THE CLOCK IS TICKING ARE YOU READY FOR. Objectives

(1)

THE CLOCK IS TICKING…

ARE YOU READY FOR

ICD-10-CM?

ICD 10 CM?

Lisa Selman-Holman, JD, BSN, RN, COS-C, HCS-O, HCS-D Andrea L. Manning, BS, RN, COS-C, HCS-D

Objectives

Identify potentially significant

implications of the transition to ICD

2

implications of the transition to

ICD-10 and their impact on home health

agencies.

Explain key differences between

ICD-9 and ICD-10

Di

l

i

d

Discuss planning and

implementation timelines for a

successful transition to ICD-10.

(2)

Implementation Date:

Oct. 1, 2014

3

ICD10 Final Rule

•

Published September 5, 2012

Single implementation date for all

4

•

Single implementation date for all

users

•

Date of service for all except

inpatient settings

•

Date of discharge for inpatient

g

p

settings

(3)

ICD10CM

October 1, 2014

5

What are we waiting on?

5010 already implemented

OASIS C changes

Case mix diagnoses

Grouper logic changes

Code Freeze

No new codes for ICD-9-CM

No new codes for ICD 10 CM

No new codes for ICD-10-CM

But that doesn’t mean no changes

ICD-10-CM changes to the tabular and

indices have been issued

ICD-10-CM guideline changes were

expected

There will be a few new changes in the

(4)

OPERATIONAL

PREPARATION

7

PREPARATION

ICD10 is NOT just about

CODING!

Impact ALL healthcare entities across the care continuum including: hospitals, physicians,

8

g p , p y ,

ambulatory care and all payer sources (Medicare, Medicaid, etc.)

Impact entire agency.

Do not assume current processes are adequate and effective

Know where your agency currently stands y g y y operationally

ICD-10-CM is NOT just a clinical operational issue.

(5)

Don’t underestimate the

impact of this transition!

Failure to be fully prepared for ICD-10 can

result in the following:

9

result in the following:

Increased claims rejections and denials

Increased delays in processing

authorization and reimbursement claims

Improper claims payment

Cash flow issues

Coding backlogs

Compliance issues

Decisions based on inaccurate data

Cost of the transition to ICD10

CMS expects the home health industry as a whole to

10

p y

have an overall transition cost at $16.58 million dollars.

You will need to determine the impact on your agency’s

budget in the following areas:

Cost of training/education Updating forms/printing Consulting costs

Staff time/loss of productivity Temp or contract staffing Data conversion

(6)

Establish Realistic Timelines

for the Transition

Utilize the time between now and January

1 2014 to conduct a thorough agency

11

1, 2014 to conduct a thorough agency

assessment, identify operational

challenges, develop and implement

operational solutions and provide high-level

ICD-10-CM education

You will not only be well prepared for

ICD-10 b t

ill

t

h

10, but your agency will operate much more

smoothly and effectively in the meantime!

Recommended Timeline

Overview

12

2012 3rd_Quarter _{Preparation and Planning Phase}_g • Establish Transition Team • Establish Timelines 2012 4th_Quarter

-2013 1st_Quarter

Assessment Phase

• Current Operations Assessment

• ICD-10 Impact Assessment and Analysis • Identify Areas for Improvement/Modification 2013 2nd_{Quarter –}

2013 4th_Quarter

Development Phase

• Develop Operational Solutions and Strategies 2013 4 Quarter Develop Operational Solutions and Strategies

• Initial Training 2014 1st_{Quarter –}

2014 3rd_Quarter

Implementation Phase

• Execute Operational Strategies and Solutions • Testing

• Intense Training for Staff October 1, 2014 ICD-10-CM Implementation Date!

(7)

Assessment and Planning

Now!

Establish Implementation

13

p

Team

Establish Timelines

Transition Team Purpose

Gather information and provide input

through a multi disciplinary team

14

through a multi-disciplinary team

approach

Oversee and drive all phases of the

project

Meet regularly with a specific “to-do”

li t

list.

(8)

Establish your ICD10CM

Transition Team

Depends on the size of your agency

Choose people that others naturally

15

Choose people that others naturally

follow (leaders) and have a positive

attitude towards change

All departments should be represented

Consider outside vendors/consultants

Id

tif

P

Ch i

Identify a Program Chairman

Assessment Phase

Q4 2012Q1 2013

Current Operations

16

p

Assessment

ICD-10-CM Impact

Assessment & Analysis

Identify Areas for

(9)

Be prepared!

