Introduction

Despite a chilly reception, ICD-10 was successfully implemented on Oct. 1, 2015.

The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). The code set allows more than 14,400 different codes and permits the tracking of many new diagnoses.

Why do we use ICD-10?

The United States is required to use the ICD for the classification of diseases and injuries under an agreement with WHO. By using the ICD, the U.S. collects, processes, and presents mortality data in a similar way to other countries around the world. This permits comparison of data across countries. Periodically, new revisions are developed to reflect advances in medical science.

How does the ICD-10-CM diagnosis code set differ from the ICD-9-CM?

• The code set has been expanded from five positions (first one alphanumeric, others numeric) to seven positions. 
• The codes use alphanumeric characters in all positions, not just the first position as in ICD-9.
• As of the latest version, there are 68,000 existing codes, as opposed to the 13,000 in ICD-9.
• The new code set provides a significant increase in the specificity of the reporting, allowing more information to be conveyed in a code.
• The terminology has been modernized and has been made consistent throughout the code set.
• There are codes that are a combination of diagnoses and symptoms, so that fewer codes need to be reported to fully describe a condition.

Examples of the enhancements made to the ICD-10-CM code set:

• It enables reporting of laterality (right vs. left designations), reflecting the importance of which side of the body or limb (e.g., left arm, left kidney, left eye) is the subject of the evaluation.
• It allows for specificity of tissue depth involved as it relates to wound care (skin, subcutaneous, muscle, bone)

Most Recent ICD 10 changes as of October 2016

• CMS will no longer accept a code in the “family” of codes for payment.
• The freeze on adding new codes expires.
• Providers will be faced with having to use the most specific code(s), as well as deal with hundreds of additional new codes and categories.
• Unspecified codes will most likely be denied
• To date, there are 1,900 new ICD-10-CM codes proposed for the October 2016 release. Of that number, there are 313 deletions and 351 revised codes

ICD 10 Specific Hyperbaric Codes

In order to meet medical necessity, HBOT diagnoses fall into 2 groups: Single and Dual

Single Diagnosis codes mean that one ICD 10 codes from the accepted CMS list from National Coverage Determination (NCD) 20.29 will meet medical necessity for hyperbaric payment..

The following indications fall under the single diagnosis rules.

            Actinomycosis

            Acute Carbon Monoxide Poisoning

            Acute Peripheral Arterial Insufficiency

            Acute Traumatic Peripheral Ischemia

            Arterial Insufficiency Ulcer Following Reconstructive Surgery

            Cerebral Arterial Gas Embolism

            Chronic Refractory Osteomyelitis

            Complications of Reattached Extremity

            Compromised Skin Grafts and Flaps

            Crush Injuries

            Cyanide Poisoning

            Decompression Illness (DCS)

            Gas Gangrene

            Necrotizing Fasciitis

            Osteoradionecrosis of the Jaw (ORN)

Dual Diagnosis codes mean that 2 ICD 10 codes from the accepted CMS list from National Coverage Determination (NCD) 20.29 will meet medical necessity for hyperbaric payment IF used in the appropriate order.

The following indications fall under the dual diagnosis rules.

            Diabetic Wounds of the Lower Extremity (Wagner Grade 3 or higher)

                        Diagnosis Group 1 -Choose a Diabetes code from the accepted CMS list.

                        Diagnosis Group 2- Choose a Wound ulcer code from the accepted CMS list

(THE DIABETES CODE MUST BE FIRST TO SHOW A CAUSAL RELATIONSHIP)

Soft Tissue Radionecrosis (STRN)

            Diagnosis Group 2- Choose a radiation effects code

Diagnosis Group 1- Choose an anatomical radiation code. Many are listed in the crosswalk.

Hyperbaric Coding Examples

Single Diagnosis Code:

1. Acute Carbon Monoxide Poisoning resulting from a residential faulty furnace 
   T58.11XA-Toxic effect of carbon monoxide from utility gas, accidental (unintentional), initial encounter
2. Chronic Refractory Osteomyelitis of the right foot 
   M86.371 Chronic Multifocal Osteomyelitis right ankle and foot
3. Osteoradionecrosis of the Mandible
   M27.2 Inflammatory conditions of the jaw

Dual Diagnosis Codes:

1. Diabetic (type 2) Wagner 3 ulcer right heel with necrosis of muscle

E11.621- Type 2 Diabetes Mellitus with foot ulcer

L97.413 Non-pressure chronic ulcer of right heel and mid-foot with necrosis of muscle

2. Soft Tissue Radiation Damage of the bladder with hematuria

L59.8 Other disorder of the skin and subcutaneous tissue related to radiation (STRN)

N30.41 Radiation Cystitis with hematuria (STRN)

Conclusion

ICD 10 does brings benefit to your institution in the following ways:

• Allows better documentation of patient complexity and level of care, supporting reimbursement for care provided
• Provides objective data for peer comparison and utilization benchmarking
• May reduce audit risk exposure by encouraging the use of diagnosis codes with a greater degree of specificity as supported by the clinical documentation.