ICD-10-CM For Orthopedics

Lynn M. Anderanin, CPC, CPC-I, COSC, AHIMA ICD-10-CM Certified Trainer

Healthcare Information Services (HIS)

  HIS is a physician management company based in Chicago, IL specializing in Revenue Cycle Management and Information Technology.

  HIS provides services for over 450 providers and has a dedicated Division for Orthopaedics.

  HIS is dedicated to helping physicians maximize their reimbursement revenue, lower overhead and enhance your bottom line. HIS is an expert partner for increased profitability for your Orthopaedic practice.

Presenter - Lynn Anderanin   Lynn Anderanin, CPC,CPC-I,COSC is the Sr. Director Coding

Compliance and Education for Healthcare Information Services (HIS). She has over 28 years experience in all areas of the physician practice including Practice Administrator, Billing Manager, and Director of Operations. Lynn’s experience is primarily in the specialties of Orthopedics, Rheumatology, and Hematology/Oncology.

  She has been a speaker for many conferences, including the AAPC National Conferences and Workshops, Community Colleges, audio conferences, and Local Chapters.

  Lynn became a CPC in 1993, and a Certified Instructor in 2002, and a Certified Orthopedic Surgery Coder in 2009. Lynn is the founder of the first local Chapter of the AAPC in Chicago, which is now 15 years old, and a former member of the AAPC National Advisory Board as well as other Boards for the AAPC.

ICD-10 is Coming  HHS hints at Delay ?   No date set or confirmation of a certain

delay  5010  Meaningful Use

 Certain Healthcare Entities   Plan for the October 2013 timetable   Do not relax and rely on a lengthy delay

General Facts ICD–9–CM  diagnosis  codes     ICD–10–CM  diagnosis  codes  

3–5  characters  in  length       3–7  characters  in  length.    

Approximately  14,000  codes     Approximately  69,000  available  codes.    

First  digit  may  be  alpha  (E  or  V)  or  numeric;  Digits  2–5  are  numeric      

Digit  1  is  alpha;  Digits  2  and  3  are  numeric;  Digits  4–7  are  alpha  or  numeric  

Limited  space  for  adding  new  codes       Flexible  for  adding  new  codes.    

Lacks  detail       Very  specific.    

Lacks  laterality       Has  laterality.    

Difficult  to  analyze  data  due  to  non-‐specific  codes  Specificity  improves  coding  accuracy  and  richness  

of  data  for  analysis.    

Codes  are  non-‐specific  and  do  not  adequately  define  diagnoses  needed  for  medical  research  

Detail  improves  the  accuracy  of  data  used  for  medical  research.    

Does  not  support  interoperability  because  it  is  not  used  by  other  countries.  

Supports  interoperability  and  the  exchange  of  health  data  between  other  countries  and  the  U.S.  

Quick References   Annual updates of each system are posted on the

ICD-10 website at http://www.cms.gov/ICD10

  Maintenance and updates of ICD-9-CM and ICD-10 are discussed at the ICD-9-CM Coordination and Maintenance (C&M) Committee meeting

http://www.cms.gov/ICD9ProviderDiagnosticCodes/03_meetings.asp

Draft ICD-10-CM

Official Guidelines for Coding and Reporting

http://www.cdc.gov/nchs/icd/icd10cm.html

GEMS   General Equivalence Mappings (GEMs) assist in

converting data from ICD-9-CM to ICD-10

  Forward and backward mappings

Information on GEMs and their use –http://www.cms.gov/ICD10 (click on ICD-10-CM or ICD-10-PCS to find most recent GEMs)

  GEMs are not a substitute for learning how to code with ICD-10

Implementation Schedule   Last regular, annual updates to both ICD-9-CM and

ICD-10 will be made on October 1, 2011

  On October 1, 2012 there will be only limited code updates to both ICD-9-CM & ICD-10 code sets to capture new technology and new diseases

  On October 1, 2013 there will be only limited code updates to ICD-10 code sets to capture new technology and new diseases

  On October 1, 2014 regular updates to ICD-10 will begin

Orthopedic Character Changes

  Right, Left, and Unspecified

  Initial Encounter, Subsequent Encounter, or Sequela

  Active Treatment or Aftercare

Other Notes   The letter U is not used in ICD-10-CM

  7th placeholder is always alpha

  The word “with” means includes, the word “and” means either or.

