ICD-10-CM KEVIN SOLINSKY, CPC, CPC-I, CEDC, CEMC PRESIDENT HEALTHCARE CODING CONSULTANTS, LLC

ICD-10-CM

KEVIN SOLINSKY, CPC, CPC-I, CEDC, CEMC PRESIDENT

HEALTHCARE CODING CONSULTANTS, LLC

480-200-4590

ICD-10 FINAL RULE

▪ Implementation date October 1, 2014.

▪ ICD-9-CM codes will not be accepted by payers on or order October 1, 2014.

▪ Single implementation date for all users.

▪ Date of service for physician reporting.

▪ Date of discharge for inpatient setting.

BENEFITS OF ICD-10-CM

▪ Improved accuracy and specificity.

▪ Ability to more accurately track public health risks.

▪ Improved capacity for tracking quality and safety of care.

CURRENT ICD-9-CM STRUCTURE

▪ The current ICD-9-CM structure utilizes:

▪ 3-5 character codes

▪ First character is either numeric or alphabetic (E or V)

▪ Always a minimum of three characters up to a

maximum of five characters.

NEW ICD-10-CM STRUCTURE

▪ Approximately 13,600 codes have been expand to over 69,000 ICD-10-CM codes.

▪ ICD-10-CM features a significantly different code structure:

▪ 3-7 character codes

▪ First character is always alphabetical (all except “U”)

▪ Character 2 is always numeric

▪ Characters 3-7 are either alpha or numeric

SOME THINGS ARE THE SAME…

▪ The tabular list is chronological just as in ICD-9-CM and chapters are divided based on condition or body system.

▪ The tabular list has the same structure and is in code number order just as in ICD-9-CM.

▪ Codes are found the same way using the alphabetic

index to identify the code section then verifying in the

tabular section.

….. AND SOME THINGS ARE NOT

▪ The first character is always alphabetic (except for “U”)

▪ Codes are up to 7 characters

▪ Many codes have laterality (right or left)

▪ Injuries are grouped anatomically now instead of by the

type of injury

ICD-10-CM - “X” PLACEHOLDER CHARACTER

▪ The use of the placeholder character “X” to allow for future expansion in the code set.

▪ Use to fill in blank when a code has fewer then 6 characters yet a 7 ^th character applies.

Example:

M22.8x1 Other disorders of patella, right knee

The “x” allows for future expansion to this

code section.

ICD-10-CM – 7 ^th CHARACTERS

Certain ICD-10-CM categories have applicable 7 ^th

characters. The applicable 7 ^th character is required for all codes within the category, or as the notes in the

Tabular List instruct. The 7 ^th character must always be the 7 ^th character in the data field. If a code that requires a 7 ^th character is not 6 characters (or 5 or 4), a

placeholder X must be used to fill in the empty characters.

ICD-10-CM Draft Official Guidelines for Coding and Reporting 2013

Section 1. Conventions, general coding guidelines and chapter specific guidelines

Item 5

ICD-10-CM – EXCLUDES NOTES

▪ Excludes notes indicate a code cannot be used together with another code on the list because the two conditions cannot be coded together.

▪ There are two types of excludes notes in ICD-10-CM.

▪ Excludes 1

▪ Excludes 2

ICD-10-CM – EXCLUDES 1

A type 1 Excludes note is a pure exclusion not. It means

“NOT CODED HERE!”. The note indicates the code should never be used at the same time as the code above the Excludes 1 note. An Excludes 1 is used when two conditions cannot occur together such as a congenital form versus an acquired form of the same condition.

ICD-10-CM Draft Official Guidelines for Coding and Reporting 2013

Section 1. Conventions, general coding guidelines and chapter specific guidelines

Item 12a

ICD-10-CM – EXCLUDES 2

A type 2 Excludes note represents “Not included here”. An Excludes 2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes 2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.

ICD-10-CM Draft Official Guidelines for Coding and Reporting 2013

Section 1. Conventions, general coding guidelines and chapter specific guidelines

Item 12b

ICD-10-CM – ADDITIONAL CODES

▪ Just as in ICD-9-CM some conditions require multiple codes to describe the patients condition.

▪ Codes will have a note such as:

▪ Code first (possible underlying cause)

▪ Use additional code (possible additional code to add

specificity to the diagnosis.

ICD-10-CM – COMBINATION CODES

▪ ICD-10-CM features new combination codes.

▪ Where previously two or more codes were needed to describe a condition now only one is.

▪ Example:

Type 2 Diabetes Mellitus with Diabetic Neuropathy ICD-9-CM – 250.60 & 357.2

ICD-10-CM – E11.40

ICD-10-CM – CHAPTER 1 (A00-B99)

▪ CERTAIN INFECTIOUS AND PARASITIC DISEASES

▪ Organized similar to ICD-9-CM however some category and subcategory titles have been changed.

