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ICD-10-CM Changes Pat Shaw. ICD-10-CM replaces ICD-9-CM for diagnosis in all settings ICD-10-PCS replaces ICD-9-CM volume 3 procedures codes for hospital

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Text of ICD-10-CM Changes Pat Shaw. ICD-10-CM replaces ICD-9-CM for diagnosis in all settings ICD-10-PCS...

ICD-10-CM Changes

ICD-10-CM ChangesPat ShawICD-10-CM replaces ICD-9-CM for diagnosis in all settingsICD-10-PCS replaces ICD-9-CM volume 3 procedures codes for hospital inpatient procedures onlyCPT/HCPCS is not affectedImplementation discharges/encounters on or after October 1, 2014.ICD-10XXXXCategory.Etiology, anatomic site, severityAdded code extensions (7th character) for obstetrics, injuries, and external causes of injury3Coding and 7th Character ExtensionsXXXAMS026.5xAAdditional CharactersAlpha (Except U)2 Numeric3 - 7 Numeric or Alpha 3 7 CharactersCoding in ICD-10-CM4ICD-9-CMICD-10-CMThree to five charactersThree to seven charactersFirst digit is numeric but can be alpha (E or V)First character always alpha

2-5 are numericAll letters used except U

Always at least three digitsCharacter 2 always numeric: 3-7 can be alpha or numericDecimal placed after the first three characters (or with E codes, placed after the first four characters)Always at least three digits

Alpha characters are not case-sensitiveDecimal placed after the first three charactersAlpha characters are not case-sensitiveDiagnoses ICD-9-CM - 14,025 ICD-10-CM - 68,069

ProceduresICD-9-CM - 3,824ICD-10-PCS - 72,589

ICD-10-CM OverviewBenefits of ICD-10-CMICD-10-CM incorporates much greater clinical detail and specificity than ICD-9-CMTerminology and disease classification have been updated to be consistent with current clinical practice A new modern classification system will provide much better data needed for:Measuring care, quality, safety, and efficacy of careReduction of paper work related to documentation queries Improving payment systems and reimbursement ICD-10-CM Overview6New ICD-10-CM featuresLaterality (left, right, bilateral) Examples: C50.511 - Malignant neoplasm of lower-outer quadrant of right female breastH16.013 - Central corneal ulcer, bilateralL89.012 - Pressure ulcer of right elbow, stage II

ICD-10-CM OverviewCombination codes for certain conditions and common associated symptoms and manifestations Examples: K57.21 - Diverticulitis of large intestine with perforation and abscess with bleedingE11.341 - Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edemaI25.110 - Atherosclerotic heartICD-10-CM OverviewCombination codes for poisonings and associated external cause Example: T42.3X2S - Poisoning by barbiturates, intentional self-harm, sequela

Obstetric codes identify trimester instead of episode of care Example: O26.02 - Excessive weight gain in pregnancy, second trimesterICD-10-CM OverviewCharacter XUsed as a 5th character placeholder in to allow for future expansion and to fill in other empty characters Used when a code less than 6 characters in length requires a 7th characterExamples: T46.1X5A - Adverse effect of calcium-channel blockers, initial encounterT15.02XD - Foreign body in cornea, left eye, subsequent encounterICD-10-CM OverviewICD-10-CM OverviewTwo types of Excludes notes Excludes 1Indicates the code excluded should never be used with the code where the note is located Do not report both codesExample: Q03 - Congenital hydrocephalus Excludes 1: Acquired hydrocephalus - G91ICD-10-CM OverviewExcludes 2Indicates the condition excluded is not part of the condition represented by the codeA patient may have both conditions at the same timeBoth codes may be assigned together to capture both conditionsExample: L27.2 - Dermatitis due to ingested foodExcludes 2: Dermatitis due to food in contact with skin - L23.6, L24.6, L25.4Inclusion of Clinical ConceptsUnderdosing, blood type, blood alcohol levelExamples: T45.526D - Underdosing of antithrombotic drugs, subsequent encounterZ67.40 - Type O blood, Rh positiveY90.6 - Blood alcohol level of 120-199 mg/100 mlICD-10-CM OverviewCode ExpansionInjuries, diabetes, substance abuse, postoperative complicationsExamples: E10.610 - Type 1 diabetes mellitus with diabetic neuropathic arthropathyF10.182 - Alcohol abuse with alcohol-induced sleep disorderT82.02XA - Displacement of heart valve prosthesis, initial encounterICD-10-CM OverviewPostoperative complicationsExpanded distinction between intraoperative complications and postprocedural disorders Examples: D78.01 - Intraoperative hemorrhage and hematoma of spleen complicating a procedure on the spleenD78.21 - Postprocedural hemorrhage and hematoma of spleen following a procedure on the spleenICD-10-CM OverviewOther Changes in ICD-10-CMInjuries grouped by anatomical site rather than by type of injuryRestructuring and reorganization in number of chaptersReclassification for certain diseases to different chaptersNew code definitions Definition of acute myocardial infarction is now 4 weeks rather than 8 weeksICD-10-CM Overview16Case 175-year-old woman receiving continued care for multiple facial lacerations, abrasions, and contusions. She was previously treated in the ER for these injuries.Case 1ICD-9-CMV58.89 Encounters for procedures and aftercareICD-10-CMS01.81xD Laceration w/o foreign body of other part of head, subsequent encounterX58.xxxD Accident, NOS, subsequent encounter18Case 2Patient presents for results of an MRI of the right knee, has severe pain and inability to descend stairs. She fell while running in the park. MRI showed complex medial meniscus tear and a Bakers cyst, along with mild chondromalacia of the patella. Options for treatment were discussed and the patient will determine what shed like to do.ICD-9-CM836.0 Tear of medical cartilage/meniscus of knee, currentE885.9 Fall on same level from slipping/tripping/stumblingE849.4 Injury or poisoning occurring at/in place for recreation and sportE001.1 Activities involving runningE000.8 External cause status727.51 Synovial cyst of popliteal space717.7 Chondromalacia of patella

