An Introduction to Organizational & Structural Changes. ICD-10-CM Coding. Presenter: Mary Valencia , CPC, CMC, CMOM, ICD-10 Instructor. Introduction to ICD-10. World Health Organization (WHO) Owns and publishes International Classification of Diseases - PowerPoint PPT Presentation
ICD-10-CM CodingAn Introduction to Organizational & Structural ChangesPresenter: Mary Valencia, CPC, CMC, CMOM, ICD-10 InstructorIntroduction to ICD-10World Health Organization (WHO)Owns and publishes International Classification of DiseasesUsed world-wide for morbidity and mortality reporting10th revision (ICD-10) endorsed in 1990Many countries have been using ICD-10 or a modified version since 1994 The U.S. has been using ICD-10 for mortality reporting since 1999, but continues to use a modified version of ICD-9 referred to as ICD-9-CM for morbidity reporting and other purposesJanuary 2009, federal government determined the U.S. would upgrade to the 10th revision of the ICD as of October 1, 2013. This was delayed by one year to October 1, 2014.Some 25 countries use ICD-10 for reimbursement and resource allocation in their health system. A few of them made modifications to ICD to better accommodate this use of ICD-10. The article below makes reference to some of these modifications. The unchanged international version of ICD-10 is used in about 110 countries ICD-10 for cause of death reporting and statistics.South Africa1 January 2005 Pretoria, Johannesburg, Cape townAustralia1 July 1998 Victoria, New South Wales, Australian Capital Territory and Northern Territory implemented ICD-10-AM.1 July 1999 Queensland, South Australia, Tasmania and Western Australia implemented ICD-10-AM.CanadaCanada introduced ICD-10-CA in 2000.ChinaChina now using ICD-10 as diagnosis reference and ICD-9 as procedure reference.FranceFrance introduced a clinical addendum to ICD-10 in 2005. See also website of the ATIH.GermanyGermany: ICD-10-GM (German Modification)KoreaA Korean modification has existed since 2008.ThailandA Thai modifications exists since 2007.Now Ministry of Public Health have **ICD 10 TM**United StatesThe deadline for the United States to begin using Clinical Modification ICD-10-CM for diagnosis coding and Procedure Coding System ICD-10-PCS for inpatient hospital procedure coding is currently October 1, 2014. The deadline was previously October 1, 2013. All HIPAA "covered entities" must make the change; a pre-requisite to ICD-10 is the adoption of EDI Version 5010 by January 1, 2012.Even though the deadline for ICD-10 has been pushed back repeatedly, CMS recommends that medical practices take several years to prepare for implementation of the new code set. The basic structure of the ICD-10 code is the following: Characters 1-3 (the category of disease); 4 (etiology of disease); 5 (body part affected), 6 (severity of illness) and 7 (placeholder for extension of the code to increase specificity) . Not only must new software be installed and tested, but medical practices must provide training for physicians, staff members, and administrators. They will also need to develop new practice policies and guidelines, and update paperwork and forms. Practices should also create crosswalks that will convert their most frequently used ICD-9 codes to the ICD-10 equivalents.Although the undertaking can seem overwhelming, especially to small practices, technology can be a big help. Practices should check with their EHR vendors to make sure they understand the data storage requirements for the new code set; seek online training available through association websites and software-based instruction; and invest in additional technology, such as patient kiosks, to boost productivity.2Introduction, continuedICD-10-CMClinical ModificationUsed to assign diagnosis codesClinical modification of ICD-10 was developed by the National Center for Health Statistics, a division of the CDCICD-10-PCSProcedural Coding SystemUsed to assign procedure codes for the inpatient settingUnique to the U.S. and independent of the ICD-10, but designed to complement the structure of ICD-10Developed by CMS with 3Ms health information systems division3Who will be affected?ICD-10-CMUsed by all healthcare providers in all settings to assign and/or interpret diagnoses.Principal/Primary diagnosisSecondary diagnosisICD-10-PCSWill capture inpatient procedures for acute care hospital claims.Professionals and the outpatient setting (Medicare Part B claims) will continue to use Current Procedural Terminology (CPT) codes.Why Change?Benefits to ICD-10-CM/PCS Reduced ambiguity Current terminology and technology Relevance to encounters Flexibility in adding new codes Recommended revisions that ICD-9 could not accommodate Future expansion Data transparency for reimbursement and compliance efforts Data of new diseases and technologies HIPAA criteria for 5010 code set standardsICD-10-CM Format (3-7 Characters)ExtensionEtiology, Anatomical Site, SeverityCategoryALPHA##DECIMALAlpha or Numeric6X X XX X XX
