Overview of ICD-10-CM
Garnet Career CenterMaggie McCabe, PAHM, CPC, CPC-H, CPC-P,
CPC-I, CMOM, CMCJanuary 30, 2015Overview of ICD-10-CMWebinar
Sponsored by WVHIMSS1DisclaimerThe information contained in this
document should not be construed as legal representation. It is
current as of October 1, 2014. All information is from the
extensive training and interpretation of the presenter. Garnet
Career Center and Maggie McCabe retain ownership of the information
contained herein. No part of this presentation may be reproduced or
transmitted in any form or by any means without the express
permission of Maggie McCabe.2Why this Change?Very simply, ICD-9-CM
is running out of codesIncreased specificityProvide the medical
necessity for services that are currently being renderedFor the
betterment of healthcareBecause the government says so (tongue in
cheek)No delaysNo grace period for using ICD-9-CM
Why is the United States moving to ICD-10-CM?ICD-9-CM has
several problems. Foremost, it is out of room. Because the
classification is organized scientifically, each three-digit
category can have only 10 subcategories. Most numbers in most
categories have been assigned diagnoses. Medical science keeps
making new discoveries, and there are no numbers to assign these
diagnoses.Computer science, combined with new, more detailed codes
of ICD-10-CM, will allow for better analysis of disease patterns
and treatment outcomes that can advance medical care. These same
details will streamline claims submissions, since these details
will make the initial claim much easier for payers to
understand.
3The ICD ManualICD-9-CMVolume 1--TabularVolume
2--IndexICD-9-PCSVolume 3
ICD-10-CMAlphabetic IndexTabular4What is the Effective Date
Now?October 1, 2015
ICD-9-CM ends September 30, 2015
Will there be another delay? July 31, 2104 AAPC article
The U.S. Department of Health and Human Services (HHS) issued a
rule Aug. 4 finalizing Oct. 1, 2015 as the new compliance date for
healthcare providers, health plans, and healthcare clearinghouses
to transition to ICD-10, the tenth revision of the International
Classification of Diseases. This deadline allows providers,
insurance companies, and others in the healthcare industry time to
ramp up their operations to ensure their systems and business
processes are ready to go on Oct. 1, 2015.The anticipated
announcement is consistent with speculation the date would be moved
back by exactly one year, as the original mandate was scheduled for
Oct. 1, 2014.Were very pleased HHS issued the official ICD-10
implementation date. We look forward to helping the industry
continue to progress with testing and improving coder productivity.
The finalization of the date provides clear incentive to improve
physician documentation, saidRhonda Buckholtz, CPC, CPMA,
CPC-I,vice president of ICD-10 Training and Education at
AAPC.========
There is a rumor that the government will skip ICD-10 and go to
ICD-11, which is what some countries are using. I do not have any
information to substantiate that statement.5Federal Rule August 4,
2014This final rule establishes October 1, 2015 as the compliance
date for ICD10.
