Appropriate Use of 7 Character in ICD 10 CM - Ahima Ahmed... · ICD-10-CM Indexes A summary of the chapters found in the Tabular List has been provided below Chapter Code Range #

©2017 AHIMA’s Intellectual Property. All rights reserved.

Appropriate Use of 7th Character inICD 10 CM

Jameel Ahmed – RHIA,CCSCorporate, Group HIM ManagerSEHA - Abu Dhabi Health Services Co

18,000Employees

12Hospitals

57AmbulatoryClinics

3MobileClinics

2Blood Banks

10PreventionScreeningCenters

SEHA: Abu Dhabi Healthservices

©2017 AHIMA’s Intellectual Property. All rights reserved.2

SEHA is the corporate marketing name of Abu Dhabi Health Services Company,an independent public joint stock company that owns and operates all publichospitals and Ambulatory Healthcare clinics across the emirates of Abu Dhabi.

‘SEHA’ is a phonetic rendering of the Arabic word for ‘Health’.

Learning Objectives

Identify theunique

characteristics ofICD-10-CM withthe use of 7th

CharacterSpecificity

UnderstandSpecific Chapters

of ICD 10 CMutilizing Seventh

character

Distinguishbetween

different ClinicalCoding Versions

based oninternational

standards


Identify theunique

characteristics ofICD-10-CM withthe use of 7th

CharacterSpecificity

UnderstandSpecific Chapters

of ICD 10 CMutilizing Seventh

character

Distinguishbetween

different ClinicalCoding Versions

based oninternational

standards

Greater Specificity:

CM

Three to seven characters


CM

CM

Three to five characters

ICD 10 CACanada

ICD 10 CMClinical Modification - USA

7th Character:

Only ICD 10 CM Contains 7th Character


ICD 10 WHOPure, World Health

Organization

ICD 10 AMAustralian Modification

11

55 66 7722 33 44

44 55

11

22 33

category etiology,anatomic site,manifestation

ICD-9/10 Code Format

ICD-10 CM Code Format

Structure of ICD 10 CM


55 66 7722 33 4411etiology,

anatomic site,manifestation

category etiology,anatomic site,

severity

extension

ICD-9-CM16,025

ICD-10-CM68,069Diagnosis Codes

ICD-9-AM14,000

ICD-10-AM21,885Diagnosis Codes

ICD 9 CM, ICD 10 AM, ICD 10 CM


ICD-9-AM14,000

ICD-10-AM21,885Diagnosis Codes

ICD-9-CA14,000

ICD-10-CA30,000Diagnosis Codes

ICD-10-CM Indexes - A summary of the chapters

Chapter Code Range # of Codes Description

1 A00-B99 1,056 Certain infectious and parasitic diseases

2 C00-D49 1,620 Neoplasms

3 D50-D89 238 Diseases of the blood and blood-forming organs andcertain disorders involving the immune mechanism

E00-E89 675 Endocrine, nutritional and metabolic diseases


4 E00-E89 675 Endocrine, nutritional and metabolic diseases

5 F01-F99 724 Mental, Behavioral and Neurodevelopmentaldisorders

6 G00-G99 591 Diseases of the nervous system

7 H00-H59 2,452 Diseases of the eye and adnexa

8 H60-H95 642 Diseases of the ear and mastoid process

9 I00-I99 1,254 Diseases of the circulatory system10 J00-J99 336 Diseases of the respiratory system

11 K00-K95 706 Diseases of the digestive system

ICD-10-CM IndexesA summary of the chapters found in the Tabular List has been provided below

Chapter Code Range # of Codes Description

12 L00-L99 769 Diseases of the skin and subcutaneous tissue

13 M00-M99 6,339 Diseases of the musculoskeletal system and connectivetissue

14 N00-N99 591 Diseases of the genitourinary system

15 O00-O99 2,155 Pregnancy, childbirth and the puerperium


16 P00-P96 417 Certain conditions originating in the perinatal period

17 Q00-Q99 790 Congenital malformations, deformations andchromosomal abnormalities

18 R00-R99 639 Symptoms, signs and abnormal clinical and laboratoryfindings, not elsewhere classified

19 S00-T88 39,869 Injury, poisoning and certain other consequences ofexternal causes

20 V00-Y99 6,812 External causes of morbidity

21 Z00-Z99 1,178 Factors influencing health status and contact withhealth services

Question : Audience Learning Questions

1. How may chapters of ICD 10 CM have 7th

Character?

