ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved. ICD-10 Impact on Coding and Billing

ICD-10-CM Complete Official Draft Code Set © 2014 IngenixAll Rights Reserved.

ICD-10 Impact on Coding and Billing

Use of this handout is for informational purposes only

Refer to current updated version of ICD-10 manual at the time of implementation to

confirm coding accuracy!

ICD-10-CM Complete Official Draft Code Set © 2014 IngenixAll Rights Reserved

Paul Cadorette CPC, CPC-H, CPC-P, CASCC, COSCAAPC ICD-10 Proficiency CertifiedDirector of [email protected]

Why the Need for ICD-10?

ICD-10 • A98.4 Ebola virus disease

ICD-9


Other specified diseases due to viruses

Arthropod-borne hemorrhagic fever

• Codes lack specificity which is necessary for identifying Ebola patients

• Makes the process of monitoring and tracking the disease more difficult

21 Chapters with alphanumeric codesICD-9 14,000 codes vs. ICD-10 68,000

ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix. All Rights Reserved.

E codes

V codes

Diseases of nervous system and sense organs

ICD-10 Guidelines

For ambulatory surgery, code the diagnosis for which the surgery was performed. If the postoperative diagnosis is known to be different from the preoperative diagnosis at the time the diagnosis is confirmed, select the postoperative diagnosis for coding, since it is the most definitive


ICD-10 CONVENTIONS General rules for the use of the

classification system with instructional notes that are applicable regardless of the health

care setting


ICD-10 Conventions

• “See” - another term should be referenced, it is necessary for the coder to go to the main term indicated by the “see” note

Arthritis, arthritic – spine

rheumatoid – see Spondylitis, ankylosing

• “See Also” – another main term can be referenced that may have additional index entries that may be useful. When the main term provides an appropriate code, it is not necessary to follow the “see also” note

Stricture (see also Stenosis)

bladder N32.89

neck N32.0


nasolacrimal duct (see also Stenosis, lacrimal duct) congenital Q10.5

“Excludes” Notes

• The two conditions cannot be reported together

When present, the EXCLUCDED code/condition should be reported instead of the code listed above it

• It may be appropriate to use both the code listed along with the excluded code when supported by the medical documentation

• S92 Fracture of foot and toe, except ankle

traumatic amputation of ankle and foot (S98.-)

fracture of ankle (S82.-)

fracture of malleolus (82.-)


.

EXCLUDES 2

EXCLUDES 1

EXCLUDES 2

EXCLUDES 1

Anatomy and Terminology


.

Spondylo- (vertebra or spinal column) -pathy (disease process)

Atlanto-occipital

Atlanto-axial

- L5-S1

- T12-L1

- C7-T1

Expansion of diagnosis code sets


Enthesopathy

• Enthesis – the point where a tendon or ligament inserts into a bone

• Enthesopathy – disease process in the zones of attachment for ligaments or tendons to bone, a disorder of entheses (bone attachments)



• Spondylopathies (M45-M49)

• spondylo (vertebra) pathy (disease process)

• Spondylosis - a term referring to degenerative osteoarthritis of the joints between the center of the spinal vertebra and/or neural foramina


S96.2 Injury of Intrinsic Muscle at Ankle and Foot Level


.

A – Flexor digitorum brevisB – Abductor digiti minimiC – Abductor hallucis

A

BC

A - Quadratus plantaeB - Lumbricales

A

B

A – Flexor hallucis brevisB – Adductor hallucisC – Flexor digiti minimi

A BC

B

Dorsal Interossei

Plantar Interossei

http://www.bartleby.com/107/131.html

http://www.bartleby.com/107/131.html

http://www.bartleby.com/107/illus447.html

Diagnosis Code Structure

S52.551A


Base code - Fracture of forearm

Other extra-articular fracture lower end of radius

Laterality

Type of Encounter

Fracture lower end of radius

Fracture of right distal radius, extra-articular


ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved.

- Base Codes



Fractures of Femur(23 Different Classifications plus 9 Other/Unspecified codes)

Current Procedural Terminology © 2014 American Medical Association. All Rights Reserved.

