8/24/2015. be oriented to the ICD-10-CM code set. explore similarities and differences between ICD-9-CM and ICD-10-CM

(1)

Nebraska Academy of Family Physicians

8/28/15 Lincoln 8/29/15 Omaha 9/25/15 North Platte 9/26/15 Grand Island 10/30/15 Nebraska City

Presented by:

Pam Koch, RHIA, CCS, CCS-P AHIMA-approved ICD-10 Trainer

2015 HealthInfo Innovations 2



be oriented to the ICD-10-CM code set



explore similarities and differences between ICD-9-CM and ICD-10-CM



review ICD-10-CM Coding Conventions



analyze and apply Official Coding

Guidelines

(2)

 Implementation date

October 1, 2015

for all users (medical providers and most insurance payers)

 Report appropriate code set by date of service…

◦ICD-9 now through September 30

◦ICD-10 as of October 1

◦Split pro fee claims for hospital services/procedures if dates of hospitalization span September to October

◦Explore system settings by payer (in case they are not ready)

 Claim will reject or deny if wrong code set is used – payers will NOT convert diagnoses codes for you

 Services prior to 10/1/15, will continue to flow through billing systems for a period of time – software needs ability to report either ICD-9 or ICD-10 codes by DOS

ICD-10-

CM

diagnoses will be used by all providers in every health care setting

ICD-10-

PCS

procedures will be used only for hospital claims for inpatient hospital procedures



CPT will continue to be used on professional fee claims (clinic claims and claims for physician visits to inpatients)

Current version available free online at http://www.cms.gov/Medicare/Coding/ICD10 /2016-ICD-10-CM-and-GEMs.html

Book is available

2015 draft has the same codes as FY2016

(3)

Limited code updates to capture new technologies and diseases only; therefore,

◦No changes have been made to ICD-9-CM diagnosis codes since 10/1/12

Code freeze will continue throughout implementation delay

First regular update to ICD-10-CM/PCS would be October 1, 2016

The “Tabular” will show codes in number order and their descriptions

(4)

(5)

2015

ICD-9-CM ICD-10-CM

Dysphagia 787.20 R13.10

Dysphagia due to stroke 438.82 I69.391

Acute bronchitis 466.0 J20.9

COPD with acute bronchitis 491.22 J44.0

UTI 599.0 N39.0

UTI in pregnancy 646.63

599.0 O23.4-

Hypertension 401.9 I10

Hypertension with CKD 403.90

585.9 I12.9

N18.9 HealthInfo Innovations 13

X X X X

.

Etiology, anatomic site, severity

Added 7^th character for obstetrics, injuries, and external causes of injury

X X X A

M S 0 2 . 6 ^{5 x} ^A

Additional Characters Alpha

(Except U)

2 Numeric 3-7 Numeric or Alpha

3–7 Characters

ICD-9-CM ICD-10-CM

14,000+ codes 69,000+ codes

Consists of 3-5 characters Consists of 3-7 characters First character is numeric OR

alphabetic E or V

• First character is always alpha

• 2^nd character is a number

• Remaining characters are mixed

• All letters used except U

• Alpha characters are NOT case- sensitive

Decimal placed after first three characters

17 chapters & two supplementary classifications (V & E codes)

21 Chapters

(6)

ICD-10-CM Code Code Description

I10 Hypertension (controlled) (uncontrolled)

K21.9 GERD

O09.91 Supervision of high risk pregnancy, unspecified, first trimester

J45.909 Asthma

S52.319A Greenstick fracture of shaft of radius left arm, initial encounter

(7)

Pain in limb 729.5

M79.601 Pain in right arm M79.602 Pain in left arm

M79.604 Pain in right leg M79.605 Pain in left leg

…plus more codes for upper arm, forearm, hand, finger, thigh, lower leg, foot and toe

2015

DOCumentation tip!

Continue to specify the body site of limb pain and left or right…now it can be coded specifically.

HealthInfo Innovations 19

Hypospadias (male) 752.61

Q54.0 Hypospadias, balanic

Q54.1 Hypospadias, penile Q54.2 Hypospadias, penoscrotal Q54.3 Hypospadias, perineal Q54.8 Other hypospadias Q54.9 Hypospadias, unspecified

2015

DOCumentation tip!

