ICD-10 Guidelines: How to Read Section References

Q:  This first question came in on ICD-10 guidelines: How to Read Section References. Specifically the person asked: “I’m finding it hard to understand the references to ‘sections’ in the guidelines in the ICD-10-CM. Example: Hypertension, transient, Section 1.C.9.a.7. or Section 1.C.18.g.”

A:  I know. It’s like a legal document. It’s a little scary at first, so we’ll break it down and show you how to read the section references in the ICD-10 Guidelines. What I thought would be good is this could be an opportunity to show you what our CCO club looks like inside because that’s where our club members get access to our BHAT® Cave document. Our BHAT® Cave is our bubble, highlight, & annotate technique guideline videos that we have that help people to mark up their manuals.

Let me show you how that works. If you are a member with us, you would basically go to www.podio.com and you would go to your hamburger menu and you’re going to go to the CCO club. Of course, I’ve got a ton of stuff in here so don’t freak out, you only have a couple compared to me. I’ll do my shortcut that I do, I just type in “club” in the upper left hand corner and I jump to it this way.

I’m going to click on the BHAT® Cave app up on the top, these are our apps. We’ve got it organized in different views: introductory videos, CPT, annotation videos, ICD, of the errata that will be coming out throughout the year in miscellaneous things. I’m going to jump in to ICD and you can see we’ve got the PCS annotated guidelines, we’ve got the CM, we go into the different sections. These are all listed in this little tile view, you can switch it to a tabular view if you prefer. That’s my view of choice. As you can see we’ve got it separated by year and we’ll keep adding to this as the years go by.

Let me show you the ICD-10-CM. Typically this is where you’ll see content. If we had a video, it would be in here, this just happens to be a PDF one. You just simply click on it, and depending on your browser or your computer system, it may open in a tab like this, or it may automatically open in your Abode viewer.  What’s I’m going to do because I want to show you the bookmarks, you can just scroll to use this. But I took a lot of time to create… these annotations are from Chandra, her nice, neat handwriting, her highlighting, but I took the document and did the bookmarking, so I’ll show you how that works. You have to download it. I’ll do that, and that’s going to pull up. In my Adobe Acrobat viewer…

Alicia:  It’s very easy to get Adobe.

Laureen:  If you click on this first icon here, this is just showing you the page thumbnails. What you want is the one right below it, it looks like a ribbon, and that’s your bookmark. I’ve actually went in and created all these bookmarks and this gives you that hierarchical view. Let me collapse this. The layout of this document, it’s 114 pages. We’ve got four main sections, so Section 1 is the Conventions, the general coding guidelines and chapter specific guidelines. Section 2 is really more for the inpatient coding community, selection of principal diagnosis, but it’s still a good read for all coders. Section 3 is on reporting additional diagnoses and Section 4 is diagnostic coding and reporting guidelines for outpatient services. Then there’s an Appendix I. That’s how it’s laid out.

This is the general text here. If you start scrolling, you’ll see they do have a Table of Contents and it’s very long. Here is Section 1: Conventions, general coding guidelines and chapter specific guidelines. Then, the first indentation, if you will, is the conventions. Then it goes A.1, the Alpha Index; A.2, the format and structure; A.3. the use of codes for reporting purposes. Then you jump down to B – and now it goes to the General Coding Guidelines. B.1 is locating a code in the ICD-10-CM; B.2 is the Level of detail in Coding; and so on and so forth.

Then it goes to C – Chapter Specific Coding Guidelines. This is where we spend a lot of our time. In that Roman numeral IC.-whatever; so here’s C.I.a. so it goes deeper, deeper, deeper, more and more nested is how it works. It’s very similar to a legal document where they’ll have I.I.2.3.a; this is how they do it. What you need to do when someone uses a reference is go back to this collapsed view and just jump into them one at a time in the order that it’s presented and you’ll get to where you need to go. It just takes a little bit. You can’t just type in that long I.C.3.- whatever and jump to it, but you can use this little menu item here.

