ICD-10-CM Training for Medical Office Staff - Touro Infirmary · ICD-10-CM Training for Medical Office Staff ... medical data code sets ... • •ICD-10-CM Coding Manual

ICD-10-CM Training for Medical Office Staff

Presented by:

Angie Audler, MBA, RHIT, CCS, CPC, AHIMA Approved ICD-10-CM/PCS

Trainer

Disclaimer

• This PowerPoint presentation is an education tool to provide basic information for coding. The information is the sole view of the author and was put together based on experience, research and expertise in the coding profession. It is not intended to be an exhaustive review and should not be considered a substitution for Coding Guidelines. The presenter does not accept any responsibility or liability with regard to errors, omissions misinterpretations or misuse by the audience.

Copyright c 2015

Confidential and Proprietary Information

Are you Ready? If Not, It’s.............

• We’re only days away!

• Implementation Date

• October 1, 2015

Today’s Topics

• Readiness Checklist

• Where You Can Find the Code Sets

• What ICD-10 Related Changes are of Particular Importance to Your Practice

• What Will Be the Impact of the Transition

• How To Look Up A Code

• Applying Coding Concepts

• Recommendations

ICD-10 Readiness Checklist Source: http://www.healthcareitnews.com

• Have both your Practice Management and EHR been updated to be ICD-10 compliant? • Have you tested submitting ICD-10 codes to your Practice Management system? • Have you considered updating your existing Encounter Forms to include ICD-10 codes with

more specificity and using laterally to meet the ICD-10 requirements? • Have you contacted all your vendors to ensure they are ICD-10 compliant, such as payers,

clearinghouses, and any lab or radiology vendors? • If necessary, have you loaded the ICD-10 dictionaries in both your Practice Management and

EHR applications? • Have you tested submitting codes from your Practice Management system to your payers and

clearinghouses? • Have you tested submitting orders (labs/diagnostics/imaging studies) from your EHR to

appropriate vendors with ICD-10 codes? • Have you identified the top 25-50 diagnoses for each specialty (based on volume and/or high

revenue) and trained appropriate staff on ICD-10 criteria for coding, billing, and clinical documentation?

• Have you optimized all preferences and enhancements within your systems to assist in the ICD-10 transition such as Billable Indicators and Clinical Qualifiers?

• Have you reviewed current clinical documentation and identified gaps for ICD-10 requirements?

• What else do you need to know and consider?

ICD-10-CM Impacts….

• Coverage of services

• Payment for services

• Documentation requirements

• Ordering diagnostic tests, obtaining authorizations, ordering prescriptions

• Collection of accurate data

• Submission of accurate data through claims

• Reporting of quality indicators

• Outcomes Measurement

Copyright © 2015 MEDKODER LLC Confidential and Proprietary Information

6

Ordering Diagnostic Tests

• A physician order must include the following elements in order to be considered valid: – Reason for ordering the test or service (diagnosis

description, ICD-10 code, sign(s), symptoms)

– Test or service requested

– Provider’s name

– Provider’s signature

– Patient complete name

– Patient date of birth

Obtaining Authorizations

• Authorizations must contain a “valid” diagnosis code for date-of-service – not date authorization was obtained

Ordering Prescriptions

• CMS FAQ 7579 – Refills

– Payer/pharmacy requiring a diagnosis code for a prescription (e.g. Medicaid):

• When conducting a standard transaction, medical data code sets (ICD-9 and ICD-10) that are valid at the time that the service is provided (prescription fill date) must be used (45 CFR 162.1000).

