To keep the medical establishment and insurance companies working together with the shared goal of good patient care and treatment, medical billing and coding professionals must have a strong mastery of the International Classification of Diseases, Tenth Revision, Clinical Modification, also known as the ICD-10-CM. This system is used to ensure insurance companies have the information they need to pay for medical care for insured patients. This universally recognized system enables medical professionals to maintain accuracy and uniformity when diagnosing illness and disease.
Because it’s crucial to use the correct billing codes when requesting payments and approval for procedures from insurance companies, medical billers and coders typically must pass a proficiency assessment to become credentialed. This guide takes some of the mystery out of the ICD-10-CM assessment by providing a breakdown of what to expect, tips for success, and expert advice on what you need to know to make the most of this crucial exam.
Breaking Down the ICD-10-CM: The Basics
Understanding the ICD-10-CM should always begin with a comprehension of how it’s organized and what the numbers mean. Let’s look at how it’s arranged and what to expect from the different alphanumeric classifications.
How the ICD-10-CM Is Arranged
The system relies on alphanumeric classifications, with each segment of those classifications signifying something different. Each code consists of three to seven characters, with the first three characters defining the broader diagnosis and the following characters becoming more specific. Here’s how they break down:
There are 21 chapters in the ICD-10-CM 2016 edition. These chapters are divided based on the overarching subject of each section. Here’s what you’ll find in the number ranges of diagnosis codes.
ICD-10-CM Codes and Diagnoses
|A00-B99||Certain infectious and parasitic diseases|
|D50-D89||Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism|
|E00-E89||Endocrine, nutritional and metabolic diseases|
|F01-F99||Mental, behavioral and neurodevelopmental disorders|
|G00-G99||Diseases of the nervous system|
|H00-H59||Diseases of the eye and adnexa|
|H60-H95||Diseases of the ear and mastoid process|
|I00-I99||Diseases of the circulatory system|
|J00-J99||Diseases of the respiratory system|
|K00-K95||Diseases of the digestive system|
|L00-L99||Diseases of the skin and subcutaneous tissue|
|M00-M99||Diseases of the musculoskeletal system and connective tissue|
|N00-N99||Diseases of the genitourinary system|
|O00-o9A||Pregnancy, childbirth, and the puerperium|
|P00-P96||Certain conditions originating in the perinatal period|
|Q00-Q99||Congenital malformations, deformations, and chromosomal abnormalities|
|R00-R99||Symptoms, signs, and abnormal and clinical laboratory findings, not elsewhere classified|
|S00-T88||Injury, poisoning, and certain other consequences of external causes|
|V00-Y99||External causes of morbidity|
|Z00-Z99||Factors influencing health status and contact with health services|
As an example, let’s say a child goes to the doctor with ear pain. Upon examination, an ear infection is found in the right ear. The code for this would read H66.91, which translates to “otitis media, unspecified, right ear.” Another example is a person who is injured in a motor vehicle accident. Though the diagnosis will change as more information is determined about the condition, the initial code would be V89.2XXA. The first part of the code reflects a vehicle accident, while the last part of the code reflects the circumstances of the injury, but not the specific injury.
Keys to Earning ICD-10-CM Certification
Are you ready to get started with earning the important certification for medical billing or coding positions? Here is a step-by-step guide on how to get it done.
Test Preparation Tips for the ICD-10-CM
You’ll need a good test preparation strategy to become a credentialed medical billing and coding professional, and these five ideas can get you there.
Though this is an open-book test, it will help to know exactly which section of the book you need to go to in order to begin answering a question. Flashcards that help you memorize the 21 chapters and some of the most common sub-sections can be a game-changer when you’re taking the test.
This is especially important if you intend to take the timed test. When taking a practice test, set a timer that sends an alert at certain intervals to give you an idea of how much time you have left. Try to make a point of getting it all done within the time frame, but use up all that time to ensure you’ve got the answers right.
Ask a friend to give you a potential scenario in which someone has an illness or injury. As they elaborate on the scenario, go through the book to find the codes that best fit that situation. This can help give you a better idea of the most common codes, and perhaps help you stumble over obscure ones.
Refresh your memory on anatomy and physiology
For some medical professionals, this was the first class you took, and your memory might be a bit rusty. Pull out that old textbook and brush up on the things you’ve almost forgotten. These reminders can help you when taking the ICD-10-CM test.
