How Home Health Can Ace the Updated ICD-10 Codes

Big changes are coming to ICD-10 this October, and home health providers need to be prepared.

The extremely large code set was first implemented in the majority of states about a year ago, to the dismay of many home health providers across the country. Then, in June, the Centers for Medicare & Medicaid Services (CMS) added just under 2,000 new codes to ICD-10, as well as revised approximately 400 codes and deleted around 300 codes. This latest round of ICD-10 changes is scheduled to take effect when the FY2017 code set takes effect on October 1, 2016.

In order to ride out the change successfully, there are certain things all health care providers should keep in mind, according to Jennifer Gibson, RN, a certified coding specialist who conducts trainings for Dallas-based home health software vendor Axxess. Gibson shared some last-minute tips for providers with Home Health Care News ahead of the Oct. 1 ICD-10 FY2017 start date:


1. Every coder must have an updated 2017 Code Book or Code Set. “With the thousands of changes to excludes notes, code additions and deletions, it is impossible to code accurately with an outdated code set or code book,” Gibson tells HHCN.

2. Health care providers should guarantee that their software vendor is prepared for the change, and that codes are available based on the date of service. “For example, codes that were deleted in the updated 2017 version should not be available for use before October 1, 2016,” Gibson says. “Likewise, codes that were in the 2016 version and deleted in the 2017 updated set should not be available to choose or enter on or after October 1.”

3. Coders and providers should expect a temporary drop in productivity due to a lack of familiarity with the new code set and guidance. “It will simply take a bit longer to code with the newer set,” Gibson says.


A great coder, Gibson adds, knows that coding is a two-step process: starting in the Alphabetic Index, and then checking the Tabular List to finish the code and to search for associated guidance and conventions. “This is most important as you are navigating through thousands of changes,” Gibson says.

4. Providers and their coders should be mindful of the changes to the updated 2017 Official Guidance for Coding and Reporting. There are several changes that will start October 1, 2016, including new guidance that clarifies the use of the word “with,” Gibson explains.

“This new guidance states ‘with’ should be interpreted to mean ‘associated with’ or ‘due to’ when it appears in a code title, the Alphabetic Index, or the Tabular List,” she says. “New guidance goes on to state that the classification presumes a causal relationship between the two conditions linked by these terms in the Alphabetic Index or Tabular List.”

These conditions should be coded as related, even without provider documentation that explicitly links them, except if the documentation clearly says the conditions are not related, according to Gibson.

“For example, when we first started using the ICD-10-CM code set, we were told that diabetes could not be linked with any other conditions unless the physician or provider explicitly linked the two conditions,” Gibson explains. “Due to the new guidance above, the classification presumes a causal relationship between diabetes and all the conditions listed in the alpha index following ‘with,’ such as Charcot’s, neuropathy, and many more diseases. However, Osteomyelitis is not listed after diabetes “with,’ and thus the classification does NOT presume a link between diabetes and osteomyelitis. Therefore the physician or provider MUST link these two disorders in order for the coder to code osteomyelitis as a manifestation of diabetes.”

Written by Mary Kate Nelson