Initial, Subsequent, and Sequela for Injuries

7th character utilized on most injuries with the exception of fractures

  A- Initial Encounter- patient receiving active treatment for an injury

  D-Subsequent encounter- patient is receiving routine care during healing or recovery phase

  S-Sequela-patient is being seen for complications or conditions as a direct result of an injury

Placeholder “x”   Used in the 4th, 5th, or 6th character position

  Utilized when a 6th or 7th character position is necessary

Examples:

  M86.8x1-Other osteomyelitis, shoulder   SØ6.5xØA-Initial encounter for traumatic subdural

hemorrhage without loss of consciousness   X75.xxxS-Intentional self-harm by explosive material,

sequela

NEC and NOS   NEC

  Not elsewhere classified   Not elsewhere classifiable  NEC leads you to certain specified forms are

classified elsewhere

  NOS   Not otherwise specified

Excludes   Two kinds of excludes notes

  Note 1- NOT CODED HERE (ICD-9)- Two codes cannot be coded together   Congenital vs. acquired

  Note 2- Not included here- Indicates that codes listed could be billed together only if appropriate, but they may be needed to reported for clarification

Chapter 12 Diseases of the Skin and Subcutaneous Tissue

  L00-L08- Infections of the skin and subcutaneous tissue

  L60-L75- Disorders of skin appendages   L76- Intraoperative and postprocedural

complications of skin and subcutaneous tissue

  L80-L89- Other disorders of the skin an subcutaneous tissue   L89-Pressure ulcer

Chapter 13 Diseases of Musculoskeletal and connective tissue (M00-M99)

  Site and laterality

  Bone Versus Joint

  Acute Traumatic vs. chronic recurrent

  Pathological Fractures

  Osteoporosis

Site and Laterality Most codes in Chapter 13 have site and laterality designations.

  Site represents   Bone   Joint   Muscle   Multiple sites code   If there is no multiple site code, multiple codes

should be used

Bone Vs. Joint

  Bone maybe affected at upper or lower end

  If joint is affected as well as bone, the designation will be the bone, not the joint

Acute Vs. Chronic or Recurrent

Many musculoskeletal conditions result of previous injury or trauma to a site, or are recurrent conditions.

  Chapter 13 has   Chronic or recurrent bone, joint, or muscle conditions   Conditions that are the result of healed injury   If it is difficult to determine acute or chronic, query

the provider

 Acute injury coding is in Chapter 19

Swelling of a Limb No longer a code for swelling of a limb

  Now classified to other soft tissue disorder NEC   See Disorder, soft tissue, specified type, NEC

ICD-9-CM- 729.81 Swelling of limb

ICD-10-CM- M79.8 Other specified soft tissue disorder

Pathological Fractures   7th character treatment status

Osteoporosis

  M80-with current pathological fracture

  M81-without pathological fracture

Osteoarthritis

M15-19  Codes to 5th and 6th character

  Listed by body part   Unilateral and bilateral   Right and left   Primary and secondary

Other Joint Disorders M20-25   M20-Acquired deformities of fingers   M21-Other acquired deformities of limbs   M22-Disorder of patella   M23-Internal derangement of knee   M24-Other specific joint derangements   M25-Other joint disorder, not elsewhere classified

Deforming Dorsopathies M40-49   M40-Kyphosis and lordosis

  M41-Scoliosis

  M42-Spinal osteochondrosis

  M43-Other deforming dorsopathies

  M45-Ankylosing spondylitis

  M46-Other inflammatory Spondylopathies

  M47-Spondylosis

  M48-Other spondylopathies

  M49-Spondylopathies in diseases classified elsewhere

Other Dorsopathies

M50-M54   M50-Cervical disc disorders

  M51-Thoracic, thoracolumbar, and lumbosacralintervertebral disc disorders

  M53-Other and unspecified dorsopathies, not elsewhere classified

  M54-Dorsalgia

Soft Tissue Disorders   M60-M63-Disorders of muscles

  M65-M67-Disorders of synovium and tendon

  M70-M79-Other soft tissue disorders

  M80-M85-Disorders of bone density and structure

  M86-Osteomyelitits

  M96-Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classified

Chapter 17 Now titled Congenitial Malformations, Deformations, and Chromosomal, Abnormalities

  Q00-Q07- Nervous system

  Q65-Q79- Musculoskeletal system

  Q80-89- Other congenital malformations

  Q90-Q99- Chromosomal abnormalities, not elsewhere classified

Chapter 19 Injury, Poisoning, and other certain consequences of external causes (S00-T88)