The importance of having strong,

effective systems in place PRIOR to the

17

effective systems in place PRIOR to the

implementation of ICD-10-CM cannot

be overemphasized.

Any operational or clinical weaknesses

or inefficiencies that currently exists

within your agency will only be

y

g

y

magnified during the transition and

implementation of a change with the

magnitude and scope of ICD-10-CM.

What to do first….

A thorough assessment of both

internal and external processes

18

internal and external processes,

policies, people and technologies.

Establish your agency’s current level

of efficiency and compliance.

Some processes will need little or no

dj

t

adjustments

(10)

Everyone will be affected:

Intake Process

Billi

/

ti

19

Billing/accounting

Quality Assurance

Clinical processes

Data entry/administrative support

Leadership/management

Coders

Systems that will be affected:

IT systems

20

y

Agency management software

Other outside vendors (billing

services, clearinghouses)

Payers (Medicare, Medicaid,

(11)

Referral Intake Process

Who is affected?

Nurses and admin

What is the potential

impact?

21

Nurses and admin

staff that process

referrals received

from outside

sources (hospitals,

physicians)

impact?

Inaccurate coding

and information

from referral

source

Preliminary coding

D t

t

f

Data entry of

referral information

Intake process

Operational Analysis

Does your agency have an effective Intake Process? Is it documented as part of a Process Manual?

22

p

Is it updated as the process, systems or people change? How are referrals received? Fax, email?

What criterion is used to evaluate appropriateness of a

referral for evaluation?

How is payer information verified and documented? Once the referral is accepted, hat process exists to staff

th l ti ? the evaluation?

How is communication with clinician, referral source and

(12)

Billing and Accounting

Who is affected? Staff

responsible for:

Potential

Impact-23

Pre billing audits Claims reviews Collections

Appeals and denials Insurance verification

Temporary increase in

coding errors resulting in rejected claims. CMS estimates 10% increase

Need to be prepared to

handle increased and authorizations handle increased _{rejections, denials,}

incorrectly submitted claims, RHHI issues and cash flow issues

Billing/Accounting Process

Operation Analysis

Does your agency have a documented, effective claims/billing/collections process?

24

g p

Do you conduct a pre-billing audit? What does that audit consist of? Who is responsible?

How are audit findings communicated to billers? Who is responsible for handling identified

problems and resolving them?

How are claims rejections handled and by j y whom?

What is your process for “working” A/R and ensuring payments are accurate and current? What is your average days to RAP? To Final

(13)

Clinical Case Management

Process

Who is affected?

Nurses and

Potential

impacts:

25

Nurses and

Therapists who

provide direct

patient care

and/or case

management

impacts:

Accurate

completion of

OASIS-C

Diagnosis

b

d 485/Pl

management

_{based 485/Plan}

of Care

development

Clinical Case Management

Operational Analysis

What clinical processes does your agency

currently have in place?

26

y p

Are they up to date?

What method of training and orientation exists for new clinicians?

Does your agency utilize standardized care pathways and patient teaching materials? How is your clinical department structured? How is your clinical department structured?

What care model do you utilize? (office based Case Management, Field Case Managers, etc.)

(14)

Quality Assurance Process

Analysis

Does your agency have a documented, effective QA process?

27

p

What is it comprised of? Who is responsible?

Is there a Utilization/Review (UR) piece?

What process exists to ensure appropriate and accurate completion of documentation, including OASIS-C and coding?

OASIS-C and coding?

Who is responsible for ensuring compliance with rules and regulations and keeping up with

changes?

What types of outcomes reports are run routinely? Who is responsible?

Agency

Leadership/Management

Clinical managers may be affected by changes in

f / OC

28

documentation requirements, forms, process, 485/POC development, OASIS-C changes as well as the actual ICD-10 coding changes.

CFO will need to budget and monitor ICD-10 conversion

costs from software upgrades and training to form

revisions, as well as model for cash flow disruptions. May need to consider securing lines of credit.

Administrators need to consider staffing needs

Administrators need to consider staffing needs,

productivity impacts, and contingency plans like

outsourcing partnerships. Strong project management will be key given all the moving parts necessary to make this transition successful.

