ICD-10-CM Training for Medical Office Staff. Presented by: Angie Audler, MBA, RHIT, CCS, CPC, AHIMA Approved ICD-10-CM/PCS Trainer

(1)

ICD-10-CM Training for

Medical Office Staff

Presented by:

Angie Audler, MBA, RHIT, CCS, CPC,

AHIMA Approved ICD-10-CM/PCS

(2)

Disclaimer

• This PowerPoint presentation is an education tool

to provide basic information for coding. The

information is the sole view of the author and

was put together based on experience, research

and expertise in the coding profession. It is not

intended to be an exhaustive review and should

not be considered a substitution for Coding

Guidelines. The presenter does not accept any

responsibility or liability with regard to errors,

omissions misinterpretations or misuse by the

audience.

(3)

Are you Ready? If Not, It’s...

• We’re only days away!

• Implementation Date

(4)

Today’s Topics

• Readiness Checklist

• Where You Can Find the Code Sets

• What ICD-10 Related Changes are of Particular

Importance to Your Practice

• What Will Be the Impact of the Transition

• How To Look Up A Code

• Applying Coding Concepts

• Recommendations

(5)

ICD-10 Readiness Checklist

Source: http://www.healthcareitnews.com

• Have both your Practice Management and EHR been updated to be ICD-10 compliant? • Have you tested submitting ICD-10 codes to your Practice Management system?

• Have you considered updating your existing Encounter Forms to include ICD-10 codes with more specificity and using laterally to meet the ICD-10 requirements?

• Have you contacted all your vendors to ensure they are ICD-10 compliant, such as payers, clearinghouses, and any lab or radiology vendors?

• If necessary, have you loaded the ICD-10 dictionaries in both your Practice Management and EHR applications?

• Have you tested submitting codes from your Practice Management system to your payers and clearinghouses?

• Have you tested submitting orders (labs/diagnostics/imaging studies) from your EHR to appropriate vendors with ICD-10 codes?

• Have you identified the top 25-50 diagnoses for each specialty (based on volume and/or high revenue) and trained appropriate staff on ICD-10 criteria for coding, billing,

and clinical documentation?

• Have you optimized all preferences and enhancements within your systems to assist in the ICD-10 transition such as Billable Indicators and Clinical Qualifiers?

• Have you reviewed current clinical documentation and identified gaps for ICD-10 requirements?

(6)

ICD-10-CM Impacts….

• Coverage of services

• Payment for services

• Documentation requirements

• Ordering diagnostic tests, obtaining

authorizations, ordering prescriptions

• Collection of accurate data

• Submission of accurate data through claims

• Reporting of quality indicators

(7)

Ordering Diagnostic Tests

• A physician order must include the following

elements in order to be considered

valid

:

– Reason for ordering the test or service (diagnosis

description, ICD-10 code, sign(s), symptoms)

– Test or service requested

– Provider’s name

– Provider’s signature

– Patient complete name

– Patient date of birth

(8)

Obtaining Authorizations

• Authorizations must contain a “valid”

diagnosis code for date-of-service – not date

authorization was obtained

(9)

Ordering Prescriptions

• CMS FAQ 7579 – Refills

– Payer/pharmacy requiring a diagnosis code for a

prescription (e.g. Medicaid):

• When conducting a standard transaction, medical data

code sets (ICD-9 and ICD-10) that are valid at the time

that the service is provided (

prescription fill date

) must

be used (45 CFR 162.1000).

(10)

ICD-10-CM Changes

• There are three main categories of changes in

ICD-10-CM

- Definition Changes

- Differences in Terminology

- Increased Documentation Specificity

• ICD-10 doesn’t affect coding only; it involves

physician reporting, billing, information

technology, and revenue management

(11)

ICD-10-CM

• Although there are approximately 70,000 codes in

ICD-10, specialists will use only a small subset of

those codes

• Over 1/3 of the expansion codes are due to laterality

(physicians are already documenting right, left,

bilateral)

– If bilateral and there is no specific code for bilateral, you

code both right and left sides

(12)

ICD-10 – Major Modifications

• Expanded categories for postoperative

complications

• Addition of sixth and seventh characters or

accidents and injuries, adverse effects

• Addition of laterality

• Combination codes for common diagnosis and

symptoms

(13)

Where Can You Find the Code Sets?

• The code sets are available on the CMS

website

• www.cms.gov/icd10

• ICD-10-CM Coding Manual

(14)

What ICD-10 Related Changes Are of

Particular Importance to Your Practice?

• Training is especially important to familiarize

staff with the concepts of ICD-10

• Physician specificity in documentation

• Workflow disruptions

(15)

What Will Be the Impact of the

Transition?

• Even the best prepared office may run into

problems directly following the transition

• Be prepared to see a decrease in productivity

and accuracy

• Expect delays in claim processing

• Potential increase in the number of rejected

or denied claims

(16)

How Do I Look Up a Code?

• How you look up a code is dependent upon

the method used for code selection

– Coding Manual

– Electronic code search

• System

• Internet

(17)

Organization of the ICD-10-CM Coding

Manual

• The ICD-10-CM coding manual contains an Alphabetic Index

and Tabular List

• The Alphabetic Index for ICD-10-CM has a similar format as

ICD-9-CM. It contains an Alphabetic Index of Diseases and

Injuries, Alphabetic Index of External Causes, Table of

Neoplasms, and Table of Drugs and Chemicals. However,

ICD-10-CM does not contain a Hypertension Table

• Morphology codes are not listed next to the descriptor in

the Alphabetic Index and no longer have a separate

Appendix

(18)

Organization of the Coding Manual

• Some codes in ICD-10-CM have a single

inclusive code for manifestations, while others

require two codes to report a manifestation.

• Example:

– In ICD-9-CM diabetes with a manifestation often required the

use of two codes. The diabetic code was coded first, followed

by the manifestation code

• Diabetes with peripheral autonomic neuropathy

250.60, 377.1

– In ICD-10-CM, a single code describes Diabetes with peripheral

autonomic neuropathy

G99.0

(19)

Alphabetic Index of Diseases and

Injuries

• Main terms are listed in alphabetical order in

bold print with subterms indented under the

main term. Non-essential modifiers are listed in

parenthesis ( ) behind the main term.