Specify the type of hypospadias if known

…now it can be coded specifically.

(8)

Only one code to report encounter for any immunization

ICD-9-CM

ICD-10-CM 604.90

Orchitis and epididymitis, unspecified

2015

Acute MI (I21.-) MI specified as acute or with a stated duration of 4 weeks (28 days) or less from onset

Subsequent acute MI (I22.-) acute MI occurring within four weeks (28 days) of a previous acute MI regardless of site

Abortion vs. Fetal Death – 20 weeks

Early vs. late vomiting of pregnancy – 20 weeks

(9)

2015

 Corrosions – burns due to chemicals Example: T21.51 Corrosion of first degree of chest wall

 Blood alcohol level (Y90.-)

 Blood type (Z67.-)

 Type of fracture – greenstick, transverse, oblique, spiral, comminuted, segmental, other, and unspecified

 Tobacco (use vs. dependence, environmental exposure, occupational environmental exposure)

 Underdosing – taking less of a medication than is prescribed by a physician or a manufacturer’s instruction with a resulting negative health consequence

DOCumentation tip!

2015

New coding concept – Underdosing is taking less of a medication than is prescribed by a physician or a manufacturer’s instruction with a resulting negative health consequence.

DOCumentation tip!

Codes for Underdosing should never be assigned as a first listed on a claim.

Intentional Z91.128

due to financial hardship Z91.120

Unintentional Z91.138

due to patient’s age related debility Z91.130 Never assigned as principal or first-listed codes.

Instead, code first the health consequence of underdosing.

(10)

situation to report an Underdosing code ? A. 85 y/o male with CHF who has increasingly had problems with edema and SOB. The patient had been prescribed Lasix but admits he forgets to take his medication every day.

B. Patient found to be subtherapeutic upon encounter for Coumadin drug monitoring due to previous history of DVT requiring adjustment of drug dosage.

C. 49 y/o female with prescribed antidepressant . Patient presents with increasing symptoms including suicidal ideation . Had been cutting pills in half to make prescription last longer.

D. Patient diagnosed with acid reflux and prescribed Nexium comes in with complaints of continued heartburn, difficulty swallowing, and persistent cough. Upon further questioning patient states he did not fill the prescription due to cost.

2015

T45.516A Underdosing anticoagulant, initial encounter

Only applicable if taken patient took less than prescribed (i.e. didn’t understand dosing instructions) or didn’t take it at all

Code Description

R79.1 Abnormal coagulation profile T45.516A Underdosing anticoagulant, initial

encounter

Z79.01 Long term (current) use of anticoagulants

Z86.718 Personal history of other venous thrombosis and embolism

(11)

General rules for use of the classification

Point dash is a reminder that one or more additional characters are needed to complete the code

Alpha Index Tabular List



X is used as a placeholder in certain codes to allow for future expansion



When a code has less than six characters and a 7

^th

character is required, X is used as a placeholder



Where required the X placeholder(s)

must be used in order for the code to

be considered valid

(12)

2015

X placeholders are sometimes built in the code X placeholders have no meaning but must be present when reporting the code

2015

DOCumentation tip!

Specify the episode of care and stage of healing



M80.00 would result in a denied claim due to invalid diagnosis code



M80.00A would result in a denied claim due to invalid code diagnosis code



M80.00xA is a valid reportable code

(13)



The word “and” should be interpreted to mean “and/or” when it appears in a title.



EXAMPLE:

2015 37

HealthInfo Innovations

2015

Excludes1 – means NOT CODED HERE!

(conditions are mutually exclusive)

•B06 Rubella [German measles]

•Excludes1: Congenital rubella (P35.0) Excludes2 – means not included here

(both may be coded if both are true)

•J04.0 Acute laryngitis

•Excludes2: Chronic laryngitis (J37.0)

(14)

Caution! This code is from the Mental Health chapter of ICD-10-CM

Code to category N52 (in Genitourinary chapter) for impotence of organic origin

(15)

M1A.9 Chronic gout, unspecified

Referring to the previous slide

, which of the following represents a valid reportable ICD- 10-CM diagnosis code for a patient with chronic gout without tophus?