What I did is I further broke it down. If I want to go to section 1C – Chapter Specific – I can expand this out, and now I see all the different chapters in ICD-10. So, if I want to drill down and go to Diseases of the Nervous System, that’s in Chapter 6, I click on that, and it jumps me right to it in the document, just the bookmark. Otherwise, you have to do lot of scrolling, and that’s where people get lost and the letters don’t line up, like, “Wait a minute, where was I?” so, if you use this one…

This PDF is available for free out on the website. What we did is we took this free version and we annotated it. We added our highlights, we added the bookmarks. What this does is it gives you Chandra’s brain on ICD-10 guidelines and it’s just little notes, little cues, circling keywords, that’s why this is part of the BHAT® system, the bubble, highlight, annotate technique system because it’s ways to make us have things jump out at us.

Here’s one, Chapter 6: Diseases of the Nervous System (G00-G99). For “a” she has highlighted codes from category G81, hemiplegia and hemiparesis, and subcategories G83.1. Here’s her note here: “Assume all are right-handed, if not documented.” Then, she just wrote here “defaults” this bulleted list. That’s pretty much how you do it.

What I did for the 2017 version, in red I indicated the new information. If you click on this one for hypertension, that’s in I.C.9.a is pretty much how you would jump to it, and here it is. Now, if you read the beginning of the guidelines, it lets you know new stuff is in bold. That’s what we’re looking at here.

Alicia:   This was a big change for 2017, too, just a heads-up.

Laureen:  Yeah. What you want to do, if you’ve purchased our ICD-10 Update webinar that Alicia and I did, you can see all this information, all the highlights of the new stuff. That’s worth checking out. Do we have any questions?

Alicia:  While she’s looking at questions, I want to just say, this is if you studied how to create outlines, I think we did that in high school. That’s what the guidelines are, they’re classic outline format; that constant indenting. Just think of it as an outline. One of the other things that I was going to mention is that with her putting everything in red, that really gives you a heads-up, but if this is in yellow, that means you’re probably going to be tested on something in this. They’re not going to specifically ask you that question, they’re going to give you a scenario when that applies. It doesn’t matter what credential you’re testing for. If it deals with ICD-10, this guideline applies, whether you’re doing inpatient, outpatient. Specifically says outpatient, inpatient stuff, but this particular one on hypertension, you’re going to be tested on that guideline. That’s why it’s beneficial to have that yellow in there, so you can go back and double check and say, “This is what they want to know if I know.”

Laureen:  This is really what you want to study guys for ICD-10. You want to know these guidelines. When I first started studying and teaching people, a lot of experienced coders don’t even know these guidelines existed, and they’re called the “ICD-10-CM Official Guidelines for Coding and Reporting.” This is in the front of most ICD-10 manual so look for yours, see if it’s there.

What ends up happening though is by the time the manuals go to print, these guidelines aren’t ready yet for the new year; so the 2017 manual that you probably have right now probably has 2016 guidelines. That’s why it’s good to have this PDF. We are actually working on getting this very document with our on-demand printer because it’s 114 pages. You could print it on your home printer if you want, if you’re part of the club or you have access to the BHAT® Cave, but we just decided to put in a little spiral bound. So, you are allowed to bring updated material that’s related to your manuals directly – this is one of them – to your exam.

I did confirm it with the AAPC. I know people get worried sometimes that the proctor won’t let them, but they are allowed to bring, you are allowed to bring errata and updated information that’s not in your current printed manual. Keep in mind too if you’re testing and you feel that a proctor doesn’t have the correct information or isn’t going to allow you to do something that you were pretty darn sure you could do, there is a hotline number that they have. Normally these exams are happening on a Saturday but they do have someone dedicated to help if there are questions like that.

You can remind the proctor, say, “Could you call the AAPC? I know they give you a hotline number because I confirmed before I came that we were allowed to bring in these guidelines because my manual has last years.” This of course is for people taking the exam after January 1. If you’re taking the exam in the next couple of days where you were doing this at the end of December, then you’re going to want the 2016 PDF printed and brought in with you.

That being said, I’ve been teaching students to take the CPC exams since the year and most of the time they did not print or bring in the new year’s guidelines. What that says, what the AAPC does, is each year they will take the exams that they’ve spent a lot of money vetting and creating, and they will go through and each question they will look at and make sure it fits with the new code set. They’re not going to go, “Oh, okay, we need to put in something on Excludes because that’s new.” “OK, now we need to put in something about ‘with’ because that’s new; and this one number 19.” They don’t do that. But probably the following year if it was a major change, they will probably try and fold in some of that new information. But they’re not right at January 1 try to get all that new information. That’s what CEUs are for, that’s what your continuing education units indicate that you’re staying up-to-date. But for that certification exam, they already have the key core established guidelines already in there.