(15)

Leadership/Management

Analysis

Do the managers in your agency have authority to identify problems AND make changes within

29

y p g

their departments?

Does your agency have a working organization chart clearly defining who is responsible for what?

Do your non-clinical managers have a basic understanding of the home health industry? What kind of training and education process

exists for Managers? Are the provided with the tools needed to be successful in their

management role?

Let’s talk about your Coders!

Is accurate and appropriate ICD coding

considered a high priority at your agency?

30

considered a high priority at your agency?

If not, then why not?

Who is responsible for coding in your

agency and are they qualified?

Do you employ or contract with certified

and/or experienced coding specialists?

Is coding just one more task added onto a

(16)

More on coding….

How confident are you that the coding in your agency is accurate and appropriate?

31

g y pp p

What QA and review processes take place prior to OASIS-C and claims submission?

What is the quality and quantity of the training your agency provides to staff responsible for this critical function?

Is there a coding piece in your orientation g p y process?

How does your average HHRG compare to those agencies that utilize certified coders? Are you leaving revenue on the table through

inaccurate coding practices?

Benefits of certified coders

and coding specialists

The purpose of home health agencies is to

provide appropriate, quality patient care to those

32

p pp p , q y p

we serve, right? There is an expectation that agency field staff will provide the highest level of quality care.

Is it realistic to also expect those same clinicians to have abilities as a coding specialist?

Utilizing certified coding specialists will improve

di d li d lik l

your coding accuracy and compliance and likely your reimbursement as well.

It will also afford your clinicians more time and resources to care for their patients.

(17)

Don’t put it off…

This is just the beginning of the dialog

for the upcoming ICD-10-CM transition

33

for the upcoming ICD 10 CM transition.

It is important that you stay abreast of

what is happening, as this change will

have a tremendous impact on your

agency.

Delaying putting this transition on our

y g p

g

radar will only contribute to the

challenges that will eventually need to

be faced.

Just do it!

34

~"The best way to get

(18)

The Clinical Aspects

35

The Clinical Aspects

What about ICD11?

House of Delegates adopted a policy to evaluate ICD-11

as a potential “alternative” to replace ICD-9

It took the US eight years to adapt the WHO version of

ICD-10 and create ICD-10-CM for use in this country

“Regardless of the benefits of ICD-11, the US would

need a national version to allow for the annual updating required by Congress and US stakeholders. Assuming that the development timeline for a national version or clinical modification of ICD-11 could be cut in half down to four years it would then take an additional two years to four years, it would then take an additional two years to get through the HIPAA rulemaking process. As with ICD-10-CM/PCS, the industry would want at least a three year period for converting systems to ICD-11.”

Assuming that ICD-11 becomes available on schedule

from WHO in 2016, then the earliest the U.S. could move to ICD-11 would be 2025, or 13 years from now. .

(19)

Tabular Chapters

A,B – Infectious and parasitic diseases C – Neoplasms

37

C Neoplasms

D – Neoplasms & blood and blood forming organs

E – Endocrine, nutritional, and metabolic F – Mental and behavioral disorders G – Nervous system

H – Eye and adnexa, ear and mastoid process I – Circulatory system

J – Respiratory system K – Digestive system

Tabular Chapters

L – Skin and subcutaneous tissue

M

Musculoskeletal and connective tissue

38

M – Musculoskeletal and connective tissue

N – Genitourinary system

O – Pregnancy, childbirth, and the

puerperium

P – Perinatal period

Q – Congenital malformations

Q Congenital malformations,

deformations and chromosomal

abnormalities

(20)

Tabular Chapters

S,T – Injury, poisoning and certain other consequences

of external causes

39

of external causes

U – Reserved by WHO for emergency codes V,W,X,Y – External causes of morbidity

- How were they hurt *

- Where they were when they were hurt - What activity were they doingWhat activity were they doing

- External cause status

Z – Factors influencing health status and contact with

health services

Note: * only required external cause code in HH

Coding and 7

th

_Character

40 Additional Characters Alpha (E t U) 2 - 7 Numeric or Alpha

X

X X

X

.

X

X X

X

A

M

S

S Ø

Ø 2

2

.

