ChiroCode’s ICD
-10
Boot Camp
Presented by Evan M. Gwilliam, MBA DC
CPC CCPC NCICS CCCPC CPC-I MCS-P CPMA
Sponsored by
1
Objectives
•
Gain a basic understanding of ICD-10
•
Understand the reason for the transition
•
Identify the similarities and differences from ICD-9
•
Get familiar with relevant guidelines
•
Learn how to select the right codes
•
Learn how to document properly
•
Know how to implement ICD-10
•
Reduce ICD-10 related anxiety
Recommended Tools
Inside you will find:• Comprehensive list of relevant ICD-10-CM codes for Chiropractic (~15,000 codes)
• Tools to help you convert from ICD-9-CM to ICD-10-ICD-9-CM
o GEMs code map
o Commonly used codes
o Alphabetic index
• Complete guide to understanding ICD-10-CM coding
• Other aids you need for a painless
transition. 3
ChiroCode’s Complete and Easy ICD-10 Coding for Chiropractic
Recommended Tools
You could also use the complete code set (~68,000 codes), available from multiple publishersDisclaimer
Every attempt has been made to make this presentation as current as possible, but things change
5
Be sure to check with your local carriers and Medicare for updates as the
ICD-10 implementation
date gets closer
Subscribe to ChiroCode
alerts or follow ChiroCode
on Twitter for updates that pertain
to DCs
The Landscape
The Landscape
7
CMS-1500 Claim form
8
•Approved for official use 08/05
•www.nucc.orgfor official instructions
9
CMS-1500 Claim form
10
Revision 02/12
•Changed to match the electronic format (5010) and ICD-10 codes
•Adds space for eight more diagnosis codes in box 21.
•January 6th, 2014 - Health plans and clearinghouses must
accept the form.
Why do we have diagnosis codes?
•
HIPAA requirement
•
Establish medical necessity
•Process claims
•
Translate written terminology into
common language
•
Provide data for statistical analysis
•Identify fraud, set healthcare policy,
measure quality
11
Where did they come from?
•
ICD-9 was developed by the World Health
Organization for public health and statistical
analysis
•
First revision 1893, ninth revision 1979
o Shifted focus from mortality to morbidity• “ICD-9-CM” means Clinical Modification - for use with health care claims in the U.S.
• ICD-9-CM was mandated in 1988 under the Medicare Catastrophic Coverage Act, then reaffirmed by HIPAA in 1996
How do I know which
codes to use?
Follow payer guidelines for code sequencing. Diagnosis code hierarchy:
1. Neurological 2. Structural 3. Functional 4. Soft tissue
• For example, sciatica (724.3) and DDD (722.4) will carry more weight than spasm (728.85) or myalgia (729.1)
• It is said that some software only looks at the first diagnosis when adjudicating a claim, so make it count!
13
Medicare Universal Diagnosis List: Short term (6-12 treatments)
• 721s Spondylosis
• 723-724s Back Pain
Moderate term (12-18 treatments)
• 353s Root lesions
• 722.9s Unspecified disc disorders
• 724s Stenosis
• 846-7s Sprains
Long term (18-24 treatments)
• 722s Degeneration, displaced discs
14
How do I know which
Do not code the “kitchen sink”. Example: • 847.0Sprain of neck
• 723.4Brachial neuritis or radiculitis NOS
• 739.1Nonallopathic lesions, cervical region
• 728.4Laxity of ligament (cervical)
• 728.85Spasm of muscle (cervical)
• 729.1Myalgia and myositis, unspecified
• 847.1Sprain of thoracic
• 724.4Thoracic or lumbosacral neuritis or radiculitis, unspecified
• 739.2Nonallopathic lesions, thoracic region
• 728.4Laxity of ligament (thoracic)
• 728.85Spasm of muscle (thoracic)
• 719.7Difficulty in walking
• 784.0Headache
• 780.5Sleep disturbances 15
How do I know which
codes to use?
•
Are all of these codes medically indicated by the
patient’s records?
•
Are any of the rendered codes merely symptoms
of other codes?
•
Are the rendered codes as accurate and precise
as possible, given the supporting medical
documentation?
16
How do I know which
Why can’t we keep using ICD
-9?
•
Too old
•
Many sections are full and
cannot be expanded
•
Not descriptive enough
•
Not able to accurately reflect
advances in medical
knowledge or technology
•
Will not meet healthcare
needs of the future
17
•
Requires excessive reliance on supporting
paper documentation
•
Hampers the ability to compare costs and
outcomes
18
ICD-9
~14,000
codes
ICD-10
~68,000
codes
19
21
Will Oct. 1, 2014 be the end of the world?
•
The World Health Organization issued the tenth
revision of the International Classification of
Disease (ICD-
10) in the early 90’s.
o Each country is responsible for adapting ICD-10 to suit its needs
• Australia uses ICD-10-AM • Germany uses ICD-10-GM • Canada uses ICD-10-CA • United States uses ICD-10-CM
o U.S. has used ICD-10 since 1999 to report mortality data on death certificates
22
• ICD-10-CM(CM=Clinical Modification) was developed by the National Center for Health Statistics for reporting morbidity and mortality in the U.S.
oReady in 1994
oPublic comments 1997-1998
oTested in 2003 by AHA and AHIMA
oFinal rule for implementation published 2009
oPostponed in 2012
oImplementation October 1, 2014 (for sure, maybe)
23
Where did ICD-10 come from?
Won’t they just postpose it again?
•
Jan. 2013, the AMA asked CMS to abandon
ICD-10
•
Feb. 6, 2013, CMS Acting Administrator,
Marilyn Tavenner said no
o Too much work has already been done to turn back now
o The old system won’t work with new technologies o That would penalize innovators
o It is necessary for health care reform
25
Won’t they just postpone it again?
ICD-10 does a better job than ICD-9 with:
•
Providing data for statistical analysis
•
Measuring quality and outcomes
•
Helping to set healthcare policy
•Identifying public health threats
•Identifying fraud and errors
•
Exchanging data among health care entities
In other words, we need it to improve our health
care system.