It also requires the continued use of ICD9CM through September
30, 2015.6Who Does This Change Effect?Those covered by HIPAASmall,
medium and large practicesClinicsHospitals, SNFs,
FQHCPayersClearing HousesAll staffPatientsList may go on and
on!7Training?WhoWhenWhyAll staff office and clinicians. Due to the
specificity it is suggested that even clinicians have a refresher
in medical terminology/anatomy
NOW
To be the best you can be8SimilaritiesSeveral
ConventionsNEC/NOSPunctuationIncludes Notes9Borderline DiagnosisIf
the provider documents a "borderline" diagnosis at the time of
discharge, the diagnosis is coded as confirmed, unless the
classification provides a specific entry (e.g., borderline
diabetes).If a borderline condition has a specific index entry in
ICD-10-CM, it should be coded as such.Since borderline conditions
are not uncertain diagnoses, no distinction is made between the
care setting (inpatient versus outpatient).Whenever the
documentation is unclear regarding a borderline condition, coders
are encouraged to query for clarification.From the
guidelines10Chapters and SuchICD-9-CM had 17 Chapters along with
V-codes and E-codesICD-10-CM has 21 chapters including the
equivalent of the V and E CodesTitles may change slightlyOrder of
chapters may varySome diagnoses have been moved to other chapters
to be more consistentStreptococcal Sore ThroatICD-9-CM was listed
with Infectious DiseasesICD-10-CM has been moved to Respiratory
System2 New ChaptersEye and AdnexaEar and Mastoid Process11Chapter
& I-10 RangeICD-9CMICD-10-CM1 (A00-B99)Infectious &
Parasitic DiseaseCertain Infections & Parasitic Diseases2
(C00-D49)NeoplasmsNeoplasms3 (D50-D89)Endocrine, Nutritional &
Metabolic Diseases, & Immunity DisordersDiseases of the Blood
& Blood forming Organs & Certain Disorders Involving the
Immune Mechanism4 (E00-E90)Diseases of the Blood and Blood Forming
OrgansEndocrine, Nutritional & Metabolic Diseases5
(F01-F99)Mental DisordersMental, Behavioral &
Neurodevelopmental Disorders6 (G00-G99)Diseases of the Nervous
System and Sense OrgansDiseases of the Nervous System7
(H00-H59)Diseases of the Circulatory SystemDiseases of the Eye and
Adnexa8 (H60-H95)Diseases of the Respiratory SystemDiseases of the
Ear & Mastoid Process9 (I00-I99)Diseases of the Digestive
SystemDiseases of the Circulatory System10 (J00-J99)Diseases of the
Genitourinary SystemDiseases of the Respiratory System12Chapter
& I-10 RangeICD-9CMICD-10-CM11 (K00-K95)Complications of
Pregnancy, Childbirth & the PeurperiumDiseases of the Digestive
System12 (L00-L99)Diseases of the Skin & Subcutaneous
TissueDiseases of the Skin & Subcutaneous Tissue13
(M00-M99)Diseases of the musculoskeletal System & Connective
TissueDiseases of the musculoskeletal System & Connective
Tissue14 (N00-N99)Congenital AnomaliesDiseases of the Genitourinary
System15 (O00-O9A)Certain Conditions Originating in the Perinatal
PeriodPregnancy, Childbirth & the Puerperium16
(P00-P96)Symptom, Signs & Ill-Defined ConditionsCertain
Conditions Originating in the Perinatal Period17 (Q00-Q99)Injury
and PoisoningCongenital Malformations, Deformations & Chromosal
Abnormalities18 (R00-R99)N/ASymptoms, Signs & Abnormal Clinical
& Laboratory Findings, Not Elsewhere Classified13Chapter &
I-10 Range ICD-9CMICD-10-CM19 (S00-T88)N/AInjury, Poisoning &
Certain Other Consequences of External Causes20
(V00-Y99)N/AExternal Causes of Morbidity21 (Z00-Z99)N/AFactors
Influencing Health Status & Contact with Health
ServicesSupplementary ClassificationV-CodesClassification of
Factors Influencing Health Status & Contact with Health
ServicesN/ASupplementary ClassificationE-CodesClassification of
External Cause of Injury & Poisoning14AlphanumericEvery code
begins with an Alpha characterUnited States does not use UAlpha
characters may appear in other positionsBe Careful:O versus 0OB/GYN
codesI versus 1Circulatory15ICD-9-CM DigitsHighest Level of
Specificity
Format3rd digit = Category4th digit = Sub-Category5th digit =
Sub-ClassificationFinish this16ICD-10-CM CharactersHighest Level of
Specificity
Format3rd character = Category4th character = Sub-Category5th
character = Sub-Category6th character = Sub-Category7th character =
Sub-Category
From the guidelines
The ICD-10-CM Tabular List contains categories, subcategories
and codes. Characters for categories, subcategories and codes may
be either a letter or a number. All categories are 3 characters. A
three-character category that has no further subdivision is
equivalent to a code. Subcategories are either 4 or 5 characters.
