ICD-10 Training: Don't use GEMs or the WSJ to teach ICD-10 coding

Carl Natale
by Carl Natale

It's probably not too early to get your physicians involved in your ICD-10 transition.

Yes, it's a big project that requires a lot of work and input. But also you need to learn their objections and deal with any problems they find.

As an example, look at the problems I had with the arguments against ICD-10 coding made by Daniel Essin. Note that I took issue with how he made his arguments not his expertise as a doctor. When he complained that there was no ICD-10-CM code for latent tuberculosis infection (LTBI), I did some digging and found that the ICD-9-CM code 795.5 (which he cites for LTBI) maps to R76.1. So when I said,"Which puzzles me why he doesn't think he will be able to use ICD-10 code R76.1," I really meant that as a question.

Thankfully Essin relied on his medical expertise to explain why it's wrong:

"I would not use that code because 'abnormal reaction to tuberculin test' is not a diagnosis. LTBI is a diagnosis. There are several criteria that can be used to establish the diagnosis of LTBI, only one of which is an abnormal reaction to the tuberculin test. Merely coding one or more of the criteria is not the same thing as making a diagnosis — which one can't do because there is no code for it."

I didn't write this post to keep the debate going. Mostly because it strikes me that Essin can't be the only physician who has trouble understanding how to navigate the ICD-10 logic. Not that he should. That's the job of the medical coders. But no one should look at the diagnosis LTBI and automatically mark what a mapping or lookup tool tells them.

There needs to be discussions about what how to handle the most important diagnoses. Medical coders need to know more than what the medical codes stand for. And the physicians need to know if they need to give more information so that the ICD-10 code is right.

[See also: ICD-10 Myths: What you need to know about GEMs]

This means medical coders and physicians need to train each other. You can't use GEMs and the Wall Street Journal as coding handbooks.