26•
Still a tabular list divided into chapters based
on body system or condition
•
Similar hierarchy
•
Still an index with main terms and sub-terms
•
Must code to the highest level of specificity
•
ICD-10 is mandated under HIPAA
27
How are ICD-9 and ICD-10 similar?
Conventions are mostly the same
(page 467)NEC“Notelsewhere classified”
Used when the information in the medical record provides detail for which a specific code does not exist NOS “Nototherwisespecified”or“unspecified”
Used when the information in the medical record is insufficient to assign a more specific code.
28
Conventions are mostly the same
(page 467) [ ] Brackets are used in the tabular list to enclosesynonyms, alternative wording or explanatory phrases. Brackets are used in the Index to identify manifestation codes
( ) Parentheses are used in both the Index and Tabular to enclose supplementary words that may be present or absent in the statement of a disease or procedure without affecting the code number to which it is
assigned. The terms within the parentheses are referred to as nonessential modifiers
29
How are ICD-9 and ICD-10 similar?
Conventions are mostly the same
“Includes”
This note appears immediately under a three-digit code title to further define, clarify, or give examples of the content of a code category.
“And”
The word “and” should be interpreted to mean either
“and” or “or” when it
appears in a title… “either or”
30
Conventions are
mostly
the same
“Excludes”
Excludes1 –is used when two conditions cannot occur
together or “NOT CODED HERE!” Mutually exclusive
codes; two conditions that cannot be reported together. Excludes2 – indicates “NOT INCLUDED HERE.”
Although the excluded condition is not part of the condition, it is excluded from, a patient may have both conditions at the same time. The excluded code and the code above the excludes can be used together if the documentation supports them.
31
How are ICD-9 and ICD-10 similar?
Conventions are mostly the same
“Code First/Use additional code”
Provides instructions on how to “sequence” the codes.
Signals that that an additional code should be reported to provide a more complete picture of the diagnosis.
“Code Also”
Alerts the coder that more than one code may be
required to fully describe the condition. The sequencing of the codes depends on the severity and/or the reason for the encounter.
32
33
How are ICD-9 and ICD-10 similar?
I. Official Guidelines (about
30 pages
)
II. Indexes
i.
Diseases and Injuries (300 pages)
i. Neoplasms (20 pages)ii. Drugs and Chemicals (30 pages)
iii. External Causes (20 pages)
ICD-9
34
I. Official Guidelines (about
30 pages
)
II. Indexes
i.
Diseases and Injuries (340 pages)
ii. Neoplasms (20 pages)
iii. Drugs and Chemicals (50 pages)
iv. External Causes (35 pages)
How are ICD-9 and ICD-10 similar?
35
How are ICD-9 and ICD-10 similar?
III. Tabular list (340 pages) 1. Infectious Diseases 2. Neoplasms 3. Endocrine 4. Blood 5. Mental 6. Nervous 7. Circulatory 8. Respiratory 9. Digestive 10. Genitourinary 11. Pregnancy 12. Skin 13. Musculoskeletal
14. Congenital malformations 15. Perinatal
16. Signs and Symptoms 17. Injuries and Poisoning E-codes. External Causes
V-codes. Health Status
ICD-9
36 III. Tabular list (600 pages)
1. Infectious Diseases 2. Neoplasms 3. Blood 4. Endocrine 5. Mental 6. Nervous 7. Eye 8. Ear 9. Circulatory 10. Respiratory 11. Digestive 12. Skin 13. Musculoskeletal 14. Genitourinary 15. Pregnancy 16. Perinatal
17. Congenital malformations 18. Signs and Symptoms 19. Injuries and Poisoning 20. External Causes 21. Health Status
How are ICD-9 and ICD-10 similar?
37
Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00 –M99)
• M00 to M25, Arthropathies (diseases of the joints)
• M40 to M43, Dorsopathies (diseases of the spine)
• M45 to M49, Spondylopathies (diseases of the vertebrae)
• M50 to M54, Other Dorsopathies
• M60 to M63, Disorders of Muscles
• M65 to M67, Disorders of synovium and tendons
• M70 to M79, Other soft tissue disorders
• M80 to M94, Osteopathies and Chondropathies (diseases of bone and cartilage)
How are ICD-9 and ICD-10 similar?
•
The alphanumeric structure of ICD-10 allows for
more specific information
•
Increased codes and categories allow for more
accurate representation of the patient’s
diagnoses
38
Feature ICD-9-CM ICD-10-CM
Number of Codes About 14,000 About 68,000
Number of characters •3-5 characters in length •Characters are all numeric (or E or V)
•Decimal is used after 3 characters
•3-7 characters in length •Character 1 is alpha •Character 2 is numeric •Characters 3-7 are alpha or numeric
•Decimal is used after 3 characters
•Some codes use “x” for characters 4-6
•Character 7 used in certain chapters Number of chapters 17 chapters (plus E and V) 21 chapters
39
How are ICD-9 and ICD-10 different?
Feature ICD-9-CM ICD-10-CM
Start Date 1975, 1979 in US 1994, 2014 in US
Expansion Very limited Has significant ability
to expand without a structural change
Detail Lacks detail Very specific
Laterality Lacks laterality Includes laterality
when appropriate
Encounters Encounters are not
defined
Initial and subsequent encounters are defined Combination Codes Combination codes
are limited
Combination codes are frequent
40
ICD-10
ICD-9
41
How are ICD-9 and ICD-10 different?
42
43
How are ICD-9 and ICD-10 different?
Placeholder “x” character (guidelines, page 466)
ICD-10-CM utilizes a placeholder character “x” in
positions 4, 5, and/or 6 in certain codes to allow for future expansion.
