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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 [email protected]
Lynn Anderanin Senior Director of Coding Education and Compliance 847-720-7090 [email protected]
WWW.HealthInfoService.com
1-855-RING-HIS
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