Non-essential modifiers do not change code

assignment

• Many non-essential modifiers that appeared

behind main terms in ICD-9-CM may appear as

subterms in ICD-10-CM with their own code

(20)

Alphabetic Index of External Causes

• External Cause codes describe environmental

events and circumstances as the cause of an

injury and other adverse effects

• They are always secondary codes and provide

additional information

(21)

Hypertension Table

• The Hypertension Table in ICD-10-CM has

been eliminated. The same code is used

regardless of whether the hypertension is

described as benign, malignant or whether or

no qualifier is used

(22)

Table of Neoplasms

• The Neoplasm Table is formatted similarly to

the table in ICD-9-CM and contains the same

Headings

Confidential and Proprietary Information 22

Neoplasm, neoplastic Malignant Ne op las m Malignant Secon d ar y C A in -situ Ben ign Un ce rt ain Un sp e cifie d Beh avio r

(23)

Table of Drugs and Chemicals

• The Table of Drugs and Chemicals Headings

better describe the circumstance of the

encounter

• It also contains new columns for “Adverse

Effect” and “Underdosing”

Copyright © 2015 MEDKODER LLC 23 Substance P ois onin g, Acc id e n tal (u n int e n ti o n al ) P ois onin g, In ten tio n al Se lf -h arm P ois onin g, Assau lt P ois onin g, Un d e te rmi n e d Ad ve rse Eff e ct Un d e rd o sing

(24)

Tabular List

• The Tabular List contains a chronological list of

codes divided by body system or condition. It

contains 21 Chapters

• The restructuring and reorganization of codes

has resulted in additional chapters

• Each Chapter in the Tabular List contains a

(25)

Conventions

• Abbreviations

– Like ICD-9-CM, the abbreviations NEC and NOS are

used:

• NEC – Not Elsewhere Classified (referring to “other”

specified conditions)

• NOS – Not Otherwise Specified (referring to

“unspecified” conditions)

(26)

Conventions

• Cross-reference, punctuation marks

– Cross-reference and punctuation marks are used

the same as they were in ICD-9-CM

(27)

Conventions

• Excludes Notes

– There are two types of Excludes Notes in

ICD-10-CM.

• Exclude 1 – means the two conditions cannot be coded

together (e.g. congenital and acquired form of the

same condition)

• Exclude 2 – means not included and can be coded if the

patient has both conditions

(28)

Conventions

• And

– Interpreted to mean and/or

• With

(29)

Conventions

• Default Code

– The term “default code” refers to a code listed

next to the main term in the Alphabetic Index

– It represents that the term is most commonly

associated with the main term or is unspecified

(30)

Full Code Titles

• ICD-9-CM

– 143 Malignant neoplasm of gum

• 143.0 Upper gum

• 143.1 Lower gum

• ICD-10-CM

– C03 Malignant neoplasm of gum

• C03.0 Malignant neoplasm of upper gum

• C03.1 Malignant neoplasm of lower gum

(31)

Conventions

• Instructional Notes

– Instructional notes are the same as they were in

ICD-9-CM:

• Code first

• Use additional code

• Code also

(32)

ICD-10 Convention

• Code First Notes

– Used when certain conditions have both an

underlying etiology and multiple body system

manifestations

– Requires the underlying condition be sequenced

first followed by the manifestation

– Proper sequencing order of the codes: etiology

followed by manifestation (same coding

(33)

ICD10 Conventions

• Use Additional Codes are secondary codes

that identify manifestations

(34)

ICD-10 Conventions

• Code Also Notes

– A code also note instructs that 2 codes may be

required to fully describe a condition but the

sequencing of the two codes depends on the

circumstances of the encounter

(35)

Understanding Basic Phrases

• Phrases “due to” and “manifested by”

– It is not sufficient to say the patient has an ulcer

and history of radiation therapy

– It needs to be stated whether or not the ulcer is

due to

radiation

(36)

Outpatient Services

• The terms “encounter” and “visit” are

synonymous when describing outpatient

services

(37)

ICD-10-CM Structure

(38)

ICD-10-CM Structure

• Alpha characters are not case sensitive

• First character is Alpha. The letter U is reserved

by the WHO for future use of new diseases of

uncertain etiology (U00-U49) and bacterial

agents resistant to antibiotics (U80-89)

• Second character is always numeric

• Characters three, four, five, six and seven can be

alpha or numeric

(39)

ICD-10-CM Structure

• The seventh character represents a visit encounter or sequelae (condition resulting from a previous disease; also known as Late Effects) for injuries and external causes. The seventh character extender must always be the seventh character of a code.

• A hyphen “-” at the end of an ICD-10 code in the Alphabetic Index indicates that additional characters are required.

• Placeholder: An “x” is used as a fifth character in certain six character codes to allow for future expansion. An “x” is also used as a placeholder when a code has less than six characters and the code requires a seventh character.

• For Example:

• Adverse effect of calcium-channel blockers, initial encounter T46.1x5A • Exposure to electric transmission lines, initial encounter W85.xxxA • Post-procedural cardiogenic shock, initial encounter T81.11xA

(40)

Characteristics

• 21 Chapters and Expanded Codes

– Some chapters are reorganized

– Some conditions are put in different Chapters

• Alphanumeric – first character is always a letter

• Addition of up to 7 characters

• 7

th

_{character code extensions in some cases}

– Injuries

• Initial encounter

• Subsequent encounter

• Sequela

(41)

Code Structure and Format

ICD-10-CM Diagnosis Code

• Some Other Differences of ICD-10-CM

– Laterality

• Right and left

– Dummy placeholders “x”

• Done to allow for future expansion without disrupting the

sixth or seventh character structure for codes where the

sixth or seventh character has a specific use

– Intent

• T37.5x1 Poisoning by antiviral drugs, accidental

(unintentional)

– Encounter

• Information relevant to ambulatory and managed care

encounters

• T16.1xxA Foreign body in right ear (initial encounter)