(out of 21 chapters of ICD 10 CM)

2. 7th Character in ICD 10 CM contains?

letter Alphabet Can have either letter or Alphabet


1. How may chapters of ICD 10 CM have 7th

Character?

(out of 21 chapters of ICD 10 CM)

2. 7th Character in ICD 10 CM contains?

letter Alphabet Can have either letter or Alphabet

7th Character:

Guideline:

Certain ICD-10-CM categories have applicable 7th characters.

The applicable 7th character is required for all codes within thecategory, or as the notes in the Tabular List instruct.

The 7th character must always be the 7th character in the datafield.

If a code that requires a 7th character is not 6 characters, aplaceholder X must be used to fill in the empty characters.


Guideline:





Place Holder X:

Utilizing Place Holder:

ICD 10 CM utilizes a placeholder which is always the letter X and hastwo uses:

As the fifth character for certain six character codes. The X providesfor future expansion without disturbing the sixth characterstructure.

When a code has less than six characters and a seventh character isrequired. The X is assigned for all characters less than six in order tomeet the requirement of coding to the highest level of specificity.


Utilizing Place Holder:

ICD 10 CM utilizes a placeholder which is always the letter X and hastwo uses:

As the fifth character for certain six character codes. The X providesfor future expansion without disturbing the sixth characterstructure.

When a code has less than six characters and a seventh character isrequired. The X is assigned for all characters less than six in order tomeet the requirement of coding to the highest level of specificity.

7th Character:

A code that has an applicable7th character is considered

invalid without the 7thcharacter.


A code that has an applicable7th character is considered

invalid without the 7thcharacter.

7th Character:

Chapters in ICD 10 CM with Seventh Characters:

SevenCharacters

(ICD 10CM)

Chapter 13

Chapter 15

Pathological or Stress Fracture Seventh Characters

Pregnancy, Childbirth and the Puerperium

Fetus identification

X

X

X

X

Coding pathological fractures


SevenCharacters

(ICD 10CM) Chapter 18

Chapter 19

Symptoms, Signs and Abnormal Clinical and LaboratoryFindings

Coma Scale

Fractures & Poisoning, Adverse Effect, Underdose

X

X

X

X

Chapter 20

EncounterX

X

X

Injury, Poisoning, and Certain Other Consequences ofExternal Causes

External Causes of Morbidity

7th Character:

Guideline:






Guideline:





The “Encounter” is the most common value of the 7th character.

The most common “encounter” values are designated as

“A” initial encounter,

“D” subsequent encounter, and

“S” sequela; however, it is important to reference the tabularindex for appropriate characters for each category (i.e., categoriesfor traumatic fractures have additional 7th character values).

7th Character:


The “Encounter” is the most common value of the 7th character.

The most common “encounter” values are designated as

“A” initial encounter,

“D” subsequent encounter, and

“S” sequela; however, it is important to reference the tabularindex for appropriate characters for each category (i.e., categoriesfor traumatic fractures have additional 7th character values).

“While the patient may be seen by a new or differentprovider over the course of treatment for an injury,

assignment of the 7th character is based on whetherthe patient is undergoing active treatment and notwhether the provider is seeing the patient for the

first time.”1

7th Character:


“While the patient may be seen by a new or differentprovider over the course of treatment for an injury,

assignment of the 7th character is based on whetherthe patient is undergoing active treatment and notwhether the provider is seeing the patient for the

first time.”1

There’s no ICD-9 equivalent of theseventh character.

In fact, it can be stated that there isno ICD 9, no ICD 10 AM, no ICD 10 CA,

no ICD 10 WHO, equivalent of theseventh character

7th Character:


There’s no ICD-9 equivalent of theseventh character.

