Medicare Compliance & Reimbursement - 2015 Issue 22
ICD-10: Uncertainty is Okay Under ICD-10
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Article Overview
This article explains the general approach to sign and symptom reporting under ICD-10-CM compared with ICD-9-CM, with emphasis on situations where documentation remains uncertain, incomplete, or still under evaluation. It is intended for coders and clinical documentation staff who need to understand how the diagnosis coding system treats unresolved conditions, resolved conditions, and symptoms that may or may not be part of a broader diagnosis. The article also references CMS guidance in MLN Matters SE1518 and illustrates the topic with several broad coding scenarios.
Why This Topic Matters
Accurate symptom and unspecified diagnosis reporting affects claim support, documentation integrity, and consistency during the transition from ICD-9-CM to ICD-10-CM. This topic is especially relevant when providers have not reached a final diagnosis or when a symptom may need to be captured separately from the underlying condition.
What You Will Learn
- How ICD-10-CM addresses encounters where the diagnosis is not yet definitive
- When symptom or unspecified diagnosis reporting may be discussed in coding guidance
- How broad documentation patterns can affect sequencing and code selection
- How CMS guidance is used to clarify signs and symptoms coding topics
- How ICD-9-CM and ICD-10-CM are compared in the context of uncertain diagnoses
Who Should Read This
- Medical coders
- Coding auditors
- Clinical documentation improvement staff
- Billing and revenue cycle professionals
- Therapists and rehabilitation documentation staff
Codes Discussed
Code Ranges Discussed
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