  Traumatic Injury- SØØ-T14.9   Code the most serious injury first

  Complications of care   Pain due to medical devices- T code section

  Aftercare Z codes should not be used for aftercare for injuries

Injuries ICD-9-CM to ICD-10-CM

ICD-9-CM

Codes looked up by type and then site

ICD-10-CM

Codes looked up by body region and then type

Injuries   SØØ-SØ9-head

  S1Ø-S19-neck

  S2Ø-S29-thorax

  S3Ø-S39-abdomen,lower back, lumbar spine, pelvis

  S4Ø-S49-shoulder and upper arm

  S5Ø-S59-elbow and forearm

  S6Ø-S69-wrist and hand

  S7Ø-S79-hip and thigh

  S8Ø-S89-knee and lower leg

  S9Ø-S99-ankle and foot

Fractures   Displaced or non-displaced

  Fracture type (2,3,or 4 part)

  What kind (greenstick, communited, transverse)

  Routine healing, delayed healing, malunion,nonunion

  Open or closed   Open breaks down further (Type I, II,IIIA,IIIB,IIIC)

Open Fractures Gustilo Open Fracture Classifications

  3 main categories, I,II,III

  Type III further divided, IIIA,IIIB,IIIC   Mechanism of injury   Extent of soft tissue damage   Degree of bone injury or involvement

Salter-Harris Fractures Occur along the epiphyseal (growth) plates

  Listed under fracture, then physeal

  Classified into 9 types   Types I-IV- most common

  Specific codes for most site   Types V-IX- less common

  Other physeal fracture

  If no type is specified, use unspecified code

Fracture 7th character extension for type of encounter

  A-Initial encounter for closed fracture

  B- Initial encounter for open fracture

  D- Subsequent encounter for fracture with routine healing

  G- Subsequent encounter for fracture with delayed healing

  K- Subsequent encounter for fracture with nonunion

  P- Subsequent encounter for fracture with malunion

  S- Sequela

Right, Left and Unspecified 6th character utilized to designate side

Fracture of pisiform

  S62.161-Displaced fracture, right wrist   S62.162-Displaced fracture, left wrist

  S62.163-Displaced fracture, unspecified wrist

  S62.164-Nondisplaced fracture, right wrist

  S62.165-Nondisplaced fracture, left wrist   S62.166-Nondisplaced fracture, unspecified wrist

Chapter 20 External Causes of Morbidity Replaces E Codes

  VØØ-X58-Accidents

  VØØ-V99-Transport accidents

  WØØ-X58-Other external causes of accidental injury

  WØØ-W19-Slipping,tripping,stumbling,and falls

  X92-YØ8-Assault

Chapter 20 Notes Y85-89- Sequelae of External Causes of Morbidity and Morality

  All late effects for each intent brought together in a subchapter

  Alpha Extender for sequelae “S” is added to the code   Y89-Sequelae of other external causes   W55.01S-Bitten by cat, sequela

Chapter 21 Factors influencing health status and contact with health services

Replaces V Codes

  Z68- Body mass index

  Z80-Z92- History of

  Z96- Presence of other functional implants

Aftercare Encounter for:

  Z45- Adjustment and management of implanted device

  Z47- Orthopedic aftercare

  Z48- Other postprocedural aftercare

References for this Presentation

Ingenix

  ICD-10-CM-The Complete Official Draft Code Set- DRAFT

  Implementing ICD-10

Contexo-Media

  Advanced Anatomy and Physiology for ICD-10-CM/PCS

Improve Profitability with HIS

  HIS is a full service Physician Management organization offering expert services in Revenue Cycle Management, EHR, Consulting and IT services.

  Expert Coding consultation, Coding Certification (including ICD-10), training, audits, assessments, etc.

  HIS typically can increase your reimbursements by 10% or more.   Call HIS to see how we can improve your reimbursements,

lower overhead and boost overall profitability. 1-855-RING-HIS

RCM plus EHR   HIS is the only reseller in the nation of the award

winning productivity-driven SRS-EHR by SRSsoft.

  More Orthopedics are using SRS than any other EHR in the country!

  Bundled service: SRS-EHR and HIS's Revenue Cycle Management Services together   Mitigates the up-front costs associated with the software,

hardware and implementation of an EHR purchase.

  HIS will amortize the hardware and software costs into HIS’ monthly service fee... allowing you to enjoy the benefits and costs savings with zero capital out-lay.

Contact HIS   Andy Salmen

  Business Development   847-720-7007   asalmen@healthinfoservice.com

  Lynn Anderanin   Senior Director of Coding Education and Compliance   847-720-7090   LAnderanin@healthinfoservice.com

WWW.HealthInfoService.com

1-855-RING-HIS