In fact, it can be stated that there isno ICD 9, no ICD 10 AM, no ICD 10 CA,

no ICD 10 WHO, equivalent of theseventh character

Initial encounter:

– The patient is receiving active treatmentfor the condition• Surgical treatment• Emergency department encounter• Evaluation and continuing (ongoing)

treatmentby the same or different physician

Initial Encounter


Initial encounter:

– The patient is receiving active treatmentfor the condition• Surgical treatment• Emergency department encounter• Evaluation and continuing (ongoing)

treatmentby the same or different physician

19

Subsequent encounter

– After patient received active treatment for thecondition and receiving routine care during healing orrecovery phase

Cast change or removal An x-ray to check healing status of fracture Removal of external or internal fixation device Medication adjustment Other aftercare and follow-up visits following injury treatment

Subsequent Encounter


Subsequent encounter

– After patient received active treatment for thecondition and receiving routine care during healing orrecovery phase

Cast change or removal An x-ray to check healing status of fracture Removal of external or internal fixation device Medication adjustment Other aftercare and follow-up visits following injury treatment

20

Sequela

– Complications or conditions that arise as a direct result of acondition

• Scar formation after burn– Use both the injury code that precipitated sequela and code

for sequela– S added only to injury code, not sequela code– S identifies injury responsible

for sequela– Specific type of sequela (like scar) sequenced first, followed by

injury code

Sequela:


Sequela

– Complications or conditions that arise as a direct result of acondition

• Scar formation after burn– Use both the injury code that precipitated sequela and code

for sequela– S added only to injury code, not sequela code– S identifies injury responsible

for sequela– Specific type of sequela (like scar) sequenced first, followed by

injury code

21

AA • Initial encounter

DD • Subsequent – routine healing

GG • Subsequent – delayed healing

Pathological or Stress FractureSeventh Characters (M00-M99)


G

KK • Subsequent – nonunion

PP • Subsequent – malunion

SS • Sequela

Pathological or Stress FractureSeventh Characters (M00-M99)

• Patient originally diagnosed with left upper lobe lung carcinoma 5years ago is seen for a fracture of the shaft of the right femur.

• Eight months ago, he was diagnosed with metastatic bone cancer(from the lung) and this fracture is a result of the metastaticdisease.

• This patient’s lung cancer was treated with radiation and there isno longer evidence of an existing primary malignancy.


• Patient originally diagnosed with left upper lobe lung carcinoma 5years ago is seen for a fracture of the shaft of the right femur.

• Eight months ago, he was diagnosed with metastatic bone cancer(from the lung) and this fracture is a result of the metastaticdisease.

• This patient’s lung cancer was treated with radiation and there isno longer evidence of an existing primary malignancy.

M84.551A Pathological fracture in neoplastic disease, rightfemur, initial encounter for fracture

C79.51 Carcinoma (malignant), metastatic, bone, femur, secondary.Z85.118 History, personal (of), malignant neoplasm (of), lungZ92.3 History, personal (of), radiation therapy

Seventh CharacterSeventh CharacterSeventh CharacterSeventh Character

Pregnancy, Childbirth and thePuerperium (000-099)


Pregnancy, Childbirth and thePuerperium (000-099)

Patient G1P0 at 39 weeks with twin gestation.The delivery was complicated by nuchal cord, without

compression, of fetus 2. Both infants were liveborn and healthy.

O30.003 Twin pregnancy, unspecified numberof placenta and unspecified number ofamniotic sacs, third trimester

O69.81X2 Labor and delivery complicated bycord around neck, withoutcompression, fetus 2

Z3A.39 Pregnancy (single) (uterine), weeks of gestation, 39weeks

Z37.2 Outcome of delivery, twins NEC, both liveborn©2017 AHIMA’s Intellectual Property. All rights reserved.

25

Patient G1P0 at 39 weeks with twin gestation.The delivery was complicated by nuchal cord, without

compression, of fetus 2. Both infants were liveborn and healthy.

O30.003 Twin pregnancy, unspecified numberof placenta and unspecified number ofamniotic sacs, third trimester

O69.81X2 Labor and delivery complicated bycord around neck, withoutcompression, fetus 2

Z3A.39 Pregnancy (single) (uterine), weeks of gestation, 39weeks

Z37.2 Outcome of delivery, twins NEC, both liveborn

• One from each subcategory(R40.21, R40.22, R40.23) needed

• Seventh character indicateswhen recorded - should match

Used withtraumatic

brain injuryor sequelaeof cerebro-

vasculardisease codes

Used withtraumatic



Symptoms, Signs and Abnormal Clinical andLaboratory Findings – Coma Scale (R00-R99)