– Other Factors that can affect health

• Lifestyle, socioeconomic, family relationships

(42)

Abstracting

• Perfecting the practice of abstracting allows

(the coder) and others to have more

confidence in the data, be able to defend

audits, justify medical necessity, and ensure

correct coding

(43)

ICD-10-CM

• It is important for clinical providers, staff and

coders to understand how diseases are

classified differently in ICD-10, as the change

affects the specific documentation that will be

needed for coders to abstract the information

for appropriate code assignment and

non-coders to understand the concepts to address

rejections and denials

(44)

Reporting Differences, Trending and

Analytic Modifications

• Converting from ICD9 to ICD10 more than triples the

number of available codes

• Looking at historical data becomes problematic

unless you can identify and capture needed

information from the two coding systems

• Simple forward mapping will not be sufficient for

most providers to make a successful transition

(45)

Steps in Coding with ICD-10-CM

• Coding Steps remain the same

– Identify all main terms in diagnostic statements

• Apply your knowledge of A& P and pathology,

pharmaceuticals, and treatments

• Main terms are USUALLY Nouns

– Identify subterms terms in diagnostic statement

• Subterms terms are USUALLY adjectives

– Locate main terms in the Alphabetic Listing

• If terms not identical, use your medical terminology

knowledge to translate from documentation to code book

(46)

Steps in Coding with ICD-10-CM

– Locate subterms under main terms

– Check for special instructions or cross-references

– TENTATIVELY select a code

– Turn to code category in the Tabular Listing

– Check for any instructional notes for code

category/chapter

– Apply your knowledge of code book conventions

– Assign code when all elements of the diagnostic

statement accounted for and code verified in

Tabular Listing

(47)

Risk Mitigation

• Denials can run high for “not medically

necessary reasons”

• In the beginning there is risk of payers not

fully mapping procedures with new allowed

diagnosis reasons

– Healthcare providers need to be prepared for

short term reduced revenues

(48)

General Equivalency Maps (GEMS)

• CMS’ GEMS (General Equivalency Maps) demonstrate the

complexity involved in moving between the two coding systems

• NCHS/CDC released General Equivalence Mappings (GEMS) to help

facilitate the transition between ICD-9-CM and ICD-10-CM. It was

intended for use by professionals working in health information,

medical research and informatics who may use the mappings in

their work to assist in the migration of historical data

• Two files were created for bi-directional mapping:

• ICD-9-CM to ICD-10-CM

(49)

GEMS

• The correlation between the two coding

systems is not one-to-one in most instances

• Since ICD-10 codes contain more extensive

descriptors, body part specificity, and other

components, most codes are one-to-many

(50)

ICD9/ICD10 Relationships

1:1, Cluster, Combination, Complex

• Individual ICD-9 codes that map to several ICD-10 code

alternatives;

• Individual 9 codes that map to a set of two of more

ICD-10 codes;

• Two or more ICD-9 codes that map to individual ICD-10 codes;

• ICD-9 codes with no representation in ICD-10;

• ICD-9 codes with an exact match in ICD-10; and

• Individual ICD-9 codes that map to codes with similar but not

identical meanings in ICD-10

(51)

CMS General Equivalent Mappings

Source: http://firstillinoishfma.org/wp-content/uploads/McGladrey-ICD-10-April-2013.pdf

(52)

ICD-10 Requires Providers to…

• Provide greater specificity in documentation

to meet the needs of ICD-10-CM code

(53)

Laterality – Left vs. Right

C50.2 Malignant neoplasm, of upper-inner quadrant of breast

– C50.21 Malignant neoplasm of upper-inner

quadrant of breast, female

• C50.211 Malignant neoplasm of upper-inner quadrant of right

female breast

• C50.212 Malignant neoplasm of upper-inner quadrant of left

female breast

• C50.219 Malignant neoplasm of upper-inner quadrant of

unspecified female breast

(54)

Tabular List

• The

Tabular List

is a chronological list of codes

divided into Chapters based on body system

or condition

(55)

Injuries

• A seventh character extension identifies the

encounter type

– A – for the initial encounter

– D – for the subsequent encounter

– S - Sequela

• Size and depth of injury is also coded

• Initial vs. subsequent vs. sequela/late effects

(56)

Applying ICD-10-CM Concepts

• Orthopedic cases will need additional documentation clarity from

physicians

– Site: joint vs. bone/limb

– Laterality

– Type and Classification of Fracture

• Salter-Harris

• Gustilo Classification for Open Fractures

– e.g., Type I – Low energy, wound less than 1cm

– Type II – Wound greater than 1cm with moderate soft tissue

damage

• A fracture not clearly identified as “open” or “closed” is coded to

“closed”

(57)

Fractures

• Laterality • Mechanism of injury • Etiology of Fracture -Traumatic, pathologic, osteoporosis, neoplastic disease • Site

-Name of the bone

-Medial, lateral, midshaft, epiphysis, etc.

• Displaced vs. Non-displaced • Closed or open (use

Gustilo-Anderson classification for open fractures)

• Type of Fracture

-Comminuted, greenstick, oblique, segmental, spiral, transverse, compression, burst, etc.

• Note Injury to Surrounding Tissue • Encounter Type

-Initial encounter for fracture (type)

-Subsequent encounter for fracture with routine healing -Subsequent encounter for fracture with delayed healing -Subsequent encounter for fracture with nonunion -Subsequent encounter for fracture with malunion -Sequela

(58)

Fracture Codes ICD-9

• Fractures, closed

– Comminuted – Depressed – Elevated – Fissured – Greenstick – Linear – Spiral

• Fractures, open

– Compound

– Infected

– Missile

(59)

ICD-10 Expanded Fracture Codes

• Instead of just “open” vs. “closed”, ICD-10 has

expanded the fracture codes to identify the specific

type of fracture

• S42.31-

Greenstick

fracture of shaft of humerus

• S42.32-

Transverse

fracture of shaft of humerus

• S42.33-

Oblique

fracture of shaft of humerus

• S42.42-

Comminuted

supracondylar fracture without

intercondylar fracture of humerus

(60)