A. M1A.9 B. M1A.90 C. M1A.9x0 D. M1A.9xx0

(16)

1) General Coding Guidelines

2) Diagnostic Coding and Reporting Guidelines for Outpatient Services

Signs and symptoms that are associated routinely with a disease process should NOT be assigned as additional codes, unless otherwise instructed by the classification.

Examples:

◦Knee pain , torn meniscus

◦Vomiting related to gastroenteritis

◦Edema due to congestive heart failure

2015

Example of being otherwise instructed by the classification to use additional code for associated symptoms HealthInfo Innovations 48

(17)



Additional signs and symptoms that may not be associated routinely with a disease process should be coded when present.



Example:

◦

Fainting due to anxiety (code both as fainting is not normally associated with anxiety)

If the same condition is described as both acute (subacute) and chronic…

…code both and sequence the acute (subacute) code first.

EXAMPLE: Acute kidney failure N17.9 Chronic kidney failure N18.9 Unless…a combination code is available

such as “Acute on chronic diastolic heart failure” I50.33

A combination code is a single code used to classify two diagnoses, or

◦A diagnosis with an associated secondary process (manifestation)

◦A diagnosis with an associated complication

Multiple coding should not be used when the classification provides a combination code that clearly identifies all of the elements documented in the diagnosis.

(18)

2015

Type II diabetic with diabetic nephropathy ICD-9-CM…250.40 [583.81]

ICD-10-CM…E11.21

Decubitus ulcer of the right side of the lower back, Stage III

ICD-9-CM…707.03, 707.23 ICD-10-CM…L89.133

Native artery CAD with angina

ICD-9-CM…414.01, 413.9 ICD-10-CM…I25.119

2015

Fractured femur due to osteoporosis, initial encounter

ICD-9-CM…733.14, 733.00 ICD-10-CM…M80.059A

Poisoning by barbiturates, intentional self- harm, initial encounter

ICD-9-CM…967.0, E950.1 ICD-10-CM…T42.3x2A

DOCumentation tip!

Specify the context or relationship of conditions and/or circumstances

(19)

Which of the following is the most appropriate way to code and report hypertension and CKD III ? A. I10 Essential (primary) hypertension

N18.3 Chronic kidney disease, stage 3

B. I12.0 Hypertensive chronic kidney disease with stage 5 chronic kidney disease or ESRD

C. I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease or unspecified CKD

D. I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease or

unspecified CKD

N18.3 Chronic kidney disease, stage 3



Residual effect after the acute phase of an illness or injury.



There is no time limit on when a sequela code can be used. May be apparent early (i.e. cerebral infarct) or months/years later (i.e. due to previous injury)



Generally requires two codes – one

exception is in the context of stroke

(20)

If no bilateral code is provided and the conditions is bilateral, assign separate codes for both the left and right side.

EXAMPLE:

”…the diagnosis is coded as confirmed unless the classification provides a specific entry.

2015

Other abnormal glucose Elevated blood pressure reading, without diagnosis of hypertension

(21)

Sign/symptom and “unspecified” codes have acceptable, even necessary, uses. While specific diagnosis codes should be reported when they are supported the available medical record documentation and clinical knowledge of the patient’s health condition, there are instances when signs/symptoms or unspecified codes are the best choices for accurately reflecting the healthcare encounter. Each healthcare encounter should be coded to the level of certainty known for that encounter.

a •No more specific diagnosis can be made even after all facts have been investigated

b

•Signs or symptoms existing at time of initial encounter - transient and causes not determined

c •Provisional diagnosis in patient failing to return

d •Referred elsewhere before diagnosis made

e •More precise diagnosis not available

f •Certain symptoms, for which supplementary information is provided, that represent important problems in medical care in their own right

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 symptoms(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 (e.g., a diagnosis of pneumonia has been determined, but not the specific type).