• One from each subcategory(R40.21, R40.22, R40.23) needed

• Seventh character indicateswhen recorded - should match

Used withtraumatic



Used withtraumatic



0 Unspecified time

1 In field (EMT or ambulance)

2 At arrival to ER3 At hospital admission4 24 hours after admission

R40.2111 Coma, with opening of eyes (never)R40.2211 Coma, with verbal response (none)R40.2311 Coma, with motor response (none)R40.2134 Coma, with opening of eyes, in

response to soundR40.2234 Coma, with verbal response,

inappropriate wordsR40.2344 Coma, with motor response, flexion

withdrawal


R40.2111 Coma, with opening of eyes (never)R40.2211 Coma, with verbal response (none)R40.2311 Coma, with motor response (none)R40.2134 Coma, with opening of eyes, in

response to soundR40.2234 Coma, with verbal response,

inappropriate wordsR40.2344 Coma, with motor response, flexion

withdrawal

27

A – Initial closed

B – Initial open

D – Subsequent routine

G – Subsequent delayed

Injury, Poisoning, and Certain OtherConsequences of External Causes (S00-T88)


G – Subsequent delayed

K – Subsequent nonunion

P – Subsequent malunion

S - Sequela

28

External Causes of Morbidity (V00-Y99)

W13.4XXA Fall from, out of or through window, initial encounter

W13.4XXD Fall from, out of or through window, subsequent encounter

W13.4XXS Fall from, out of or through window, sequela

W13.8XXA Fall from, out of or through other building or structure, initial encounter

W13.8XXD Fall from, out of or through other building or structure, subsequent encounter


W13.8XXS Fall from, out of or through other building or structure, sequela

W13.9XXA Fall from, out of or through building, not otherwise specified, initial encounter

W13.9XXDFall from, out of or through building, not otherwise specified, subsequentencounter

W13.9XXS Fall from, out of or through building, not otherwise specified, sequela

W14.XXXA Fall from tree, initial encounter

W14.XXXD Fall from tree, subsequent encounter

W14.XXXS Fall from tree, sequela



Phase I & Phase II : 350 Coders Training Completed from SEHA Corporate, with each Coder covering 15 hours training 100 Revenue Cycle Employees are trained across SEHA BE’s Around 50 Case Managers are trained for SEHA BE’s, covering each employee 5 hours of training

Region SEHA BE’s Scheduled Sessions Status

Island Region SKMC, Corniche,21st & 22nd , Sep 2016

SKMC training room 2 – Administration Block.2 days (15 hours) Completed

Al Ain RegionAl Ain, AHS

Tawam Hospital

19th & 20th October 2016Al Ain Hospital(Block F - Computer Lab 1 Training Room)

17th & 24th October 2016, Recreation TrainingRoom, Tawam

2 days (15 hours)

2 days (15 hours)

Completed

Completed

ICD-10 CM Training100%

Completion &Implementatio

n in all SEHABE’s


Al Ain, AHS

Tawam Hospital

19th & 20th October 2016Al Ain Hospital(Block F - Computer Lab 1 Training Room)

17th & 24th October 2016, Recreation TrainingRoom, Tawam

2 days (15 hours)

2 days (15 hours)

Completed

Completed

Middle Region Al Rahba, Al MafraqAl Gharbia

11th & 12th Oct 2016,Al Rahba AuditoriumAdministration Block

2 days (15 hours) Completed

Gharbia Region Al Gharbia Hospitals 11th & 12th Oct 2016,Al Rahba AuditoriumAdministration Block


Middle Region AHS 26th & 27th Oct 2016,AHS Training Room, 8th FloorAHS Headoffice


ICD 10 Assessment All BE’s Nov/Dec 2016, 1st & 2nd WeekMandatory Requirement for all Coders acrossBE’s

December 2016(16 hours (2 days) in each

SEHA BE)

Completed

References

• www.ahima.org• https://www.cms.gov/• www.ahima.academy• http://www.who.int/en/


• www.ahima.org• https://www.cms.gov/• www.ahima.academy• http://www.who.int/en/

33

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Appropriate Use of 7 Character in ICD 10 CM - Ahima Ahmed... · ICD-10-CM Indexes A summary of the chapters found in the Tabular List has been provided below Chapter Code Range #