7th Characters
Certain ICD-10-CM categories have applicable 7th
characters. The applicable 7th character is required for all codes within the category, or as the notes in the Tabular List instruct. The 7th character must always be the 7th character in the data field. If a code that requires a 7th
character is not 6 characters, a placeholder “x” must be
used to fill in the empty characters.
ICD-10-CM code for chronic gout due to renal
impairment, left shoulder, without tophus.
Note: there are 11 gout codes in ICD-9 and 365 in ICD-10
44
45
What are some ICD-10 examples?
In ICD-9:
E844.8
Sucked into a jet without damage to airplane;
ground crew
46
What are some ICD-10 examples?
In ICD-10:
V97.2
:
Sucked into a jet without damage to
airplane;
47
What are some ICD-10 examples?
In ICD-10:
V97.2
9&
A
#g
€
:
Sucked into a jet without damage to
airplane;
luggage cart driver;
male; under 5’5” in
height;
slightly bald;
wearing a tank top;
during a
full moon
• V95.42XA: Spacecraft crash injuring occupant, initial encounter.
• W59.22XA: Struck by a turtle, initial encounter • G44.82: headache associated with sexual activity • V91.07XA: Burn due to water-skis on fire, initial
encounter (search for this one on FindACode.com)
• T75.01XD: shock due to being struck by lightning, subsequent encounter • Y34: Unspecified event,
undetermined intent • R45.2: Unhappiness
48
49
• M refers to "diseases of the musculoskeletal system and connective tissue."
• After the letter are two characters, then a decimal, then more characters which add more specific information.
• For example, the “21” in M21.752(page 183) refers to "other acquired deformities of limbs" • The “7” adds the detail of "ʺunequal limb
length."
• The “5” tells us that it is at the femur
• The “2” tells us that it is on the left
What are some ICD-10 examples?
50
W61.43 Pecked by a turkey
Migraines
(page 140)
44 choices available for migraines • Documentation must include:
o With or without aura
o Intractable or not intractable
o With or without status migrainosus
o Persistent or chronic
o With or without vomiting
o With or without opthalmoplegic, menstrual, etc
o Induced by ICD-10 training
G43.701 Chronic migraine without aura, not intractable, with status migrainosus
51
What are some ICD-10 examples?
In the Alphabetic Index:
o Kissing Spine
In ICD-9
Kissing
Osteophyte 721.5
Spine 721.5
Vertebra 721.5
52
What are some ICD-10 examples?
In ICD-10
Kissing Spine, unspecified M48.20 Occipito-atlanto region M48.21 Cervical region M48.22 Cervicothoracic region M48.23 Thoracic region M48.24 Thoracolumbar region M48.25 Lumbar region M48.26 Lumbosacral region M48.27
Sixty one year old female presents to your office with ongoing right hip pain and stiffness. Patient stated she had a soft-tissue injury to her right hip six years ago following a bicycle accident. X-rays at the time negative for fracture.
Tenderness to palpation in the right hip, with a positive Patrick’s test on
the right reproducing the hip symptoms. X-rays of the left hip were unremarkable, however, the right hip showed sclerosis of the superior aspect of the acetabulum.
DX: Post-traumatic osteoarthritis of the right hip.
ICD-10:
1. M99.06 Segmental and somatic dysfunction of lower extremity 2. M16.51 Unilateral post-traumatic osteoarthritis, right hip
53
What are some ICD-10 examples?
General coding guidelines
(page 470)o ICD-10-CM codes should be listed at their highest level of specificity and characters.
a. Use three digit codes only if there are no four digit codes within the coding category. These are the heading of a category of codes.
b. Use the 4, 5, 6, or 7 digit code to the greatest degree of specificity available. These provide further detail.
54
Which guidelines do DCs
need to know?
General coding guidelines
o Codes that describe symptoms and signs are only acceptable if that is the highest level of diagnostic certainty documented by the doctor. No other diagnosis has been established (confirmed) by the provider. (see R00 to R99)
o Signs and symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.
o Additional signs and symptoms that are not routinely associated with a disease may be reported. 55
Which guidelines do DCs
need to know?
General coding guidelines
o Coding for diagnoses that are probable, suspected, likely or questionable are not to be coded, because they indicate uncertainty.
o Code all documented conditions that coexist at the time of the visit that REQUIRE OR AFFECT patient care. Do not code conditions that no longer exist.
56
Which guidelines do DCs
need to know?
General coding guidelines
o Coding for diagnoses that are probable, suspected, rule out, etc are not allowed for outpatients.
o The acute condition should always be listed before the chronic condition if both are present.
57
need to know?
General coding guidelines
o If the condition is bilateral and there is no bilateral code, then you have to list the left and right code separately.
o List unspecified if laterality is not described
58
Which guidelines do DCs
need to know?
General coding guidelines
(page 472)o An unspecified code should be reported only when it is the code that most accurately reflects what is
known about the patient’s condition at the time of
that particular encounter.
o It is inappropriate to select a specific code that is not supported by the health record documentation or conduct medically unnecessary diagnostic testing in order to determine a more specific code.
.
59
Which guidelines do DCs
need to know?
60 III. Tabular list
1. Infectious Diseases 2. Neoplasms 3. Blood 4. Endocrine 5. Mental 6. Nervous 7. Eye 8. Ear 9. Circulatory 10. Respiratory 11. Digestive 12. Skin 13. Musculoskeletal 14. Genitourinary 15. Pregnancy 16. Perinatal
17. Congenital malformations
18. Signs and Symptoms 19. Injuries and Poisoning 20. External Causes
21. Health Status
ICD-10
Which guidelines do DCs
need to know?
61
Chapter 6: Guidelines for diseases of the nervous system
(G00 –G99) (page 473)
Dominant or non-dominant side in hemiplegia (G81): • For ambidexterous patients, default is dominant • If the left side is affected, default is non-dominant • If the right side is affected, default is dominant Pain (G89)
• For generalized acute, chronic, post-thoracotomy, post-procedural, or neoplasm related.