6

5 5 x

x

A

Characters (Except U)

Category Etiology, anatomic site, severity

Added code extensions (7th_{character) for}

obstetrics, injuries, and external causes of injury

3 – 7 Characters

(21)

Overview

Official Conventions

41

Placeholder ‘X’

•

Addition of dummy placeholder

42

‘X’ is used in certain codes to:

•

Allow for future expansion

•

Fill out empty characters when a

code contains fewer than 6

(22)

Example

Addition of 7

th

_Character

•

Used in certain chapters to provide

information about the characteristic

43

information about the characteristic

of the encounter

•

Must always be used in the 7

th

character position

•

If a code has an applicable 7

th

h

t

th

d

t b

character, the code must be

reported with an appropriate 7

th

character value in order to be valid

Excludes Notes

Excludes 1:

• An excludes 1 note is a pure excludes note. It means

44

p “NOT CODED HERE”

• Indicates the code excluded should never be used at

the same time as the code above the Excludes 1 notes.

• Is used when two conditions cannot occur together,

such as a congenital form versus an acquired form of the same condition

Excludes 2

• An excludes 2 note represents “not included here”. • Indicates the condition excluded is not part of the

condition represented by the code, but a patient may have both conditions at the same time

(23)

Excludes Note

Example

•

J18.Ø Bronchopneumonia, unspecified

organism

45

organism

Excludes1:

hypostatic bronchopneumonia (J18.2)

lipid pneumonia (J69.1)

Excludes2:

acute bronchiolitis (J21.-)

chronic bronchiolitis (J44.9)

Sequencing

ICD-10-CM coding guideline I.A.17 states

“

d

l

”

t i

t

t th t t

d

46

a “code also” note instructs that two codes

may be required to fully describe a

condition, but this note does not provide

sequencing direction.

In contrast, the Code First/Use Additional

co

as ,

e Code

s /Use dd o a

Code notes provide sequencing order of

the codes.

(24)

Laterality

•

For bilateral sites, the final character

47

of the code indicates laterality.

•

If no bilateral code is provided and

the condition is bilateral, assign

separate codes for both the left and

right side

•

An unspecified code is also provided

should the side not be identified in

the medical record

Laterality

Example

Osteoarthritis

M16 Ø Bilateral primary osteoarthritis

48

•

M16.Ø Bilateral primary osteoarthritis

of hip

•

M16.11 Unilateral primary

osteoarthritis, right hip

•

M16.12 Unilateral primary

(25)

Clinical Documentation

Improvement

Dependent somewhat on

improvement in physician

49

improvement in physician

documentation

OASIS

If injury, need to know how that

injury happened.

If late effect of injury, need to know

how that injury happened.

Laterality

Common Home Health

Di

i S

ifi E

l

50

(26)

Diabetes

51

Diabetes

Diabetes Mellitus

E10

E1Ø: Type 1 DM Includes: 52 Includes:

- brittle diabetes (mellitus)

- diabetes (mellitus) due to autoimmune process - diabetes (mellitus) due to immune mediated

pancreatic islet beta-cell destruction

- idiopathic diabetes (mellitus)p ( ) - juvenile onset diabetes (mellitus) - ketosis-prone diabetes (mellitus)

(27)

Diabetes Mellitus

E10

E1Ø: Type I DM Excludes 1 53 Excludes 1

-

diabetes mellitus due to underlying condition (EØ8.-) - drug or chemical induced diabetes mellitus (EØ9.-) - gestational diabetes (O24.4-)

- hyperglycemia NOS (R73.9) - neonatal diabetes mellitus (P7Ø.2)

- postpancreatectomy diabetes mellitus (E13.-)postpancreatectomy diabetes mellitus (E13. ) - postprocedural diabetes mellitus (E13.-) - secondary diabetes mellitus NEC (E13.-) - type 2 diabetes mellitus (E11.-)

Diabetes Mellitus

E1Ø Example

•

Type I insulin dependent

54

diabetic admitted for

management of new meds

related to exacerbation of

macular edema and mild

non-proliferative retinopathy

(28)

Diabetes Mellitus

E1Ø Answer

•

M1Ø2Ø: E1Ø.321 Type 1 diabetes

mellitus with mild nonproliferative

55

mellitus with mild nonproliferative

diabetic retinopathy with macular

edema

•

Note: Combination code includes all

aspects of disease

Diabetes Mellitus

E11

E11: Type II Diabetes Mellitus

Includes:

56

Includes:

- diabetes (mellitus) due to insulin

secretory defect

- diabetes NOS

- insulin resistant diabetes (mellitus)

Use an additional code for insulin use

(29)

Diabetes Mellitus

E11

E11: Type II Diabetes Mellitus

_Excludes1:

57

- diabetes mellitus due to underlying condition (EØ8-)

- drug or chemical induced diabetes mellitus (EØ9.-)

- gestational diabetes (O24.4-)

- neonatal diabetes mellitus (P7Ø 2)neonatal diabetes mellitus (P7Ø.2)

- postpancreatectomy diabetes mellitus (E13.-) - postprocedural diabetes mellitus (E13.-) - secondary diabetes mellitus NEC (E13.-) - type 1 diabetes mellitus (E1Ø.-)

Diabetes Mellitus

E11 Example

•

Patient was admitted for

58

uncontrolled diabetes type II

with neuropathy. Patient takes

insulin

(30)

Diabetes Mellitus

E11 Answer

• M1Ø2Ø: E11.4Ø Type II diabetes mellitus with diabetic neuropathy, unspecified

59

p y, p

• M1Ø22: E11.65 Type II diabetes mellitus with hyperglycemia

• M1Ø22: Z79.4 Long term current use insulin Note: alpha instruction: out of control - code to

Diabetes by type with hyperglycemia Diabetes, by type, with hyperglycemia

Neuropathy is coded unspecified.

Polyneuropathy is a specific code E11.42

Diabetes Mellitus

E11 Example

•

Patient was admitted for

60

diabetes type II with

gangrene. Patient takes

insulin

(31)

Diabetes Mellitus

E11 Answer

•

M1Ø2Ø: E11.52 Type II

61

yp

diabetes mellitus with diabetic

peripheral angiopathy with

gangrene

M1Ø22 Z79 4 L

t

•

M1Ø22: Z79.4 Long term

current use insulin

Diabetes Mellitus

E11 Example

•

Patient was admitted for

62

diabetes type II with Charcot’s

foot. Patient takes insulin for

his uncontrolled diabetes.

(32)

Diabetes Mellitus

E11 Answer

•

M1Ø2Ø: E11.610 Type II

63

diabetes mellitus with diabetic

neuropathic arthropathy

•

M1Ø22: E11.65 Type II

diabetes with hyperglycemia

•

M1Ø22: Z79.4 Long term

current use insulin

Ulcers

(33)

Pressure Ulcer

Example

•

Patient admitted with a stage

65

g

III pressure ulcer to left heel.

A stage II pressure ulcer to

right heel. The stage III

d i

wound is gangrenous.

Pressure Ulcer

Answer

•

M1Ø2Ø: I96 Gangrenous cellulitis

M1Ø22 L89 623 Press re lcer of

66

•

M1Ø22: L89.623 Pressure ulcer of

left heel, stage 3

•

M1Ø22: L89.612 Pressure ulcer of

right heel, stage 2

Note: Code first any associated

(34)

Pressure Ulcers

The patient has a Stage 3 on the

right buttock and a Stage 4 on

67

right buttock and a Stage 4 on

right shoulder blade. There is a

suspected DTI on the right heel.

He also has Type 2 diabetes and

failure to thrive. Dressing

g

changes on Stage 3 and Stage

4. Pressure relief for DTI with no

dressings.

Answer

ICD-10-CM Code Description 68

L89.114 Pressure ulcer R upper back Stage 4 L89.313 Pressure ulcer R buttock Stage 3 E11.9 Type 2 diabetes without complications R62.7 Failure to thrive, adult

L89.610 Pressure ulcer R heel, unstageable Z48.00 Non surgical dressing change

(35)

Arterial Ulcer

Example

•

Patient admitted with arterial

69

skin ulcer of left calf due to

atherosclerosis

Arterial Ulcer

Answer

•

M1Ø2Ø: I7Ø.242 Atherosclerosis of

native arteries of left leg with ulceration

70

native arteries of left leg with ulceration

of calf

•

M1Ø22: L97.221 Non pressure ulcer of

left calf limited to skin

Note: Reason for ulcer if known should

Note: Reason for ulcer, if known, should

be sequenced first

(36)