▪ Changes to the organization of viral hepatitis codes.

▪ Many of the codes have been expanded to reflect

manifestations by means of additional characters

(combination codes).

ICD-10-CM – CHAPTER 1 (A00-B99)

▪ HIV / AIDS

▪ Code only confirmed cases of HIV infection/illness. This is an exception to the hospital inpatient guideline Section II, H.

▪ Confirmation does not require positive serology or culture for HIV only the providers diagnostic statement that the patient is HIV positive.

▪ When sequencing HIV codes if the patient is admitted for an HIV

related condition the code B20 (HIV) should be primary followed

by additional diagnosis codes for all reported HIV-related

conditions.

ICD-10-CM – CHAPTER 1 (A00-B99)

▪ HIV / AIDS

▪ When a patient is admitted with an unrelated condition who has HIV the code for the unrelated condition should be principal.

▪ For an asymptomatic HIV patient Z21 is assigned when the patient is without any documentation of symptoms or conditions caused/related to the HIV status but is documented as being HIV positive or some similar terminology.

▪ If a patient has a previously diagnosed HIV related illness do not

use Z21 again instead use B20.

ICD-10-CM – CHAPTER 2 (C00-D49)

▪ NEOPLASMS

▪ Organized in blocks with primary first.

▪ In situ neoplasms now in the block before benign.

ICD-10-CM – CHAPTER 2 (C00-D49)

▪ NEOPLASMS

▪ New category is “overlapping lesions”. A primary malignant neoplasm that overlaps two or more contiguous sites should be classified to subcategory/code .8 (‘overlapping lesion’) unless the combination is specifically indexed elsewhere

▪ For multiple lesions of the same site that are not contiguous

such as tumors in different breast quadrants of the same

breast codes for each site should be assigned.

ICD-10-CM – CHAPTER 3 (D50-D89)

▪ DISEASES OF THE BLOOD AND BLOOD FORMING

ORGANS AND CERTAIN DISORDERS INVOLVING THE IMMUNE MECHANISM

▪ New organization with codes in blocks making it easier to identify the type of conditions classified in Chapter 3.

▪ Example:

ICD-9-CM 282.4 Thalassemias

ICD-10-CM D56 Thalassemia

D56.0 Alpha Thalassemia

D56.1 Beta Thalassemia

D56.2 Delta-beta Thalassemia

D56.3 Thalassemia minor

D56.4 Hereditary persistence [HPFH}

D56.8 Other Thalassemias

D56.9 Thalassemia, unspecified

ICD-10-CM – CHAPTER 3 (D50-D89)

▪ DISEASES OF THE BLOOD AND BLOOD FORMING

ORGANS AND CERTAIN DISORDERS INVOLVING THE IMMUNE MECHANISM

▪ No guidelines have been written for this section yet.

ICD-10-CM – CHAPTER 4 (E00-E89)

▪ ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES

▪ Several new subchapters added.

▪ Diabetes combination codes.

▪ Five categories now instead of one.

▪ Reflect manifestations and complications (combination codes).

▪ Malnutrition codes.

ICD-10-CM – CHAPTER 4 (E00-E89)

▪ DIABETES MELLITUS

▪ If the type of diabetes is not documented in the record the default is E11.- ( Type 2 DM ).

▪ If the record doesn’t mention the type but states the patient uses

insulin E11.- should be assigned ( Type 2 DM ). Also code Z79.4

(long term insulin use). Insulin use should be not coded if it is only

being given temporarily to lower the patients blood sugar.

ICD-10-CM – CHAPTER 5 (F01-F99)

▪ MENTAL AND BEHAVIORAL DISORDERS

▪ Several new subchapters added.

▪ More accurately reflects modern terminology.

▪ Nicotine use and addiction more definable.

ICD-10-CM – CHAPTER 6 (G00-G99)

▪ DISEASES OF THE NERVOUS SYSTEM

▪ This section is organized similarly to ICD-9-CM.

▪ Exception is that it only contains nervous system

diseases as the eye/ear sections each now have their own chapter.

▪ Alzheimer’s disease codes are expanded to reflect onset.

ICD-10-CM – CHAPTER 6 (G00-G99)

▪ Dominant/Non-Dominant

▪ If the side is specified but not listed as dominant or non- dominant the default is right side dominant.

▪ Pain (G89 category codes)

▪ Category G89 codes are acceptable as principal diagnosis or first listed code when pain control or pain management is the reason for encounter. The underlying cause of pain should also be listed.

▪ When a patient is admitted for insertion of pain control

neurostimulator or other device.

ICD-10-CM – CHAPTER 6 (G00-G99)

▪ DISEASES OF THE NERVOUS SYSTEM

▪ Pain (G89 category codes)

▪ When a category G89 code supplies more specific information it may be used on conjunction with a site specific pain code.

