SCGhealth Blog

ICD-10 Codes to Get You Through the Holidays

Monday, December 25, 2017

By Audrey Landers

I love the Holiday season, it is by far my favorite time of the year, but even I can admit that the traditions I look forward to are pretty strange. The period between Thanksgiving and Christmas can be a transformative time, the air takes on a surreal quality as people put up lights, spend entire paychecks on gifts for people they may not even like and cut down enormous trees only to attempt to keep them alive for just a few weeks inside their own homes. It only makes sense that the injuries that arise during this time of the year can be just as unique as the season itself. To help you get through the holidays, I’ve taken the liberty of pulling a few ICD-10 codes you may find yourself needing.

Y93.D1 Activity, Knitting or Crocheting
From scarves to sweaters, as grandmothers and hipster millennials across the country rush to finish their homemade presents, don’t be surprised to find a few with knitting-related injuries in your waiting room.

R46.2 Strange and Inexplicable behavior
In families that celebrate Christmas, mothers may find that their children are acting a little different. They put their toys away, eat all their vegetables, and may even vacuum the living room without being asked! Surely something must be wrong. Not to worry though, Timmy and Susie are just doing their best to make sure they end up on the Nice List this year.

Z63.1 Problems with relationship with in-laws
It’s a stressful time of the year, and can put a huge strain on relationships. From unexpected extended stays to missed Christmas brunches. You can’t get through the season without someone’s feelings getting hurt.

R45.4 Irritability and anger & Y92.810 Car as the place of occurrence
Road rage happens all year round but it is exacerbated by holiday travel. Drivers will be getting angry everywhere you go: from the grocery store, to the mall and especially at the airport. 

W13.2XXS Fall from, out of or through roof
Some people get serious about their holiday lights. As houses everywhere begin to brighten up, don’t be surprised if you have one more patients come in needing to be patched up after trying (and failing) to add one more string of lights to the gutter.

W20 Struck by thrown, projected or falling object
When I was younger, my best friend’s only brother got his nose broken when he took a snowball to the face. This code will remain relevant throughout winter as the snow continues to fall, and kids continue to pack it into projectiles.

Z62.891 Sibling Rivalry
Parents will do their best to keep the kids from getting at each others’ throats but things happen. Maybe they miscounted and William got one more present than Peter or perhaps Kelly is mad because her cookie isn’t as big as Rachel’s. Fights will happen, and kids can be pretty brutal both emotionally and physically.

W55.32X Struck by other hoof stock
Santa and his flying reindeer probably don’t follow traffic laws. If your patients aren’t careful on Christmas Eve they could end up like the grandma in the famous song.

To Be Precise

Tuesday, November 08, 2016

By: Ben Regalado, Contributing Writer

“The difference between the right word and the almost right word is the difference between lightning and a lightning bug.” - Mark Twain

In October, Medicare and other health plans tightened diagnosis coding requirements, pushing providers to increase specificity within the wide range of ICD-10 codes available. Those who previously found an easy out by using “unspecified” codes are now finding their claims denied and returned. 

You may be asking yourself what the big deal is all about, especially if you are facing frustrating claims denials. Detailed ICD-10 coding may not seem like it, but it will have some role in moving toward “precision medicine," and accelerating a dramatic shift away from what Dr. Eric Topol said are too many treatments out there today that have marginal efficacy that are being applied widely.” 

Precision medicine is backed with enthusiasm and funding by the current White House, where a National Institutes of Health initiative made a grant of “$120 million to the Scripps Research Institute in La Jolla, Calif. to create mobile apps, web platforms, biosensors, and other tools to collect and analyze data” on one million volunteers. Let that number sink in. One million participants providing information through technology tools such as mobile apps, web platforms and biosensors.

The focus of precision medicine becomes applying this treasure trove of data to the individual; using it to support and enhance your own diagnostic skills to deliver treatment customized to your patient’s acute and chronic diseases, life and lifestyle, genome sequence or living environment. 

When Meaningful Use was established, the goal was to put you on electronic platforms, and then nudge you toward data interchange. However, even with e-prescribing and admissions reporting paving the way, and with initiatives such as the Prescription Drug Monitoring Program coming on line, we are still only to the point where the dream is only partially realized, even within “healthcare systems.”

The MACRA Final Rule just published will root 25% of an eligible clinician’s score and hence future payments on “Advancing Care Information,” and this will likely be followed by increasing demands to tie compensation to data gathering and collaboration.

Your patients aren’t going to wait on you, however. Many are engaging in “health” monitoring on a basic level, using apps or personal devices such as FitBits to track weight, food consumption, walking, running and other exercises, and then bringing that information to their frequently skeptical doctors (although there are isolated success stories). 

Patients are used to technology delivering personalized, detailed and cost effective service delivery in all other aspects of their life. (Don’t believe me? Look over your Netflix suggestions, or those on Pandora or Spotify or even YouTube.) This is where precision medicine will take us - straight to the use of technology to “transform trial and error medicine.