Codes may be 3, 4, 5, 6 or 7 characters. That is, each level of
subdivision after a category is a subcategory. The final level of
subdivision is a code. Codes that have applicable 7th characters
are still referred to as codes, not subcategories. A code that has
an applicable 7th character is considered invalid without the 7th
character 17Four Character
CategoriesDefineSiteEtiologyManifestation18Five - Six Character
Sub-ClassificationEither of these characters represent the most
accurate level of specificityRelated to patients condition or
diagnosisAdd an example19Seventh Character ExtensionMust always be
in the 7th character position
Therefore
Dummy placeholder of X may be needed in the 5th and/or 6th
character20Placeholder7 character formatSometimes not all
characters usedValue of X is used in the 5th or 6th position Blanks
or dashes are not acceptableFrom the guidelines
The ICD-10-CM utilizes a placeholder character X. The X is used
as a placeholder at certain codes to allow for future
expansion.
Where a placeholder exists, the X must be used in order for the
code to be considered a valid code 21Excludes NotesExcludes 1
AND
Excludes 2From the guidelines
Excludes Notes The ICD-10-CM has two types of excludes notes.
Each type of note has a different definition for use but they are
all similar in that they indicate that codes excluded from each
other are independent of each other. a. Excludes1 A type 1 Excludes
note is a pure excludes note. It means NOT CODED HERE! An Excludes1
note indicates that the code excluded should never be used at the
same time as the code above the Excludes1 note. An Excludes1 is
used when two conditions cannot occur together, such as a
congenital form versus an acquired form of the same condition. b.
Excludes2 A type 2 Excludes note represents Not included here. An
excludes2 note indicates that the condition excluded is not part of
the condition represented by the code, but a patient may have both
conditions at the same time. When an Excludes2 note appears under a
code, it is acceptable to use both the code and the excluded code
together, when 22Locating a CodeNEVER Code from the Index of ANY
Code ManualICD-9-CMIndex Volume 2Tabular Volume
1ICD-10-CMIndexTabularLook up main term in the index
Follow any instructions in the index listed under the main
term
Verify the code in the tabular
Follow instructions in the tabular list: chapter title, block
title, category, subcategory, subclassifications
Determine if code has a 7th character extension and select
appropriate one
Use place holder between 5th and 7th character if there is not a
6th. In some cases there may not be a 5th or 6th character in which
there would be 2 placeholder xs
Verify any conventions
Assign the code
23SequelaResidual Effect
Acute EncounterFrom the guidelines
A sequela is the residual effect (condition produced) after the
acute phase of an illness or injury has terminated. There is no
time limit on when a sequela code can be used. The residual may be
apparent early, such as in cerebral infarction, or it may occur
months or years later, such as that due to a previous injury.
Coding of sequela generally requires two codes sequenced in the
following order: The condition or nature of the sequela is
sequenced first. The sequela code is sequenced second. An exception
to the above guidelines are those instances where the code for the
sequela is followed by a manifestation code identified in the
Tabular List and title, or the sequela code has been expanded (at
the fourth, fifth or sixth character levels) to include the
manifestation(s). The code for the acute phase of an illness or
injury that led to the sequela is never used with a code for the
late effect24LateralityRightLeftBilateral
Consistency with CPTSome ICD-10-CM codes indicate laterality,
specifying whether the condition occurs on the left, right or is
bilateral. If no bilateral code is provided and the condition is
bilateral, assign separate codes for both the left and right side.
