Soon, your hospital or group will be expecting you to document your emergency visits in an ICD-10-CM–friendly manner. To paraphrase a famous Vice President, “ICD-10-CM is a big %%^& deal.” All emergency physicians will need to have a basic understanding of ICD-10-CM key concepts. 


ICD-10 will be impossible to ignore since it is tied to physician and hospital reimbursement as well as value-based and quality-of-care metrics. The reality of working in a busy emergency department within an electronic medical record means that ICD-10 will likely present unique challenges.

ACEP has a number of ICD-10 resources designed for the busy emergency physician that can be found at www.acep.org/content.aspx?id=28754.

This article presents two experts’ guidance on ICD-10.

David Chauvin, DO, FACEP, ACEP Coding & Nomenclature Advisory Committee
Vice President Reimbursement
Premier Physician Services, Inc.
Dayton, Ohio

1. How will this impact how I document?

Dr. Jeffrey Linzer: In reality, there isn’t much more required than would currently be expected for good medical documentation with the current system. The emergency physician is choosing the right term that will demonstrate why the patient was being seen and explain resource utilization. This will also help support quality metrics.

The emergency physician should consider performing a descriptive history of the present illness (HPI) instead of using checkboxes. While some electronic health records try to put this information into a “readable” format, actually dictating or free texting the HPI will provide for better details for the coder to be able to extract information. In documenting the physical exam, the emergency physician should also be clear as to the location of the problem, including laterality (left, right) and in some cases anatomic site (eg, proximal, distal, forearm, upper leg).

Dr. Pamela Bensen: The diagnosis is like a user ID, and ICD-10-CM codes are like the password—they must match to open the payment stream. ICD-10-CM will contain more than 140,000 diagnosis codes that must be selected based on the documented diagnosis. About 4,200 of the ICD-9-CM diagnosis-code pairs have a 1:1 match in ICD-10-CM (only the code numbers change, while the descriptors remain the same). However, these diagnoses match to ICD-10-CM codes that are unspecified—unspecified as to right-left, acute-chronic, type of condition, and links to etiology or manifestations. Since these codes are unspecified and represent a low severity of illness (SOI) that may not warrant medical care, many payers have decided not to pay for care related to unspecified codes. In order to get paid, emergency physicians will have to document to avoid unspecified codes by using specific words to more accurately represent the patient’s SOI.

2. Why is SOI important, and how and why should I document it?

JL: Clearly documenting SOI is important regardless of which diagnosis coding system is being used. ICD-10 will allow for better clarity in identifying the severity of the problem. For example, there are codes to identify if acute respiratory failure is associated with hypoxia or hypercapnia or if a sickle cell crisis is associated with acute chest or splenic sequestration.