20ICD-10-CMS83.231A Tear, torn (traumatic) meniscus (knee) (current injury), medial, complexM71.21Bakers cyst see Cyst, BakersM22.41Chondromalacia (systemic), patellaW19.xxxA Index to External Causes Fall, falling (accidental)Y92.830 Index to External Causes Place of occurrence, park (public)Y93.02Index to External Causes Activity (involving) runningY99.8Index to External Causes External cause status, leisure activity21Case 3A patient is seen in the hospital with a diagnosis of congestive heart failure due to hypertensive heart disease. The patient responds positively to Lasix therapy. The patient also has chronic kidney disease stage 5.ICD-9-CM404.93 Hypertensive heart and chronic kidney disease stage V or end state renal disease, with heart failure, unspecified benign or malignant585.5 Chronic kidney disease, stage V428.0 Congestive heart failure, unspecified

ICD-10-CMI13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end state renal disease I50.9 Heart failure, unspecifiedN18.5 Chronic kidney disease, stage 5

Case 4This woman is 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. ICD-9-CM651.01 Twin pregnancy, delivered663.31 Other and unspecified cord entanglement, without mention of compressions, deliveredV27.2 Mother with twins, both livebornICD-10-CMO30.003 Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, thirdO69.81x2 Labor and delivery complicated by cord around neck, without compression, fetus 2Z37.2 Outcome of delivery, twins, both liveborn

Case 555 year old male was admitted for OT following hospitalization for type I open traumatic fracture of the left radius and ulna. ICD-9-CMV57.21 Encounter for Occupational TherapyV54.12 Aftercare for healing traumatic fracture of lower armICD-10-CMS52.92xE Fracture, traumatic, radiusS52.202E Fracture, traumatic, ulnaX58.xxxD Index to External Cause, accidentCase 6This type 1 diabetic patient has a severe chronic diabetic left foot ulcer with diabetic peripheral angiopathy. He also has diabetic stage 2 chronic kidney disease. He is being evaluated to see if debridement is required for this ulcer with breakdown of the skin.ICD-9-CM250.81 Diabetes mellitus with specified manifestation, type I (juvenile type), not stated as uncontrolled707.15 Ulcer of foot (toes)250.71 Diabetes mellitus with peripheral circulatory disorder, type I (juvenile type), not stated as uncontrolled443.81 Peripheral angiopathy in diseases classified elsewhere 250.41 Diabetes mellitus with renal manifestations, type I (juvenile type), ), not stated as uncontrolled585.2 Chronic kidney disease, stage II (mild)

32ICD-10-CME10.621 Type 1 diabetes mellitus with foot ulcerL97.521 Non-pressure chronic ulcer of other part of left foot limited to breakdown of skinE10.51 Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangreneE10.22 Type 1 diabetes mellitus with diabetic chronic kidney diseaseN18.2 Chronic kidney disease, stage 2 (mild)Mapping between Old & New Systems34GEMs MapsGEMs Maps= GEMs CrosswalksICD-9-CM ICD-10-PCS via CMS web site

ICD-9-CM ICD-10-CM via CMS /NCHS web sites

General equivalence maps (GEMs) between ICD-9-CM and ICD-10-CM/PCS have been developed

34General equivalence maps (GEMs) between ICD-9-CM and ICD-10-CM/PCS have been developed

Backward and forward maps between ICD-9-CM and ICD-10-PCS are currently available on CMS web site

Backward and forward maps between ICD-9-CM and ICD-10-CM are currently available on CMS and NCHS web sites

GEMs are not crosswalks they are reference mappings to help the user navigate the complexity of translating meaning from one code set to the otherDifferences between these maps arise because of differences in specificity of the classifications, especially in situations where one code in the new coding system maps to multiple codes in the previous classification and these codes are spread over multiple DRGs.

Mapping from ICD-9-CM to ICD-10-CM/PCS is not a straightforward one-to-one crosswalk. For more information on mapping: AHIMA Practice Briefs: Putting the ICD-10-CM/PCS GEMS into Practice, and Data Mapping Best Practices. Publication Transitioning to ICD-10-CM/PCS: The Essential Guide to GEMs

Actually that is a good thing if the two classifications were the same, and easily mapped, then we would not need a new classification system.ICD-10 Resourceshttps://www.cms.gov/ICD10/11b14_2012_ICD10CM_and_GEMs.asp

2012 Code Set, Official Guidelines, GEMShttp://www.cms.gov/ICD10