Documentation Example

• Instead of documenting fractured right

arm, documentation will now need to include:

– Fell while running, traumatic, acute, closed,

transverse right distal radial fracture with

(61)

7

th

Character – Open Fractures

• The open fracture designations are based on the Gustilo open

fracture classification

• The appropriate 7th character is to be added to each code from category S52 – A - initial encounter for closed fracture

– B - initial encounter for open fracture type I or II

– C - initial encounter for open fracture type IIIA, IIIB, or IIIC

– D - subsequent encounter for closed fracture with routine healing

– E - subsequent encounter for open fracture type I or II with routine healing

– F - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing – G - subsequent encounter for closed fracture with delayed healing

– H - subsequent encounter for open fracture type I or II with delayed healing

– J - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing – K - subsequent encounter for closed fracture with nonunion

– M - subsequent encounter for open fracture type I or II with nonunion

– N - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion – P - subsequent encounter for closed fracture with malunion

– Q - subsequent encounter for open fracture type I or II with malunion

– R - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion – S - sequela

(62)

Place of Occurrence

• Y92.0x Home

• Y92.1x Residential institution

• Y92.2x School, other institution and public

administrative area

• Y92.3x Sports and athletic area

• Y92.4 Street and highway

• Y92.5x Trade and service areas

• Y92.6 Industrial and construction area

• Y92.7 Farm

(63)

Activity

• Y93.0x - Injured while engaged in sports activity

• Y93.1 - Injured while engaged in leisure activity

• Y93.3x - Injured while engaged in other types of

work

• Y93.4 - Injured while resting, sleeping, eating or

engaging in other vital activities

• Y93.8 - Injured while engaged in personal hygiene

• Y93.9 - Injured during unspecified activity

(64)

Factors Influencing Health Status and

Contact with Health Service

• New Features

• Z72 Problems related to lifestyle

– Z72.3 Lack of physical exercise

– Z72.4 Inappropriate diet and eating habits

• Z73 Problems related to life-management difficulty

– Z73.1 Type A behavior pattern

(65)

Unspecified Codes

• Surveys indicate that as much as 50% of

physician documentation cannot be coded to

appropriate level of specificity with ICD-10

(66)

Unspecified Codes

• Sometimes the use of unspecified codes makes

sense

– Early in the course of evaluation

– Secondary diagnoses not directly being treated by that

provider but impacts that encounter

– Generalist vs specialist

• Payers are discouraging the use of unspecified

codes

– When providers review their severity and risk scores it may

impact their reimbursement because it won’t have the

specificity in their codes that are needed to justify higher

levels and better reimbursement

(67)

Ordering Diagnostic/Therapeutic

Services

• Governmental and third party payers require the performing

provider (hospital ancillary departments, outpatient

freestanding centers, independent labs, etc.) to provide

ICD9/10 codes for outpatient diagnostic and/or therapeutic

testing/services that they perform and submit for payment on

behalf of your patients

• These providers rely on the ordering physician to submit the

appropriate diagnosis code at the time of ordering to

establish medical necessity for the test ordered

(68)

Communication

• Hospital ancillary departments depend on the

referring physician to give the order for and the

reason behind services

• They are also dependent on the physician for

pertinent information related to an ordered exam

• With ICD10 codes, it is not the amount of

information required from the referring physician

but the specificity of the information that will

(69)

Key Updates to Infectious and

Parasitic Diseases (A00-B99)

• Terminology change - the term Sepsis has replaced the term

Septicemia

• Urosepsis is a nonspecific term and is not coded in

ICD-10-CM. Coding guidelines direct the coder to query the provider

for clarification if this term is used

• Infections resistant to antibiotics require the use of an

additional code for any associated drug resistance only if the

infection code does not identify drug resistance (Z16 category,

resistance to antimicrobial drugs if the infection code does

not identify drug resistance)

• The codes have been expanded to reflect manifestations of

the disease

(70)

West Nile Virus

(manifestation example)

ICD-9-CM ICD-10-CM

066.40 West Nile fever, unspecified

066.41 West Nile fever with encephalitis 066.42 West Nile fever with other

neurologic manifestation

A92.30 West Nile fever infection , unspecified

A92.31 West Nile fever infection with encephalitis

A92.32 West Nile infection with other neurologic manifestation

*Use additional code to specify the neurologic manifestation:

A92.39 West Nile virus with other complications

**Use additional code to specify the other conditions:

A93.8 Other specified arthropod-borne viral fevers

(71)

Key Updates for Neoplasms (C00-D49)

• This section contains code expansions

• Many codes in this section instruct us to

Use

An Additional code

• Significant expansions or revisions are related

to:

– laterality for some of the neoplasm sites

– Malignant neoplasm of the male breast

– The use of an additional code to identify estrogen

receptor status (Z17.0, Z17.1)

(72)

Neoplasm Documentation

Neoplasm Documentation Awareness

Documentation should include: • Behavior

- Malignant (primary, secondary, in-situ) - Document any secondary sites - Benign

- Unspecified behavior

- Of certain histological behavior • Laterality (right/left)

• Anatomical site (topography)

• Other condition(s) associated with malignancy – (dehydration, anemia, etc.) • Complication(s) associated with neoplasm

• Include estrogen receptor status (if applicable) • History of:

- Has the malignancy been excised or eradicated?

- Is there still treatment being provided for the primary and/or secondary site? - Is there evidence of remaining malignancy at the primary site?

