Find-A-Code Focus Newsletter

Medicare ICD-10 Update

July 03, 2014

ICD-10 Basics: Unspecified Diagnosis Codes and CPT Codes

The Department of Health & Human Services (HHS) expects to release a final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015. The new compliance date would give providers an extra year to prepare. Now is a great time to brush up on ICD-10 basics as you get ready for the transition.

Unspecified Diagnosis Codes
In both ICD-9 and ICD-10, sign/symptom and “unspecified” diagnosis codes have acceptable, even necessary, uses.  While specific diagnosis codes should be reported when they are supported by the available medical record documentation and clinical knowledge of the patient’s condition, there are instances when signs/symptoms or unspecified codes are the best choices for accurately reflecting the health care encounter. Each health care encounter should be coded to the level of certainty known for that encounter.

If a definitive diagnosis has not been established by the end of the encounter, it is appropriate to report codes for sign(s) and/or symptom(s) in lieu of a definitive diagnosis. When sufficient clinical information isn’t known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate “unspecified” code (e.g., a diagnosis of pneumonia has been determined, but not the specific type). In fact, unspecified codes should be reported when they are the codes that most accurately reflect what is known about the patient’s condition at the time of that particular encounter. It would be inappropriate to select a specific code that is not supported by the medical record documentation or to conduct medically unnecessary diagnostic testing in order to determine a more specific code.

CPT Codes
The transition to ICD-10 does not affect Current Procedural Terminology (CPT) coding for outpatient procedures.  Like ICD-9 procedure codes, ICD-10 procedure codes (ICD-10-PCS) are for hospital inpatient procedures only.


More Items in July 2014

To view more items select a month from our "Items by Month" list.

Or view documentation, coding and billing articles.



The ideal length of a webinar should be around:

News Items by Month
May 2020- 1
April 2020- 1
March 2020- 1
February 2020- 4
January 2020- 2
December 2019- 1
November 2019- 1
October 2019- 4
September 2019- 2
August 2019- 3
July 2019- 3
May 2019- 2
April 2019- 3
March 2019- 9
February 2019- 3
January 2019- 5
2018 - View
2017 - View
2016 - View
2015 - View
2014 - View
2013 - View
2012 - View
2011 - View
2010 - View
2009 - View
2008 - View
free demo
request yours today
for any budget
sign IN
welcome back!