Ulcer Severity

L97.22- Non-pressure chronic ulcer of left calf

71

-1Non-pressure chronic ulcer of left calf limited to breakdown of skin

-2Non-pressure chronic ulcer of left calf with fat layer exposed

-3Non-pressure chronic ulcer of left calf with p necrosis of muscle

-4Non-pressure chronic ulcer of left calf with necrosis of bone

-9Non-pressure chronic ulcer of left calf with unspecified severity

Injuries

(37)

Injuries

•

No aftercare code for injuries

A

Initial enco nter

73

A = Initial encounter

D = Subsequent encounter

S = Sequela

•

Required to add the external cause

•

Required to add the external cause

code for how the injury happened

for home care

Open Wound

Example

•

Patient admitted for wound

74

care to lacerated right forearm

due to falling from moving

(38)

Open Wound

Answer

•

M1Ø2Ø: S51.811D Laceration

without foreign body of right

75

without foreign body of right

forearm

•

M1Ø22: VØØ.831D Fall from

moving motorized mobility scooter

Note: Fall from non moving

motorized mobility scooter

WØ5.2xxD

Acute Burn

Example

•

Patient admitted for wound

76

care due to second degree

burn of left foot due to hot

bath water

(39)

Acute Burn

Answer

•

M1Ø2Ø: T25.222D Burn of

second degree of left foot

77

second degree of left foot

•

M1Ø22: X11.ØxxD Contact with

hot bath water

Note: 5

th

_{and 6}

th

_{character ‘x’}

Note: 5

th

_{and 6}

th

_{character x}

required

Note: 7th character required

Sequela (Late Effect) Burn

Example

•

Patient admitted for PT and OT due

to joint contracture after the healing

78

to joint contracture after the healing

of a third degree burn to the right

foot when the hot oil from a fry

kettle poured on his foot at the

restaurant at which he worked.

•

Sequela are coded with a S 7

th

(40)

Sequela (Late Effect) Burn

Answer

• M1Ø2Ø: M24.574 Joint contracture right foot • M1Ø22: T25 321S Burn of third degree of right

79

• M1Ø22: T25.321S Burn of third degree of right foot, sequela

• M1Ø22: X1Ø.2xxS Contact with hot oil, sequela

The condition or nature of the sequela is

sequenced first The sequela code is sequenced sequenced first. The sequela code is sequenced second.

Note: 5th _{and 6}th _{character ‘x’ required}

Note: 7th character required

Traumatic Hip Fracture

Example

•

Patient admitted for aftercare

80

of traumatic right hip fracture

after falling out of wheelchair

(41)

Traumatic Hip Fracture

Answer

•

M1Ø2Ø: S72.ØØ1D Subsequent

encounter for closed fracture of

81

encounter for closed fracture of

unspecified part of neck of right femur with

routine healing

•

M1Ø22: WØ5.ØxxD Fall from wheelchair

Note: A fracture not indicated as opened or

l

d h

ld b

d d t

l

d

closed should be coded to closed

Example 7

th

_Character

Fractures

A = Initial encounter for closed fracture

B I iti l t f f t

82

B = Initial encounter for open fracture

D = Subsequent encounter for fracture with routine healing

G = Subsequent encounter for fracture with delayed healing

K = Subsequent encounter for fracture with nonunion

(42)

Osteoporosis With Fracture

Example

•

Patient admitted for aftercare

83

of pathological fractured

vertebra due to age related

osteoporosis. Documentation

indicates patient had previous

p

healed pathological fracture of

humerus due to osteoporosis

Osteoporosis With Fracture

Answer

• M1Ø2Ø: M8Ø.Ø8xD Age related osteoporosis with current pathological fracture, vertebra

84

p g ,

subsequent encounter

• M1Ø22: Z87.31Ø Personal history of healed osteoporosis fracture

Note: Age related osteoporosis is separate

category from other osteoporosisg y p

Note: Pathological fracture is separate category

(43)

Osteoporosis Fracture

Definition

•

Fragility fracture is defined as a

85

fracture sustained with trauma

no more than a fall from a

standing height or less that

occurs under circumstances that

would not cause a fracture in a

normal healthy bone

Circulatory

(44)

