1st Edition

Advanced ICD-10 for Physicians Including Worker’s Compensation and Personal Injury

By Eugene Fukumoto Copyright 2017
    294 Pages 25 B/W Illustrations
    by Productivity Press

    294 Pages 25 B/W Illustrations
    by Productivity Press

    ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization. It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury of diseases. The code set allows more than 14,000 different codes and permits the tracking of many new diagnoses.

    The U.S. has used ICD-10-CM (Clinical Modification) since October, 2015. This national variant of ICD-10 was provided by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics, and the use of ICD-10-CM codes are now mandated for all inpatient medical reporting requirements.

    This book is for physicians, practice managers and all others who need learn ICD-10. It’s designed for the clinician to learn how to put their diagnosis into a code and not rely on staff or computer software programs to decide it form them.

    ICD-10 is a complex system of coding and Medicare and third party insurers have been lenient giving providers a year to get used to the coding system. As a result, physicians and their staff have become very complacent regarding proper coding. However, Medicare and third party insurers will soon begin to deny claims which are not coded correctly, which in turn will cost physician groups time and money.

    This book focuses on Worker’s Compensation and Personal Injury, a very large segment of the healthcare industry and is a new area to ICD-10. The diagnosis coding for injuries is much different than for Medicare or group insurance and unless the physicians and their staff learn how to use it properly, they risk losing income for themselves and worse, they risk losing the case for the patient.


    1: Introduction to Worker’s Compensation and Personal Injury in ICD-10

    2: Structure Overview of the "2015 ICD-10-CM"

    • Code structure basics
    • Using ICD-10 Overview

    3: Components of ICD-10 and Their Usage

    • ‘Z’ codes and their importance in Worker’s Compensation/Personal Injury
    • A basic 7-Step process for Diagnostic coding
    • A basic 7-step process case example
    • 6-category process for injury coding

    4: Provider Requirements

    • Combination codes
    • 7th character codes
    • Greater level of detail required
    • External cause codes
    • External causes of morbidity (transport and other)

    5: Worker’s Compensation, Personal Injury and Drug or Chemically Induced Diabetes

    • Diabetes Mellitus discussion
    • Use of flow charts for diabetes
    • Diabetes flow charts
    • 2015 ICD-10-CM draft release expert edition – diabetes mellitus section

    6: Worker’s Compensation and Personal Injury Billing Guide

    • Personal injury example – case #1
    • Worker’s compensation example – case #2
    • Worker’s compensation example – case #3
    • Billing for physical therapy
    • Billing for injections
    • Billing for x-rays
    • Billing for minor surgical procedures

    7: Commonly Used Diagnosis Codes

    • Abdominal pain – ICD-10 category R10
    • Carpal Tunnel Syndrome in Worker’s Compensation and Personal Injury
    • Psychosocial discussion

    8: Complex Examples and Worksheet section

    • Example of whiplash case
    • Example on pain management
    • Example on carpal tunnel syndrome with multiple other injuries
    • Example on Agreed Medical re-evaluation from an Internal Medical or Cardiovascular standpoint
    • Example on medical sleep disorder evaluation
    • Example on Orthopaedic Agreed Medical evaluation – complicated by Straph Infection following surgery
    • Example on Psychiatric Agreed Medical re-examination

    9: Causation and Apportionment in Worker’s Compensation and Personal Injury

    10: Dilemma of the Independent Medical Evaluator

    • The Law of Unintended Consequences
    • Overview for Independent Medical Evaluators


    Appendix 1: Medicare coverage, diagnosis requirements and coding edits

    • Correct Coding Initiative (CCI) Edits
    • ICD-9 Diagnosis Codes are used in Current LCD’s

    Appendix 2: Worker’s Compensation and Medicare Set asides

    Appendix 3: Implementation Guide for ICD-10

    Appendix 4: Discussion of ICD-10 Crosswalks

    Appendix 5: Crosswalk from ICD-9 to ICD-10 of common diagnosis codes used in Worker’s Compensation and Personal Injury with notes on potential problem areas

    Appendix 6: Glossary

    Appendix 7: General Sample Fee Slip

    Appendix 8: New California Worker’s Compensation Forms

    Appendix 9: Web Links for additional information


    Eugene Fukumoto is President and General Manager of Health Claims Services, Inc., a consulting firm that manages the billing and collection for sole proprietors and medical groups including provider disputes with Insurance Companies. He is an authorized billing vendor for the Regents of the University of California, and has contracted with the USC School of Medicine and UCLA. He previously was General Manager for Health Computer Systems, a referenced Hewlett-Packard software vendor of medical billing systems which developed the first electronic billing software for medical practices. He is the author of numerous publications including Conquering ICD-10 for Chiropractors and Conquering ICD-10 for Family Physicians and General Practice.