If the side is not identified in the medical record, assign the
code for the unspecified side. 25
DiabetesICD-10-CM Combination CodesType of diabetes mellitusBody
system affectedComplications affecting that body system
Five Categories of Diabetes in ICD-10-CME08 Diabetes mellitus
due to an underlying conditionE09 Drug or chemical induce diabetes
mellitusE10 Type 1 diabetes mellitusE11 Type 2 diabetes mellitusE13
Other specified diabetes mellitus26EyePatient presents to the
physician with acute serous conjunctivitis, non-viral,
bilaterally
ICD-CM-10 Code =
Edema right orbit
ICD-CM-10 Code =
H10.233
Steps = Conjunctivitis, acute, serous except viral
H05.221
27OB/GYNHigh risk pregnancy in ICD-9-CM was a V-code; now it is
located in Chapter 15 with the other codesGuideline in
ICD-CM-10:Pre-existing condition vs. condition related to the
pregnancyPre-existing hypertension in pregnancySepsis and Septic
ShockAlcohol and tobacco usePoisoning, toxic effects, adverse
effects and underdosing in a pregnant patientPregnancy associated
with cardiomyopathy7th character for fetus identificationSelection
of trimester and weeks gestationAAPC reference guide28Sprain, Lower
ExtremityGrade I mild sprain, ligaments stretched but not tornGrade
II moderate sprain, ligaments are partially torn and there may be
some loss of functionGrade III severe sprain, ligament is
completely torn/ruptured
Episode of careA Initial encounterD Subsequent encounterS
Sequela7th character A, initial encounter is used while the patient
is receiving active treatment for the condition. Examples of active
treatment are: surgical treatment, emergency department encounter,
and evaluation and treatment by a new physician. 7th character D
subsequent encounter is used for encounters after the patient has
received active treatment of the condition and is receiving routine
care for the condition during the healing or recovery phase.
Examples of subsequent care are: cast change or removal, removal of
external or internal fixation device, medication adjustment, other
aftercare and follow up visits following treatment of the injury or
condition.
The aftercare Z codes should not be used for aftercare for
conditions such as injuries or poisonings, where 7th characters are
provided to identify subsequent care. For example, for aftercare of
an injury, assign the acute injury code with the 7th character D
(subsequent encounter). 7th character S, sequela, is for use for
complications or conditions that arise as a direct result of a
condition, such as scar formation after a burn. The scars are
sequelae of the burn. When using 7th character S, it is necessary
to use both the injury code that precipitated the sequela and the
code for the sequela itself. The S is added only to the injury
code, not the sequela code. The 7th character S identifies the
injury responsible for the sequela. The specific type of sequela
(e.g. scar) is sequenced first, followed by the injury code.
29Pathologic Fracture7th character A is for use as long as the
patient is receiving active treatment for the fracture. Examples of
active treatment are: surgical treatment, emergency department
encounter, evaluation and treatment by a new physician. 7th
character, D is to be used for encounters after the patient has
completed active treatment. The other 7th characters, listed under
each subcategory in the Tabular List, are to be used for subsequent
encounters for treatment of problems associated with the healing,
such as malunions, nonunions, and sequelae. 30Fractures7th
Character Extension ExampleA = initial encounter for closed
fractureB = initial encounter for open fractureD = subsequent
encounter for fracture with routine healingG = subsequent encounter
for fracture with delayed healingK = subsequent encounter for
fracture with nonunionP = subsequent encounter for fracture with
malunionS = sequelaMore specific guidelines are as follows: 1)
Initial vs. Subsequent Encounter for Fractures Traumatic fractures
are coded using the appropriate 7th character for initial encounter
(A, B, C) while the patient is receiving active treatment for the
fracture. Examples of active treatment are: surgical treatment,
emergency department encounter, and evaluation and treatment by a
new physician. The appropriate 7th character for initial encounter
should also be assigned for a patient who delayed seeking treatment
for the fracture or nonunion. Fractures are coded using the
appropriate 7th character for subsequent care for encounters after
the patient has completed active treatment of the fracture and is
receiving routine care for the fracture during the healing or
recovery phase. Examples of fracture aftercare are: cast change or
removal, removal of external or internal fixation device,
medication adjustment, and follow-up visits following fracture
