ICD-10 brings with it many diagnosis code expansions, and this is particularly true for endocrinology. As with all specialties, physicians need to be careful when selecting a diagnosis code. Specificity is important in terms of medical necessity, reimbursement, and data quality.
Following are several tips that you should keep in mind once ICD-10 goes live on October 1, 2015.
1. When selecting an ICD-10 code for diabetes, be sure to double check the cause, presence of any organ system affected, presence of any complications, and whether the patient is insulin dependent (for patients with non-type 1 diabetes). ICD-10 captures all of this information in one singular code, although endocrinologists may need to report multiple diabetes codes when patients present with more than one complication.
2. Although ICD-10 codes for diabetes are considered combination notes, the EHR may prompt endocrinologists to also report an additional code for the following: Any underlying conditions, insulin use (for patients with non-type 1 diabetes), specific stage of chronic kidney disease, specific site of any diabetic ulcer (as well as anatomical location, laterality, and severity), poisoning due to drug or toxin, or specific drug or toxin that causes the adverse effect.
3. For endocrine and metabolic disorders, specify the disorder, disease, defect, deficiency or syndrome as well as any underlying conditions and the significance of any abnormal lab findings.
4. For vitamin/mineral/other nutritional deficiencies, specify the specific vitamin and/or mineral.
5. For metabolic disorders, specify the amino acid, carbohydrate, or lipid enzyme deficiency responsible for the metabolic disorder.
6. Document any symptoms of premature menopause (such as flushing, sleeplessness, headache, or lack of concentration associated with the premature menopause), as this affects ICD-10 code assignment.
7. ICD-10 includes codes for iodine-deficiency-related goiter, so be on the lookout for these codes, when applicable.
8. Document the specific type/cause of Cushing’s disease.
9. When a patient presents with gout, be sure to document the cause, episode, location, and with or without tophi (for chronic gout).
Due to the complexity that ICD-10 can bring for endocrinologists, an EHR may be an invaluable tool. If your practice is not on an EHR this is a good time to implement one to avoid the need to update and manage a much more complicated paper superbill. If you do have an EHR, check with your EHR vendor to ensure that any templates or documentation prompts are updated for ICD-10.
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