• Localized pain codes are found in other chapters (i.e. M54.9, back pain)
• G89can be the principal diagnosis when it is reason for visit
need to know?
62
Chapter 13: Guidelines for diseases of the musculoskeletal system and connective tissue
(M00 –M99) (page 476)
Site & laterality
• Site represents the bone, muscle, or joint involved • Bone conditions occurring in a joint are classified by
the bone involved, not the joint
• If a “multiple sites” code is available, use it instead of
listing several sites individually Acute traumatic versus chronic recurrent
• In general acute injury should be coded from chapter 19, recurrent or chronic conditions are coded from chapter 13
Which guidelines do DCs
need to know?
63
Chapter 18: Guidelines for symptom, signs, and abnormal clinical findings, not elsewhere classified
(R00 –R99) (page 477)
Use of symptom codes
• Acceptable when a definitive diagnosis has not been established by the provider
With a definitive diagnosis
• Only when the symptom is not routinely associated with the diagnosis
In a combination code
• Don’t code the symptom separately if it is part of a
combination code
Which guidelines do DCs
need to know?
64
Chapter 19: Guidelines for injury, poisoning, and certain other consequences of external causes
(S00 –T88) (page 478)
The seventh character
• A –initial encounter, while patient is receiving active treatment such as surgery, ER, or evaluation and treatment by a new physician
• D –subsequent encounter, routine care during the healing or recovery phase, such as cast change, medication adjustment, aftercare and follow up • S –sequela, complications or conditions that arise as
a direct result of a condition, such as scar formation after a burn. Sequela code (i.e. scar) is first, then the injury code.
Which guidelines do DCs
need to know?
65
Chapter 19: Guidelines for injury, poisoning, and certain other consequences of external causes
(S00 –T88) (page 478)
Injuries
• Code most serious injury first
• Superficial injuries are not coded with more serious injuries at the same site (such as contusions)
• Primary injury is first, then code for minor injury to nerves and blood vessels
• Pain due to medical devices would sequenced with a T code followed by G89.18or G89.28
need to know?
66
Chapter 20: Guidelines for external causes of morbidity
(V00 –Y99) (page 480)
Never sequenced first
Provide data about cause, intent, place, activity, or status of the accident or patient
No national requirement to use these codes, but voluntary reporting is encouraged
Place of occurrence = Y92, listed after other codes, used only once at initial encounter, in conjunction with Y93 Activity code = Y93, used only once, at initial encounter
Which guidelines do DCs
need to know?
How do I find the ICD-10 code?
Three methods using the ChiroCode ICD-10 book: 1. GEMs code map (but don’t stop there!)
2. Alphabetic index (don’t stop here either!)
3. Commonly used code list (this is not safe either!)
Always confirm the code using the tabular list.
6869
How do I find the ICD-10 code?
General Equivalence Mappings (GEMs)o Created by the National Center for Health Statistics, part of the CDC
o Forward maps from ICD-9 to ICD-10
o Backward maps from ICD-10 to ICD-9
o Download the free tablet/smartphone
app called “FindACode”
o Use the Code Map section in the ChiroCode ICD-10 book (pages 55-131)
o ChiroCode members can access the MapACode tool in their accounts
One-to-one mapping:
723.1
Cervicalgia
M54.2
Cervicalgia
One-to-four mapping:
724.4
Thoracic or lumbosacral neuritis (radicular
syndrome of the lower limbs)
M54.14, M54.15,M54.16, M54.17
Radiculopathy
(How do these four codes differ?)
(page 207)
How do I find the
ICD-10 code?
One-to-many mapping:
733.82
Other disorders of bone and cartilage,
nonunion of fracture
S02.91XK through S92.919K
(for a total of 2530 corresponding ICD-10-CM possibilities)
How do I find the
ICD-10 code?
Look up
724.3
in the “
Code Map
” section
(this is using GEMs-page 82)
-
M54.30
-unspecified codes need to be investigated
Look
up “
sciatica
” in the ICD
-10 index (page 455)
-
M54.3
-at least five characters required to code to
the highest level of specificity
Now find it in the tabular list (page 207)
72
How do I find the
ICD-10 code?
Combination mapping:
724.3
Sciatica
M54.30
Sciatica, unspecified side
M54.31
Sciatica, right side
M54.32
Sciatica, left side
OR
M54.40
Sciatica with lumbago, unspecified
M54.41
Sciatica with lumbago, right side
M54.42
Sciatica with lumbago, left side
ICD-10 code?
One-to-two mapping:
728.85
Spasm of muscle
M62.40
Contracture of muscle, unspecified site
M62.838
Other muscle spasm
But is that the
whole story?
How do I find the
Look up these codes in the tabular list (page 215) and you’ll find:
728.85
Spasm of muscle
M62.40 Contracture Of Muscle Unspecified Site
M62.411 Contracture Of Muscle Right Shoulder
M62.412 Contracture Of Muscle Left Shoulder
M62.419 Contracture Of Muscle Unspecified Shoulder
M62.421 Contracture Of Muscle Right Upper Arm
M62.422 Contracture Of Muscle Left Upper Arm
M62.429 Contracture Of Muscle Unspecified Upper Arm
M62.431 Contracture Of Muscle Right Forearm
M62.432 Contracture Of Muscle Left Forearm
M62.439 Contracture Of Muscle Unspecified Forearm
M62.441 Contracture Of Muscle Right Hand
M62.442 Contracture Of Muscle Left Hand
M62.449 Contracture Of Muscle Unspecified Hand
M62.451 Contracture Of Muscle Right Thigh
M62.452 Contracture Of Muscle Left Thigh
M62.459 Contracture Of Muscle Unspecified Thigh
M62.461 Contracture Of Muscle Right Lower Leg
M62.462 Contracture Of Muscle Left Lower Leg
M62.469 Contracture Of Muscle Unspecified Leg
M62.471 Contracture Of Muscle Right Ankle And Foot
M62.472 Contracture Of Muscle Left Ankle And Foot
M62.479 Contracture Of Muscle Unspecified Ankle And Foot
M62.48 Contracture Of Muscle Other Site
M62.49 Contracture Of Muscle Multiple Sites
M62.830 Muscle Spasm Of Back
M62.831 Muscle Spasm Of Calf
M62.838 Other Muscle Spasm
How do I find the
ICD-10 code?