Anything else to share about ICD-10 guidelines that you can think of, Alicia?

Alicia:  Again, they’re testing you on what you know and they’re testing you on the guidelines and we’ve always said both with ICD and CPT, read the guidelines at least three times. That’s going to be very, very important.

Laureen:  And it’s not necessarily about memorizing all of these pages, but it’s familiarizing yourself with it; so you go, “Wait a minute, there’s something about diabetes, I’m going to go look for that.” What’s nice about real world coding versus doing it on the certification exam, is you can use the search tools to look up words. If I wanted to type in diabetes, if this is an OCR document or the one from the original site…

Alicia:  They know you know how to look up a code. That’s not what you’re being tested on.

Laureen:  My search isn’t working, so what I’d had to do is because what we did in order to get the annotations in the notes, we had to actually scan back in a PDF, so the PDF on the internet, that when you download it, it’s already searchable, so I would just need to make this so it’s OCR-ready and you can look up the words. But that’s the nice thing, is that you can search the document that way versus having to go through each section.

Let me just scroll through this a little bit so you can see here she’s running everything prior to the Tabular list. Then, when you’re actually taking an exam or in the real world and you’re trying to code, “I know there’s an ICD-10 guideline, let me go check my guidelines,” and you can go back and look at it.

Alicia:  If you scroll up just a little bit, that NEC and NOC, another classic example of what they’re going to test you on. Right there, if you look up where she’s got it highlighted, the NOS “Not otherwise specified” and then it gives what that stands for.

Laureen:  Yeah. I normally, when I very first started teaching this, when I was really like confused myself and I have to give myself these funny stories, I said, “Hmm. Really, NOS is the doctor’s fault, they weren’t specific enough. NEC is really the book’s fault, because the book didn’t go into enough specifics even though the physician gave the details.” That’s how I’ve always reminded myself.

Alicia:  You could even write yourself a note there.   

Laureen:  Books fault, doctor’s fault. Yeah, exactly. No offense to any doctors listening. So, this just gives you an idea, this is all available in the BHAT® Cave. Just as a reminder to our club members and our students that do have access to this, that this is proprietary; once we annotated and add our touch to it, it is not to be shared. It’s for people that’s our CCO club members; so you’re free to use it and download it for your own personal use, but it should not be shared. If you’ve learned of someone who’s doing that, we would appreciate you letting us know because it takes a lot of time for us to do these annotations and things and it’s a little disheartening when it gets shared out there.

Let’s see if anyone else has any questions. Donna is asking which of the ICD-10 code books do they have the guidelines just prior to the codes? I think all of the ones, Optum…

Alicia:  Yeah. I think all of them do. CPT also is always in the front, too. Is it HCPCS, has something at the back? One of them has it at the back, I guess it’s HCPCS, where everything is flipped to what you normally expect.

Laureen:  Yeah. That’s always been a pet peeve of mine too, that they put the index in ICD in the front. Most books have the index in the back. At any rate, years ago when they first came out, they literally were in three separate bound volumes, because so many codes, the codes are growing that the Find-A-Code people, they have a division, they do ICD-10 specialty manuals. You’re welcome to check it out in the CCO store, but they also have a general ICD-10 manual. It’s so big because they did not do what many of the other publishers did with the small, teeny fonts. It’s in two volumes, so they’re putting the Index in one volume and the Tabular in another, which you’re like “two books” but a lot of people are reporting they actually like it because they can have the index open and then flip to the codes. If you’re a paper manual user, you might want to consider that for next year.

We’re actually working with the Find-A-Code folks and doing a lot of our color coding and annotating, and things like that. So, look for some good news hopefully in the future on that. They’re really good folks at Find-A-Code. They really listen, they want to know what do people want and they try and do that. That’s what I really like about them.

Alicia:  I think they’re education-based too. Education is something that they think about, not all encoder companies think of that.  

This segment “ICD-10 Guidelines: How to Read Section References” originally aired on Live with Laureen #012.