ICD-10: Final Preparation and What to Expect After Oct. 1



Learn how to make the most of your final ICD-10 preparation from our in-house billing expert. Cara Buckhaulter is a Certified Professional Coder with more than 25 years of experience in the medical field, including billing, coding, practice management, and consulting. Check out this ICD-10 webinar for tips on how to make sure your practice is ready!



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ICD-10 Resources



 ICD-10 Formatting

Q: Can we leave out the "A", "D", or "S" characters during the 12-month grace period?

A: Not all ICD10 codes require the 7th digit extender; however, for categories where the 7th digit is required, it does need to be used, even during the grace period. 

You must assign a seventh character to codes in certain ICD-10-CM categories as noted within the Tabular List of codes—primarily Chapter 19 (Injury, poisoning and certain other consequences of external causes) and Chapter 15 (Pregnancy, childbirth and the puerperium). This character must always be in the seventh position; if a code has fewer than six characters and requires a seventh character extension, you must fill in all of the empty character spaces with a placeholder “X.”


Q: What is the difference between "D" and "S"?

A: Subsequent (D) – this is any maintenance and/or treatment being administered to a patient for the problem indicated on the initial encounter. There is no limit to the amount of times you will use this 7th character for a specific diagnosis since this is based on whatever care is needed to treat the illness.

Sequela (S) – this is assigned for complications that arise as a direct result of the item determined in the initial encounter.


Q: Do providers for mental and behavioral health ever use a 7th character when coding?

A: No, mental health ICD-10 codes do not contain a 7th digit extender.


Q: If a patient sees multiple providers for the same complaint, does each provider bill using the initial visit code? Or only the provider who renders initial care?

A: An initial encounter is defined as the period when the patient is receiving active treatment for the injury, poisoning, or other consequences of an external cause. An "A" may be assigned on more than one claim. For example, a patient is seen in the emergency department (ED) for a head injury and is first evaluated by the ED physician. The physician then requests a CT scan (interpreted by a radiologist) and a consultation by a neurologist. In this instance, the 7th character is used by all three physicians and also reported on the ED claim. If the patient required admission to an acute care hospital, the 7th character would be reported for the entire acute care hospital stay. The 7th character extension is used for the entire period that the patient receives active treatment for the injury.


Q: Is there a time limit on subsequent visits? (E.g., We are a pediatrics practice — if we treat a sick child and they return two months later with the same illness, is this considered an initial or subsequent visit?)

A: No. If the child returns and is diagnosed with the same condition, it should be coded as a subsequent visit.


Q: If a patient first sees the doctor in the hospital and then has an appointment at the office, should the office visit be coded as an initial or subsequent encounter?

A: If the physician seeing the patient in the office is the same physician who treated the patient for this condition in the hospital, the office visit should be coded as a subsequent visit diagnosis.


Q: Which codes require a 7th digit?

A: The 7th character modifiers are primarily found in two chapters: Chapter 19 (Injury, Poisoning and Certain Other Consequences of External Causes) and Chapter 15 (Pregnancy, Childbirth and the Puerperium). The details captured with these characters are not details recorded under ICD-9-CM.


Q: What 7th digit should be utilized with Medicare and chiropractic for a patient receiving treatment for an acute exacerbation of a chronic condition?

A: The 7th digit of the ICD-10 code would be "A" the first time you treat the patient for this condition and "D" for subsequent treatments. This does not negate the need for the AT modifier on the sublaxation to reflect active treatment.


Code Specific Questions

Q: I am a sub-specialist.  When I get a referral from another physician, do I need to use the same diagnostic code as the referrer?

A: In many cases you will use the same diagnosis as the referring physician; however, if the patient is referred to you based on signs and symptoms and you are able to diagnosis the patient based on additional testing, etc, you would then use the diagnosis code for the confirmed condition as the primary diagnosis. 


Q: I work for a behavioral health practice and we currently use 304.00 (ICD-9) and the ICD-10 is F11.20. For an initial assessment should I use F11.20A?

A:  Mental health codes do not require the use of the episode of care extender. 


Q: What about provider's seeing patient's in the hospital? Will the coding still need to be more specific for the DX codes?

A: Yes, all patients (regardless of the place of service) will need to be diagnosed to the highest level of specificity and coded with ICD-10 as of 10/1/15.


Submitting Paper Claims 

Q: What version of the CMS 1500 did you indicate we were to use?

A: Only the 2014 CMS 1500 Form supports ICD-10 Codes so all Payers are poised to use it. (The form has a revision date of 02-12 in the bottom right corner.) 


Billing for Services Rendered Prior to Oct. 1

Q: When coding for services that were performed prior to Oct. 1, should I use ICD-9 or ICD-10 codes?

A: Per CMS, claims will need to be split using the Dates of Service previous to 10/1/2015 and Dates of Service on and after 10/1/2015. 

Services performed prior to 10/1/2015 should be billed using ICD-9 codes while services performed on or after 10/1/2015 should be billed using ICD-10 codes.

The assumption is that most payer's adjudication systems will be equipped to process claims in a like manner.

As always, we advise that you confirm with your payers to determine if they would like you to submit claims according to another guideline.


ICD-10 Resources

Q: What are the best free apps for Apple devices? What's the best paid app?

A: There are many free apps—including the ICD-10 code search we developed—so there's no reason to pay for one. The native iOS version will be available in the App Store soon, but the online version is mobile responsive and works just as well on your mobile device.

For Android users, our Coder app is available now on Google Play.


Q: Where can I purchase a hard copy of ICD-10-CM book?

A: ICD-10 Code books may be purchased online from several retailers including: Amazon.com, AMA Store, AAPC, and OptumCoding.com.    


Q: What advice would you give to educate our providers with the increase of documentation?

A: Take advantage of the specialty specific documentation requirements being provided by most specialty associations. Compile a list of the most used diagnoses in your practice and give your providers this information including a mapping of the ICD-9 to the ICD-10 code as well as the complete description of the diagnosis codes. This will help them find the ICD-10 of the highest specificity compared to the ICD-9 counterpart. Give your providers additional admin time per patient for documenting and coding.