If you’ve ever visited a foreign country, you know how frustrating the language barrier can be. By learning a few key phrases before embarking on your travels, though, you can usually get by without too much trouble. The same goes for ICD-10. Yes, the new codes are complex, and yes, it’s going to take some time to become fluent in the language of ICD-10. But if you go into the transition with a handful of commonly used codes in your back pocket, you’ll feel much less overwhelmed by the switch.
Unfortunately, finding ICD-10 equivalents to ICD-9 codes is a bit more complicated than looking up “please” and “thank you” in your pocket English-to-German dictionary. Because ICD-10 offers a much higher degree of specificity than ICD-9, there are many cases in which a single ICD-9 code has several possible ICD-10 translations. To continue with the language metaphor, choosing the correct ICD-10 equivalent of a certain ICD-9 code is kind of like choosing the correct Eskimo term for the English word “snow.” There are dozens of options, and each one indicates a very specific type of frozen precipitation.
So, with cut-and-dried crosswalking off the table, how should you go about pinpointing the correct ICD-10 version of a particular ICD-9 code? Well, you should start by downloading the complete Tabular List of ICD-10 codes. You’ll find the most up-to-date version here. (Click the link labeled “ICD-10-CM PDF Format” under the section with the heading “2014 release of ICD-10-CM.”) When you open the PDF, you’ll see that the codes are organized by chapter. As a rehab therapist, you’ll deal mostly with chapters 13 and 19—“Diseases of the musculoskeletal system and connective tissue” and “Injury, poisoning and certain other consequences of external causes,” respectively.
If your PDF viewer has a search function, you might be able to find the code you’re looking for—or at least identify a few starting points—simply by entering the appropriate term in the search field. (You can also keyword search at FindACode.com.) Alternatively, you can begin your translation process using this ICD-9 to ICD-10 conversion tool. Remember—and I cannot stress this enough—you absolutely should not use this tool as a “plug-and-chug” crosswalk solution. Most of the time, the ICD-10 codes the tool suggests are not specific enough to use. In fact, you will see the following disclaimer message underneath the search field: “Keep in mind that while many codes in ICD-9-CM map directly to codes in ICD-10, in some cases, a clinical analysis may be required to determine which code or codes should be selected for your mapping.”
However, this tool does give you a good idea of where to start. For example, 719.46 (Pain in joint, lower leg) is one of the most commonly used ICD-9 codes among physical therapists. If you enter this code into the ICD-10 conversion tool I referenced above, it will generate a single result: M25.569 (Pain in unspecified knee). At first glance, it would appear that this code is the definitive equivalent of 719.46—after all, it’s the only ICD-10 code that appeared in the search results. The problem is, this code—though technically correct—is not the most correct code because it is not the most specific code available.
The whole point of ICD-10 is improved data due to increased specificity. If you do not use the most specific code possible, you risk having your claims rejected. Thus, you should avoid using an “unspecified” code if a more specific option exists. And in this case, there is almost certainly a more specific code available.
To find it, open the Tabular List and head to chapter 13 (the “M” code chapter). Scroll down to M25.56, the “Pain in knee” category. There, you’ll see code options for both the left and right knees. Chances are that you, as the therapist, know which knee is causing pain for the patient. Therefore, you should select a code that accounts for laterality: M25.561 (Pain in right knee) or M25.562 (Pain in left knee).
Furthermore, keep in mind that if it is possible to code for the specific condition that is causing the pain, you should absolutely do so. In this case, for example, if you determine that the patient is suffering from patellar tendinitis, you would select either M76.51 (Patellar tendinitis, right knee) or M76.52 (Patellar tendinitis, left knee) as the diagnosis code for this patient.
Finally, make sure you read the instructions at the beginning of each chapter and category. In some cases, you may need to submit an external cause code or attach a seventh character. At the beginning of chapter 13, for example, you’ll see the following directive: “Use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition.” Basically, if you know additional details about the cause of the patient’s condition, you should account for them using supplemental external cause codes from chapter 20. To continue with the knee pain scenario, if the patient developed patellar tendinitis as a result of running on a treadmill, you would indicate this scenario using the code Y93.A1 (Activity, treadmill).
So, to recap, when searching for the ICD-10 equivalent of a particular ICD-9 code, follow these steps:
- Use a simple conversion tool (like this one) to find a starting point.
- Consult the Tabular List (which you can download here) to determine whether a greater level of coding specificity is possible.
- If possible, code for the actual condition (e.g., patellar tendinitis) rather than the result (e.g., pain in knee).
- Within the Tabular List, check chapter/category headings for additional instructions regarding external cause codes or seventh characters.
- If applicable, identify pertinent external cause codes within chapter 20 of the Tabular List.
Have you started creating a list of ICD-10 equivalents to your most frequently used ICD-9 codes? If so, what advice or questions do you have? Share your thoughts in the comment section below.