treatment. Care for complications of surgical treatment for
fracture repairs during the healing or recovery phase should be
coded with the appropriate complication codes. Care of
complications of fractures, such as malunion and nonunion, should
be reported with the appropriate 7th character for subsequent care
with nonunion (K, M, N,) or subsequent care with malunion (P, Q,
R). A code from category M80, not a traumatic fracture code, should
be used for any patient with known osteoporosis who suffers a
fracture, even if the patient had a minor fall or trauma, if that
fall or trauma would not usually break a normal, healthy bone. See
Section I.C.13. Osteoporosis. The aftercare Z codes should not be
used for aftercare for traumatic fractures. For aftercare of a
traumatic fracture, assign the acute fracture code with the
appropriate 7th character.ICD-10-CM Official Guidelines for Coding
and Reporting 2014 Page 69 of 117
2) Multiple fractures sequencing Multiple fractures are
sequenced in accordance 31Traumatic FracturesGrade IThe wound is
less than 1cm long. It is usually a moderately clean puncture,
through which a spike of bone has pierced the skin. There is little
soft-tissue damage and no sign of crushing injury. The fracture is
usually simple, transverse, or short oblique, with little
commination.Grade IIThe laceration is more than 1 cm long, and
there is no extensive soft-tissue damage, flap, or avulsion. There
is slight or moderate crushing injury, moderate commination of the
fracture, and moderate contamination.Grade IIIThese are
characterized by extensive damage to soft-tissues, including
muscles, skin, and neurovascular structures, and a high degree of
contamination. The fracture is often caused by high velocity
trauma, resulting in a great deal of commination and
instability.III A Soft tissue coverage of the fractured bone is
adequateIII B Extensive injury to, or loss of soft tissue, with
periosteal stripping and exposure of bone, massive contamination,
and severe commination of the fracture. After debridement and
irrigation a local or free flap is needed for coverage.III C Any
open fracture that is associated with an arterial injury that must
be repaired, regardless of the degree of soft tissue injury.The
definitive grade should be assigned in theatre after thorough
debridement.The risk of infection in an open fracture depends on
the amount of contamination, severity of soft tissue injury, and
operative treatment of the fracture
32Fracture of the FemurThe appropriate 7th character is to be
added to all codes from category S72A = initial encounter for
closed fractureB = initial encounter for open fracture type I or
IIC = initial encounter for open fracture type IIIA, IIIB, or IIICD
= subsequent encounter for closed fracture with routine healingE =
subsequent encounter for open fracture type I or II with routine
healingF = subsequent encounter for open fracture type IIIA, IIIB,
or IIIC with routine healingG = subsequent encounter for closed
fracture with delayed healingH = subsequent encounter for open
fracture type I or II with delayed healingJ = subsequent encounter
for open fracture type IIIA, IIIB, or IIIC with delayed healingK =
subsequent encounter for closed fracture with nonunionM =
subsequent encounter for open fracture type I or II with nonunionN
= subsequent encounter for open fracture type IIIA, IIIB, or IIIC
with nonunionP = subsequent encounter for closed fracture with
malunionQ = subsequent encounter for open fracture type I or II
with malunionR = subsequent encounter for open fracture type IIIA,
IIIB, or IIIC with malunionS = sequela
S72 = Fracture of Femur33Behavior Health Depressive DisorderNo
Chapter Specific Guidelines ICD-9-CMPain disorders related to
psychological factorsRemissionPsychoactive Substance Use, Abuse and
DependenceIf both use and abuse are documented, assign only the
code for abuse If both abuse and dependence are documented, assign
only the code for dependence If use, abuse and dependence are all
documented, assign only the code for dependence If both use and
dependence are documented, assign only the code for
dependencePsychoactive Substance AbuseAapc reference guide
Guidelines
Chapter 5: Mental, Behavioral and Neurodevelopmental disorders
(F01 F99) a. Pain disorders related to psychological factors Assign
code F45.41, for pain that is exclusively related to psychological
disorders. As indicated by the Excludes 1 note under category G89,
a code from category G89 should not be assigned with code F45.41
Code F45.42, Pain disorders with related psychological factors,
should be used with a code from category G89, Pain, not elsewhere
classified, if there is documentation of a psychological component
for a patient with acute or chronic pain.
