ICD-10 Tips for Rheumatology Practices


Rheumatologists will be heavily impacted by new requirements for laterality, causation and anatomical location in ICD-10. Here are five tips to improve documentation now.

Specificity is the name of the game when it comes to keeping up with the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). This is particularly true for rheumatologists who, like many specialists, see more specific diagnoses that require details, such as, laterality, anatomical location and causation. It’s important to review documentation to ensure that it supports these additional details necessary for coding. 

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Tips to ensure compliance

Distinguish between drug-induced lupus and lupus with organ or system involvement. If drug-induced, be sure to document the specific drug. If another organ or system is involved, also document that organ or system (e.g., lung, endocarditis, glomerular disease).

Specify type, anatomic location and laterality for gout. Types of gout include idiopathic, lead-induced, drug-induced, due to renal impairment or secondary.

Document the specific anatomical location and laterality for all cases of rheumatoid arthritis. 

Watch for other conditions that have expanded in ICD-10, such as psoriatic arthritis and ankylosing spondylitis. These diagnoses, as well as many others, expanded from one code in ICD-9 to multiple codes in ICD-10 due to greater anatomical specificity and laterality. 

Beware of combination codes. These codes capture a diagnosis as well as an underlying condition or complication. It’s important for rheumatologists to document the link between the two conditions, when appropriate, by using terms such as:  with, in, due to or exacerbated by. For example, ICD-10 code M32.11 denotes endocarditis in systemic lupus erythematosus. ICD-10 code M05.412 denotes rheumatoid myopathy with rheumatoid arthritis of the left shoulder. 

Do now before Oct. 1 implementation deadline

There’s no time like the present to review coding changes, perform a documentation gap analysis and educate coders and physicians about these important changes. Take the following steps between now and the Oct. 1, 2015 implementation deadline:

Contact the American College of Rheumatology to obtain a comprehensive list of diagnoses relevant to rheumatology practices and their corresponding ICD-9 vs. ICD-10 codes. Your practice management and EHR software vendors may also offer top codes reports, coding crosswalks and other helpful tools, and CMS provides several specialty-specific resources. Another good resource is a rheumatology toolkit from the Boston Medical Center.

Examine the ICD-10 code titles and descriptions to determine which codes require more detailed information. 

Perform a documentation audit to determine whether current documentation includes these details. Perform physician education, as necessary.

Work with your EHR vendor to update templates to accommodate details necessary for ICD-10. 

Update paper or electronic encounter forms and superbills to include details necessary for ICD-10. 

The goal is to avoid unspecified codes when possible. Unspecified codes not only impact patient care, but they can also potentially lead to denials. Coders and physicians need to familiarize themselves with the ICD-10 code changes so precious time isn’t lost fighting and appealing denied claims. 

Invest in coder education and training. Astute and well-trained coders will ensure accuracy and revenue integrity. They’ll also be able to spot insufficient documentation before claims are sent. In the meantime, think ‘specificity,’ and you can’t go wrong. When possible, document left vs. right vs. bilateral. Be as specific as possible in terms of anatomical location. Update your encounter forms - and use them. Proper planning, education and foresight will ensure success in ICD-10 and beyond. 

Michelle Cavanaugh, RN, CPC, CANPC, CGIC, CPB, CMRS, is an American Health Information Management Association approved ICD-10-CM trainer, certified coder, certified professional biller and certified medical reimbursement specialist at Kareo.


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