Lori A. Cox
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Each year when I receive my new coding books the first thing I do is transfer all my notes from one book to the other. This may seem like a time-consuming task, but it’s a very good review! The second thing I do is to re-read the ICD-10-CM Coding Guidelines. You should re-read the coding guidelines each year to refresh your memory. We coders/auditors/billers get in the rut of using the same codes repeatedly, and we forget that there may be guidelines for those codes. Join us for the next several weeks as we dissect each section of the ICD-10-CM Coding Guidelines. Today, we'll kick off this new series with Section 1.A. Conventions for the ICD-10-CM
These are the rules for ICD-10-CM. These rules and conventions can be found throughout the entire ICD-10-CM codebook. From this section, it's important to understand the format and structure of the codes, the placeholder “X” along with the 7th characters.
There are a couple conventions here that can trip even the savviest of coders. The first is the alphabetic abbreviations “NEC” and “NOS.” NEC means “Not Elsewhere Classified” while NOS means “Not Otherwise Specified.” Simply put, NEC means the provider gave you a very detailed diagnosis, but the codes do not get that specific. NOS is the more commonly used and means the provider did not give you the specifics. For example, “pain in limb.” You would use a NOS code because there are more specific codes available, but your provider did not state them.
The second problematic convention deals with the Excludes 1 and 2 notes that were new to coders when we switched from ICD-9. It is important to pay attention to these, especially the Excludes1 notes. For example, did you know that Allergic rhinitis cannot be coded with asthma? If you look in the Tabular List under J30.9, Allergic rhinitis, unspecified, you will see an Excludes1 note that states allergic rhinitis with asthma (bronchial) should be coded with J45.909. This is one of the most common coding errors that I see while auditing.
Excludes1 notes mean “NOT CODED HERE!” You should never be using the two codes at the same time unless the provider is very clear that the two conditions are not related. I compare this edit to the National Correct Coding Initiative (NCCI) edits where two CPT codes cannot be coded at the same time. Same concept, different code set.
Excludes2 notes are similar in that they should not typically be coded together however, the patient could have both conditions at the same time, so it is not a “never” event. An example is code C10.1, Malignant neoplasm of the anterior surface of epiglottis. There is an Excludes2 note for code C32.1, Malignant neoplasm of the epiglottis (suprahyoid portion) NOS. If the provider states the patient has cancer of the epiglottis AND the anterior surface of the epiglottis, both codes can be used. Otherwise, only use one of these codes based on the provider’s documentation of the site.
The last convention in this section deals with the “code first”, “use additional code”, “in diseases classified elsewhere” notes, as well as the use of “and” and “with”. These words are the reason you should always be coding from the Tabular List and not the Index. The Index may not have these notes listed with the codes. Pay attention to these notes in the Tabular to put your codes in the correct order.
Let me know your thoughts/questions/comments in the section below and I look forward to next week as we continue this ICD-10 series and discussion.
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