ICD-10 Concepts FAQs

ICD-10 Concepts FAQs

Q: What is episode of care (EOC)?
In ICD-10 many diagnoses such as injuries and poisonings include episode of care into the code as the 7th character. Because the EOC character is the 7th character, the placeholder X is used to fill in the empty character fields for diagnoses that are otherwise 3-5 characters. The meaning of the different characters is as follows:

  • A – initial¬† encounter defined as “active treatment”
  • D – subsequent encounter which is for visits after the active phase of treatment but when the patient is receiving routine care for the injury during the period of healing or recovery
  • S – sequela encounter for “late effects” such as complications or conditions that arise as a result of an injury.

For fractures, the 7th character options are expanded to include the Gustilo classifications for open fractures of long bones:

  • A – initial encounter for closed fracture
  • B – initial encounter for open fracture type I or II
  • C – initial encounter for open fractures type IIIA, IIIB or IIIC
  • D – subsequent encounter for closed fracture with routine healing
  • E – subsequent encounter for open fracture type I or II with routine healing
  • F – subsequent encounter for open fracture type IIIA, IIIB or IIIC with routine healing
  • G – subsequent encounter for closed fracture with delayed healing
  • H – subsequent encounter for open fracture type I or II with delayed healing
  • J – subsequent encounter for open fracture type IIIA, IIIB or IIIC with delayed healing
  • K – subsequent encounter for closed fracture with nonunion
  • M – subsequent encounter for open fracture type I or II with nonunion
  • N – subsequent encounter for open fracture type IIIA, IIIB or IIIC with nonunion
  • P – subsequent encounter for closed fracture with malunion
  • Q – subsequent encounter for closed fracture type I or II with malunion
  • R – subsequent encounter for closed fracture type IIIA, IIIB or IIIC with malunion

Q: Can I still use unspecified codes in ICD-10?
Yes. Unspecified codes are still acceptable if greater specificity is unknown at the time of the encounter. Your reported diagnoses should reflect the medical record and clinical knowledge of the patient’s condition. Unspecified codes should not be used as a shortcut, and should only be applied when more specific is not available at the time of service. For example, there is a code for sprain of unspecified deltoid ligament of the ankle but your documentation and code assignment should clearly indicate whether the patient has injured their right or left ankle.

Q: Can I still assign Signs and Symptoms under ICD-10?
Yes. If a definitive diagnosis has not been established by the end of the encounter, it is appropriate to report codes for signs(s)/symptoms(s) in lieu of a definitive diagnosis.

Q: What does Severity of Illness really mean?
Severity of Illness (SOI) reflects the patient’s level of sickness and disease complications. ICD-10 codes allow for improved support for documentation of illness. Examples include:

  • Chronic kidney disease, Stage I-V or ESRD
  • Ulcer staging, Stage I-V
  • Burn degree including whether it is extensive, and what percentage of TBSA is involved

Q: What elements should be included in documentation for infections?
When documenting infections include:

  • Type (cellulitis, viral diarrhea)
  • Location (specific anatomic site)
  • Acuity (acute, chronic, recurrent)
  • Causative organism (e.g. MRSA)
  • Complications (e.g. hypoxia, tachycardia)
  • Clinical manifestations (e.g. pain, fever)
  • Tobacco/ETOH involvement

Q: What elements should be included in documentation for injuries and poisonings?
When documenting injuries and poisonings include:

  • Location (specific anatomic site)
  • Laterality (left, right)
  • Where the incident occurred (geographic locations)