•Includes “Somatic” and “Segmental” Dysfunction •Note: The word “subluxation” does not appear in
ICD-9-CM in the 739codes.
76
How do I code for a
subluxation?
739.1 - Nonallopathic lesions,
Not Elsewhere Classified; cervical
region, cervicothoracic region
739.1 - Nonallopathic lesions,
Not Elsewhere Classified; cervical
region, cervicothoracic region
•Using GEMs / code map (page 95), we find:
•M99.01: Biomechanical lesions, NEC; segmental and somatic dysfunction of cervical region
•Note: Still no mention of the “subluxation” 77
How do I code for a
subluxation?
•Using the tabular list (page 238), we find:
•M99.11: Subluxation complex (vertebral) of cervical region
•Note: this code maps back to839, not 739
78
How do I code for a
subluxation?
739.1 - Nonallopathic lesions,
Not Elsewhere Classified; cervical
region, cervicothoracic region
•Using the alphabetic index (Subluxation and
dislocation cervical vertebrae) we find:
•S13.100A –S13.181S
•S13.1_ _ _ is “subluxation and dislocation of cervical vertebrae”
Still 54 possible combinations!
Note: These codes all map back to 839codes in ICD-9 79
How do I code for a
subluxation?
739.1 - Nonallopathic lesions,
Not Elsewhere Classified; cervical
region, cervicothoracic region
Fifth character gives the specific vertebral level:
S13.10_ _ Subluxation and dislocation of unspecified cervical vertebrae S13.11_ _ Subluxation and dislocation of C0/C1 cervical vertebrae S13.12_ _ Subluxation and dislocation of C1/C2 cervical vertebrae S13.13_ _ Subluxation and dislocation of C2/C3 cervical vertebrae S13.14_ _ Subluxation and dislocation of C3/C4 cervical vertebrae S13.15_ _ Subluxation and dislocation of C4/C5 cervical vertebrae S13.16_ _ Subluxation and dislocation of C5/C6 cervical vertebrae S13.17_ _ Subluxation and dislocation of C6/C7 cervical vertebrae S13.18_ _ Subluxation and dislocation of C7/T1 cervical vertebrae
How do I code for a
subluxation?
Sixth character differentiates between a subluxation and a dislocation:
0= subluxation 1= dislocation
S13.110_ Subluxation of C0/C1 cervical vertebrae S13.111_ Dislocation of C0/C1 cervical vertebrae
How do I code for a
subluxation?
Seventh character identifies the encounter:
S13.110A Subluxation of C0/C1 cervical vertebrae, initial encounter S13.110D Subluxation of C0/C1 cervical vertebrae, subsequent encounter S13.110S Subluxation of C0/C1 cervical vertebrae, sequela
•Seventh character extension:
•A= initial encounter: (i.e. active treatment - initial E/M visit) •D= subsequent encounter: (i.e. healing, recovery, aftercare, or
follow-up)
•S= sequela (complications as a result of an injury) •(ex: scar due to burns)
How do I code for a
subluxation?
•All of these options are listed in the “Commonly Used
Codes for Chiropractic” (page 47) for the cervical region.
• Be sure to confirm the code selected with the tabular list. • Understand the guidelines and conventions.
83
How do I code for a
subluxation?
739.1 - Nonallopathic lesions,
Not Elsewhere Classified; cervical
region, cervicothoracic region
847.0: Sprain of neck
(includes strain of joint capsule, ligament, muscle, tendon)
•Using the Alphabetic index (sprain
of spine cervical) we find:
•S13.4_ _ _ sprain of ligaments of the cervical spine
•Note that there must be seven characters for the code to be
complete. (See page 265)
How do I code for
whiplash?
847.0: Sprain of neck
•Using GEMs / code map (p. 122) we find:
•S13.4xxA sprain of ligaments of the cervical spine •S13.8xxA sprain of joints and ligaments of other parts of the neck
•This represents six possible codes, depending on the 7th
character, or encounter (A: initial, D: subsequent, or S: sequela)
How do I code for
whiplash?
847.0: Sprain of neck
•S13.4xxA specifies the anterior longitudinal
ligament, atlanto-axial joints, atlanto-occipital joints, and whiplash injury
•S13.8xxA just says “other parts of the neck”
•Documentation should match these descriptions.
How do I code for
847.0: Sprain of neck
•Which code will be acceptable? •Contact the payer to be sure
•Note the use of the placeholder “x” •Note the seventh character
How do I code for
whiplash?
847.0: Sprain of neck
(includes strain of joint capsule, ligament, muscle, tendon)
Using the Alphabetic index (injury of muscle, fascia and tendon at neck level) we find:
S16.1xxA Strain of muscle, fascia and tendon at neck level, initial encounter
•Note: S16.xxA maps backward to 847.0
How do I code for
whiplash?
722.4: degeneration of
a cervical
intervertebral disc
•Using GEMs / code map, we find:
•M50.30 other cervical disc degeneration, unspecified cervical region
•Unspecified codes should be avoided, if possible
How do I code for
DDD?
722.4: degeneration of
a cervical
intervertebral disc
•On our own, we find:
•M50.31 other cervical disc degeneration, high cervical region •M50.32 other cervical disc degeneration, mid-cervical region •M50.33 other cervical disc degeneration, cervicothoracic region
How do I code for
DDD?
91
What does the documentation
look like?
Codes must be supported by the documentation in the patient record.
The AAPC estimates an increase in documentation time of 15%.
The AAPC also found that 65% of physician notes were not specific enough.
Examples of details not necessary in ICD-9:
• side of dominance
• trimesters
• stages of healing
• laterality
• ordinality
What does the documentation
look like?