(22)

Unspecified codes should be reported when they are the codes that most accurately reflect what is known about the patient’s condition at the time of that particular encounter. 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.

It does not say use unspecified codes to make coding easier

It does not say use unspecified codes to make pick lists in EHRs shorter

It does not say use unspecified codes to fit all the diagnoses you want to use on a charge ticket

“LCDs and NCDs that contain ICD-10 codes for right side, left side, or bilateral do not allow for unspecified side.”

(23)

Do not code diagnoses documented as

◦Probable

◦Suspected

◦Questionable

◦Rule out

◦Working diagnosis or

◦Similar terms indicating uncertainty (possible, likely, ?)

Rather code the conditions(s) to the highest degree of certainty for that encounter/visit, such as symptoms, signs, abnormal test results, or other reason for the visit.

History of CA of prostate (Z85.46)

In coding “history of” means “a patient’s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring”

CA of prostate (C61)

1. Sequence first a code from Z01.81, Encounter for pre-procedural examinations

2. Assign a code for the condition to describe the reason for the surgery 3. Code also any findings related to the

pre-op evaluation.

(24)

Z01.818 Encounter for other preprocedural examination M17.11 Unilateral primary osteoarthritis, right knee

I10 Essential (primary) hypertension G47.33 Obstructive sleep apnea (adult) (pediatric)

ASSESSMENT:

1. Vertigo related to labyrinthitis 2. Rash on legs suspect nummular eczema

3. Borderline diabetes

(25)

2015

Rehearsing the ICD-10 Script:

Coding Examples

Act 1

(26)

Guidelines say… “Code assignment depends on the information that is known at the time the encounter is being coded. For example, if no abnormal findings were found during the examination, but the encounter is being coded before test results are back, it is acceptable to assign the code for “without abnormal findings.”

When assigning a code for “with abnormal findings,” additional code(s) should be assigned to identify the specific abnormal findings(s)



Pre-existing, chronic conditions and history codes may also be included as additional codes

(27)

57 y/o female in for wellness exam. No pap. No abnormal findings at this exam. Diabetes well controlled at this time.

Tetanus booster was given as well as flu shot.

Referring to the previous six slides

, which of the following ICD-10-CM diagnosis codes is NOT appropriate to report for this case scenario?

A. Z00.129 B. Z00.00 C. E11.9 D. Z23

(28)

2015

DOCumentation tip!

Specify right or left. It is not appropriate to document

“unspecified” as a shortcut in an EHR template.

(29)

Conjunctivitis

Hordeolum

Pterygium

Blepharoptosis

Cataract

Visual loss/discomfort

Blindness

Right, left or bilateral options!

(30)

Code for open-angle glaucoma

H40.10x0

(31)

E08 •Diabetes mellitus due to underlying condition

E09 •Drug or chemical induced diabetes mellitus

E10 •Type 1 diabetes mellitus

E11 •Type 2 diabetes mellitus

E13 •Other specified diabetes

2015

NOTE: Use additional code to identify any long term (current) use of insulin (Z79.4) except for Type 1

Many combination codes for diabetes &

manifestation/complication

◦Example: Type II diabetic with diabetic nephropathy ICD-9-CM…250.40 [583.81]

ICD-10-CM…E11.21

Coders cannot assume diabetes is the cause of a condition, therefore, providers must specify “due to” diabetes or use the word “diabetic” in front of the condition to show the causal relationship

Do not document DM only if the patient has a complication of their diabetes

(32)

2015

Diabetes codes are combination codes that include the type of diabetes, the body system affected, and the complications affecting that body system

Assign as many codes from categories E08-E13 as needed to identify all of the associated conditions that the patient has

If the type of diabetes is not documented, the default code is E11.-, Type 2 diabetes mellitus

(33)

No longer classified as controlled or uncontrolled

Index directs us to code diabetes described as inadequately controlled, out of control or poorly controlled by type “with

hyperglycemia”

There are also codes for diabetes by type

“with hypoglycemia” with or without coma

55-year-old female, with diabetic

gastroparesis documented as due

to steroid-induced diabetes. The

patient is on long-term use of

systemic corticosteroids, which are

properly taken.

