ICD-10:  Unspecified Codes
Written by Editor   
Monday, August 24, 2015 12:00 AM

The Journal of AHIMA warns about taking the easy road and reporting unspecified codes, stating, "Yes, there is an 'unspecified' code in ICD-10, and you can code it all you want. But in two to three years when you review your severity and risk scores you will be in bad shape, because you won't have the specificity in your codes that you need to justify higher levels and better reimbursement."

With this information in mind, if unspecified codes are available in ICD-10, how can a provider know when it is appropriate to use them?

AHIMA's  Clarification on the Use of External Cause and Unspecified Codes in ICD-10-CM  states, "In both ICD-9-CM and ICD-10-CM, sign/symptom and 'unspecified' codes have acceptable, even necessary, uses... If a definitive diagnosis has not been established by the end of the encounter, it is appropriate to report codes for sign(s) and/or symptom(s) in lieu of a definitive diagnosis.

When sufficient clinical information isn't known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate "unspecified" code... It would be inappropriate to select a specific code that is not supported by the medical record documentation or conduct medically unnecessary diagnostic testing in order to determine a more specific code."


Source: ACA