S:Mrs. Finley presents today after having a new cabinet fall on her last week, suffering a concussion, as well as some cervicalgia.She was cooking dinner at the home she shares with her husband.She did not seek treatment at that time.She states that the people that put in the cabinetin her kitchenmissed the stud by about two inches. Her husband, who was home with her at the time told her she was “out cold” for about two minutes.The patient continues to have cephalgiassince it happened, primarily occipital, extending up into the bilateral occipital and parietal regions. The headaches come on suddenly, last for long periods of time, and occur every day. They are not relieved by Advil.She denies any vision changes, any taste changes, any smell changes. The patient has a marked amount of tenderness across the superior trapezius.
O:Her weight is 188 which is up 5 pounds from last time, blood pressure 144/82, pulse rate 70, respirations are 18. She has full strength in her upper extremities. DTRs in the biceps and triceps are adequate. Grip strength is adequate. Heart rate is regular and lungs are clear.
A: Status post concussionwithacutepersistentheadaches
Cervicalgia
Cervical somatic dysfunction
P:The plan at this time is to send her for physical therapy, three times a week for four weeks for cervical soft tissue muscle massage, as well as upper dorsal. We’ll recheck her in one month, sooner if needed.
S06.0x1A Concussion with loss of consciousness of 30 minutes or less,initial encounter
G44.311 Acutepost traumatic headache,intractable
M54.2 Cervicalgia
M99.01 Segmental and somatic dysfunction of cervical region
W20.8xxAStruck by falling object (accidentally),initial encounter Y93.G3 Activity, cooking and baking
Y92.010 Place of occurrence, house, single family, kitchen
93
http://www.aapc.com/icd-10/icd-10-documentation-example.aspx
What does the documentation
look like?
What does the documentation
look like?
“Exam findings are consistent with cervical sprain/strain and
acute cephalgiadue to motor vehicle accident”
In ICD-9, the codes might be:
• 847.0Cervical sprain
• 339.21Acute post-traumatic headache
• E813.0Motor vehicle traffic accident involving collision with other vehicle; driver of motor vehicle other than motorcycle injured
What does the documentation
look like?
“Exam findings are consistent with cervical sprain/strain and
acute cephalgiadue to motor vehicle accident”
In ICD-9, the codes might be:
•
847.0
Cervical sprain
• 339.21Acute post-traumatic headache
• E813.0Motor vehicle traffic accident involving collision with other vehicle; driver of motor vehicle other than motorcycle injured
95
What does the documentation
look like?
“Exam findings are consistent with cervical sprain/strain and acute cephalgia due to motor vehicle accident”
In ICD-9, the codes might be:
• 847.0Cervical sprain
General Equivalence Mappings (free FindACode app) suggest the following codes:
• S13.4xxASprain of ligaments of the cervical spine, initial encounter
OR
• S13.8xxASprain of other parts of the neck, initial encounter
Note: When you look up S13.4xxAin the tabular list, you will find which parts of the cervical spine it includes in the fine print. This is why you need a complete book, not just a short crosswalk list of codes.
What does the documentation
look like?
“Exam findings are consistent with cervical sprain/strain and acute cephalgiadue to motor vehicle accident”
In ICD-9, the codes might be: • 847.0Cervical sprain
If you knew to look up
“injury of muscle, facscia and tendon at necklevel” in the index you would also find:
• S16.1xxA Strain of muscles, fascia and tendon at neck level, initial encounter
Note: Sprain and strain are separate codes in ICD-10.
Crosswalks won’t tell you about this code, you need to know how to use the alphabetic index.
97
What does the documentation
look like?
“Exam findings are consistent with cervical sprain/strain and
acute cephalgiadue to motor vehicle accident”
In ICD-9, the codes might be:
• 847.0Cervical sprain
•
339.21
Acute post-traumatic headache
• E813.0Motor vehicle traffic accident involving collision with other vehicle; driver of motor vehicle other than motorcycle injured
What does the documentation
look like?
“Exam findings are consistent with cervical sprain/strain and
acute cephalgia due to motor vehicle accident”
In ICD-9, the codes might be:
• 339.21Acute post-traumatic headache GEMs suggest:
• G44.319Acute post-traumatic headache, not intractable
Note: In the index G44.319is next to G44.311which is the intractable version of this condition.
o Intractable means “hard to control or deal with”
o This must be documented in order to select the correct code.
99
What does the documentation
look like?
“Exam findings are consistent with cervical sprain/strain and
acute cephalgiadue to motor vehicle accident”
In ICD-9, the codes might be:
• 847.0Cervical sprain
• 339.21Acute post-traumatic headache
•
E813.0
Motor vehicle traffic accident
involving collision with other vehicle;
driver of motor vehicle other than
motorcycle injured
What does the documentation
look like?
“Exam findings are consistent with cervical sprain/strain and
acute cephalgiadue to motor vehicle accident”
In ICD-9, the codes might be:
• E813.0Motor vehicle traffic accident involving collision with other vehicle; driver of motor vehicle other than motorcycle injured
Note: External cause codes describe location, circumstances, and causes of injury. More detail is needed since these codes are greatly expanded in ICD-10.
(However, they are only required if you already use ICD-9 E-codes)
101
What does the documentation
look like?
“Exam findings are consistent with strain and sprain of the ligaments and muscles of the cervical spine and acute traumatic headache, which does not respond to over the counter medications. Patient was the driver of a vehicle that collided with another motor vehicle on the interstate. He
was not treated at the scene.” The ICD-10 codes in this case are:
• S13.4xxASprain of ligaments of the cervical spine, initial encounter
• S16.1xxA Strain of muscles, fascia and tendon at neck level, initial encounter
• G44.311Acute post-traumatic headache, intractable
• V49.40xADriver injured in collision with unspecified motor vehicle, traffic accident, initial encounter
• Y92.411Interstate as place of occurrence of the external cause
What does the documentation
look like?
