Facing ICD-10 Preparation

Facing ICD-10 Preparation

by abilling, March 14, 2014

We want to share with you what we are facing with ICD-10 coming in October.  While is this a very elementary explanation, I hope it compels everyone to begin now to be attentive to the specificity of detail we will need in order to process claims for proper payment.

As a general rule, everyone will need to begin by documenting effectively.  The use of adjectives, notating cause and effect, specifics about the aspects of the disease, including the anatomical site, and the use of exact dates all become important components in supporting billing.  We have listed below some notes which may help.

  • The use of adjectives include; Acute, Chronic, Acute on Chronic, Mild, Moderate, Severe, and Persistent.
  • Indicate cause and effect; use “due to” or “secondary to” – Acute systolic heart failure due to hypertension.
  • Be specific about the aspects of the disease; Use current terminology – Paroxysmal versus persistent atrial fibrillation or Typical or Type I versus atypical or Type II atrial flutter.
  • Specify anatomical site; acute deep vein thrombosis of left tibial vein. In ICD-10 there is a feature called laterality for right, left, and bilateral conditions.
  • Use exact dates: Myocardial infarction ‘10/10/2012” not “last month”

Let’s look at some examples to illustrate what will happen.

Cataract Case

Using ICD-9 we would expect to see the following.

Cataract or IOCL, senile, or unspecified.  From this we would interpret

66984 – Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification) or

00142 Anesthesia for procedures on eye; lens surgery


366.10 Senile Cataract NOS

366.19 Senile Cataract NEC


Using ICD -10, we can expect to set the following

66984 and 00142 remain the same.

H25.9 – Unspecified age-related cataract, however we are being warned many payers will not pay with this code alone. This where laterality, mentioned above impacts our coding.  For each specific cataract code, we have four choices:

  • Right eye
  • Left eye
  • Both eyes
  • Unspecified eye

For those anesthesia providers who either typically code all cataracts as senile or do specify at all, need to begin providing detail now.

For example, cataracts caused by trauma equate to H26.1XX (where XX are additional sub-classifications or descriptors)

Cataracts caused by exposure to drugs equates to H26.3XX,

And, Diabetic cataracts expand 366.41 to

E08.36 diabetes mellitus due to underlying condition with diabetic cataract

E09.36 drug or chemical induced diabetes mellitus with diabetic cataract

E10.36 Type I diabetes mellitus with diabetic cataract

E11.36 Type II diabetes mellitus with diabetic cataract

E13.36 Other specified diabetes mellitus with diabetic cataract.


Pain Injection

724.4 – Thoracic or lumbosacral radiculopathy, unspecified


Expands to eight (8) choices

M51.14: intervertebral disc disorders with radiculopathy, thoracic region

M51.15: intervertebral disc disorders with radiculopathy, thoracolumbar region

M51.16: intervertebral disc disorders with radiculopathy, lumbar region

M51.17: intervertebral disc disorders with radiculopathy, lumbosacral region

M54.14: radiculopathy, thoracic region

M54.15: radiculopathy, thoracolumbar region

M54.16: radiculopathy, lumbar region

M54.17: radiculopathy, lumbosacral region



abinsights Contact Information

abinsights readers are invited to submit comments, questions, tips, and suggestions for articles on any subject related to billing, collections, coding, reimbursement, and compliance.  Send to:  Anesthesia Billing, Inc.,     P O Box 388, Newton, KS  67114-0388.  Phone 316-281-3700.  Fax 316-282-4322.

Our purpose is to help you meet inevitable challenges.  We hope to deliver practical knowledge and solutions drawn from top resources and business publications in every issue, knowledge you can use today.

Reasonable attempts have been made to be accurate.  However, medical billing, collections, coding and compliance are part science, part art, and even experts sometimes differ.  Neither Anesthesia Billing, Inc., the editors, publisher, contributors, or consultants warrant or guarantee the information contained will be applicable or appropriate in all situations.  For information specific to your practice, consult a qualified professional.

The information included in this publication is provided, among other things, to alert you to legal developments and should not be considered legal advice.  Specific questions about how this information affects your particular situation should be addressed to your attorney.

Editor:  Philip Blann (pblann@anesthesiabilling.com).

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