(34)

E11.9 Type 2 diabetes mellitus without complications K31.81 Gastroparesis

E09.43 Diabetes due to drug or chemical, with gastroparesis

E10.43 Type 1 diabetes mellitus with diabetic gastroparesis

E11.43 Type 2 diabetes mellitus with diabetic gastroparesis

T38.0x1A Poisoning corticosteroid, accidental T38.0x5A Adverse effect corticosteroid T38.0x6A Underdosing corticosteroid Z79.52 Long-term drug therapy, steroid

2015 HealthInfo Innovations ¹⁰0

Referring to the two previous slides, which ICD-10-CM codes are appropriate for this case?

A. E11.9 and K31.84

B. E11.43, T38.0x1A, Z79.52 C. E09.43, T38.0x5A, Z79.52 D. E09.43, T38.0x5A

(35)

2015

New options

Guidelines say…

◦For ambidextrous patients, default should be dominant

◦If left side is affected, default is non-dominant

◦If right side is affected, default is dominant

(36)

2015

J45.2- Mild intermittent asthma J45.3- Mild persistent asthma J45.4- Moderate persistent asthma J45.5- Severe persistent asthma J45.9- Other and unspecified asthma

DOCumentation tip!

Specify the type of asthma

2015 Source: Worldallergy.org

(37)

(38)

ICD-9-CM ICD-10-CM

305.1

Nicotine dependence

20 codes available in category F17 Nicotine dependence

Cigarettes

Chewing tobacco

Other tobacco product

Uncomplicated

In remission

With withdrawal

2015 112 HealthInfo Innovations

(39)

Link to:

 end-stage COPD?

 oral cancer?

 emphysema?

 lung cancer?

Example: F17.229 Nicotine dependence, chewing tobacco, with other nicotine-induced disorders

Tobacco use Z72.0

History of tobacco use Z87.891

◦What is the difference between this code and

Coders please note the main term Smoker directs you to --

see

Dependence, drug, nicotine

Chronic obstructive moderately

persistent asthma exacerbation

due to acute bronchitis in a patient

who smokes a pack of cigarettes

per day

(40)

Referring to the previous slides , what are the ICD-10-CM diagnoses codes to report for this diagnosis?

A. J44.0 J45.41 F17.218 B. J44.1 J45.41 F17.218 C. J44.0, J45.41, F17.210 D. J44.0, F17.218

…and more for each sinus all structured with a

“recurrent” option as shown in this example

Confirmed cases (J09.- and J10.-)

◦Example

Unconfirmed cases, suspected, possible, probable (J11.-)

◦Example

Note: this is an exception to the guideline regarding coding unconfirmed conditions in the outpatient setting.

(41)



The Hypertension table is gone from the classification



Hypertension codes are no longer classified by “benign,” “malignant,”

and “unspecified”



Only one code for essential hypertension – I10

ICD-9-CM ICD-10-CM

427.31 Atrial Fibrillation

I48.0 Paroxysmal AF

I48.1 Persistent AF

I48.2 Chronic AF

I48.2 Permanent AF

(42)

Paroxysmal (I48.0) – Episodes that terminate spontaneously

Persistent (I48.1) – Paroxysmal atrial fibrillation sustained for more than seven days or atrial fibrillation that terminates only with cardioversion

Chronic/permanent (I48.2) – Continuous atrial fibrillation that is unresponsive to cardioversion;

cardioversion will not be reattempted

…and more for each site of Crohn’s disease all structured with the same options as shown in this example

(43)

Crohn’s disease of the sigmoid/rectal intestine with rectal bleeding ICD-9-CM…555.1, 569.3 ICD-10-CM…K50.111

Rehearsing MORE of the ICD-10 Script:

Coding Examples

Act 2

(44)



MUCH greater specificity

◦Type of fracture

◦Specific anatomical site

◦Displaced vs. nondisplaced (when not stated displaced will be coded per Guidelines)

◦Laterality

◦Episode of care

Initial encounter (active treatment)

Subsequent encounter

Sequela

◦Stage of healing

Routine vs. Delayed healing vs.

