Tips to decipher ICD-10

Oct. 1 is the start date to use ICD-10. If you do not use those codes, you will not be paid on your claims. Be prepared, though, for there is expected to be confusion on the payers’ side, and payments may be delayed.

We are going from 16,000 codes to more than 100,000 codes.

The number of codes is so extensive because we will now demonstrate laterality, specificity, and reason or cause.

For instance: H66.001 acute supportive on w/o rupture right ear; H66.002 left ear. If a patient was hurt from jumping, was it jumping from a trampoline, a building, etc.?

Richard Lander

The new codes have three to seven characters. The first is an alpha and uses all letters except for U. The second is numeric. The third to seventh is either.

X is sometimes used as a fifth character placeholder to allow for future expansion.

The first three characters delineate category. Characters four to six are for etiology or site. The seventh character is for extension.

V codes will be replaced by Z codes, which will not only be used for well visits but for other health visits and vaccines.

There will be a BIG book to look things up first on the index for conditions or symptoms and then with the alpha and three digits in the tabular section. You can also use General Equivalence Mappings or SNOMED to convert ICD-9 into ICD-10.

— Richard Lander, MD, is a pediatrician in private practice in northern New Jersey and clinical assistant professor of pediatrics at the University of Medicine and Dentistry of New Jersey in Newark, N.J. He is immediate past chair of the AAP Section on Administration and Practice Management and a member of the Infectious Diseases in Children Editorial Board.

Disclosure: Lander is co-owner of both the National Discount Vaccine Alliance, and Resources in Physician Management Services. He also is a speaker for Merck and Sanofi-Pasteur.