(73)

Neoplasms

• Overlapping sites

• Laterality – Left vs. Right

• C50.2 Malignant neoplasm, of upper-inner

quadrant of breast)

– C50.21 Malignant neoplasm of upper-inner quadrant

of breast, female

• C50.211

Malignant neoplasm of upper-inner quadrant of

right female breast

• C50.212

Malignant neoplasm of upper-inner quadrant of left

female breast

• C50.219

Malignant neoplasm of upper-inner quadrant of

unspecified female breast

(74)

CA of Breast

ICD-9-CM ICD-10-CM

174.9 Malignant neoplasm of breast (female, unspecified)

C50.919 Malignant neoplasm of unspecified site of unspecified female breast

* Use additional code to identify estrogen receptor status

(75)

Key Updates for Diseases of Blood &

Blood Forming Organs (D50-D89)

• Anemia is the most common condition

included in this section. The use of specific

terminology is important in applying codes for

this condition

• Procedural complications affecting the spleen

are included in this section

(76)

Anemia

Anemia Documentation Awareness

• Documentation of Anemia should include the type of anemia: -- Nutritional

-- Hemolytic -- Aplastic

-- Due to blood loss -- Other (please specify)

• Include in documentation if Anemia is due to nutrition or mineral deficits, resulting in a nutritional anemia

• Document if the Anemia is due to a neoplasm (primary and/or secondary)

• Document whether the ANEMIA is “related to or due to” chemo or radiotherapy treatments

• Document any “cause–and-effect” relationship between the intervention and the blood or immune disorder

• Document the specific drug if anemia is drug-induced

(77)

Anemia

ICD-9-CM ICD-10-CM

285.9 Anemia, unspecified D64.9 *Anemia, unspecified

*There are more specific code choice selections available in ICD-10-CM. These include:

D64.81 Anemia due to antineoplastic chemotherapy

D63.0 Anemia in neoplastic disease D61.1 Aplastic anemia due to

antineoplastic chemotherapy

(78)

Key Updates for Endocrine,

Nutritional & Metabolic Disorders (E00-E89)

• Many codes in this section instruct us to

Use An Additional Code

• ICD-10-CM Diabetes Mellitus codes are now combination codes

that include the type of diabetes (1 or 2), the body system affected

and complications affecting the body system.

• As many codes within a particular category as are necessary to

describe all of the complications of the disease may be used.

• Diabetes Mellitus (E08-E13) is no longer classified as controlled or

uncontrolled in ICD-10- CM.

• ICD-10-CM there are 5 category codes for Diabetes Mellitus:

– E08 – Diabetes Mellitus due to underlying conditions

– E09 - Drug or chemical induced Diabetes Mellitus

– E10 – Type 1 Diabetes Mellitus

– E11 - Type 2 Diabetes Mellitus

(79)

Key Updates for Endocrine,

Nutritional & Metabolic Disorders (E00-E89)

– Overweight and obesity codes:

• The classification for overweight and obesity has been

expanded in ICD-10-CM to include:

– Obesity due to excess calories

– Morbid (severe) obesity due to excess calories

– Drug induced obesity

– Morbid (severe) obesity due to alveolar hypoventilation

– Overweight

– An additional code (Z68 category) is used to identify the

body mass index (BMI), if known

(80)

Diabetes Mellitus

ICD-9-CM ICD-10-CM

Type • Type I • Type 2

• Secondary diabetes mellitus

Type • Type 1 • Type 2

• Drug/chemical induced

• Due to underlying condition

• Specified Type Control • Controlled • Uncontrolled Control • Inadequately controlled • Out of control • Poorly controlled • Hypoglycemia • Hyperglycemia Manifestation/Complication • Hyperosmolarity • Ketoacidosis • Neurological manifestations • Other coma

• Peripheral circulatory disorder • Renal Manifestations

• Other specified manifestations • Without Complications Manifestation/Complication • Arthropathy • Circulatory complications • Hyperosmolarity • Hypoglycemia • Ketoacidosis • Kidney complications • Neurological complications • Ophthalmic complications • Oral complications • Skin complications • Without complications

(81)

Diabetes Mellitus

ICD-9-CM Code ICD-10-CM Code(s)

250.00 – Diabetes mellitus without

mention of complications type II or

unspecified type, not states as controlled

E11.9 – Type 2 diabetes mellitus without

complications

Diabetes Mellitus Documentation Awareness

Capturing the correct code for Diabetes Mellitus requires clear and precise

documentation of the underlying cause. Diabetes mellitus codes in ICD-10 reflect combination codes. The components of the combination codes are:

• Type of Diabetes

• Body System Affected

• Specified complications/manifestations affecting the body system

(82)

Diabetes Mellitus Documentation Awareness

Type of Diabetes

• Drug or Chemical Induced (E09) – (anticonvulsants; antihypertensive drugs including diuretics and beta blockers; antipsychotic drugs including lithium and antidepressants; antiretroviral drugs; chemotherapy drugs; hormone supplements including anabolic steroids, contraceptives, estrogen, growth hormones and hormones for prostate cancer)

• Due to an underlying condition (E08)

• Type I diabetes (E10) – controlled/not specified; uncontrolled • Type 2 diabetes (E11) – controlled/not specified; uncontrolled • Other specified diabetes (E13) – secondary diabetes mellitus –

controlled/not specified; uncontrolled

For Type 2 diabetes mellitus and secondary diabetes mellitus, any long-term

or current use of insulin is reported as an additional code.

You may report more than one diabetes code for patients with multiple complications or when multiple body systems are affected as a result of the diabetes.

Secondary diabetes is defined as a diabetic condition with an underlying cause other than genetics or environmental conditions (includes due to drugs, chemicals, medical conditions, surgical procedures or trauma)

(83)

Diabetes

Diabetes Mellitus Documentation Awareness

Body System Affected

• Circulatory complications • Hyperosmolarity • Kidney complications • Ketoacidosis • Other coma • Neurological complications • Ophthalmic complications

• Other specified complications/manifestations • Unspecified complications/manifestations • Without complications/manifestations

(84)

Diabetes Mellitus Documentation Awareness

Specified complications/manifestations affecting the body system

• Circulatory complications – peripheral • Hyperosmolarity

• Hypoglycemia (with or without coma)

• Kidney complications – diabetic nephropathy; chronic kidney disease; other • Ketoacidosis – with or without coma

• Neurological complications – amyotrophy; autonomic polyneuropathy; mononeuropathy, polyneuropathy; other; unspecified

• Ophthalmic complications – diabetic retinopathy (mild, moderate or severe nonproliferative with or without macular edema); diabetic cataract; other

• Other specified complications/manifestations – skin complications (dermatitis, foot ulcer; other skin ulcer; other skin complications; oral complications

(periodontal disease; other)

• Unspecified complications/manifestations • Without complications/manifestations

(85)

Key Updates for Mental, Behavioral,

Neurodevelopment Disorders (F01-F99)

• Classification improvements (different categories)

• Code expansions: – Most notably, Other Isolated or Specific

Phobias

• Updates to medical terminology:

• – Bipolar I disorder, single manic episode will change to manic

episode

• – Undersocialized conduct disorders, aggressive will become

Conduct disorder childhood-onset type

• Nicotine dependence updated to identify specific tobacco

products (cigarettes, chewing tobacco, and other tobacco)

• ICD-10-CM does not provide separate “history” codes for

alcohol and drug abuse. These conditions are identified as “in

remission.”

