Skip to main content

ICD-10 CM Conventions and General Coding Guidelines - PART 1

Format and Structure

The Tabular List contains are Categories Subcategories codes.  

All categories are 3 characters. A three-character category that has no further subdivision. The Subcategories are either 4 or 5 characters. The Codes maybe 3,  4, 5,  6, or  7 characters. That is, each level of subdivision after a category is a subcategory. The final level of subdivision is a  code. 

Placeholder Character

The ICD-10-CM utilizes a placeholder character  “X”.  The “X” is used as a placeholder at certain codes to allow for future expansion. 

An example of this is at the poisoning, adverse effect, and underdosing codes, categories  T36-T50.  Where a placeholder exists, the X  must be used in order for the code to be considered a valid code

NEC - Not  Elsewhere Classifiable

NEC - This  abbreviation  in the  Alphabetic  Index & Tabular List represents “other  specified.” When a  specific code is not available for a  condition,  the  Alphabetic Index directs the coder to the “other specified”  code in the  Tabular  List. 

NOS - Not Otherwise Specified 

NOS - This abbreviation is the equivalent of unspecified. 

Punctuation

[ ] Brackets are used in the  Tabular  List to enclose synonyms, alternative wording, or explanatory phrases. Brackets are used in the  Alphabetic  Index to identify manifestation codes. 

( ) Parentheses are used in both the Alphabetic Index and Tabular List to enclose supplementary words that may be present or absent in the statement of a disease or procedure without affecting the code number to which it is assigned. The terms within the parentheses are referred to as nonessential modifiers. 

: Colons are used in the Tabular List after an incomplete term which needs one or more of the modifiers following the colon to make it assignable to a given category.

Other Specified Codes

“Other” codes Codes titled  “other”  or  “other specified”  are for use when the information in the medical record provides detail for which a specific code does not exist in the alphabetic index or Tabular list

Unspecified Codes

 “Unspecified” codes Codes  titled  “unspecified”  are for use when the information in the medical record is insufficient to assign a more specific code.

Labels:

Popular posts from this blog

Usage of CPT Index - Instructions

The alphabetic index is not a substitute for the main text of the CPT codebook. Even if only one code is present, the coder must refer to the main term to ensure that the code is selected accurately and correctly to identify the services rendered. Main Terms The index is organized by main terms. Each main term can stand alone or can be followed by up to three modifying terms. There are four primary classes of main entries, Procedures or Services - E.g, Scopic, Anastomosis, Splint, Opening Organ or Other Anatomical Site - E.g, Knee, Arm, Ear, Tibia, Colon Conditions - E.g, Abscess, Entropion, Tetralogy of Fallot. Synonyms, Eponyms, and Abbreviations. - ECG, EEG, PET, Brock Operations, Clagett Procdures Modifying Terms The main term may be followed by up to three indented terms that modify the terms they follow. EG. The main term "Endoscopy" is subdivided by the anatomical sites in which the procedure is used. And within these anatomical sites, the specific purpose of the pr
Read more

Additional Information About Modifiers

Sequencing of modifiers  How can that be if the modifiers used were accurate?  There is an order to reporting modifiers and there are three categories that modifier usage fall under:  1. Pricing  Pricing modifiers are always sequenced “before” payment modifiers and/or location modifiers.   The only exception to this rule is when a global surgery package is involved.  For example, you would code modifier 58 first and modifier 82 second in a global surgery.  A few examples of pricing modifiers are: 22, 26, 50, 52, 53, 62, 80, and P1-P6.   2. Payment   Payment modifiers alert the insurance carrier that there is a special situation within the claim  Some examples of payment modifiers would be: 24, 25, 51, 57, 58, 59, 76, and 78.  3. Location  Examples of location modifiers are: E1-E4, FA, F1-F9, LC, LD, LT, RT, RC, TA, and T1-T9.  The general order of sequencing modifiers is ( 1) pricing (2) payment (3) location. Location modifiers, in all coding situations, are coded “last”.  If you code
Read more

Evaluation and Management (E/M) Services - Domiciliary or Rest Home Environment

Domiciliary, Rest Home, or Custodial Care Services CPT codes 99324 - 99337 Domiciliary, Rest Home (e.g. Boarding Home), or Custodial Care Services, are used to report E/M services to individuals residing in a facility which provides room, board, and other personal assistance services, generally on a long-term basis.  These codes are also used to report E/M services in an assisted living facility. The facility’s services do not include a medical component. A home or domiciliary visit includes a patient History, Physical Examination and Medical Decision Making in various levels depending upon a patient’s needs and diagnosis.  The visits may also be performed as counseling and/or coordination of car, when medically necessary outside the office environment and are an integral part of a continuous of the patient's care.  The patients seen may have chronic conditions, may be disabled, either physically or mentally, making access to a traditional office visit very difficult, or may have l
Read more