So be prepared. As data is collected, and then becomes more available, your participation in sharing and access is likely to become more of a requirement so you have the best information available to provide your patient the best, most appropriate and most cost effective diagnostic and treatment options. That is truly the Meaningful Use of your EMR, training and skills.

If You’re Not Ready, Say Your Prayers: ICD-10 “Grace” Period Ending

Tuesday, September 13, 2016

About a year ago, healthcare’s “Y2K” (non-)event occurred with the transition to ICD-10 diagnosis coding. For many providers who made the transition (aided by EMRs), it seemed easy enough, as they simply chose broad, or unspecific, codes which surprisingly did not disrupt payments.

However, these providers were unintended beneficiaries of one-year “flexibilities” granted to contractors so that medical reviews or claim denials were not based solely on the specificity of the ICD-10 code selected. In the next few weeks, if these providers have not fully made the transition to using more specific coding, they’re going to have to say grace and other prayers, because on October 1, it's over - and there is no accompanying “phase in” period.

In updated answers to the joint announcement between the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA), originally released July 6, 2015, CMS noted, “Providers should already [emphasis added] be coding to the highest level of specificity. ICD-10 flexibilities were solely for the purpose of contractors performing medical review so that they would not deny claims solely for the specificity of the ICD-10 code as long as there is no evidence of fraud.”

In the Journal of the American Health Information Management Association (AHIMA), staff noted this deadline is really a renewed focus on the role of physicians in improving (and coordinating) patient care. Outlining and refuting major objections (from “It’s too big and complex” to “I don’t have time to learn”), the AHIMA staff noted, “The additional, more specific information could, indeed, impact treatment decisions, but are more likely to promote more targeted and better care. This could also lead to more focused evidence-based practice and a more effective relationship between a patient and a physician, who can now know more specifics about that patient as an individual, not just as a member of a group.”

CMS isn’t saying Unspecified Codes aren’t allowed. However, Unspecified Codes should be not be a “general” or default selection, especially when the examination and subsequent documentation supports selection of a more detailed code. In essence, the repeated and regular use of Unspecified Codes could cause claims to hit the radar for review, and payment delays could follow.


  • Perform a quick audit of diagnosis coding patterns since October 1, 2015 for all payers, not just Medicare. What are the most frequently used, and by which providers?
  • Determine if the high frequency codes have greater levels of specificity. Compare the specific chart documentation to the code selected for a sample of charts.
  • Provide updated data and training to your providers (and/or coders)

SCG Health's Year in Review: 2015

Tuesday, December 29, 2015

By: Elizabeth Lauzon, Public Relations Specialist

As 2015 winds down, everyone here at SCG Health is thankful and proud to have worked with our clients this past year to simplify the business of medicine one patient encounter at a time. While this is the time of year to look forward to goals for 2016, and we’re certainly excited about what we have planned for the upcoming year, it’s also a time to look back at some of the highlights of 2015.

Credit: GraphicStock (c) 2015.

Photo credit: GraphicStock © 2015.

Social media continues to be the main way for us to share information and not surprisingly, there were certain topics that were consistently top hits in 2015.

Top Three Social Media Topics

1. Mobile health and technology in health care: Topics such as mobile health and insurance, and savvy smartphone users were among the most popular. Check out this top read article from AIS Health about the challenges facing health insurers.

2. ICD-10: This article from RCM Answers on ICD-10 and proposed safe harbors was one of the most popular on ICD-10.

3. Electronic Health Records: Knowing how to use them to your advantage were of particular interest. Health Data Management’s article on EHRs and analytics led the trend.

Client Support

The core of our work and mission is helping our clients. Here are a few highlights of client work from 2015:

  Educational programs for clearinghouse customers on a variety of revenue cycle management topics such as the modernization of denial management and Medicare quality reporting  

"SCG Health has brought a fresh new perspective to our webinar program. Jen is a tremendous speaker and industry leader. For over a year now SCG Health has been contributing the industry’s hottest topics and subject matter to our program, we couldn’t be happier with what they have done for TriZetto Provider Solutions." 
-Heidi Budreau, TriZetto Provider Services

   Specialty contract negotiations, integrating care coordination, enhanced community services and value-based payment models  

 "Before Infectious Disease Physicians started working with SCG Health, I asked myself the following three questions. Why am I doing it? What the results might be? And what would I consider successful negotiations? Once I found the answers I was able to convey to Jennifer and her team what IDP was seeking in contract negotiations. Jennifer and her team have been efficient, reliable and relentless in seeking the outcomes we desire. SCG Health has displayed individual commitment to this effort – displayed exceptional team work, within SCG Health and encompassing IDP."
-Patricia Mullins, IDP Physicians

   Compliance support and guidance reinforcing specialty needs while clinicians and administrative staff are still seeing patients  

"SCG Health has been supportive and knowledgeable. A remarkable resource capable of handling our most difficult issues in a timely manner. I feel very fortunate to have the expertise of SCG Health to rely on."
-Dianne Beach, Maryland Pain Specialists


We look forward to continuing the relationships with our clients and navigating the business side of medicine in the upcoming year. And all of us here at SCG Health wish you and your team a happy and healthy New Year!