CVA

Example

•

Patient admitted for CVA with

87

right sided hemiparesis

CVA

Example

• M1Ø2Ø: I69.351 Hemiplegia and hemiparesis f ll i b l i f ti ff ti i ht

88

following cerebral infarction affecting right dominant side

Note: Should the affected side be documented, but not specified as dominant or non-dominant and the

classification system does not indicate a default, code selection as follows:

For ambidextrous patients, the default should be dominant

If the left side is affected, the default is non dominant If the right side is affected, the default is dominant

(45)

Code a CVA Example

The patient is admitted to home care

89

with dysphagia, dysphasia, and

ataxia following cerebral infarction.

ICD-10-CM

Code

Description

Code a CVA Example

The patient is admitted to home care

90

with dysphagia, dysphasia, and

ataxia following cerebral infarction.

ICD-10-CM

Code

Description

I69.393 Ataxia following CVA I69.391 Dysphagia following CVA R13.10 Dysphagia, unspecified

(46)

Myocardial Infarction

Example

•

Patient admitted to home

91

health with new diagnosis of

CAD after acute MI 5 weeks

ago. Patient is no longer

h

i

t

having symptoms

Myocardial Infarction

Answer

•

M1Ø2Ø: I25.1Ø Atherosclerotic heart

disease of native coronary artery

92

disease of native coronary artery

without angina

•

M1Ø22: I25.2 Old healed MI

N t

ICD 1Ø d fi iti

t MI

4 Note: ICD-1Ø definition acute MI = 4

weeks

(47)

Myocardial Infarction Example

Patient was treated for an

inferior wall MI in last 3 weeks

93

inferior wall MI in last 3 weeks

and then was readmitted to

hospital for anterior wall MI. He

is being admitted to home care

for O and A of unstable angina

g

and his CAD and teaching on his

multiple new cardiac meds.

Myocardial Infarction Answers

M1Ø2Ø: I25.11Ø AHD with

bl

i

94

unstable angina

M1Ø22: I21.19 MI other

coronary artery inferior wall

M1Ø22: I22.Ø MI of anterior wall

M1Ø22: Z79.899 Other long

(48)

Notes

Angina is considered integral to

CAD unless otherwise noted by the

95

CAD unless otherwise noted by the

physician.

A MI is coded as I21.- in the first 4

weeks.

If the patient has a second MI in the

fi t 4

k

it i

d d

ith I22

first 4 weeks, it is coded with

I22.-

The sequencing of the I21 and I22

codes depends on the

circumstances of the encounter.

Hypertension

I10 Essential hypertension

I11 Hypertensive Heart Disease

96

I11 Hypertensive Heart Disease

Use additional code for heart failure (I50.-)

I12 Hypertensive Chronic Kidney Disease

Use additional code for CKD (N18.-)

I13 Hypertensive Heart and Chronic Kidney

Disease

Use additional code for heart failure Use additional code for CKD

(49)

Examples to code

Hypertensive chronic diastolic heart failure

I11 0 Hypertensive heart disease with heart

97

I11.0 Hypertensive heart disease with heart

failure

I50.32 Chronic diastolic (congestive) heart

failure

Hypertension

I10 Hypertension

H

t

i

d ESRD

di l

i

Hypertension and ESRD on dialysis

I12.0 Hypertensive CKD with Stage 5 or ESRD

N18.6 ESRD

Z99.2 dialysis status

Nervous System

(50)

Code these…

Parkinson’s G20 99 Multiple sclerosis G35

Spastic hemiplegia of the left side after CHI and subdural

hemorrhage in 1988 after he fell off a ladder

G81.14

S06.5x9S

W11.xxxSS

Quadriplegia after a spinal cord injury at C6 one year ago

when the auto he was driving ran into a tree. H&P mentions complete lesion.

G82.53 Quadriplegia

S14.116S Complete lesion C6

V47.52xS Driver of other car collision with fixed or stationary object

Neoplasms and Blood

Di

d

100

(51)

Anemia Due To Neoplasm

Example

•

Patient admitted for

101

management of anemia

related to colon cancer. The

focus of care is the anemia.