(86)

Attention Deficit Hyperactivity

Disorder (ADHD)

ICD-9-CM ICD-10-CM

314.00 ADD w/o mention of hyperactivity

F90.0 ADHD, predominantly inattentive type

314.01 ADD w/ mention of hyperactivity

F90.1 ADHD, predominantly hyperactive type

F90.2 ADHD, combined type

F90.8 ADHD, other type

F90.9 ADHD, unspecified type

Note: codes within this category may be used

regardless of the age of a patient. These disorders generally have onset within the

childhood or adolescent years, but may continue throughout

(87)

Key Updates for Diseases of the

Nervous System (G00-G99)

• Classification improvements (significant changes

to sleep disorders)

• Code expansions (e.g. Alzheimer’s, headaches)

• Updates to medical terminology (epilepsy,

seizures)

• Codes for TIA are now included in the nervous

system chapter, rather than circulatory

• Codes for migraine have been expanded to fifth

and sixth characters to indicate if the migraine is

intractable and to provide additional specificity

within the code description

(88)

Headache

Headache Documentation Tips

Headache Document type: - Cluster

- Vascular - Tension-type - Post-traumatic

- Drug-induced (specify drug) - Other Document: - Intractable - Not intractable Document timing: - Episodic - Chronic

- Episodic paroxysmal hemicrania - Chronic paroxysmal hemicrania - Short lasting unilateral

(89)

Headache

ICD-9-CM ICD-10-CM

784.0 Headache R51 Headache

G44.10 Vascular headache, NEC, not intractable

G4411 Vascular headache, NEC, intractable

(90)

Migraine

Document type: - Migraine w/ aura - Migraine w/o aura - Hemiplegic migraine -

Persistent migraine aura w/o cerebral infarction - Persistent migraine aura w/ cerebral infarction - Chronic migraine

Identify when migraine is due to drugs and specify the drug

Document: - With status migrainosus - Without status migrainosus - Intractable - Not intractable

(91)

Migraine

ICD-9-CM ICD-10-CM

346.31 Hemiplegic migraine, with

intractable migraine, so stated, without mention of status migrainosus

G43.419 Hemiplegic migraine, intractable, without status migrainosus

346.32 Hemiplegic migraine, without mention of intractable migraine with status migrainosus

G43.401 Hemiplegic migraine, not intractable, with status migrainosus 346.33 Hemiplegic migraine, with

intractable migraine, so stated, with status migrainosus

G43.411 Hemiplegic migraine, intractable, with status migrainosus

346.40 Menstrual migraine, without mention of intractable migraine without mention of status migrainosus

G43.829 Menstrual migraine, not

intractable, without status migrainosus

(92)

Migraine (cont’d)

ICD-9-CM ID-10-CM

346.41 Menstrual migraine, with

intractable migraine, so stated, without mention of status migrainosus

G43.839 Menstrual migraine, intractable, without status migrainosus

346.42 Menstrual migraine, without mention of intractable migraine with status migrainosus

346.43 Menstrual migraine, with intractable migraine, so stated, with status migrainosus

346.50 Persistent migraine aura without cerebral infarction, without mention of intractable migraine without mention of

G43.821 Menstrual migraine, not intractable, with status migrainosus

G43.831 Menstrual migraine, intractable, with status migrainosus

G43.509 Persistent migraine aura without cerebral infarction, not intractable,

(93)

Migraine (cont’d)

ICD-9-CM ICD-10-CM

346.51 Persistent migraine aura without cerebral infarction, with intractable

migraine, so stated, without mention of status migrainosus

G43.519 Persistent migraine aura without cerebral infarction, intractable, without status migrainosus

*There are additional codes to further describe migraine.

(94)

Key Updates for Eye and Adnexa (H00-H59)

• Terminology improvements (bringing terms up

to date)

• Many codes in this section instruct us to

Use

An Additional code

• Revisions to identify laterality:

– Many of the codes have laterality designation and,

in some instances bilateral designation for

diseases of the eye

(95)

Key Updates for the Ear &

Mastoid Process (H60-H95)

• There is greater specificity and detail in the codes

• Many of the codes have laterality designation

• Many conditions in this section (e.g. otitis media) tell

us to

Use An Additional Code

to identify:

– Exposure to environmental tobacco smoke (Z77.22)

– Exposure to tobacco smoke in the perinatal period

(P96.81)

– History of tobacco use (Z87.891)

– Occupational tobacco exposure to environmental tobacco

smoke (Z57.31)

– Tobacco dependence (F17.-)

– Tobacco use (Z72.0)

(96)

Chronic Suppurative Otitis Media

ICD-9-CM ICD-10-CM

382.3 Unspecified chronic suppurative otitis media

H66.3x1 Other chronic suppurative otitis media, right ear

H66.3x2 Other chronic suppurative otitis media, left ear

H66.3x3 Other chronic suppurative otitis media, bilateral

H66.3x9 Other chronic suppurative otitis media, unspecified ear

*Use additional code for any associated perforated tympanic membrane (H72-)

(97)

Chronic Suppurative Otitis Media

ICD-9-CM ICD-10-CM

• Use additional code to identify:

Exposure to environmental tobacco smoke (Z77.22)

• Exposure to tobacco smoke in the perinatal period (P96.81)

• History of tobacco use (Z87.891) • Occupational exposure to

environmental tobacco smoke (Z57.31) Tobacco dependence (F17-)

• Tobacco use (Z72.0)

