CMS’s Road to 10

on Monday, 06 October 2014. All News Items | Case Management | Documentation | Coding

Attention K-Mart shoppers, we are now about 3 weeks out from Halloween, 7 weeks out from Thanksgiving, 11 weeks out from Christmas, and about 50 weeks out from the new ICD-10 Compliance date of October 1, 2015. In July of this year we spotlighted free I-10 Education Resources available on the CMS website. One particular resource discussed in that article was the "Road to 10": the Small Physician’s Practice’s Route to ICD-10 tool. As a reminder, this tool is intended to help small medical practices jumpstart their ICD-10 transition. “Road to 10” includes specialty references and gives providers the capability to build ICD-10 action plans tailored for their practice needs.”

What I found to be especially helpful on this webpage are the Specialty Specific References. To date there is specialty specific information for Family Practice, Pediatrics, OB/GYN, Cardiology, Orthopedics, Internal Medicine and Other Specialty.

Each Specialty includes pages where you can explore:

  • Common Codes for your Specialty,
  • A Clinical Documentation Primer,
  • Clinical Scenarios, and
  • Training and Education Resources.
  • The three main categories of change when transitioning from ICD-9-CM to ICD-10-CM coding include definition changes, terminology differences, and increased specificity.

The Primer for Clinical Documentation page is the section that I believeCoding and CDI Professionals may find most useful. Especially as you educate yourself and look for ways to educate your Physician staff. “This document introduces ICD-10 clinical documentation changes for common conditions associated with” the Specialist’s area of practice. “It highlights increased specificity and laterality requirements and provides brief descriptions of the related documentation nuances significant to” a MD’s practice.

Here a just a few examples of documentation guidance that can be found in Primer for Clinical Documentation pages.

  • “Benign or malignant” hypertension no longer exist in ICD-10 codes. Instead, accurate documentation of hypertension should include the type (e.g., primary or essential, secondary, etc.) and a causal relationship if known (e.g., hypertensive heart disease).
  • In a pregnant patient, documentation of the trimester is required. The definitions of trimesters are:
    • First Trimester is < 14 weeks, 0 days,
    • Second Trimester is 14 weeks, 0 days through 27 weeks and 6 days, and
    • Third Trimester is 28 weeks through delivery.
  • An Acute Myocardial Infarction (AMI) will be considered “acute” for 4 weeks from the time of the incident in ICD-10 versus the current timeframe of 8 weeks in ICD-9.
  • The ICD-10 focus for orthopedics is increased specificity and “over 1/3 of the expansion of ICD-10 codes is due to the addition of laterality (left, right, or bilateral).”

For additional Clinical Documentation Changes I encourage you to visit this CMS web page at http://www.roadto10.org/.

Article by Beth Cobb

Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Services at Medical Management Plus, Inc. Beth has over twenty-three years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. In her current position, Beth monitors, interprets and communicates current and upcoming Case Management / Clinical Documentation issues as they relate to specific entities concerning Medicare. You may contact Beth at This email address is being protected from spambots. You need JavaScript enabled to view it..

This material was compiled to share information. MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.

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