Anemia Due To Neoplasm

Answer

•

M1Ø2Ø: C18.9 Colon cancer

unspecified

102

unspecified

•

M1Ø22: D63.Ø Anemia in

neoplastic disease

(52)

Antineoplastic Chemotherapy Anemia

Example

•

Patient admitted for

103

management of anemia

related to chemotherapy due

to colon cancer. The focus of

i th

i

care is the anemia.

Antineoplastic Chemotherapy Anemia

Answer

•

M1Ø2Ø: D64.81 Anemia due to

antineoplastic chemotherapy

104

antineoplastic chemotherapy

•

M1Ø22: T45.1x5D Adverse

effect of antineoplastic and

immunosuppressive drugs

subsequent

•

M1Ø22: C18.9 Colon cancer

(53)

Neoplasm Example

Patient with history of prostate

cancer and mets to the right

105

cancer and mets to the right

femur has pathological fx with

routine healing to the right femur.

He is admitted for therapy and

nursing for O & A, strengthening,

g

,

g

g,

transfers and pain management.

He is taking Morphine for pain.

Neoplasm Answers

M1Ø2Ø: M84.551D Pathological fracture

i

l

ti di

i ht f

ti

106

in neoplastic disease, right femur, routine

healing

M1Ø22: C79.51 Secondary malignant

neoplasm, bone

M1Ø22: G89.3 Neoplasm related pain

M1Ø22 Z85 46 Hi t

f

t t

M1Ø22: Z85.46 History of prostate ca

M1Ø22: Z79.891 Long term (current)

(54)

Aftercare & Postsurgical

C

li

i

107

Complications

Remember…

No aftercare codes for trauma

108

or fractures

We don’t know what CMS will

do with OASIS and the use of

M1024

(55)

Example

Patient had left BKA for diabetic

109

gangrene. Providing aftercare,

observation and assessment and

dressing changes.

ICD-10-CM Description M1024 (3) M1024(4)

Answers

110 ICD-10-CM Description M1024 M1024(4 (3) )

Z47.81

Aftercare

amputation

E11.5

2 E11.51

DM w/peripheral

angiopathy wo

g p

y

gangrene

Z89.51

Acquired absence

(56)

Same patient, but….

The amputation site is infected (MRSA)

d

d O d

t

ti

t

111

and necrosed. Orders are to continue to

provide care to the surgical wound and

dressing changes.

ICD-10-CM Description

T87.548 5 Necrosis of amp stump, LLEec os s o a p stu p, T87.44 Infection of amp stump, LLE B95.62 MRSA (cause of diseases

classified elsewhere)

Aftercare

The patient had a cholecystectomy

due to acute cholecystitis She also

112

due to acute cholecystitis. She also

has a history of breast cancer and is

taking Tamoxifen prophylactically.

She’s had some problems with

urinary retention after surgery. You

are to DC the indwelling catheter

and attempt to instruct on

(57)

Answers

ICD-10-CM Description M1024 (3) M1024 4)

113

Z48.815 Aftercare following

digestive system surgery

K81.0 R33.9 Urinary retention,

unspecified

Z46.6 Fitting and adjustment of g j urinary catheter

Z79.810 Long term use of Tamoxifen

Z85.3 History of breast cancer

Same patient but one of the

surgical wounds is dehisced

114 ICD-10-CM Description M1024 (3) M1024(4) T81.31xD Disruption of external surg wound R33.9 Urinary retention, unspecified

Z46 6 Fitting and adjustment of Z46.6 Fitting and adjustment of

urinary catheter Z79.810 Long term use of

(58)

SelmanHolman & Associates, LLC

115

Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, HCS-O

AHIMA Approved ICD-10-CM/PCS Trainer AHIMA ICD-10-CM Ambassador

Home Health Insight—Consulting, Education and Products

CoDR—Coding Done Right

606 N. Bell Ave. Denton, Texas 76209 940 383 2130 940.383.2130 972.692.5908 fax [email protected] www.selmanholmanblog.com www.selmanholman.com

Manning Healthcare Group, Inc.

116

Andrea L. Manning, BS, RN, HCS-D, COS-C

Home Health Consulting Home Health Consulting

Coding Services Education Leadership Coaching P.O. Box 1008 Talkeetna, Alaska 99676 907.733.4734 817.578.5075 cell [email protected] www.manninghealthcaregroup.com

(59)

THE CLOCK IS TICKING ARE YOU READY FOR. Objectives