(98)

Perforation of Tympanic Membrane

ICD-9-CM ICD-10-CM

384.20 Perforation of tympanic membrane, unspecified

H72.90 Unspecified perforation of tympanic membrane, unspecified ear

** Code first any associated otitis media (H65-, H66.1-, H66.2-, H66.3-, H66.4-, H66.9-, H67-)

H72.91 Unspecified perforation of tympanic membrane, right ear H72.92 Unspecified perforation of

tympanic membrane, left ear H72.93 Unspecified perforation of

(99)

Perforation of Tympanic Membrane

ICD-9-CM ICD-10-CM

** There are more specific code choice selections available in ICD-10-CM. These include:

H72.00 Central perforation of tympanic membrane, unspecified ear

H72.01 Central perforation of tympanic membrane, right ear

H72.02 Central perforation of tympanic membrane, left ear

H72.03 Central perforation of tympanic membrane, bilateral

H72.10 Attic perforation of tympanic membrane, unspecified ear

H72.11 Attic perforation of tympanic membrane, right ear

(100)

Perforation of Tympanic Membrane

ICD-9-CM ICD-10-CM

H72.12 Attic perforation of tympanic membrane, left ear

H72.13 Attic perforation of tympanic membrane, bilateral

H72.2x1 Other marginal perforations of tympanic membrane, right ear

H72.2x2 Other marginal perforations of tympanic membrane, left ear

H72.2x3 Other marginal perforations of tympanic membrane, bilateral

H72.2x9 Other marginal perforations of tympanic membrane, unspecified ear

(101)

Perforation of Tympanic Membrane

ICD-9-CM ICD-10-CM

H72.811 Multiple perforations of tympanic membrane, right ear H72.812 Multiple perforations of tympanic membrane, left ear H72.813 Multiple perforations of tympanic membrane, bilateral H72.819 Multiple perforations of tympanic membrane, unspecified ear H72.821 Total perforations of tympanic membrane, right ear

H72.822 Total perforations of tympanic membrane, left ear

H72.823 Total perforations of tympanic membrane, bilateral

H72.829 Total perforations of tympanic membrane, unspecified ear

(102)

Key Updates to Diseases of the

Circulatory System (I00-I99)

• The time frame for assigning the acute MI code is four (4) weeks in

ICD-10-CM

• A new category has been added for coding a subsequent acute MI,

which is an MI that occurs within 28 days (4 weeks) of a previous

acute MI

• Terminology used to describe several cardiovascular conditions has

been revised to reflect more current medical practice

• Many codes in this section instruct us to

Use An Additional Code

• A major change is the classification of hypertension, which in

ICD-9-CM was classified by type:

– Benign, Malignant or Unspecified

• That classification is not required in ICD-10-CM

(103)

Coronary Artery Disease (CAD)

ICD-9-CM ICD-10-CM

414.01 Coronary artery disease, native vessel

411.1 Unstable angina

I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina

I25.111 Atherosclerotic heart disease of native coronary artery with angina

pectoris with documented spasm

I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris

I25.119 Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris

I25.10 Atherosclerotic heart disease of native coronary artery without

angina pectoris

(104)

Key Updates for Diseases

of the Respiratory System (J00-J99)

• Modifications have been made to specific

categories that bring the terminology

up-to-date with current medical practice

– Emphysema now contains codes with panlobular

and centrilobular in their description

• Asthma is now classified as mild intermittent, mild

persistent, moderate persistent and severe persistent

• Many codes in this section instruct us to

Use An

(105)

Asthma Severity

Asthma Severity Frequency of Daytime Symptoms

Intermittent Less than or equal to 2 times per week.

Mild Persistent More than 2 times per week.

Moderate Persistent Daily. May restrict physical activity.

Severe Persistent Throughout the day. Frequent severe attacks limiting

ability to breathe.

(106)

Key Updates for Diseases of the

Respiratory System (J00-J99) continued…

• Specificity increased for diseases like

influenza, acute bronchitis

• Coding notes updated to require the coder to

include information about tobacco

use/dependence, where applicable

• Procedural complications that affect the

respiratory system are now included

(107)

Documentation Awareness Tips

Asthma Documentation Awareness

Acuity: e.g. acute, chronic

Cause: e.g. exercise induced, cough variant, related to smoking, chemical or particulate cause, occupational

Severity (for

persistent asthma patients)

e.g. mild, moderate or severe persistent

(108)

Asthma

ICD-9-CM ICD-10-CM

493.01 Extrinsic asthma with status asthmaticus J45.21 Mild intermittent asthma with acute exacerbation

493.02 Extrinsic asthma with acute exacerbation

J45.22 Mild intermittent asthma with status asthmaticus

493.11 Intrinsic asthma with status asthmaticus J45.31 Mild persistent asthma with acute exacerbation

493.12 Intrinsic asthma with acute exacerbation J45.32 Mild persistent asthma with status asthmaticus 493.21 Chronic obstructive asthma with status

asthmaticus

J45.41 Moderate persistent asthma with acute exacerbation

493.22 Chronic obstructive asthma with acute exacerbation

J45.42 Moderate persistent asthma with status asthmaticus

493.81 Exercise induced bronchospasm J45.51 Severe persistent asthma with acute exacerbation

(109)

Asthma

ICD-9-CM ICD-10-CM

493.91 Asthma, unspecified with status asthmaticus

J45.901 Unspecified asthma with acute exacerbation* 493.92 Asthma, unspecified

with acute exacerbation

J45.902 Unspecified with status asthmaticus* J45.909 Unspecified asthma, uncomplicated* J44.0 COPD with acute lower respiratory infection

** 5th_{digit of each code}

represents unspecified

J44.1 COPD with acute exacerbation J45.990 Exercise induced bronchospasm J45.991 Cough variant asthma

** 5th_{digit of 0 is uncomplicated except for unspecified J45.909}

• *Use additional code to identify:

• Exposure to environmental tobacco smoke (Z77.22) • Exposure to tobacco smoke in perinatal period (P96.81) • History of tobacco use (Z87.891)