“Exam findings are consistent with strain and sprain of the ligaments and muscles of the cervical spine and acute traumatic headache, which does not respond to over the counter medications. Patient was the driver of a vehicle that collided with another motor vehicle on the interstate. He
was not treated at the scene.” The ICD-10 codes in this case are:
• S13.4xxASprain of ligaments of the cervical spine, initial encounter
• S16.1xxA Strain of muscles, fascia and tendon at neck level, initial encounter
• G44.311Acute post-traumatic headache, intractable
• V49.40xADriver injured in collision with unspecified motor vehicle, traffic accident, initial encounter
• Y92.411Interstate as place of occurrence of the external cause
103
What does the documentation
look like?
“Exam findings are consistent with strain and sprain of the ligaments and muscles of the cervical spine and acute traumatic headache, which does not respond to over the counter medications. Patient was the driver of a vehicle that collided with another motor vehicle on the interstate. He
was not treated at the scene.” The ICD-10 codes in this case are:
• S13.4xxASprain of ligaments of the cervical spine, initial encounter
• S16.1xxA Strain of muscles, fascia and tendon at neck level, initial encounter
• G44.311Acute post-traumatic headache, intractable
• V49.40xADriver injured in collision with unspecified motor vehicle, traffic accident, initial encounter
• Y92.411Interstate as place of occurrence of the external cause
What does the documentation
look like?
“Exam findings are consistent with strain and sprain of the ligaments and muscles of the cervical spine and acute traumatic headache, which does not respond to over the counter medications. Patient was the driver of a vehicle that collided with another motor vehicle on the interstate. He
was not treated at the scene.” The ICD-10 codes in this case are:
• S13.4xxASprain of ligaments of the cervical spine, initial encounter
• S16.1xxA Strain of muscles, fascia and tendon at neck level, initial encounter
• G44.311Acute post-traumatic headache, intractable
• V49.40xADriver injured in collision with unspecified motor vehicle, traffic accident, initial encounter
• Y92.411Interstate as place of occurrence of the external cause
105
What does the documentation
look like?
“Exam findings are consistent with strain and sprain of the ligaments and muscles of the cervical spine and acute traumatic headache, which does not respond to over the counter medications. Patient was the driver of a vehicle that collided with another motor vehicle on the interstate. He
was not treated at the scene.” The ICD-10 codes in this case are:
• S13.4xxASprain of ligaments of the cervical spine, initial encounter
• S16.1xxA Strain of muscles, fascia and tendon at neck level, initial encounter
• G44.311Acute post-traumatic headache, intractable
• V49.40xADriver injured in collision with unspecified motor vehicle, traffic accident, initial encounter
• Y92.411Interstate as place of occurrence of the external cause
What does the documentation
look like?
“Exam findings are consistent with strain and sprain of the ligaments and muscles of the cervical spine and acute traumatic headache, which does not respond to over the counter medications. Patient was the driver of a vehicle that collided with another motor vehicle on the interstate. He
was not treated at the scene.” The ICD-10 codes in this case are:
• S13.4xxASprain of ligaments of the cervical spine, initial encounter
• S16.1xxA Strain of muscles, fascia and tendon at neck level, initial encounter
• G44.311Acute post-traumatic headache, intractable
• V49.40xADriver injured in collision with unspecified motor vehicle, traffic accident, initial encounter
• Y92.411Interstate as place of occurrence of the external cause
107
What does the documentation
look like?
“Exam findings are consistent with strain and sprain of the ligaments and muscles of the cervical spine and acute traumatic headache, which does not respond to over the counter medications. Patient was the driver of a vehicle that collided with another motor vehicle on the interstate. He was not treated at the scene.”
The ICD-10 codes in this case are:
• S13.4xxASprain of ligaments of the cervical spine, initial encounter
• S16.1xxAStrain of muscles, fascia and tendon at neck level, initial encounter
• G44.311Acute post-traumatic headache, intractable
• V49.40xADriver injured in collision with unspecified motor vehicle, traffic accident, initial encounter
• Y92.411Interstate as place of occurrence of the external cause
What does the documentation
look like?
“Exam findings are consistent with strain and sprain of the ligaments and muscles of the cervical spine and acute traumatic headache, which does not respond to over the counter medications. Patient was the driver of a vehicle that collided with another motor vehicle on the interstate. He
was not treated at the scene.” The ICD-10 codes in this case are:
• S13.4xxASprain of ligaments of the cervical spine, initial encounter
• S16.1xxA Strain of muscles, fascia and tendon at neck level, initial encounter
• G44.311Acute post-traumatic headache, intractable
• V49.40xADriver injured in collision with unspecified motor vehicle, traffic accident, initial encounter
• Y92.411Interstate as place of occurrence of the external cause
109
Example
You diagnose a patient with the ICD-9 code 723.3Cervicobrachial syndrome.
o Cervicobrachial syndrome (diffuse) is a term used to indicate a collection of symptoms that arise due to the anterior (inside) neck muscles compressing the nerve root known as the brachial plexus, which controls movement of and sensation from the nerves of the shoulder and arm. This disorder presents with pain that radiates from the shoulder to the arm and/or the back of the neck, and may also present with muscle weakness in the arm.
• A code map using GEMs (pages 55-131) says that the ICD-10 code could be:
M53.1 Cervicobrachial syndrome
• The alphabetic index (pages 441-457) says that the ICD-10 code could be:
M53.1 Cervicobrachial syndrome
• The tabular list (page 206) confirms that the code is:
M53.1 Cervicobrachial syndrome
Example
M53.1 Cervicobrachial syndrome The fine print in the tabular list says:
-Excludes2:
cervical disc disorder (M50._)
thoracic outlet syndrome (G54.0)
This means that these diagnoses are not included in this code. If they are present, these codes should be listed as well. This information did not appear in ICD-9.