ICD-10-CM Changes

• There are three main categories of changes in ICD-10-CM

- Definition Changes

- Differences in Terminology

- Increased Documentation Specificity

• ICD-10 doesn’t affect coding only; it involves physician reporting, billing, information technology, and revenue management

Copyright © 2015


ICD-10-CM

• Although there are approximately 70,000 codes in ICD-10, specialists will use only a small subset of those codes

• Over 1/3 of the expansion codes are due to laterality (physicians are already documenting right, left, bilateral)

– If bilateral and there is no specific code for bilateral, you code both right and left sides

11

ICD-10 – Major Modifications

• Expanded categories for postoperative complications

• Addition of sixth and seventh characters or accidents and injuries, adverse effects

• Addition of laterality

• Combination codes for common diagnosis and symptoms


12

Where Can You Find the Code Sets?

• The code sets are available on the CMS website • www.cms.gov/icd10

• ICD-10-CM Coding Manual

• Practice Management Systems

http://www.cms.gov/icd10

What ICD-10 Related Changes Are of Particular Importance to Your Practice?

• Training is especially important to familiarize staff with the concepts of ICD-10

• Physician specificity in documentation

• Workflow disruptions

What Will Be the Impact of the Transition?

• Even the best prepared office may run into problems directly following the transition

• Be prepared to see a decrease in productivity and accuracy

• Expect delays in claim processing

• Potential increase in the number of rejected or denied claims

How Do I Look Up a Code?

• How you look up a code is dependent upon the method used for code selection

– Coding Manual

– Electronic code search

• System

• Internet

Organization of the ICD-10-CM Coding Manual

• The ICD-10-CM coding manual contains an Alphabetic Index and Tabular List

• The Alphabetic Index for ICD-10-CM has a similar format as

ICD-9-CM. It contains an Alphabetic Index of Diseases and Injuries, Alphabetic Index of External Causes, Table of Neoplasms, and Table of Drugs and Chemicals. However, ICD-10-CM does not contain a Hypertension Table

• Morphology codes are not listed next to the descriptor in

the Alphabetic Index and no longer have a separate Appendix


17

Organization of the Coding Manual

• Some codes in ICD-10-CM have a single inclusive code for manifestations, while others require two codes to report a manifestation.

• Example:

– In ICD-9-CM diabetes with a manifestation often required the use of two codes. The diabetic code was coded first, followed by the manifestation code

• Diabetes with peripheral autonomic neuropathy 250.60, 377.1

– In ICD-10-CM, a single code describes Diabetes with peripheral autonomic neuropathy G99.0


18

Alphabetic Index of Diseases and Injuries

• Main terms are listed in alphabetical order in bold print with subterms indented under the main term. Non-essential modifiers are listed in parenthesis ( ) behind the main term. Non-essential modifiers do not change code assignment

• Many non-essential modifiers that appeared behind main terms in ICD-9-CM may appear as subterms in ICD-10-CM with their own code

Copyright © 2015 MEDKODER LLC

Confidential and Proprietary Information 19

Alphabetic Index of External Causes

• External Cause codes describe environmental events and circumstances as the cause of an injury and other adverse effects

• They are always secondary codes and provide additional information


20

Hypertension Table

• The Hypertension Table in ICD-10-CM has been eliminated. The same code is used regardless of whether the hypertension is described as benign, malignant or whether or no qualifier is used


21

Table of Neoplasms

• The Neoplasm Table is formatted similarly to the table in ICD-9-CM and contains the same Headings


22

Neoplasm, neoplastic

Mal

ign

ant

Ne

op

lasm

Mal

ign

ant

Seco

nd

ary

CA

in-s

itu

Be

nig

n

Un

cert

ain

Un

spe

cifi

ed

Be

hav

ior

Table of Drugs and Chemicals

• The Table of Drugs and Chemicals Headings better describe the circumstance of the encounter

• It also contains new columns for “Adverse Effect” and “Underdosing”


23

Substance

Po

iso

nin

g,

Acc

iden

tal

(un

inte

nti

on

al)

Po

iso

nin

g,

Inte

nti

on

al

Se

lf-h

arm

Po

iso

nin

g,

Ass

ault

Po

iso

nin

g,

Un

det

erm

ined

Ad

vers

e E

ffe

ct

Un

de

rdo

sin

g

Tabular List

• The Tabular List contains a chronological list of codes divided by body system or condition. It contains 21 Chapters