▪ Example: Acute neck pain due to trauma (G89.11)

followed by cervicalgia (M54.2).

ICD-10-CM – CHAPTER 7 (H00-H59)

▪ DISEASES OF THE EYES AND ADNEXA

▪ New section for ICD-10-CM.

▪ Laterality a major feature of this section.

Example:

H05.01 Cellulitis of Orbit

H05.011 Cellulitis of right orbit H05.012 Cellulitis of left orbit

H05.013 Cellulitis of bilateral orbits

H05.019 Cellulitis of unspecified orbit

ICD-10-CM – CHAPTER 7 (H00-H59)

▪ DISEASES OF THE EYES AND ADNEXA

▪ Glaucoma stages & laterality.

▪ When a patient has documented bilateral glaucoma with both eyes are the same stage use only one code if the classification doesn’t distinguish laterality.

▪ When a patient has documented bilateral glaucoma with

different stages use two codes.

ICD-10-CM – CHAPTER 8 (H60-H95)

▪ DISEASES OF THE EAR AND MASTOID PROCESS

▪ New section for ICD-10-CM.

▪ Laterality a major feature of this section.

▪ Many more “code first underlying disease” notes.

ICD-10-CM – CHAPTER 9 (I00-I99)

▪ DISEASES OF THE CIRCULATORY SYSTEM

▪ Terminology changes to more accurately reflect modern medical practice and documentation.

▪ One big change is hypertension which is no longer specified as benign, malignant or unspecified.

▪ I10 Essential (primary) hypertension

includes high blood pressure,

hypertension (arterial) (benign)

(essential) (malignant) (primary) (systemic)

ICD-10-CM – CHAPTER 9 (I00-I99)

▪ DISEASES OF THE CIRCULATORY SYSTEM

▪ Heat conditions classified I50.- or I51.4-I51.9 are assigned to a code from category I11 (Hypertensive Heart Disease) when a causal relationship is stated or implied.

▪ Example: “due to htn” or “hypertensive”.

ICD-10-CM – CHAPTER 10 (J00-J99)

▪ DISEASES OF THE RESPIRATORY SYSTEM

▪ Terminology changes to more accurately reflect modern medical practice and documentation.

▪ Individual codes for recurrent sinusitis for each sinus.

▪ Acute Bronchitis expanded to include manifestations

(combination codes).

ICD-10-CM – CHAPTER 11 (K00-K94)

▪ DISEASES OF THE DIGESTIVE SYSTEM

▪ Several new subcategories including diseases of the liver that were grouped with other diseases in ICD-9-CM.

▪ Crohn’s disease expanded to 4 ^th , 5 ^th and 6 ^th characters.

▪ 4 ^th – Location of disease

▪ 5 ^th – Complication present

▪ 6 ^th – Classifies the complication

ICD-10-CM – CHAPTER 12 (L00-L99)

▪ DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE

▪ Decubitus ulcer coding now includes location, laterality and stage all in one code.

▪ Example:

Stage III Decubitus Ulcer of the Left Heel

ICD-9-CM 707.14 & 707.23

ICD-10-CM L89.623

ICD-10-CM – CHAPTER 12 (L00-L99)

▪ DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE

▪ When pressure ulcers are documented as healed no code is used.

▪ Patients with pressure ulcers documented as healing should be assigned the appropriate stage code based on the documentation.

▪ If the stage is evolving into another stage during an

admission assign the code for the highest stage.

ICD-10-CM – CHAPTER 13 (M00-M99)

▪ DISEASES OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE.

▪ ICD-10-CM expands this section from four subchapters to 18.

▪ Almost every code in the section has been expanded to include very specific location and laterality.

▪ Some subcategories require a 7 ^th character to define healing stage for fractures.

(initial encounter, subsequent encounter with routine /

delayed / nonunion / malunion / sequelae)

ICD-10-CM – CHAPTER 14 (N00-N99)

▪ DISEASES OF THE GENITOURINARY SYSTEM

▪ This chapter includes many new “includes notes” to help clarify the types of disorders.

▪ Example:

N00 Acute Nephritis Syndrome

Includes: Acute glomerular disease

Acute glomerulonephritis

Acute nephritis

ICD-10-CM – CHAPTER 14 (N00-N99)

▪ DISEASES OF THE GENITOURINARY SYSTEM

▪ CKD is staged based on severity.

▪ If both a stage of CKD and ESRD are both assigned use only

code N18.6.

ICD-10-CM – CHAPTER 15 (O00-O94)

▪ PREGNANCY, CHILDBIRTH AND THE PUERPERIUM

▪ The former episode of care specificity has been replaced with 5 ^th and 6 ^th character specification of trimester.