Know exactly what is expected
Get the answers to your crucial questions. Where will you take the test? When do you have to be there? What do you need to bring? Will you be doing this online or in person? Are there any rules you must adhere to for your particular testing facility or test choice? Knowing what to expect can enhance your confidence, which can enhance how well you do on the test.
Insight From an Expert on the ICD-10-CM
Sena Ayatey, the medical program director at Texas Advancement Center, is a 2013 graduate of Stephan F. Austin University with a Bachelor of Science in Kinesiology. Sena has been working at Medical City Dallas for the last 7 years, starting as a patient care tech and now working in the medical billing department, all while starting and running a successful trucking company. Sena came on board with the Texas Advancement Center in February of 2020.
Q. What’s the most difficult part of passing the ICD-10-CM exam?
A. In my opinion, the most difficult part of passing the ICD-10-CM exam is recalling the ranges and the corresponding injury/disease.
Q. The ICD is updated regularly. What should students be aware of right now to help them stay ahead of the curve when the ICD-11 becomes the norm?
A. Students should be aware of the major changes that will be coming along when ICD-11 becomes the norm, including how data is identified when recording harmful events. Students should be paying close attention to how the current pandemic is affecting the industry.
Q. What do you wish more students would pick up on and use as they go through medical billing and coding courses?
A. I wish more students would pick up how to break down the code in sections and understand how the sections come together. This would ultimately help streamline the process and help the student avoid coding errors.
Q. Do you have any tips on how students can break up their study of the ICD-10-CM to make them more effective on test day?
A. My suggestion to students would be to first understand the basic structure of the diagnosis code. Next, I would suggest studying the ICD-10-CM in blocks according to the range defined by the first three characters.
Q. Anything else you’d like to add about the ICD-10-CM exam?
A. The proficiency exam doesn’t necessarily test memorization of the ICD-10-CM manual, but it does test whether or not the student can understand the code’s structure and properly identify elements of the code.
The following resources can help you prepare for the test, learn more about the codes, and find places to get further information.
Study Materials and Aids
- Clinical Concepts for Family Practice. This is a list of codes for those in family practice; this can serve as an excellent study guide for some of the most common issues you might see in coding.
- Flashcards: Learn ICD-10. This site offers a variety of flashcards designed to help you memorize the pertinent codes of the ICD-10.
- ICD-10-CM Basic Coding Training Workbook. Offered through agencies in North Carolina, this training book can serve as an excellent guide for those studying for the test.
- ICD-10-CM Self-Study Resources. Students can find numerous study guides here, such as webinars, practice assessments, and online coding training.
- ICD-10-CM Theory Quiz. This multiple-choice quiz can help point out strengths and weaknesses as you prepare for the test.
Webinars and YouTube Videos
- AHA Coding Clinic Advisor. Filled with webinars, quizzes, and educator resources, this website offers a wealth of study and information for billing and coding experts.
- Code Master Coach. This YouTube channel is a medical coding tutor who covers a wide variety of issues surrounding the ICD-10-CM.
- Coding with Kate. This helpful YouTube channel focuses on the ICD-10-CM as well as other issues in healthcare that are related to billing, coding, and insurance.
- ICD-10-CM Webinars. These webinars offered through the American Academy of Pediatrics is a great way to brush up on the basics and the theories around the coding process.
Apps and Social Media
- CPC Exam Prep. Offered by Pocket Coder, this app has over 500 practice questions and 17 content subjects, right there on your smartphone.
- ICD10 Consult. This app offers a searchable database of ICD-10 codes, conversions from ICD-9 to the newer requirements, and more functions to help you get through your day without opening up that big book to find what you need.
- MD Code Pro. Providers no longer have to worry about using the right codes. This program can help them find exactly what they need with a few swipes and clicks.
- Supercoder Blog. This regularly-updated blog focuses on timely issues with the ICD-10 codes, such as adding vaping-related codes and mastering seven characters.
Associations and Official Sites
- American Association of Professional Coders. This is where students go to take the exam that will lead to the credential they need in the billing and coding field.
- American College of Physicians: ICD-10. The ACP offers numerous resources for those who are just learning as well as those who are already working in the field.
- American Health Information Management Association. The AHIMA is a go-to resource for those who want to do anything from brush up on their skills to get education and training to taking the important steps to become certified.
- World Health Organization: Classifications. Where the ICD-10 and all other iterations started, the WHO offers information on all the past classifications as well as current and emerging ones.