• Occupational exposure to environmental tobacco smoke (Z57.31) • Tobacco dependence (F17-)

(110)

Tobacco Dependence and

Abuse

ICD-9-CM ICD-10-CM

305.1 Tobacco

abuse/dependence

F17.211 Nicotine dependence , cigarettes, in remission

F17.213 Nicotine dependence, cigarettes, with withdrawal

F17.218 Nicotine dependence, cigarettes, with other nicotine-induced disorders

F17.221 Nicotine dependence , chewing tobacco, in remission

F17.223 Nicotine dependence, chewing tobacco, with withdrawal

F17.228 Nicotine dependence, chewing tobacco, with other nicotine-induced disorders

(111)

Key Updates for Diseases of the

Digestive System (K00-K95)

• A number of new subcategories have been added to this chapter

• Hernia with both gangrene and obstruction is classified to Hernia

with gangrene

• Codes for Crohn’s disease have been expanded to specify site, if a

complication is present, and what that complication is

• Many codes in this section instruct us to

Use An Additional Code

• Some terminology changes and revisions to the classification of

specific digestive conditions have occurred in ICD-10-CM as well.

– The term hemorrhage is used when referring to ulcers.

– The term bleeding is used when classifying gastritis, duodenitis,

diverticulosis and diverticulitis

(112)

Clinical Documentation Awareness Tips

Enteritis / Crohn’s Documentation Awareness

Site: e.g. small, large, both

(113)

Enteritis / Crohn’s Disease

ICD-9-CM ICD-10-CM

555.9 Regional enteritis of unspecified site

K50.90 Crohn’s disease, unspecified, without complications

** Use additional code to identify manifestations, such as: pyoderma gangrenosum (L88)

* There are more specific code choice selections available in

ICD-10-CM. These include:

K50.00 Crohn’s disease of small intestine without complications

(114)

Crohn’s Disease

ICD-9-CM ICD-10-CM

K50.011 Crohn’s disease of small intestine with rectal bleeding

K50.012 Crohn’s disease of small intestine with intestinal obstruction

K50.013 Crohn’s disease of small intestine with fistula

K50.014 Crohn’s disease of small intestine with abscess

K50.018 Crohn’s disease of small intestine with other complication

K50.019 Crohn’s disease of small intestine with unspecified complications

(115)

Crohn’s Disease

ICD-9-CM ICD-10-CM

K50.10 Crohn’s disease of large intestine without complications

K50.111 Crohn’s disease of large intestine with rectal bleeding

K50.112 Crohn’s disease of large intestine with intestinal obstruction

K50.113 Crohn’s disease of large intestine with fistula

K50.114 Crohn’s disease of large intestine with abscess

K50.118 Crohn’s disease of large intestine with other complication

(116)

Crohn’s Disease

ICD-9-CM ICD-10-CM

K50.119 Crohn’s disease of large intestine with unspecified complications

K50.80 Crohn’s disease of both small and large intestine without complications

K50.811 Crohn’s disease of both small and large intestine with rectal bleeding

K50.812 Crohn’s disease of both small and large intestine with intestinal obstruction K50.813 Crohn’s disease of both small and large intestine with fistula

K50.814 Crohn’s disease of both small and large intestine with abscess

(117)

Crohn’s Disease

ICD-9-CM ICD-10-CM

K50.818 Crohn’s disease of both small and large intestine with other complication K50.819 Crohn’s disease of both small and large intestine with unspecified

complications

K50.911 Crohn’s disease, unspecified, with rectal bleeding

K50.912 Crohn’s disease, unspecified, with intestinal obstruction

K50.913 Crohn’s disease, unspecified, with fistula

K50.914 Crohn’s disease, unspecified, with abscess

K50.918 Crohn’s disease, unspecified, with other complication

K50.919 Crohn’s disease, unspecified, with unspecified complications

(118)

Key Updates for Diseases of

the Skin and Subcutaneous System (L00-L99)

• This section has been restructured to include groups of diseases

that are related to one another

– Assume causal condition with any condition listed below with Lower Extremity ulcer

• Atherosclerosis of Lower Extremity • Chronic venous hypertension

• Diabetic ulcers

• Postphlebitic syndrome • Postthrombotic syndrome • Varicose ulcer

• Any associated gangrene

• Unlike ICD-9 codes, pressure ulcer codes are now combination

codes that identify the site and stage of the ulcer.

• Procedural complications of the skin and subcutaneous tissue have

been enhanced

(119)

Non-pressure Chronic Ulcer Left Heel and Midfoot

Open into Dermis

ICD-9-CM ICD-10-CM

707.14 Ulcer of heel and midfoot L97.421 Non-pressure chronic ulcer of the left heel and midfoot limited to

(120)

Key Updates for Diseases of the

Musculoskeletal System and Connective System (M00-M99)

• Site and laterality designations

• Three different causes for pathological fractures:

– Neoplastic disease,

– Osteoporosis, and

– other specified disease

• The 7th character describes type of encounter, or

the state of a fractures’ healing and any sequelae.

Some codes in this chapter will have the 7th

(121)

Scoliosis

Scoliosis Documentation Tips

•Identify the type of scoliosis:

o Idiopathic - Infantile - Juvenile - Adolescent - Other o Secondary - Neuromuscular - Other o Thoracogenic o Other form o Unspecified • Identify site: o Cervical o Cervicothoracic o Thoracic o Thoracolumbar o Lumbar o Lumbosacral

o Sacral/sacrococcygeal (only applies to infantile idiopathic scoliosis) o Site unspecified

(122)

Scoliosis

ICD-9-CM ICD-10-CM

737.30 Scoliosis (and kyphocoliosis) idiopathic

M41.112 Juvenile idiopathic scoliosis, cervical region

M41.113 Juvenile idiopathic scoliosis, cervicothoracic region M41.114 Juvenile idiopathic scoliosis, thoracic region

M41.115 Juvenile idiopathic scoliosis, thoracolumbar region M41.116 Juvenile idiopathic scoliosis, lumbar region

M41.117 Juvenile idiopathic scoliosis, lumbosacral region M41.119 Juvenile idiopathic scoliosis, site unspecified