WHERE IS SECTION B???????
c. Mental and behavioral disorders due to psychoactive substance
use 1) In Remission Selection of codes for in remission for
categories F10-F19, Mental and behavioral disorders due to
psychoactive substance use (categories F10-F19 with -.21) requires
the providers clinical judgment. The appropriate codes for in
remission are assigned only on the basis of provider documentation
(as defined in the Official Guidelines for Coding and Reporting).
2) Psychoactive Substance Use, Abuse And Dependence When the
provider documentation refers to use, abuse and dependence of the
same substance (e.g. alcohol, opioid, cannabis, etc.), only one
code should be assigned to identify the pattern of use based on the
following hierarchy: If both use and abuse are documented, assign
only the code for abuse If both abuse and dependence are
documented, assign only the code for dependence If use, abuse and
dependence are all documented, assign only the code for dependence
If both use and dependence are documented, assign only the code for
dependence.
3) Psychoactive Substance Use As with all other diagnoses, the
codes for psychoactive substance use (F10.9-, F11.9-, F12.9-,
F13.9-, F14.9-, F15.9-, F16.9-) should only be assigned based on
provider documentation and when they meet the definition of a
reportable diagnosis (see Section III, Reporting Additional
Diagnoses). The codes are to be used only when the psychoactive
substance use is associated with a mental or behavioral disorder,
and such a relationship is documented by the provider.
34Circulatory DocumentationAMI must be identified as initial or
subsequent (occurring w/in 4 weeks (28 day) acute phase of the
initial MIAtherosclerosis of the extremities now sub-divided into
legs & other extremitiesLaterality required with embolism,
thrombosis, varicose veins, etc35Endocrine, Nutritional &
MetabolicMore specific information is required to code the type of
congenital hypothyroidism; iodine deficiency thyroid disorders;
parathyroid glandSecondary diabetes requires documentation related
to whether the condition is due to an underlying condition or
whether it is drug or chemical inducedCushings syndrome is not
differentiated by type and causeDisorders related to
hyperalimentation require documentation of the specific
conditionMetabolic disorders require greater detail related to the
specific amino-acid, carbohydrate or lipid enzyme deficiency
responsible for the disorder
Cushings syndrome over production of cortisol that may be caused
by a pituitary tumor. Could be benign also36Documentation
SuggestionsNot Documented, Didnt HappenThereforeCant Code ItCant
Bill ItNo Reimbursement
True today, even truer tomorrow!!!!!
37DocumentationAddress the reason for the encounter or the
problemShow an examinationTie it all
togetherAssessmentPlan38DocumentationReduce Coder/Auditor QueriesBe
specificIf it is a thought, document it39DocumentationSeven
elements current documentation lacksDisease type is not
indicatedExact details pertaining to disease are not
mentionedDocumentation missing in entirelySpecific location (if
relevant) is not identifiedStages of diseases are missing
documentation Right/left sides are not properly
identifiedDocumentation for combination codes is improperly
documented to code accurately40NeoplasmRequire more specific
documentation of the site of the malignancyRequire laterality for
the extremitiesRequire stages for melanomaStage I localizedStage IA
less than 1.0 mm thick, no ulcerationStage IB less than 1.0 mm
thick, ulcerationContinues through stage IV
41Follicular LymphomaSeveral different types; some with a
grading systemGrade I 0-5 centroblasts per hpf with a predominance
of small centrocytesGrade II 6-15 centroblasts per hpf with
centrocytes presentGrade III -- >15 centroblasts per hpf with
decreased or no centroctyes still presentGrade IIIA -- >15
ecntroblasts per hpf with centrocytes still presentGrade IIIB --
>15 centroblasts per hpf presenting as solid sheets with no
centrocytes present
Hpf = high power field42How Will Superbills Change?Current, CPT
one sideICD-9 Flip side
Future, CPT one side
Many examples on Internet, especially with .Aapc article
Important things to understand from this exercise:A superbill is
a form used by medical practitioners and clinicians so they can
quickly complete and submit the procedure(s) and diagnosis(s) for a
patient visit for reimbursement. It is generally customized for a
