ICD-10 with its increased specificity ensures more accurate data and better patient care as a result. The new coding system will allow primary care physicians to document chronic conditions and other common diagnoses more accurately. Here we examine some of the major ICD-10 changes for primary care.
Headache
When it comes to reporting migraine in ICD-10, physicians must specify the type of migraine – common, hemiplegic, persistent, chronic, ophthalmologic, abdominal, or menstrual. There are separate codes for each of them.
- G43: Migraine
- G43.0: Migraine without aura
- G43.1: Migraine with aura
- G43.4: Hemiplegic migraine
- G43.5: Persistent migraine aura without cerebral infarction
- G43.7: Chronic migraine without aura
- G43.B: Ophthalmoplegic migraine
- G43.D: Abdominal migraine
- G43.82: Menstrual migraine, not intractable
Cluster headaches and other trigeminal autonomic cephalgias (G44.0) are grouped into:
- G44.01: Episodic cluster headache
- G44.02: Chronic cluster headache
- G44.03: Episodic paroxysmal hemicrania
- G44.04: Chronic paroxysmal hemicrania
- G44.05: Short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT)
- G44.09: Other trigeminal autonomic cephalgias (TAC)
There are codes for vascular headaches (G44.1), tension-type headaches (G44.2), post-traumatic headaches (G44.3), drug-induced headaches (G44.4) and a variety of other headache syndromes. Most of the codes in this section require the documentation of with or without aura, intractable vs. not intractable and with or without status migrainosus.
Depression
Depression codes have been expanded in ICD-10 and you must document single episode vs. recurrent, mild moderate or severe, with or without psychotic features and in partial or full remission. The relevant codes are given below.
- F32.0: Major depressive disorder, single episode, mild
- F32.1: Major depressive disorder, single episode, moderate
- F32.2: Major depressive disorder, single episode, severe without psychotic features
- F32.3: Major depressive disorder, single episode, severe with psychotic features
- F32.4: Major depressive disorder, single episode, in partial remission
- F32.5: Major depressive disorder, single episode, in full remission
- F33.0: Major depressive disorder, recurrent, mild
- F33.1: Major depressive disorder, recurrent, moderate
- F33.2: Major depressive disorder, recurrent severe without psychotic features
- F33.3: Major depressive disorder, recurrent, severe with psychotic symptoms
- F33.41: Major depressive disorder, recurrent, in partial remission
- F33.42: Major depressive disorder, recurrent, in full remission
Ear Infections
In the new code system, different codes are there to specify middle ear infection or otitis media. Those codes are grouped in H65 – H67 and you should document the following different forms of otitis media to choose the most appropriate code.
- Serous
- Allergic
- Mucoid
- Nonsuppurative
- Suppurative
- Tubotympanic suppurative
- Atticoantral suppurative
It is also required to document acute vs. chronic, laterality (left vs. right vs. bilateral) and any associated perforated tympanic membrane. Some examples are given below.
- H65.11: Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous)
- H65.21: Chronic serous otitis media, right ear
- H65.22: Chronic serous otitis media, left ear
- H65.23: Chronic serous otitis media, bilateral
Hypertension
Though code I10 denotes essential (primary) hypertension, there are separate codes for hypertension involving vessels of the brain (codes I60-I69) and hypertension involving vessels of the eye (code H35.0).
The hypertension codes in ICD-10 also include the following:
- I11: Hypertensive heart disease
- I12: Hypertensive chronic kidney disease
- I13: Hypertensive heart and chronic kidney disease
- I15: Secondary hypertension
Diabetes
Diabetes codes have expanded considerably in the new coding system. The basic diabetes codes include the following:
- E08: Diabetes mellitus due to underlying condition
- E09: Drug or chemical induced diabetes mellitus
- E10: Type 1 diabetes mellitus
- E11: Type 2 diabetes mellitus
- E13: Other specified diabetes mellitus
Each of these codes is expanded to a number of codes depending on various specific conditions. So, in addition to the type of diabetes, you must document the specific underlying condition, the particular drug or toxin and the use of any insulin. The new system also requires exact details about any complications or manifestations of the diabetes.
ICD-10 coding for diabetes is complex and a very careful review of codes is required to ensure compliance. For example, E08.331 denotes Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema. You must carefully document each specific detail in this case.
Asthma
Asthma (J45) has expanded in the new coding system and you must document whether the asthma is:
- Mild intermittent
- Mild persistent
- Moderate persistent
- Severe persistent
You must also specify whether it is uncomplicated, with acute exacerbation, or with status asthmaticus. Read more for a detailed understanding.
Health Status and Services
There are some new codes related to factors that influence health status and contact with health services. They are found in Chapter 21 of the ICD-10-CM Manual. These include:
- Codes Z55 through Z65 pertaining to health hazards related to socioeconomic and psychosocial circumstances
- Codes in the Z68 category denoting specific data related to body mass index
- Codes in the Z72 category specifying problems related to lifestyle (for example tobacco use, lack of exercise, and high-risk sexual behavior)
How the Changes Are Beneficial for PCPs
Whether coding for family practice, internal medicine or general practice, the new system benefits PCPs in the following ways.
- The new system supports more specific coding so that you will be better able to integrate the reason for the diagnosis or characteristics of the patient as well as the laterality of the body. This will enhance the quality of care.
- With more number of codes, it is easier to research unusual diagnoses, signs and symptoms.
- PCPs can improve the description of the extent of diagnosis and thereby report the complexity of encounter more accurately.
- With more specific codes, PCPs can easily assign codes without any confusion and reduce coding mistakes.
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