111
Quiz
#10. Patient presents with pain, weakness, numbness, and tingling in both legs. The final diagnosis is
bilateral sciatica. a) M54.41, M54.42 b) M54.31, M54.32 c) M54.5
d) M54.9
What method did you use to find the answer?
ICD-10 Myths
• October 1, 2014 will be the end of the world • The date will be delayed
• Worker’s Comp and Auto insurance will still use
ICD-9
• The number of codes make ICD-10 impossible to use • Documentation requirements will make ICD-10
impossible to use
• ICD-10 is already out of date • ICD-10 will replace CPT
http://www.cms.gov/Medicare/Coding/ICD10/downloads/ICD-10MythsandFacts.pdf
How do I implement ICD-10
in my practice?
How do I implement ICD-10
in my practice?
115
Front Desk
• System updates, training Management
• Vendor and payer contracts • Budgeting
• Training plan
• Compliance plan, coding guidelines
Providers
• Documentation with more specificity
• New code specific training
Which parts of a practice will
Clinical areas
• New patient coverage policies • New super bills
• New LCDs Billing
• Code set training
• Reimbursement policies (more denials?)
Which parts of a practice will
be affected?
118
According to CMS, 1
in 5 physician
practices will see
Medicare denials
double within 6
months because they
weren't prepared for
ICD-10 by Oct. 1, 2014.
How do I implement ICD-10
Readiness Survey:
1. What do you already know about ICD-10?
2. Why are we changing?
3. How much do you think ICD-10 will affect
your clinic?
4. What specific questions would you like
answered on ICD-10?
5. Where do you plan to go for more
information?
How do I implement ICD-10
in my practice?
Questions for your software vendors:
•
What implementation plans do you have in
place?
•
What software changes will be needed (if any)?
•
What products and services will be available?
•
When will you be ready to test your program?
•
What guidance and assistance will you provide
during the rollout?
•
Is your clearinghouse ready?
http://www.cms.gov/Medicare/Coding/ICD10/Downloads /ICD10TalkingtoVendorforMedicalPractices.pdf
How do I implement ICD-10
in my practice?
Budgeting for ICD-10 falls into four categories:
1. Information systems upgrades
2. Auditing and monitoring documentation for
ICD-10
3. Education and training
4. Staffing and overtime costs
According to a RAND corporation study, it
could cost as much as $40,000 on average,
but small clinics may be closer to just $4,000.
How do I implement ICD-10
in my practice?
Places to update your ICD-9 codes:
•
EHR/EMR
•
Software
–
allow time for updates and training.
•
Forms
–
charting forms, internal forms, etc.
•
Documents
–
ex. ABN form
•
Website
•
Contracts
•
Policy & Procedure Manuals
•
Inter-departmental documents
How do I implement ICD-10
in my practice?
Update the list of ICD-9 codes you use most often. Create a new superbill with yourspecific ICD-10
mapping!
Start with GEMs code maps, the common code list, and the alphabetic index, but recognize the need to dig deeper.
How do I implement ICD-10
in my practice?
Medicare: free training
ChiroCode.com:free email alerts and webinars, more training, memberships, and chart audits, coding tools
FindACode.com: Crosswalks and other advanced tools
ICD10Monitor.com: free articles AAPC.comand AHIMA.org
How do I implement ICD-10
in my practice?
How do I implement ICD-10
in my practice?
1. Learn the basics-review these notes again with your whole office
2. Buy ChiroCode Complete and Easy ICD-10 Coding for Chiropractic or some other comprehensive resource 3. Dedicate a few minutes of each office meeting to ICD-10
1. Assign someone to read ten pages from the book, then report on what they learned (only 45 intro pages). 2. Find articles in Chiropractic trade journals and share
them at each meeting.
3. Run a report with the list of most common ICD-9 codes, then create your own crosswalk
4. Take a real patient file and crosswalk it to ICD-10, then rework the documentation.
How do I implement ICD-10
in my practice?
5. Use the project management steps in the book (page 36) to keep on track. You will:
1. Plan a budget for implementation expenses 2. Create an internal crosswalk
3. Update all your forms 4. Contact all your vendors 5. Conduct internal testing 6. Use ChiroCode Consulting
services if you need help. 7. Have a good time!
How do I implement ICD-10
in my practice?
•
Researchers will have better data
•
Physicians will need to work on documentation
•
Billers and coders will need to get familiar with
which codes are preferred by payers
•
Payers will be able to reimburse more accurately
•
Expect increased rejections, denials, and payment
delays as both health plans and providers get used
to the new codes.
128
Is ICD-10 good….
or bad?
Recommendation: don’t procrastinate.
129
Is ICD-10 good….
or bad?
Procrastination
Dr. Evan Gwilliam
•
Education
• Bachelor’s of Science, Accounting - Brigham Young University
• Master’s of Business Administration - Broadview University
• Doctor of Chiropractic, Valedictorian - Palmer College of Chiropractic
•
Certifications
• Certified Professional Coder (CPC) - AAPC
• Nationally Certified Insurance Coding Specialist (NCICS) - NCCT
• Certified Chiropractic Professional Coder (CCPC) - AAPC
• ChiroCode Certified Chiropractic Professional Coder (CCCPC) - ChiroCode
• Certified Professional Coder –Instructor (CPC-I) - AAPC
• Medical Compliance Specialist –Physician (MCS-P) - MCS
• Certified Professional Medical Auditor (CPMA) –AAPC, NAMAS
• Certified ICD-10 Trainer - AAPC
131
Dr. Evan Gwilliam
•Affiliations / Experience
• Chiropractic Practice –in Washington and Utah
• Executive Director of Education and Consulting –ChiroCode Institute
• Editorial Board Member - ICD10Monitor.com
• Speaker/Instructor –Cross Country Education, ChiroCode, Target Coding, AAPC, multiple state associations
• Contributor –Chiropractic Economics, ACANews, AAPC Cutting Edge, The American Chiropractor
• Member—National Alliance of Medical Auditing Specialists