provider office and contains patient information, the most common
CPT (procedure) and ICD (diagnostic) codes used by that office, and
a section for items such as follow-up appointments, copays, and the
providers signature.Blue Cross Blue Shield Association started with
a model superbill created by the American Academy of Family
Practitioners practice management journal,Family Practice
Management (FPM).The back of the superbill shows 164 ICD-9
diagnosis codes identified by FPM as being those most commonly used
by family physicians.About half of the 164 ICD-9 codes on the
superbill are general codes such as "unspecified" or "not otherwise
specified." These general codes exist so that all information
encountered in a medical record can be assigned a code. While they
lack the specificity necessary to infer diagnosis details, they are
often used on superbills due to space limitations. Continuing their
use in ICD-10 will only further prevent realization of the code
sets increased granularity.CMS has published "Generalized
Equivalency Mappings" or "crosswalks" that relate every ICD-9 code
to one or more ICD-10 codes. We used these crosswalks to convert
each ICD-9 code on the superbill to its equivalent ICD-10 code or
codes.In some cases the CMS crosswalks were incomplete or possibly
inaccurate, and conversion to ICD-10 actually produced
farlessclinical detail than had been provided by the original ICD-9
code. In these few instances we tried to provide an equivalent
mapping, while still using more general ICD-10 codes as is typical
with superbills. For example:The AAFP superbill includes the ICD-9
codes for "845.00 Sprained/strained ankle, unspecified". The CMS
crosswalk maps this to two codes: 1) "S93.409A Sprain of
unspecified ligament of unspecified ankle, initial encounter," and
2) "S93.409D Sprain of unspecified ligament of unspecified ankle,
subsequent encounter."However, this is incomplete because it does
not include a code for a strained ankle. Therefore, we added 1)
"S96.919A Strain of unspecified muscle and tendon at ankle and foot
level, unspecified side, initial encounter;" and 2) "S96.919D
Strain of unspecified muscle and tendon at ankle and foot level,
unspecified side, subsequent encounter."The AAFP superbill includes
the ICD-9 codes for "919.0 Abrasion, unspecified"; "924.9
Contusions, unspecified"; and "919.4 Insect bite". The CMS
crosswalk simply maps these to either of two catch-all ICD-10
codes, "T07 Unspecified multiple injuries" or "T14.90 Unspecified
injury of unspecified body region".Such general diagnosis codes
submitted by a provider would be insufficient to determine the
medical necessity of a procedure. We therefore listed the most
residual ICD-10 codes available for each injury type*, e.g.
"S90.519A Abrasion, unspecified ankle; Initial encounter".* Note
that there is no single residual ICD-10 code for an Abrasion,
Contusion, or Insect bite, respectivelyinstead, one can only choose
among a number of codes for each injury type such as "Abrasion of
[particular body part]".DISCLAIMER:BCBSA prepared the sample
superbill for illustrative only purposes, and it is not intended to
be an official or approved crosswalk.
43WEDI Survey InformationVendor product development 40% of
vendors indicate complete. Improvement over 2013 surveyVendor
product availability More than 25% responded their products would
not be ready until2015Health plan impact assessment Nearly 75%
completed their impact assessmentHealth plan testing More 50%
already begun external testing compared to 25% in prior
surveyProvider Impact Assessment About 50% completed
assessmentProvider testing About 35% have completed; in 2013 60%
expected to begin in 2014External testing approach 60% providers
expect to test with a sample or providers; 20% indicated they will
test with a majority of providers514 respondents; 324 providers; 87
vendors; 103 health plans
WEDI urges the industry to accelerate implementation efforts44In
SummaryWhen do we start should have started 2-3 years ago
What has to be done internal/external audits; training;
testing
How do we do it talk to your providers immediately; contact your
vendor and health plans; test as much as possible
It is very important to take the time now!
45ReferencesAAPC Professional Medical Coding CurriculumAAPC
Licensed Instructor Curriculum AAPC ICD-10-CM ExpertAAPC Coder
ReferencesICD-10-CM Coding GuidelinesCMS Website
Information46Questions???Thank you47
