How To Find The Right ICD-10 Code

ICD-10 Boot Camp

Part 3 - Code Selection Strategies

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Presented by Evan M. Gwilliam, DC MBA BS CPC CCPC NCICS CCCPC CPC-I MCS-P CPMA

Chief Product Officer

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Dr. Evan Gwilliam

• Education• Bachelor’s of Science, Accounting - Brigham Young University• Master’s of Business Administration - Broadview University• Doctor of Chiropractic, Valedictorian - Palmer College of

Chiropractic

• Certifications• Certified Professional Coder (CPC) - AAPC• Nationally Certified Insurance Coding Specialist (NCICS) - NCCT• Certified Chiropractic Professional Coder (CCPC) - AAPC• ChiroCode Certified Chiropractic Professional Coder (CCCPC) -

ChiroCode• Certified Professional Coder – Instructor (CPC-I) - AAPC• Medical Compliance Specialist – Physician (MCS-P) - MCS• Certified Professional Medical Auditor (CPMA) – AAPC, NAMAS• Certified ICD-10 Trainer - AAPC

Overview• Part 1 - ICD-10 fundamentals and navigation• Part 2 - Coding conventions and guidelines• Part 3 - ICD-10 code selection strategies• Part 4 - Documentation improvement

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1. Common codes list(but don’t stop there!)

2. GEMs code map (don’t stop here either!)

3. Alphabetic Index(still not safe!)

Always confirm the code using the Tabular List

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Find the code

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1. Common Codes

2. GEMs

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2. GEMsGeneral Equivalence Mappings (GEMs)

o Created by the National Center for Health Statistics, part of the CDC

o Forward maps from ICD-9 to ICD-10

o Backward maps from ICD-10 to ICD-9

o Approximations only

3. Alphabetic Index

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Example #1Patient is an 18-month old fussy, white female with a three-day history of otalgia, runny nose and fever of 100. There is no exposure to tobacco smoke. Otoscopic examination reveals acute serous otitis media of the right ear. Assessment: Acute serous otitis media, right ear. On September 30, 2015, the diagnosis is 381.01 Acute serous otitis media.

On October 1, 2015, it is:

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1. Common codes list(but don’t stop there!)

2. GEMs code map (don’t stop here either!)

3. Alphabetic Index(still not safe!)

Always confirm the code using the Tabular List

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Find the code

1. Common Codes

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1. Common codes list(but don’t stop there!)

2. GEMs code map (don’t stop here either!)

3. Alphabetic Index(still not safe!)

Always confirm the code using the Tabular List

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Find the code

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2. GEMs

1. Common codes list(but don’t stop there!)

2. GEMs code map (don’t stop here either!)

3. Alphabetic Index(still not safe!)

Always confirm the code using the Tabular List

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Find the code

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3. Alphabetic Index

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3. Alphabetic Index

1. Common codes list(but don’t stop there!)

2. GEMs code map (don’t stop here either!)

3. Alphabetic Index(still not safe!)

Always confirm the code using the Tabular List

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Find the code

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Tabular List

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Tabular List

Example #1Patient is an 18-month old fussy, white female with a three-day history of otalgia, runny nose and fever of 100. There is no exposure to tobacco smoke. Otoscopic examination reveals acute serous otitis media of the right ear. Assessment: Acute serous otitis media, right ear. On September 30, 2015, the diagnosis is 381.01 Acute serous otitis media

On October 1, 2015, it is: H65.01 Acute serous otitis media, right ear

NOTE:• Common codes lists are just an expert guess• GEMs often leads to unspecified codes• Alphabetic Index often gives incomplete or multiple options 22

1. Common codes list(but don’t stop there!)

2. GEMs code map (don’t stop here either!)

3. Alphabetic Index(still not safe!)

Always confirm the code using the Tabular List

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Find the code

The next step for converting to ICD-10

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1. Go to the Tabular Listo Look at the following:

1. Notes2. Includes and alternative wording3. Excludes14. Excludes25. Code Also, Code First, Use Additional6. Seventh character extensions

2. Repeat at the level of the code, then the subcategory, category, block, and chapter

3. Reverse map for confirmation if necessary

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Tabular List

Example #2This 30-year old white male sustained a right knee injury while playing basketball on Saturday. He was seen in our urgent care clinic and sent for MRI of the right knee to rule out meniscal tear. MRI revealed right bucket-handle medial meniscal tear and tear of the anterior cruciate ligament (ACL). Patient will be scheduled for surgery on Tuesday.

On September 30, 2015, the diagnosis is 836.0 Bucket handle tear, meniscus, knee

On October 1, 2015, it is:

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1. Common codes list(but don’t stop there!)

2. GEMs code map (don’t stop here either!)

3. Alphabetic Index(still not safe!)

Always confirm the code using the Tabular List

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Find the code

1. Common Codes

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?

1. Common codes list(but don’t stop there!)

2. GEMs code map (don’t stop here either!)

3. Alphabetic Index(still not safe!)

Always confirm the code using the Tabular List

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Find the code

1. Common Codes

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2. GEMs

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Tabular List

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2. GEMs

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Tabular List

1. Common codes list(but don’t stop there!)

2. GEMs code map (don’t stop here either!)

3. Alphabetic Index(still not safe!)

Always confirm the code using the Tabular List

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Find the code

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3. Alphabetic Index

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Tabular List

The next step for converting to ICD-10

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1. Go to the Tabular Listo Look at the following:

1. Notes2. Includes and alternative wording3. Excludes14. Excludes25. Code Also, Code First, Use Additional6. Seventh character extensions

2. Repeat at the level of the code, then the subcategory, category, block, and chapter

3. Reverse map for confirmation if necessary

The next step for converting to ICD-10

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1. Go to the Tabular Listo Look at the following:

1. Notes2. Includes and alternative wording3. Excludes14. Excludes25. Code Also, Code First, Use Additional6. Seventh character extensions

2. Repeat at the level of the code, then the subcategory, category, block, and chapter

3. Reverse map for confirmation if necessary

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Tabular List

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Tabular List

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Tabular List

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The next step for converting to ICD-10

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1. Go to the Tabular Listo Look at the following:

1. Notes2. Includes and alternative wording3. Excludes14. Excludes25. Code Also, Code First, Use Additional6. Seventh character extensions

2. Repeat at the level of the code, then the subcategory, category, block, and chapter

3. Reverse map for confirmation if necessary

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Tabular List

Example #2This 30-year old white male sustained a right knee injury while playing basketball on Saturday. He was seen in our urgent care clinic and sent for MRI of the right knee to rule out meniscal tear. MRI revealed right bucket-handle medial meniscal tear and tear of the anterior cruciate ligament (ACL). Patient will be scheduled for surgery on Tuesday.

On September 30, 2015, the diagnosis is 836.0 Bucket handle tear, meniscus, knee

On October 1, 2015, it is:S83.212A Bucket handle tear of medial meniscus, right knee

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34 specialty specific ICD-10 books• More than 70 pages which

teach• Conventions• Guidelines• Implementation steps• Documentation

strategies• Provider Documentation

Guides• Specialty specific

• GEMs mapping• Alpha Index• Abridged Tabular List

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