ICD-10 Laterality

• RT is usually indicated with 1• LT is usually indicated with 2• Bilateral is usually indicated with 3

• M20.40 Other hammertoe(s) (acquired), unspecified foot• M20.41 Other hammertoe(s) (acquired), right foot• M20.42 Other hammertoe(s) (acquired), left foot

Unspecified character is 0 if in the fifth position or 9 when it is in the sixth position

• M20.011 Mallet finger of right finger(s)• M20.012 Mallet finger of left finger(s)• M20.019 Mallet finger of unspecified finger(s)


(When no bilateral code exists, report both the RT and LT code)

(Bilateral refers to paired organs)

ICD-10 Laterality


.

NOTE: Although toes are identified by proximal, medial or distal phalanx the specific toe (second, third, fourth or fifth) is not mentioned


.

Wrist and Hand Level

CPT Code Sections• Forearm, Wrist • Hand, Finger

Select CPT code based on the anatomical site where at which the procedure was performed

Hand or Wrist

For categories where no multiple site code is provided and more than one bone, joint or muscle is involved, multiple codes should be used to indicate the different sites involved

ICD-10 Laterality

Exceptions


Other and Unspecified

ICD-10 Laterality



Eyelid Characters

• .

CPT Code Modifiers

Seventh Character Extensions

Additional digits required


Seventh Character Extension7th vs. X7th

• When a diagnosis code requires a 7th character - that character must always be the 7th character in the data field, which sometimes necessitates the use of placeholder “X”

• Some codes may be only 4 characters long, but they require a 7th character extension - so placeholder “x” is used twice

ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix

All Rights Reserved.

S33.0XXA

S43.50XA

The appropriate 7th character is to be added to each code from category S00A initial encounterD subsequent encounterS sequela

S33.0 Traumatic rupture of lumbar intervertebral disc

S43.50 Sprain of acromioclavicular joint

S46.011 Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder S46.011A

Encounters (7th Character Extensions)

• A - Initial encounter – Active treatment (surgical treatment, emergency department encounter or evaluation and treatment by new physician)

• D - Subsequent encounter – Routine care during healing or recovery phase (cast change/removal, removal of internal/external fixation device, medication adjustment, follow-up visits)

• S - Sequela - Late effect from initial injury • Condition that occurs after the acute phase of an injury• No time limit to identify a late effect


Fracture Encounters


No open fx code

Defaults

Implant Removal


.

Previous Injury

Fracture of 1st metatarsal bone right foot S92.311D(Subsequent encounter “D” – defaulted to displaced)

Previous Surgery

Austin bunionectomy for hallux valgus Z47.2(Acquired deformity)

Acute vs. Chronic


Chapter 13. Diseases of the Musculoskeletal System and Connective Tissue

Chapter 19. Injury, Poisoning and Certain Other Consequences of External Causes

Strains and Sprains

• Strain – injury to a muscle or tendon• Tendons connect muscle to bone• Quadriceps tendon to superior pole of patella• S76.119A Strain of unspecified quadriceps muscle,

fascia and tendon, initial encounter

• Sprain – stretching or tearing of a ligament• Ligaments connect bone to bone• Anterior cruciate ligament• S83.519A Sprain of anterior cruciate ligament of

unspecified knee, initial encounterICD-10-CM Complete Official Draft Code Set © 2014 Ingenix

All Rights Reserved..

Herniated Disk 722.10


Chapter 13 - Old/Chronic Chapter 19 - Acute/Current

Barrett’s Esophagus


ICD-9

Different codes in ICD-10

Same ICD-9 code

Precancerous changes

Severe precancerous changes

K22.70 Barrett’s esophagus without dysplasia Barrett’s esophagus NOS


NOS – Not Otherwise Specified

Carrier PolicyTreatment of Barrett’s

• Radiofrequency ablation is considered investigational as a treatment of Barrett’s esophagus in the absence of dysplasia (Nondysplastic Barrett’s)

• Radiofrequency ablation may be considered medically necessary for treatment of Barrett’s esophagus with low-grade dysplasia, when the initial diagnosis of low-grade dysplasia is confirmed by a second pathologist who is an expert in GI [gastrointestinal] pathology

• Radiofrequency ablation may be considered medically necessary for treatment of Barrett’s esophagus with high-grade dysplasia

The diagnosis of high-grade dysplasia should be confirmed by two pathologists prior to radiofrequency ablation

BCBS of NC Current Procedural Terminology © 2014 American Medical Association. All Rights Reserved.

