New ICD-10 codes bring opportunities, challenges for providers

The addition of thousands of new diagnosis and procedure codes in a single year might typically be cause for concern for hospitals, with ICD-9-CM updates before the 2012 code freeze rarely topping more than a couple hundred per year.

However, after providers successfully implemented tens of thousands of ICD-10-CM and ICD-10-PCS codes last year, along with the accompanying guidelines, the approximately 6,000 new and revised codes set to be activated October 1 will be a relatively less challenging process.

Some of the new codes will certainly require coordination between HIM departments and providers to ensure all necessary information is documented and subsequently coded. Codes R29.700-R29.742 will allow coders to report a patient’s score on the National Institutes of Health Stroke Scale (NIHSS).

The NIHSS is a 42-point scale comprised of 11 tests that objectively determine a patient’s stroke severity. For example, if a patient is asked his or her age and the current month, they would receive a score of 0 for correctly answering both questions, 1 for correctly answering one question, and 2 for answering neither correctly. The results of the tests are added together to determine a final score to determine the stroke’s severity.

Currently, providers may not be performing all of these tests or including the results in documentation. Similarly to the way the introduction of the Glasgow Coma Scale in ICD-10-CM allowed providers to gauge and track the severity of a patient’s coma, providers will want to ensure they’re capturing NIHSS scores, when applicable, to better understand a patient’s injury and recovery.

Despite the large number of codes, the updates won’t be adding thousands of distinct concepts or details providers will need to document. Many of the new ICD-10-CM codes are due to the different potential seventh characters, despite only one new diagnosis being added.

For example, code S99.111- (Salter-Harris Type I physeal fracture of right metatarsal) will include all of the following variations:

• S99.111A, Salter-Harris Type I physeal fracture of right metatarsal, initial encounter for closed fracture
• S99.111B, Salter-Harris Type I physeal fracture of right metatarsal, initial encounter for open fracture
• S99.111D, Salter-Harris Type I physeal fracture of right metatarsal, subsequent encounter for fracture with routine healing
• S99.111G, Salter-Harris Type I physeal fracture of right metatarsal, subsequent encounter for fracture with delayed healing
• S99.111K, Salter-Harris Type I physeal fracture of right metatarsal, subsequent encounter for fracture with nonunion
• S99.111P, Salter-Harris Type I physeal fracture of right metatarsal, subsequent encounter for fracture with malunion
• S99.111S, Salter-Harris Type I physeal fracture of right metatarsal, sequela

To view a complete list of the new codes, see tables 6A and 6B in the proposed rule.