ICD-10: One Small.... This is Going to be a Pain the Ass

This post is more geared toward fellow physical therapist or healthcare professionals. If you regularly read this blog for more general fitness or injury advice, may I suggest perusing my articles page for other topics I've written on. Likewise, if you have fitness or injury questions feel free to contact me.


So, with October 1 fast approaching, us healthcare providers (in the United States at least) have to prepare for the switch from ICD-9 coding practices to the ICD-10 system. I'll admit, it seems a little daunting and it's going to be a pain in the ass... for a couple weeks. I think after that it'll become common place and we'll wonder how we ever used that archaic ICD-9 system for 30+ years. That's right, ICD-9 was introduced in 1979. I think it's high-time for an update. Here's some things that happened in that amount of time:

Michael Jacksons Thriller album
The Fall of the Berlin Wall
The end of the Cold War
The Blue Jays won the 2 World Series
The Montreal Canadien won 3 stanley cups
Phase out from Vinyl to Cassette to CD to MP3
A plethora of Microsoft and Mac commercials
Planking (what the hell was that fad about)

Anyway, you get my point. A lot of stuff has happened in 36 years. A lot of stuff has changed in 36 years. It's high time we change along with it.

So what does that mean for us as physical therapists?

From what I can gather it means we can be a lot more specific about treatment diagnosis. It will also help with tracking what patients seek treatment for. For example, if someone is referred to physical therapy for medial epicondylitis of the right elbow there are a number of things that we can now chose under our diagnosis to be as accurate as possible for treatment and billing. See below for a comparison.

ICD-9
726.31 (medial epicondylitis)
719.42 (pain in joint: elbow)
782.3 (edema)
719.53 (stiffness of joint, forearm)
728.87 (weakness)

ICD-10
M77.01(Medial epicondylitis: right elbow)
M25.521 (Pain in right elbow)
M25.421 (Effusion in right elbow)
M62.81 (muscle weakness) OR M62.531 (muscle wasting or atrophy of right forearm)
M25.631 (Stiffness of right wrist)
Y93.53 (cause: golfing)

As you can see there's more specificity with ICD-10 coding, with the ability to chose the side of the body effected, the exact joint with swelling, where the weakness and loss of ROM occurs, and what the cause of injury was.

This all seems a little daunting, especially for those of you still using paper charting. However, with an intuitive EMR system (I personally use webpt) the transition should be fairly easy. Some things to note are that anyone currently being seen in your practice must have their codes switch over to the ICD-10 system in the first session of October, and you cannot switch to codes prior to that date. Also, there is a distinction in coding for initial encounter (A), subsequent encounter (D), and sequela (S). My understanding of it is this: If you are in a direct access state and the patient is seeing you without a referral and it is their first time seeking medical attention for the injury then you would be tack (A) onto the end of your coding, if you're seeing a patient who is referred to you then (D) and if the condition is chronic then (S).

Good luck to all you fellow healthcare professionals out there over the next couple of weeks! We're all in the same boat, and it's going to be a bitch for a while. 




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