▪ ICD-10-CM requires the use of a 7 ^th character at times to

identify the fetus to which certain complication codes may

attributed.

ICD-10-CM – CHAPTER 16 (P00-P96)

▪ CERTAIN CONDITIONS ORIGINATING IN THE PERINATAL PERIOD

▪ ICD-10-CM contains terminology updates for example the terms

“fetus” and “newborn” have been removed from code titles.

▪ The first block of codes for newborns affected by material factors

now includes “suspected to be” in the code title.

ICD-10-CM – CHAPTER 17 (Q00-Q99)

▪ CONGENITAL MALFORMATIONS, DEFORMATIONS AND CHROMOSOMAL ABNORMALITIES

▪ New codes provide greater specificity and laterality.

ICD-10-CM – CHAPTER 18 (R00-R99)

▪ SYMPTOMS, SIGNS AND ABNORMAL CLINICAL AND

LABORATORY FINDINGS, NOT ELSEWHERE CLASSIFIED

▪ Organized by the body system involving the signs and symptoms.

▪ Codes that describe symptoms and signs are acceptable for reporting purposes when a related definitive diagnosis has not been establish (confirmed) by the provider.

▪ Codes for signs and symptoms may be reported in addition to a

related definitive diagnosis when the sign or symptom is not

routinely associated with that diagnosis.

ICD-10-CM – CHAPTER 18 (R00-R99)

▪ SYMPTOMS, SIGNS AND ABNORMAL CLINICAL AND LABORATORY FINDINGS, NOT ELSEWHERE CLASSIFIED

▪ ICD-10-CM includes a number of combination codes that identify both a definitive diagnosis and common symptoms of the diagnosis.

When using one of these combination codes an additional code should not be assigned for the symptom.

▪ New code R29.6 is used for Repeated Falls when a patient has

recently fallen.

ICD-10-CM – CHAPTER 19 (S00-T88)

▪ INJURY, POISONING AND CERTAIN OTHER CONSEQUENCES OF EXTERNAL CAUSES

▪ Major change to this section.

▪ ICD-9-CM organized section by type of injury.

▪ ICD-10-CM organizes section by location of injury.

Example:

S00-S09 Injuries to head

S10-S19 Injuries to neck

S20-S29 Injuries to thorax

ICD-10-CM – CHAPTER 19 (S00-T88)

▪ INJURY, POISONING AND CERTAIN OTHER CONSEQUENCES OF EXTERNAL CAUSES

▪ Most categories in chapter 19 have a 7 ^th character requirement for each applicable code. Most have three 7 ^th character values (with the exception of fractures).

▪ A. Initial

▪ D. Subsequent encounter

▪ S. Sequela

ICD-10-CM – CHAPTER 19 (S00-T88)

▪ INJURY, POISONING AND CERTAIN OTHER CONSEQUENCES OF EXTERNAL CAUSES

▪ When coding injuries assign separate codes for each injury unless a combination code is provided.

▪ Code T07 (unspecified multiple injuries) should not be used in the inpatient setting unless information for more specific codes is not available.

ICD-10-CM – CHAPTER 20 (V00-Y99)

▪ EXTERNAL CAUSES OF MORBIDITY

▪ With ICD-10-CM external causes are no longer located in a supplemental classification system (ie: E-Codes).

▪ The causes currently in the E-Code section of ICD-9-CM are now

located in either chapter 19 or chapter 20 of ICD-10-CM.

ICD-10-CM – CHAPTER 21 (Z00-Z99)

▪ FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVICES

▪ Basically the current V-Code section.

▪ Some codes are actually less specific in ICD-10-CM for example the ICD-9-CM V09 code had specificity for the type of drug a

microorganism was resistant too but ICD-10-CM does not.

2014 ICD-10-CM CONVENTIONS - REMINDERS

▪ Just as in ICD-9-CM conditions that are an integral part of a disease process are not coded with the disease

diagnosis.

▪ Example: A patient presents with a fever, cough, shortness of breath and fatigue. A chest xray is

performed and a diagnosis of pneumonia is made. All of these symptoms are integral parts of pneumonia

thus they would not be coded with the diagnosis.

▪ Only code the symptoms when instructed by the classification.

▪ When a condition is not an integral part of a disease

process you should code the signs and symptoms.

2014 ICD-10-CM CONVENTIONS - REMINDERS

▪ If the same condition is described as both acute (subacute) and chronic and separate subentries exist in the alphabetic index at the same indentation level code both and sequence the acute code first.

▪ Use a combination code instead when available and do not code separately acute/chronic conditions with two codes.

▪ For the assignment of BMI, non-pressure chronic ulcer depth and pressure ulcer stage codes the code assignment can be made based on medical record documentation from

clinicians who are not the provider (ex: wound care nurse).

ICD-10-CM

Questions?