08/28/2013 Harry Goldsmith, DPM
ICD-9 to ICD-10 Questions
With ICD-10 coming October 1, 2014, how will a
Local Coverage Determination (LCD) such as one
for routine foot care be affected with respect to
the typical ICD-9 codes currently being used?
Codes like ICD-9 703.8, ICD-9 443.9, ICD-9
250.60, ICD-9 110.1, and ICD-9 701.1, for
example.
Can someone provide "crosswalk" examples for
these ICD-9 codes to ICD-10 showing how they will
be changed? Also, what about the list asterisked
codes representing "active management" systemic
conditions? How will they change?
Joseph Borreggine, DPM Charleston, IL
Response: The following is a sample crosswalk
from the APMA Coding Resource Center* (CRC)
development site - scheduled to be introduced on
the CRC “live” site October 1, 2013.
* The APMA Coding Resource Center subscription
rate for APMA members is, as of today, $189 per
year. As of September 1, 2013 – in a few days –
the annual subscription rate will be going up for
APMA members to $249. For information on the CRC
and subscription, go to
http://www.apmacodingrc.org/)
To your questions…
ICD-9 703.8 (onychauxis) to ICD-10:
Acquired
L60.2 (onychogryphosis; hypertrophic nails)
L60.3 (nail dystrophy)
L60.8 (other nail disorders)
L60.9 (nail disorder, unspecified)
Congenital
Q84.5 (onychauxis - enlarged and hypertrophic
nails)
Q84.6 (other congenital malformations of nails)
--------
ICD-9 443.9 (peripheral vascular disease,
unspecified) to ICD-10:
I70.2- (atherosclerosis of native arteries of
the extremities)
[IMPORTANT POINT: the hyphen denotes additional
characters are required to specifically identify
the (actual) atherosclerosis disease the patient
has]
[NOTE: Unlike the "unspecified" code given for
ICD-9, you will, in all likelihood, need to
provide the specific vascular disorder diagnosis
code in order to be reimbursed]
--------
ICD-9 250.60 (diabetes with neurological
manifestations) to ICD-10:
E10.4- (type 1 diabetes mellitus with
neurological complications).....plus use
additional code to identify any insulin use
(Z79.4)
E11.4- (type 2 diabetes mellitus with
neurological complications).....plus use
additional code to identify any insulin use
(Z79.4)
E13.4- (other specified diabetes mellitus with
neurological complications).....plus use
additional code to identify any insulin use
(Z79.4)
E13.61- (other specified diabetes mellitus with
diabetic arthropathy).....plus use additional
code to identify any insulin use (Z79.4)
--------
ICD-9 110.1 (onychomycosis) to ICD-10:
B35.1 (onychomycosis)
--------
ICD-9 701.1 (keratoderma, acquired) to ICD-10:
L85.1 (acquired keratoderma/keratosis; acquired
keratoderma palmaris et plantaris)
L85.2 (keratosis punctata [palmaris et
plantaris])
--------------------------------------------
The process of converting ICD-9 diagnoses to ICD-
10 for your practice needs to begin NOW (or
better, yesterday). The first step is
identifying your most commonly used ICD-9
codes/diagnoses. You can do this without an ICD-
10 database. Once you have your 'everyday' ICD-
9, you can manually crosswalk those ICD-9 codes
to ICD-10 codes or purchase a source (e.g., APMA
Coding Resource Center) that provides you the
crosswalk-converter or, if your practice
management software has/will have a converter
built-in, use it. Remember, you are responsible
for the codes you list on a claim so even with
someone providing you codes in a nice package,
check those codes for accuracy and specificity.
As far as guidelines, policies, etc. that
currently include ICD-9 codes, payers (including
Medicare) will be performing their own crosswalks
to ICD-10 coding. The question that needs to be
asked is, what if your ICD-10 codes accurately
reflect the patient's diagnoses, conditions, etc.
and should qualify the service or procedure, but
the payer's conversion doesn't quite match up to
yours? It's a rhetorical question. What do you
think will happen (or won't happen)?
Because ICD-10 will be implemented October 1,
2014 (count on it; presume it), and you only have
13 months left to get ready...what are you
waiting for, a miracle? There are no miracles in
reimbursement.
Harry Goldsmith, DPM
Codingline
hgoldsmith@codingline.com
[NOTE: Dr. Goldsmith will be speaking on ICD-10 -
getting ready, guidelines, and coding with
examples - at both the Codingline Oakland Foot &
Ankle Coding Seminar (October 19 -
www.codingline.com/events-ca.htm) and the
Codingline-NYSPMA Foot & Ankle Coding Seminar
(January 23; New York, the day before the
Clinical Conference). For information, contact
him at hgoldsmith@codingline.com]