Nonunion vs. Malunion



Where a 7

^th

character is required it must be used or the code is invalid and will cause a claim rejection or denial.



Applies to most injury codes

(45)



Initial encounter (7

^th

character A)

◦The patient is receiving active treatment for the condition

Surgical treatment

Emergency department encounter

Evaluation and continued treatment by the same or a different physician

While the patient may be seen by a new or different provider over the course of treatment for an injury, assignment of the 7^th character is based on whether the patient is undergoing active treatment and not whether the provider is seeing the patient for the first time.



Subsequent encounter

After patient received active treatment for the condition and is receiving routine care during the healing or recovery phase

Cast change or removal

Removal of external or internal fixation device

Medication management

Other aftercare and follow-up visits following injury treatment

These are applicable to “closed” fracture codes:

A = initial encounter

D = subsequent encounter w/ routine healing G = subsequent encounter w/ delayed healing K = subsequent encounter w/ nonunion P = subsequent encounter w/ malunion S = sequela

(46)

2015

Specify the episode of care and stage of healing DOCumentation

tip!

6 year boy was running and tripped falling forward into a low brick wall and striking both upper arms.

Sustained bilateral greenstick humerus fractures. Comes in today for a follow-up of his

fractures and appears to be healing well at this time.

Referring to the previous two slides, which of the following codes should be reported for this encounter?

A. S42.311 and S42.312 B. S42.311D and S42.312D C. S42.311A and S42.312A D. S42.319D

(47)

Example #1

Patient seen in the ER by Dr. Smith for an injury (A -Initial encounter) and followed up by Dr.

Smith in his office the next day but no active treatment of the injury was required in the office (D –Subsequent encounter)

Example #2

Same as above except patient is followed up by Dr. Smith’s partner, Dr. Jones (D –subsequent encounter)

2015

Example #3

Fracture stabilized in the ER and referred to orthopedist for follow-up care (A – Initial encounter)

Example #4

Same patient presents to a local orthopedist who casts the fracture (A – Initial encounter)

Example #5

Same patient returns to local orthopedist for recheck.

Provider notes healing well. (D – Subsequent encounter for fracture with routine healing). Mother informs provider they are moving to Colorado next week.

Provider recommends an orthopedist in the new area.

Example #6

Same patient presents to the new orthopedist and cast is changed (D – Subsequent encounter for fracture with routine healing)

Example #7

Patient presents for removal of sutures due to laceration of right cheek 10 days ago. Code S01.411D (Subsequent encounter). Do not code Z48.02 “Encounter for removal of sutures.”

Guidelines say…the aftercare Z codes should

not be used for aftercare for conditions such as

injuries or poisonings, where 7

^th

characters are

provided to identify subsequent care.

(48)

DOCumentation tip!

Specify the type of open fracture, episode of care, and stage of healing. NOTE: There is no option

for unspecified. HealthInfo Innovations 2015 142

Gustilo Classification I Low energy, wound less than 1 cm

II Wound greater than 1 cm with moderate soft tissue damage

III High energy wound greater than 1 cm with extensive soft tissue damage

IIIA Adequate soft tissue cover

IIIB Inadequate soft tissue cover

IIIC Associated with arterial injury Used in Categories S52, S72 and S82

Sequela (Late Effect)

◦Complications or conditions that arise as a direct result of a condition

Example: Arthritis due to old fracture now healed

◦Use both the injury code that precipitated sequela and code for sequela

◦S added only to injury code, not sequela code

◦S identifies injury responsible for sequela

◦Specific type of sequela (like scar) sequenced first, followed by injury code

(49)

Traumatic arthritis of the right knee due to lower leg fracture five years ago

M12.561 S82.91xS

Scar due to third degree burn left forearm L90.5

T22.312S

Chronic headaches due to traumatic brain injury R51 S06.9x0S

DOCumentation tip!

Specify the episode of care

(50)

NOTE: Same 7^th character options apply to ALL superficial injuries – abrasion, insect bite, blister, foreign body and external constriction!

Which of the following is the appropriate way to code “neck pain secondary neck sprain, initial encounter?”