Colon Polyps 211.3


Adenomatous polyps are site specific and code to benign neoplasms

Hyperplastic polyps code to K63.5

Hyperplastic polyps of anus/rectum

Screening

• Testing for disease in seemingly well individuals

• Testing to rule out or confirm a sign or symptom is a diagnostic exam and not a screening

• List the screening code as the primary diagnosis

• Conditions found during screening exam should be listed as additional diagnoses


“Accidental” Dural Puncture 998.2


.

ICD-9 Diagnosis Coding

1.

2.

1.2.

3.

4.

5.

Complications (998.2 Accidental puncture or laceration)

K91.71Accidental puncture and laceration of a digestive system organ or structure during a digestive system procedure

K91.72Accidental puncture and laceration of a digestive system organ or structure during other procedure


N99.71Accidental puncture and laceration of a genitourinary system organ or structure during a genitourinary system procedure

N99.72Accidental puncture and laceration of a genitourinary system organ or structure during other procedure

Female pelvic pain with lysis of adhesions and destruction of endometriosis. Colon is perforated during/while lysing adhesions.

While placing tape during a TVT procedure, the bladder is perforated.

Chapter 11 Diseases of the digestive system K00-K94

Chapter 14 Diseases of the Genitourinary System N00-N99

Discontinued Procedure


V64.1 – Surgical or other procedure not carried our because of contraindication(unacceptable primary diagnosis in ICD-9)

Z53.09 – Procedure and treatment not carried out because of other contraindication

DO NOT USE V64.1 (ICD-9) OR Z53.09 (ICD-10) AS A PRIMARY OR FIRST LISTED DIAGNOSIS

Chapter 20 External Causes of MorbidityChapter 21 Factors Influencing Health Status


Unless a provider is subject to state-based reporting or these codes are required by a specific payer - reporting of External Causes of Morbidity codes is not required

ICD-9 ICD-10

S51.851A Open bite right forearm, initial encounterY04.1XXA Assault by human bite, initial encounterY92.210 Daycare center as the place of occurrence of the external causeY93.F9 Activity, other caregivingY99.0 Civilian activity done for income or pay

Daycare worker bitten by child, bleeding wound on right forearm

Personal and Family History codes

CMS-1500 Claim Forms


Z12.11 D12.3

A B45385 PT

http://www.newmedicalforms.com/new-cms-1500-02-12-claim-form-laser-cut-25-sheets/

ICD-10 Testing Week: November 17-21, 2014

• Test claims with ICD-10 codes must be submitted with current dates of service (i.e. October 1, 2014 through November 17, 2014), since testing does not support future dated claims.

• Test claims will be subject to all existing EDI front-end edits including Submitter authentication and NPI validation.

• Test claims will receive the 277CA or 999 acknowledgement as appropriate, to confirm that the claim was accepted or rejected in the system.

• Testing will not confirm claim payment or produce remittance advice.


Next test dates - March 2-6, 2015, June 1-5, 2015


http://www.novitas-solutions.com/webcenter/spaces/NovitasSolutions

FUTURE: Local Coverage Determination (LCD): (L35350)UPPER GASTROINTESTINAL ENDOSCOPY (DIAGNOSTIC AND THERAPEUTIC)

• Diagnosis Codes meeting Medical Necessity

• Non-Covered Diagnosis Codes


Effective: Oct. 1, 2015 Approximately 290 ICD-10 codes vs 234 ICD-9 codes


FUTURE: Local Coverage Determination (LCD): (L34974) Facet Joint Injections


Code Comparison• Approximately 264 ICD-10 LCD diagnosis codes

• 38 ICD-9 LCD diagnosis codes

• Diagnosis codes with “A” Encounters only

Effective: Oct. 1, 2015


FUTURE: Local Coverage Determination (LCD): (L34974) Facet Joint Injections

Spondylolysis M43.00 – M43.09• Aka. Pars defect

Spondylolisthesis M43.10 – M43.19• Pars defect-vertebra slips forward

Spondylosis M47.11 – M47.9• Osteoarthritis, Osteoarthrosis

Osteoarthropathy




ICD-10 Impact on Coding and Billing

Paul Cadorette CPC, CPC-H, CPC-P, CASCC, COSCAAPC ICD-10 Proficiency CertifiedDirector of [email protected]

Documents

ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved. ICD-10 Impact on Coding and Billing