• The restructuring and reorganization of codes has resulted in additional chapters

• Each Chapter in the Tabular List contains a summary of the categories within the Chapter



Conventions

• Abbreviations

– Like ICD-9-CM, the abbreviations NEC and NOS are used:

• NEC – Not Elsewhere Classified (referring to “other” specified conditions)

• NOS – Not Otherwise Specified (referring to “unspecified” conditions)



Conventions

• Cross-reference, punctuation marks

– Cross-reference and punctuation marks are used the same as they were in ICD-9-CM


26

Conventions

• Excludes Notes

– There are two types of Excludes Notes in ICD-10-CM.

• Exclude 1 – means the two conditions cannot be coded together (e.g. congenital and acquired form of the same condition)

• Exclude 2 – means not included and can be coded if the patient has both conditions



Conventions

• And

– Interpreted to mean and/or

• With

– Interpreted as “associated with” or “due to”


28

Conventions

• Default Code

– The term “default code” refers to a code listed next to the main term in the Alphabetic Index

– It represents that the term is most commonly associated with the main term or is unspecified


29

Full Code Titles

• ICD-9-CM – 143 Malignant neoplasm of gum

• 143.0 Upper gum

• 143.1 Lower gum

• ICD-10-CM – C03 Malignant neoplasm of gum

• C03.0 Malignant neoplasm of upper gum

• C03.1 Malignant neoplasm of lower gum


30

Conventions

• Instructional Notes

– Instructional notes are the same as they were in ICD-9-CM:

• Code first

• Use additional code

• Code also


31

ICD-10 Convention

• Code First Notes

– Used when certain conditions have both an underlying etiology and multiple body system manifestations

– Requires the underlying condition be sequenced first followed by the manifestation

– Proper sequencing order of the codes: etiology followed by manifestation (same coding convention as ICD-9-CM)



ICD10 Conventions

• Use Additional Codes are secondary codes that identify manifestations

ICD-10 Conventions

• Code Also Notes

– A code also note instructs that 2 codes may be required to fully describe a condition but the sequencing of the two codes depends on the circumstances of the encounter


34

Understanding Basic Phrases

• Phrases “due to” and “manifested by”

– It is not sufficient to say the patient has an ulcer and history of radiation therapy

– It needs to be stated whether or not the ulcer is due to radiation


35

Outpatient Services

• The terms “encounter” and “visit” are synonymous when describing outpatient services


36

ICD-10-CM Structure

37

ICD-10-CM Structure

• Alpha characters are not case sensitive

• First character is Alpha. The letter U is reserved by the WHO for future use of new diseases of uncertain etiology (U00-U49) and bacterial agents resistant to antibiotics (U80-89)

• Second character is always numeric

• Characters three, four, five, six and seven can be alpha or numeric

• The decimal (.) is placed after the third character


38

ICD-10-CM Structure

• The seventh character represents a visit encounter or sequelae (condition resulting from a previous disease; also known as Late Effects) for injuries and external causes. The seventh character extender must always be the seventh character of a code.

• A hyphen “-” at the end of an ICD-10 code in the Alphabetic Index indicates

that additional characters are required. • Placeholder: An “x” is used as a fifth character in certain six character codes

to allow for future expansion. An “x” is also used as a placeholder when a code has less than six characters and the code requires a seventh character.

