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ICD-10 Is Here for Pathology

October 2015

By Bill Gilbert, Vice President of Marketing, AdvantEdge Healthcare Solutions (AHS)

Originally published in the LeadingEdge by AdvantEdge Healthcare Solutions.

The entire healthcare and pathology industry has been preparing for ICD-10 for years. Now that it is here, are hospitals, pathology practices and payers ready? We are in the midst of answering that question.

In the meantime, there are a number of resources to assist. For example, we've created an ICD-10 Hotline.

As with everyone else, over the past 3+ years, AdvantEdge has devoted a lot of time and resources to get ready for ICD-10, including our Coding teams, our systems and our entire staff.

ICD-10 Documentation Reminders
For pathologists, here are some general documentation reminders:

  • Think about how you are currently documenting.
  • Are you:
    • Saying which side the problem is on/where it is located? i.e. Right vs. Left
    • Dictating where the diagnosis can be found within the anatomy of the organ system?
      • Polyp - where in the colon is it located?
      • Neoplasm - which part of the structure - be specific?
    • Telling your coding team if this is the first time this problem is being treated (initial episode of care) or is this something that has been treated before?
    • Utilizing the information provided by your client manager which indicates your most highly used diagnosis codes to make sure have the specifics needed to code accurately?

Over the coming months, our primary goal is to work to enhance documentation, if needed, so that unspecified codes are reduced as much as possible (since it is widely expected that payers will eventually deny most unspecified codes where a more detailed code is available).

An overview of pathology documentation requirements is shown in this chart.

To understand how common ICD-9 codes map or "cross walk" to ICD-10 codes, feel free to visit our ICD-10 Hotline.

As always, your Client Manager is available to answer questions and assist with the transition. In addition, the companies, ourselves included, have provided online resources to help with this conversion, like our ICD-10 Hotline.

CMS Reminders
ICD-10 was effective October 1 for everyone:

  • The good news: any issues will be identified quickly with many people and organizations responding.
  • The bad news: the cutover may slow payer response times and affect provider or coder productivity during the transition.

CMS and the AMA recently announced a "grace period" of one year, but what does that mean? Essentially, claims will not be denied if they are not as specific as ICD- 10 codes allow, as long as a valid ICD-10 code is used. Here is some of the CMS and AMA language:

  • For 12 months, Medicare review contractors will not deny physician or practitioner claims based solely on the specificity of the ICD-10 diagnosis code - as long as the physician / practitioner used a "valid code" from the right "family" of codes.
  • Medicare claims with a date of service on or after October 1, 2015, will be rejected if they do not contain a valid ICD-10 code.
  • "Family of codes" is the same as the ICD-10 three-character category. Codes within a category will be clinically related and provide differences in capturing specific information on the type of condition. For instance, category H25 (Age-related cataract) contains a number of specific codes that capture information on the type of cataract as well as information on the eye involved. Examples include: H25.031 (anterior subcapsular polar age-related cataract, right eye), which has six characters; H25.22 (age-related cataract, morgagnian type, left eye), which has five characters; and H25.9 (unspecified age-related cataract), which has four characters. One must report a valid code and not a category number. In many instances, the code will require more than 3 characters in order to be valid.

Bill Gilbert is the Vice President of Marketing at AdvantEdge Healthcare Solutions. He can be reached for comment at or 908.279.8120.

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