A. M54.2 Cervicalgia and

S13.9xxA Sprain of joints and ligaments of unspecified parts of neck B. S19.9xxA Unspecified injury of neck C. S13.9xxA Sprain of joints and ligaments of unspecified parts of neck D. M54.2 Cervicalgia

(51)

151

ICD-10-CM...

Y93.49

Many external cause codes available to show:

◦cause

◦place

◦activity

◦status

Yes some are silly (like they are now) but some have a valid purpose…

Reporting the cause and place (especially if it happened at home) will help get a claim processed by patient insurance. Avoids the

“inquiry to the patient for accident details” step that causes delays in reimbursement.

2015 HealthInfo Innovations ¹⁵2

(52)

2015

day of the last menstrual period 1st •Less than 14 weeks 0 days

2nd

•14 weeks 0 days to less than 28 weeks 0 days

3rd •28 weeks 0 days until delivery

DOCumentation tip!

Specify the weeks of gestation

2015

NOTE: Replaces ICD-9-CM V22 codes

(53)

O09.- in the Obstetrics Chapter

Multiple options for type of high risk

Each option

structured with codes for first, second, third trimester

2015

NOTE: Replaces ICD-9-CM V23 codes

Which of the following is the appropriate supervision of pregnancy code for a G3P2 obstetrical patient with uncomplicated pregnancy (gestation 14 weeks, 3 days)?

A. Z34.01 B. Z34.90 C. O09.212 D. Z34.82

Conditions complicating pregnancy are coded differently than in a patient who is not pregnant!

◦Hypertension (gestational or pre-existing)

◦Diabetes (gestational or pre-existing)

◦Urinary tract infection

◦Tobacco use

◦and MANY others…

All should be coded from the Obstetrics chapter

(54)

2015

Do NOT use Z79.4 “Long-term (current) use of insulin” with O24.414

Category Z3A – Additional codes that identify the specific week of pregnancy

Z3A.00 Weeks of gestation of pregnancy not specified

Z3A.01 Less than 8 weeks gestation of pregnancy Z3A.10 – Z3A.42 for specific week

Z3A.49 Greater than 42 weeks gestation of pregnancy

Note to code this appears at the beginning of the OB Chapter so applies to all codes in the chapter;

however, guidelines say it “may” be added so not required.

2015

DOCumentation tip!

In multiple gestations, specify the fetus affected by the condition

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2015

EXAMPLES

• Single breech fetus = O32.1xx0

• Twins with fetus 1 breech = O32.1xx1

• Twins with fetus 2 breech = O32.1xx2

October 1, 2015 Will your office be ready?

Software update

EHR template revisions

CMS 1500 forms (revised due to ICD-10)

Requisition process for lab, imaging, etc.

Prior authorization process

LCD/NCD coverage issues

Staff training

Loss in productivity at first

Plan for possible increase in rejected claims, transaction issues and/or payers not ready

Plan for revenue slow down for a time

(56)

Located at

http://www.cms.gov/Medicare/Coding/ICD1 0/2016-ICD-10-CM-and-GEMs.html

Two separate files

◦Forward mapping ICD-9 to ICD-10

◦Backward mapping ICD-10 to ICD-9

Be aware it is not always a one-to-one match

GEM file is not pretty; uses no decimals

780.79 “Other malaise and fatigue” maps to…

◦G93.3 Postviral fatigue syndrome

◦R53.1 Weakness

◦R53.81 Other malaise

◦R53.83 Other fatigue (includes Fatigue NOS)

Ganglion of joint 727.41 maps to seven specific joint codes

◦M67.419 shoulder

◦M67.429 elbow

◦M67.439 wrist

◦M67.449 hand

◦M67.459 hip

◦M67.469 knee

◦M67.479 foot

There are additional codes for left or right of each joint as well

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2015

Pam Koch, RHIA, CCS, CCS-P AHIMA-approved ICD-10 Trainer HealthInfo Innovations 223 East 14^th St.