• For Example: • Adverse effect of calcium-channel blockers, initial encounter T46.1x5A • Exposure to electric transmission lines, initial encounter W85.xxxA • Post-procedural cardiogenic shock, initial encounter T81.11xA


39

Characteristics

• 21 Chapters and Expanded Codes – Some chapters are reorganized

– Some conditions are put in different Chapters

• Alphanumeric – first character is always a letter

• Addition of up to 7 characters

• 7th character code extensions in some cases – Injuries

• Initial encounter

• Subsequent encounter

• Sequela



Code Structure and Format ICD-10-CM Diagnosis Code

• Some Other Differences of ICD-10-CM – Laterality

• Right and left – Dummy placeholders “x”

• Done to allow for future expansion without disrupting the sixth or seventh character structure for codes where the sixth or seventh character has a specific use

– Intent

• T37.5x1 Poisoning by antiviral drugs, accidental (unintentional)

– Encounter

• Information relevant to ambulatory and managed care encounters

• T16.1xxA Foreign body in right ear (initial encounter) – Other Factors that can affect health

• Lifestyle, socioeconomic, family relationships


41

Abstracting

• Perfecting the practice of abstracting allows (the coder) and others to have more confidence in the data, be able to defend audits, justify medical necessity, and ensure correct coding


42

ICD-10-CM

• It is important for clinical providers, staff and coders to understand how diseases are classified differently in ICD-10, as the change affects the specific documentation that will be needed for coders to abstract the information for appropriate code assignment and non-coders to understand the concepts to address rejections and denials


43

Reporting Differences, Trending and Analytic Modifications

• Converting from ICD9 to ICD10 more than triples the number of available codes

• Looking at historical data becomes problematic unless you can identify and capture needed information from the two coding systems

• Simple forward mapping will not be sufficient for most providers to make a successful transition


44

Steps in Coding with ICD-10-CM

• Coding Steps remain the same

– Identify all main terms in diagnostic statements

• Apply your knowledge of A& P and pathology, pharmaceuticals, and treatments

• Main terms are USUALLY Nouns

– Identify subterms terms in diagnostic statement

• Subterms terms are USUALLY adjectives

– Locate main terms in the Alphabetic Listing

• If terms not identical, use your medical terminology knowledge to translate from documentation to code book



Steps in Coding with ICD-10-CM

– Locate subterms under main terms

– Check for special instructions or cross-references

– TENTATIVELY select a code

– Turn to code category in the Tabular Listing

– Check for any instructional notes for code category/chapter

– Apply your knowledge of code book conventions

– Assign code when all elements of the diagnostic statement accounted for and code verified in Tabular Listing


46

Risk Mitigation

• Denials can run high for “not medically necessary reasons”

• In the beginning there is risk of payers not fully mapping procedures with new allowed diagnosis reasons

– Healthcare providers need to be prepared for short term reduced revenues

47

General Equivalency Maps (GEMS)

• CMS’ GEMS (General Equivalency Maps) demonstrate the complexity involved in moving between the two coding systems

• NCHS/CDC released General Equivalence Mappings (GEMS) to help facilitate the transition between ICD-9-CM and ICD-10-CM. It was intended for use by professionals working in health information, medical research and informatics who may use the mappings in their work to assist in the migration of historical data

• Two files were created for bi-directional mapping: • ICD-9-CM to ICD-10-CM • ICD10-CM to ICD-9-CM


48

GEMS

• The correlation between the two coding systems is not one-to-one in most instances

• Since ICD-10 codes contain more extensive descriptors, body part specificity, and other components, most codes are one-to-many


49

ICD9/ICD10 Relationships 1:1, Cluster, Combination, Complex

• Individual ICD-9 codes that map to several ICD-10 code alternatives;

• Individual ICD-9 codes that map to a set of two of more ICD-10 codes;

• Two or more ICD-9 codes that map to individual ICD-10 codes;

• ICD-9 codes with no representation in ICD-10;

• ICD-9 codes with an exact match in ICD-10; and

• Individual ICD-9 codes that map to codes with similar but not identical meanings in ICD-10


50

CMS General Equivalent Mappings Source: http://firstillinoishfma.org/wp-content/uploads/McGladrey-ICD-10-April-2013.pdf


51

ICD-10 Requires Providers to…

• Provide greater specificity in documentation to meet the needs of ICD-10-CM code requirements


