Be the First to Conquer ICD-10 2017 Official Guideline Changes

prepare for ICD10 2017 Official Guidelines

In the previous post about ICD-10 2017, I mentioned the importance of reviewing the updated Official Guidelines. News of the 2017 OGs being out is enough to make any coder’s pulse quicken, and to keep the excitement going, here’s a quick guide to what’s new in the conventions and general coding guidelines.

Remove the ‘Interim’ From Excludes1 Advice

The 2015 interim advice on using Excludes1 has made its way into the 2017 Official Guidelines, which go into effect Oct. 1, 2016. Section I.A.12.a states that an “exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other.”  The Guidelines go on to say that if the relationship isn’t clear, ask the provider for clarification.

Report Underlying Condition First ‘If Applicable’

When a condition has both an underlying etiology and manifestations, ICD-10 requires sequencing the underlying condition first. The 2017 Guidelines add the important words “if applicable” to this rule in Section I.A.13.

This clarification matches information in AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS, First Quarter 2016: “The ‘code first’ note means code first, if present.”

Consider ‘With’ to Mean ‘Due To’

A change to the convention described in Section I.A.15 has important consequences for those who code hypertensive heart disease.

The revised explanation of “with” says you should presume a causal relationship between two conditions linked by the term “with” in the Alphabetic Index or Tabular List. That means you should code those two documented conditions as related even if the documentation doesn’t specifically link them. But if the documentation states the conditions are unrelated, then you should code them as unrelated.

This change ties into revisions to Section I.C.9.a, Hypertension. In 2016, as cardiology coders likely know, the OGs said you should not presume a relationship when documentation shows hypertension with heart conditions. In 2017, Section I.C.9.a takes a U-turn and says to report hypertension with heart conditions as hypertensive heart disease unless the provider has specifically documented a different cause.

Code Based on Provider’s Statement

Section I.A.19 is a new addition to the OGs and applies to “Code assignment and clinical criteria.”

The rule is that “The assignment of a diagnosis code is based on the provider’s diagnostic statement that the condition exists.  The provider’s statement that the patient has a particular condition is sufficient. Code assignment is not based on clinical criteria used by the provider to establish the diagnosis.”

Memorize This Bilateral Coding Rule

If you ever report bilateral conditions, be sure to commit to memory an addition to Section I.B.13, Laterality.

According to the 2017 Guidelines:

  • When a patient has a bilateral condition, assign the bilateral code even when the provider treats each side during different encounters.
  • If at a later encounter, the condition no longer exists on the treated side, but it continues to exist on the other side, report the unilateral code.

Think of the example of a patient with cataracts in both eyes who has surgery on one eye at a time. Before the surgery on the first eye, you’d use the bilateral cataract code. After the surgery on only the first eye, you’d report a unilateral code for the side that still has the cataract.

Add Documentation Flexibility to Coma Scale and NIHSS

You may be familiar with Section I.B.14’s rule that acknowledges real-world documentation practices. In 2016, Guidelines say you may choose a code based on documentation from a clinician who isn’t the provider legally responsible for diagnosing the patient for these:

  • Body mass index (BMI)
  • Non-pressure chronic ulcers depth
  • Pressure ulcer stage.

For instance, dietitians often document the BMI and nurses often document pressure ulcer stage.

In 2017, the Guidelines add two more areas:

  • Coma scale
  • NIH stroke scale (NIHSS).

For example, if an EMT documents the coma scale, you can code based on that documentation.

Watch out: The provider needs to be the one to document the associated diagnosis, such as the acute stroke related to the NIHSS code.

Check It Out for Yourself

We’ve taken just a quick tour of the changes to Section I.A, Conventions for the ICD-10-CM, and Section I.B, General Coding Guidelines. Be sure to review the official language for yourself and read the guidelines for the ICD-10 chapters you use. You’ll discover changes regarding Zika, diabetes, ulcers, obstetrical care, and more.

Remember: If your print ICD-10 2017 manual includes the guidelines, they may be the 2016 guidelines (because the book’s publishing deadline may have been before the 2017 guidelines came out). As we’ve seen, guidelines can change substantially from year to year, so be sure you’re using the guidelines that apply to your date of service.

What About You?

Are you happy or upset about any of these changes? How do you remember to check and apply these guidelines when you code?


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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