66First character is alpha except for the use of U. 7th character for obstetrics, injuries and external cause of injury.6Diagnosis Coding & Data DifferencesICD-9-CM3-5 characters in lengthFirst digit is numeric but can be alpha (E or V)Always at least three digitsDigits 2-5 are numericAlpha characters are not case sensitiveICD-10-CM3-7 characters in lengthFirst character always alphaAll letters used except UAlways at least three digitsCharacter 2 always numeric: 3-7 can be alpha or numericAlpha characters are not case sensitiveHierarchal structure is the same 21 Chapters rather than 19 ChaptersDiseases and Conditions of the Sense Organs (Eyes and Ears) separated from Nervous System ChapterTo reflect current medical knowledge, certain diseases have been reclassified to a more appropriate chapter Example: Gout moved from Endocrine to Musculoskeletal
ICD-10-CM Organizational ChangesCombination codes for conditions and common symptoms or manifestationsI25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectorisCombination codes for poisonings and external causesT42.4X5A Adverse effect of benzodiazepines, initial encounterAdded lateralityH60.332 Swimmers ear, left ear
ICD-10-CM New FeaturesGreater SpecificityAdded seventh-characters for episode of careM80.051A Age-related osteoporosis with current pathological fracture, right femur, initial encounter for fractureExpanded codes (injuries, diabetes, alcohol and substance abuse, postoperative complications)E11.341 Type 2 diabetes mellitus with sever nonproliferative diabetic retinopathy with macular edemaInclusion of trimesters in obstetrics codes (and elimination of fifth digits for episode of care)O99.013 Anemia complicating pregnancy, third trimester
ICD-10-CM New FeaturesChanges in time frames specified in certain codesAcute myocardial infarction time period changed from 8 weeks to 4 weeksAdded standard definitions for two types of excludes notesExcludes 1Not Coded Here. The code being excluded is never used with the code. The two conditions cannot occur together.Excludes 2Not Included Here. The excluded condition is not part of the condition represented by the code. It is acceptable to use both codes together if the patient has both conditions.
ICD-10-CM New FeaturesUsed InSeventh CharacterObstetricsInjuryExternal Cause
Either alpha or numeric
Meanings varyGEMSGeneral Equivalence MappingsFacilitate transition from ICD-9-CM to ICD-10-CMTwo files available for bidirectional mappingsDesigned with programmers in mindCMS websitehttp://www.cms.hhs.gov/ICD10 NCHS websitehttp://www.cdc.gov/nchs/icd/icd10cm.htm
Organization & Structure of ICD-10-CMAlphabetic Index Divided into two partsIndex to Diseases and Injuries includingNeoplasm TableTable of Drugs and ChemicalsIndex to External CausesTabular List21 ChaptersOrder is a bit different from ICD-9-CMChapters divided into Subchapters with instructional notesother versus unspecifiedMorphology codes no longer listed in Alphabetic Index. Manifestation codes indicated in Index but in standard (not slanted) brackets. 14Terminology ChangesSepsis SepticemiaBleeding HemorrhageAndrogenic Alopecia Baldness
15ICD-10-CM ConventionsPlaceholder CharacterThe letter x has two usesAs a fifth character for certain six character codesT37.0X1A Poisoning by sulfonamides, accidental (unintentional), initial encounterWhen a code has less than six characters but a seventh character is required.W85.XXXA Exposure to electric transmission lines, initial encounter7th CharactersCan be either a number or letterRequired for some of the ICD-10-CM codesAdded for increased specificityMust always be in the 7th character positionO 6 50 X X1
Obstructed labor due to deformed pelvis, fetus 1AbbreviationsNEC (Not Elsewhere Classified)Describes a code which has not been classified anywhere else in the code set.
NOS (Not Otherwise Specified)Used when the documentation of the condition identified by the provider is insufficient to assign a more specified code.ICD-10-CMICD-9-CMH26.8 Other specified cataract366.8 Other cataractICD-10-CMICD-9-CMJ12.9 Viral pneumonia, unspecified480.9 Viral pneumonia, unspecifiedInstructional NotesIncludesUsed in Tabular SectionNot an exhaustive listExcludesExcludes 1Excludes 2Code First Use Additional CodeCross Reference NotesSee, See Also, and See ConditionIncludes (K25) Gastric Ulcer (includes erosion of stomach, pylorus ulcer, stomach ulcer)Use Additional Code(G30) Alzheimers disease (secondary)Code First (F02) Dementia in other diseases (primary)20Instructional NotesRelational TermsAnd, interpreted as and/orWith, interpreted as associated with or due towith is sequenced immediately after the main term in the IndexLateralityLeft/RightIf no bilateral code provided, code both the left and right.If the side is not identified in the record, assign the coder for the unspecified side.Condition Specific ChangesInfectious & Parasitic Diseases A00-B99Includes diseases generally recognized as communicable or transmissibleUse additional code