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8/9/2013
8/9/2013
Agenda
ICD-10 in the news
ICD-10 Overview
ICD-10-CM Coding Examples
Highlights of the ICD-10-CM manual
Coding Guidelines
News from CMS
The last ever ICD-9 update has been released!
Downloadable files of diagnosis and procedure codes and their full and abbreviated titles are available at CMS.gov. There are no new or revised or deleted ICD-9-CM
diagnosis codes effective for October 1, 2013.
There are no revised or deleted ICD-9-CM procedure codes effective for October 1, 2013.
Other News from CMS
8/9/2013
ICD-10 Basics MLN Connects National Provider Call
Thursday, August 22; 1:30-3pm ET
Are you ready to transition to ICD-10 on October 1, 2014? Join Medicare Fee-for-Service for a keynote presentation on ICD-10 basics by Sue Bowman from the American
Health Information Management Association (AHIMA), along with an implementation update by CMS. A question and answer session will follow the presentation.
Registration information is available on the CMS Sponsored ICD-10 Teleconferences web page.
More News from CMS
Talk Ten Tuesday Podcasts
CMS participates in the ICD-10 Monitor’s Talk Ten
Tuesday podcasts. Visit the Talk Ten Tuesday
website to listen to past presentations from CMS
including:
March 26, 2013: CMS: Helping the Industry Prepare for ICD-10
March 7, 2013: HIMSS Week Day 3: Live from New Orleans
February 12, 2013: CMS Pilot for End-to-End Testing: It Takes a Village
8/9/2013
ICD-10 Overview
ICD-10-CM (diagnosis) and ICD-10-PCS
(inpatient procedure) codes must be used
for service dates on and after October 1,
2014
Outpatient claims based on date of service
Inpatient claims based on date of discharge
Applies to both Electronic and Hardcopy
claims
Commonly Billed Codes
Documentation simplifies ICD-10
When you see an ICD-9 to ICD-10 crosswalk, it may seem that the specificity in ICD-10 is overwhelming.
If you look at the elements of ICD-10, you will see how simple documentation will ease coding in ICD-10.
Let’s review an example:
Pathological fracture of humerus
Starts with 18 possible codes
If the notes state Follow-up visit
3 codes are eliminated:
Laterality
Laterality is an important component in ICD-10. In this example identifying the right humerus eliminates 10
possible codes
How is it healing?
The best ICD-10-CM code is:
M84.421D Pathological fracture, humerus, right humerus, subsequent encounter, routine healing
The information necessary to select the most appropriate and specific ICD-10 code should be standard in your
medical records.
Look up the ICD-10 codes for your most commonly encountered clinical conditions. Verify the necessary
information is being documented today. If it isn’t, you have a documentation improvement training opportunity.
Acute Otitis Media
This common diagnosis is a good example of where you may need additional documentation
H65.1 Other acute nonsuppurative otitis media. Requires
a 5th and 6th character
Laterality – Left ear, Right ear, or Bilateral? Is the problem initial or recurrent?
Acute Otitis Media
The documentation should look something like this:
Patient has an acute onset of otitis media of the right ear, a recurrent condition.
Now you can correctly code using ICD-10-CM as
H65.114 Acute and subacute otitis media recurrent, right ear
8/9/2013
Highlights of the ICD-10-CM
In many ways ICD-10-CM is similar to ICD-9-CM. Changes you need to be aware of include:
The length of codes increased to a maximum of seven
characters. Use of the additional characters is mandatory ICD-10-CM is alpha-numeric, using all letters except U V and E codes are incorporated in the main classifications Injury codes grouped by site of injury instead of type of
injury
Combination codes, which reduce the number of codes needed in certain situations
Highlights of the ICD-10-CM
Some chapters have been rearranged Some titles have changed
Conditions have been regrouped Increase in categories
21 Chapters instead of 17
Chapter comparison
Chapter Notes
Examples of new chapters: Diseases of Eye and Adnexa
Diseases of the Ear and Mastoid Process ICD-9 “V Codes” are now ICD-10 “Z Codes”
ICD-9 “E Codes” are now ICD-10 “S and T Codes”
Coding Guideline: Code First
ICD-10 has a coding convention that requires the
underlying or causal condition be sequenced first followed by the manifested condition.
For example, if a patient is on the antidepressant drug Trypatanol, and this drug caused the patient’s weight gain, it is considered an adverse effect and is the
underlying or causal condition of the patient’s obesity. Therefore, the correct sequence of coding is:
T43.015 Adverse affects of tricyclic antidepressants E66.1 Drug-induced obesity
Coding Guideline: Combination Codes
In certain situations, ICD-10 includes combination codes A combination code is a single code used to clarify:
Two diagnoses;
A diagnosis with an associated secondary process (manifestation);
A diagnosis with an associated complication
The combination code can only be used if the code fully identifies the diagnostic conditions involved. All of the diagnostic conditions must be clearly documented
Combination Code Example
ICD-10 diabetes mellitus codes are combination codes that include:
Type of diabetes mellitus; Body system affected;
Complication/manifestation affecting the body system
Combination Code Example
In ICD-9 multiple codes are necessary
250.52 Diabetes with ophthalmic manifestations, type 2 or unspecified type, uncontrolled
362.05 Moderate nonproliferative diabetic retinopathy
362.07 Diabetic macular edema
One ICD-10 combination code reports the same detail E11.331 Type 2 diabetes mellitus with moderate
nonproliferative diabetic retinopathy with macular edema
ICD10.HMSA.com - Coding Challenge
In order to become proficient and comfortable in ICD-10 practice is needed
HMSA’s Coding Challenge website will be available to all participating providers
We will publish scenarios, you select the most appropriate ICD-10 code(s), and the website will provide feedback
NOTE: This website does not replace ICD-10 training and is not intended to tell you how to file claims. It is a tool to give you an opportunity to practice coding in ICD-10.
Log in using your NPI or HMSA provider number
ICD-10 Tools and Resources
HMSA Provider Resource Center
ICD-10 Information and Resources
http://www.hmsa.com/portal/provider/zav_pel.a
a.ICD.100.htm
ICD-10 Code Translator
http://www.hmsa.com/providers/supportcenter/i
cd10.aspx
[email protected]
Email for questions and suggestions
ICD-10 Tools and Resources
CMS released ICD-10 Implementation Guidelines.
Go to CMS.gov and search for ICD-10 Implementation Guide for a free download.
The National Center for Vital Health Statistics has
published guidelines to be used as a companion to the ICD-10-CM and PCS.
http://www.cdc.gov/nchs/data/icd10/10cmguidelines_2 013_final.pdf
WEDI ICD-10 Workgroup
Send WEDI-ICD-10 mailing list submission to [email protected]
Who wants an ICD-10-CM book?
We will be giving away one ICD-10-CM Complete Official Draft Code Set each month for the next few months.
Answer an ICD-10 coding question.
Send your answer to [email protected] by Friday, August 16, 2013 at 4:00 pm.
We will randomly select one participant from all correct answers received and send that person a copy of the ICD-10-CM.
CONGRATULATIONS TO OUR JULY WINNER – KRISTLYN FROM WAILUKU!
