The ICD-10-CM Official Coding Guidelines

Written by  | Monday, 16 May 2011 14:14
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Just like ICD-9-CM, the ICD-10-CM coding guidelines are a set of rules that accompany the official coding conventions and instructions within ICD-10-CM. The ICD-10-CM coding conventions are instructions for the use of the classification system that must be followed for correct code assignment. And, as with ICD-9-CM, adherence to these guidelines when assigning ICD-10-CM diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA).

Like its predecessor, ICD-10-CM uses certain abbreviations, punctuation marks and instructional notes known as coding conventions to direct code assignment. The ICD-10-CM coding guidelines include the conventions and instructions that are incorporated into the Alphabetic Index and the Tabular List, as well as general coding guidelines and chapter-specific guidelines.

These are based on the coding and sequencing instructions in the Tabular List and Alphabetic Index of ICD-10-CM, but they also provide additional instruction. However, the instructions and conventions in the classification take precedence over other guidelines.

The Centers for Medicare & Medicaid Services (CMS) and the National Center for Health Statistics (NCHS) provide the guidelines as a companion document to the official version of ICD-10-CM. These guidelines have been approved by the four organizations that make up the cooperating parties for ICD-10-CM: the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), CMS, and NCHS. Only guidelines approved by the cooperating parties are considered official.

Coding with ICD-10-CM requires familiarity with its organization and the format of the codes in addition to the coding conventions and guidelines that direct code assignment.

Changes were made to the code format in ICD-10-CM, for example, to allow for a greater level of specificity and clinical detail. These changes establish two new coding conventions (i.e., extension characters and placeholder characters.)

Since a solid understanding of the ICD-10-CM coding guidelines and conventions will be needed for a smooth transition to ICD-10-CM, now may be a good time to review them and to identify some of the similarities and differences between ICD-10-CM and ICD-9-CM. You may be surprised to see how much hasn’t changed.

The recently released 2011 updates to the ICD-10-CM Official Coding Guidelines can be found on the National Center for Health Statistics website at

About the Author

Sarah A. Serling, CCS, CCS-P, CPC, CPC-H, CPC-I, CEMC, ICD-10-CM/PCS Trainer, is a Medical Coding Educator/Developer for Precyse. Sarah is credentialed by the AHIMA as an ICD-10-CM/PCS Trainer, a Certified Coding Specialist (CCS) and Certified Physician-based Coding Specialist (CCS-P). She is also credentialed by the AAPC as a certified coding instructor (CPC-I) and as a certified professional coder of physician (CPC) and hospital services (CPC-H) with specialty certification in Evaluation/Management Services (CEMC).

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