Suite 240 Hastings, NE 68901 Phone: 402-463-6111 Email: [email protected] A medical billing, coding training, and consulting company since June, 2000

R45.2

8/24/2015. be oriented to the ICD-10-CM code set. explore similarities and differences between ICD-9-CM and ICD-10-CM

be oriented to the ICD-10-CM code set

explore similarities and differences between ICD-9-CM and ICD-10-CM

review ICD-10-CM Coding Conventions

analyze and apply Official Coding

Guidelines

October 1, 2015

CM

PCS

CPT will continue to be used on professional fee claims (clinic claims and claims for physician visits to inpatients)

X X X X

.

X X X A

M S 0 2 . 6 5 x A

3–7 Characters

R79.1 Abnormal coagulation profile T45.516A Underdosing anticoagulant, initial

encounter

Z79.01 Long term (current) use of anticoagulants

Z86.718 Personal history of other venous thrombosis and embolism

X is used as a placeholder in certain codes to allow for future expansion

When a code has less than six characters and a 7

character is required, X is used as a placeholder

Where required the X placeholder(s)

must be used in order for the code to

be considered valid

M80.00 would result in a denied claim due to invalid diagnosis code

M80.00A would result in a denied claim due to invalid code diagnosis code

M80.00xA is a valid reportable code

The word “and” should be interpreted to mean “and/or” when it appears in a title.

EXAMPLE:

M1A.9 Chronic gout, unspecified

Referring to the previous slide

Additional signs and symptoms that may not be associated routinely with a disease process should be coded when present.

Example:

Fainting due to anxiety (code both as fainting is not normally associated with anxiety)

such as “Acute on chronic diastolic heart failure” I50.33

Residual effect after the acute phase of an illness or injury.

There is no time limit on when a sequela code can be used. May be apparent early (i.e. cerebral infarct) or months/years later (i.e. due to previous injury)

Generally requires two codes – one

exception is in the context of stroke

“LCDs and NCDs that contain ICD-10 codes for right side, left side, or bilateral do not allow for unspecified side.”

1. Sequence first a code from Z01.81, Encounter for pre-procedural examinations

2. Assign a code for the condition to describe the reason for the surgery 3. Code also any findings related to the

pre-op evaluation.

Z01.818 Encounter for other preprocedural examination M17.11 Unilateral primary osteoarthritis, right knee

I10 Essential (primary) hypertension G47.33 Obstructive sleep apnea (adult) (pediatric)

ASSESSMENT:

1. Vertigo related to labyrinthitis 2. Rash on legs suspect nummular eczema

3. Borderline diabetes

Rehearsing the ICD-10 Script:

Coding Examples

Act 1

Pre-existing, chronic conditions and history codes may also be included as additional codes

57 y/o female in for wellness exam. No pap. No abnormal findings at this exam. Diabetes well controlled at this time.

Tetanus booster was given as well as flu shot.

Referring to the previous six slides

A. Z00.129 B. Z00.00 C. E11.9 D. Z23

H40.10x0

55-year-old female, with diabetic

gastroparesis documented as due

to steroid-induced diabetes. The

patient is on long-term use of

systemic corticosteroids, which are

properly taken.

Referring to the two previous slides, which ICD-10-CM codes are appropriate for this case?

A. E11.9 and K31.84

B. E11.43, T38.0x1A, Z79.52 C. E09.43, T38.0x5A, Z79.52 D. E09.43, T38.0x5A

J45.2- Mild intermittent asthma J45.3- Mild persistent asthma J45.4- Moderate persistent asthma J45.5- Severe persistent asthma J45.9- Other and unspecified asthma

ICD-9-CM ICD-10-CM

see

Chronic obstructive moderately

persistent asthma exacerbation

due to acute bronchitis in a patient

who smokes a pack of cigarettes

per day

Referring to the previous slides , what are the ICD-10-CM diagnoses codes to report for this diagnosis?

A. J44.0 J45.41 F17.218 B. J44.1 J45.41 F17.218 C. J44.0, J45.41, F17.210 D. J44.0, F17.218

The Hypertension table is gone from the classification

Hypertension codes are no longer classified by “benign,” “malignant,”

and “unspecified”

M S 0 2 . 6 ^{5 x} ^A