t use the term uncontrolled
, and much time and energy was spent trying to figure out thecircumstances under which these codes could be used.
ICD-10 does not contain any diabetes codes that use the term uncontrolled
. If the words inadequately controlled
or out of control
are used, that documentation translates to a code that specifies the diabetes by
type and the fact that the patient currently is hyperglycemic. For example, a patient described as “Type 2 DM poorly
controlled” is all the documentation needed for using ICD-10 code E11.65 Type 2 diabetes mel itus with
Patients with long-standing diabetes who have developed additional manifestations such as retinopathy oftenrequire additional separate ICD-9 codes in order to fully capture the complexity of a case. In ICD-9 this carries with itthe risk that complex cases don’t get completely and accurately coded, and the coded data doesn’t accurately reflecthow ill your patient actually is.
This situation has been improved in ICD-10, because many ICD-10 codes describe the diabetes plus many of themanifestations associated with complex cases in a single code. For example, a patient documented as “Type 1diabetic with nonproliferative retinopathy and macular edema” can be completely described with a single ICD-10code.
Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema
250.51 Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled 362.04 Mild nonproliferative diabetic retinopathy 362.07 Diabetic macular edema
There are no documentation changes for type 2 diabetes without any complications or other manifestations.
E11.9 Type 2 diabetes mel itus without complications
250.00 Diabetes mel itus without mention of complication, type II or unspecified type, not stated as
Congestive heart failure
Heart failure documentation for ICD-9 got more complicated a few years ago when specific codes were added
classifying heart failure by the clinical subtypes acute/chronic and systolic/diastolic, such as 428.22 Chronic systolic
. In ICD-9, if one of these specific diagnoses was documented in addition to the fact that the patient has
CHF, the coding looked like this:
428.22 Chronic systolic heart failure
428.0 Congestive heart failure, unspecified
This is yet another example where ICD-10 is actual y more streamlined than ICD-9, and therefore more likely to becorrectly coded. (The term congestive
in the context of such very specific heart failure codes is a non-essentialmodifier
in ICD-10, which is just a fancy way of saying it doesn’t need to be recorded in a separate code, because itis already included in the meaning of the code.)
Since heart failure is not always documented in such detail, the code subtypes specifying acute/chronic andsystolic/diastolic don’t get used as much as the unspecified CHF code by itself. But if you do make the effort todocument heart failure in this way, the good news is that the terminology used in ICD-10 is exactly the same. Sowhatever you have done to adjust documentation to the requirements of ICD-9, they are no different in ICD-10. And,CHF is not required to be coded separately in ICD-10, in addition to the very specific heart failure code. The ICD-9code pair above rendered in ICD-10 looks like this:
I50.22 Chronic systolic (congestive) heart failure
As with ICD-9, the “acute on chronic” heart failure classification describes patients with diagnosed CHF who arehaving an acute exacerbation/decompensation. Here is what they look like in ICD-10.
I50.23 Acute on chronic systolic (congestive) heart failure
I50.33 Acute on chronic diastolic (congestive) heart failure
I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
“Decompensation” or “exacerbation” documented on the record in some form correlates to the concept of “acute” as
used in ICD-10 without any additional documentation or queries from the coder.
A patient who is described as “on Lasix for CHF” is correctly documented as is for using the ICD-10 code below.
428.0 Congestive heart failure, unspecified
I50.9 Heart failure, unspecified
Next blog I plan to compare ICD-9 and ICD-10 coding and documentation needs for asthma and COPD, and wouldlove to hear from you if you have any suggestions. Thanks for reading.
Rhonda Butler is a senior clinical research analyst with 3M Health Information Systems. She is responsible for thedevelopment and maintenance of the ICD-10 Procedure Coding System since 2003 under contract to CMS, and forthe development and maintenance of the ICD-10 General Equivalence Mappings (GEMs) and ReimbursementMappings under contract to CMS and the CDC. She leads the 3M test project to convert the MS-DRGs to ICD-10for CMS, and is on the team to convert 3M APR-DRGs to ICD-10. Rhonda also writes for the 3M Health InformationSystems blog .
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