ICD-10 frequently asked questions

Thursday, December 03, 2015

SCG Health is answering your questions on ICD-10. Below are the top questions that we have received so far. 

Q: For the new ICD-10 Z codes, what constitutes an abnormal finding?

A: Some of the codes for routine health examinations distinguish between “with” and “without” abnormal findings. The simple answer right now is that we don’t have enough coding guidance on when does something become abnormal findings. My interpretation of the CMS guidelines is that if a patient presents with:
∗ A new illness or disease then it is “with abnormal findings”
∗ Controlled chronic conditions, even if you are treating it during an encounter, then it is “without abnormal findings”
∗ Uncontrolled chronic condition, then it is “with abnormal findings”

Any abnormal finding must be coded as a secondary code to the encounter.
Source: 2015 Official Guidelines for Coding & Reporting

Q: What if the abrasion was seen at another office, but the patient is here as a new patient for follow up and the abrasion is healed?

A: Is that still initial visit since it is the 1st visit here? Actually, since the healing has started and it is no longer an active wound (or abrasion), it would be considered “subsequent.” Why? Ask: is it active treatment? Probably not because it is healing. It the abrasion was awhile ago and the new patient visit is because of complications, then it would be sequela. The rule: If the patient was seen in the emergency room for an injury, then your visit is a subsequent encounter. For most physicians, all visits for injuries will be subsequent encounters.

Q: Where can I find the 2016 ICD-10 coding guidelines and the updated tabular and alphabetical list?

Go to this page on the CMS website. The guidance is the last link. 2016 ICD-10-CM Guidelines [PDF, 1MB] The tabular and alphabetical index is part of this download. 2016 Code Tables and Index [ZIP, 16MB]

Cost of ICD-10 may be less than $2,000?

Thursday, November 20, 2014

There’s finally some good news on the ICD-10 front: the costs of converting to it may be lower – much lower – than originally thought. 

According to a new analysis in the Journal of the American Health Information Management Association, a small physician’s practice – defined as three physicians and two staff, such as coders - will likely pay between $1,960 to $5,900 to implement ICD-10. The American Medical Association had originally estimated that the cost would range between $22,560 to $105,506.  

Why is there such a discrepancy between the two estimates? The authors, who are with 3M Health Information Systems, Inc. cite several reasons why their cost estimates are lower:
  • Some conversion costs estimates included the costs related to electronic health record (HER) adoption, even though they are not directly related to ICD-10 conversion.
  • The documentation and coding training expenses aren’t as high as originally projected. For instance, the ICD-10 Diagnoses Code Book can be downloaded for free. Training also can be found free on websites or from practice’s software vendors; medical societies are also offering training at reasonable prices.  There’s even a $1.99 and a free downloadable app that enables one to search for ICD-10 codes on one’s smart phone.   
  • Many vendors are including the ICD-10 software update as part of their routine annual software updated at no additional cost. 
  • Many physicians have transitioned from paper records to EHRs and received  incentive payments for doing so by participating in the Medicare and Medicaid EHR Meaningful Use Program; according to the authors, using an EHR “lays the foundation” for a smooth transition to ICD-10.
  • The cost of changing superbills is less of a factor than originally thought since physicians who use superbills already update them annually to make ICD-9 changes. 
  • Physician offices were originally expected to conduct extensive “end to end” testing with multiple payers; in reality the billing, EHR and clearinghouse vendors have the primary responsibility for testing.   
The analysis downplayed the costs of increased documentation and associated reduction in productivity, noting that many practices already have established appropriate documentation practices and the use of EHRs make the documentation much easier. The authors point out that physicians who are using EHRs and improving their documentation can actually increase revenue because they are documenting and billing for the full value of their services.  

It also found that practices are further along in ICD-10 conversion than originally estimated.

The report may be a tad optimistic, since it doesn’t address the fact that many physicians have not yet purchased an EHR and that some vendors are not offering ICD-10 upgrades for free.  It also doesn’t seem to factor in costs already incurred, such as moving to an EHR system. 
The article also doesn’t take into account that practices may be farther along in ICD-10 implementation simply because they thought they’d have to start using it several years ago. The industry was supposed to transition to ICD-10 by Oct. 1, 2013. The effective date was first delayed to Oct. 1, 2014; Congress enacted legislation earlier this year delaying the effective date to no earlier than Oct. 1, 2015 in large part on the perceived cost and loss of productivity during the transition. 

Still, it is encouraging to hear that the costs of converting to ICD-10 are not as bad as first feared.

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