52

Laterality – Left vs. Right

C50.2 Malignant neoplasm, of upper-inner quadrant of breast

– C50.21 Malignant neoplasm of upper-inner

quadrant of breast, female • C50.211 Malignant neoplasm of upper-inner quadrant of right

female breast

• C50.212 Malignant neoplasm of upper-inner quadrant of left

female breast

• C50.219 Malignant neoplasm of upper-inner quadrant of

unspecified female breast

53

Tabular List

• The Tabular List is a chronological list of codes divided into Chapters based on body system or condition


54

Injuries

• A seventh character extension identifies the encounter type

– A – for the initial encounter

– D – for the subsequent encounter

– S - Sequela

• Size and depth of injury is also coded

• Initial vs. subsequent vs. sequela/late effects


55

Applying ICD-10-CM Concepts

• Orthopedic cases will need additional documentation clarity from physicians

– Site: joint vs. bone/limb

– Laterality

– Type and Classification of Fracture • Salter-Harris

• Gustilo Classification for Open Fractures

– e.g., Type I – Low energy, wound less than 1cm

– Type II – Wound greater than 1cm with moderate soft tissue damage

• A fracture not clearly identified as “open” or “closed” is coded to “closed”



Fractures

• Laterality • Mechanism of injury • Etiology of Fracture

-Traumatic, pathologic, osteoporosis, neoplastic disease

• Site -Name of the bone -Medial, lateral, midshaft, epiphysis, etc.

• Displaced vs. Non-displaced • Closed or open (use Gustilo-

Anderson classification for open fractures)

• Type of Fracture -Comminuted, greenstick, oblique, segmental, spiral, transverse, compression, burst, etc.

• Note Injury to Surrounding Tissue • Encounter Type

-Initial encounter for fracture (type) -Subsequent encounter for fracture with routine healing -Subsequent encounter for fracture with delayed healing -Subsequent encounter for fracture with nonunion -Subsequent encounter for fracture with malunion -Sequela


57

Fracture Codes ICD-9

• Fractures, closed – Comminuted

– Depressed

– Elevated

– Fissured

– Greenstick

– Linear

– Spiral

• Fractures, open

– Compound

– Infected

– Missile


58

ICD-10 Expanded Fracture Codes

• Instead of just “open” vs. “closed”, ICD-10 has expanded the fracture codes to identify the specific type of fracture

• S42.31- Greenstick fracture of shaft of humerus

• S42.32- Transverse fracture of shaft of humerus

• S42.33- Oblique fracture of shaft of humerus

• S42.42- Comminuted supracondylar fracture without intercondylar fracture of humerus



Documentation Example

• Instead of documenting fractured right arm, documentation will now need to include:

– Fell while running, traumatic, acute, closed, transverse right distal radial fracture with surrounding soft tissue hematoma and swelling


60

7th Character – Open Fractures

• The open fracture designations are based on the Gustilo open fracture classification

• The appropriate 7th character is to be added to each code from category S52 – A - initial encounter for closed fracture – B - initial encounter for open fracture type I or II – C - initial encounter for open fracture type IIIA, IIIB, or IIIC – D - subsequent encounter for closed fracture with routine healing – E - subsequent encounter for open fracture type I or II with routine healing – F - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing – G - subsequent encounter for closed fracture with delayed healing – H - subsequent encounter for open fracture type I or II with delayed healing – J - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing – K - subsequent encounter for closed fracture with nonunion – M - subsequent encounter for open fracture type I or II with nonunion – N - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion – P - subsequent encounter for closed fracture with malunion – Q - subsequent encounter for open fracture type I or II with malunion – R - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion – S - sequela


61

Place of Occurrence

• Y92.0x Home • Y92.1x Residential institution • Y92.2x School, other institution and public

administrative area • Y92.3x Sports and athletic area • Y92.4 Street and highway • Y92.5x Trade and service areas • Y92.6 Industrial and construction area • Y92.7 Farm • Y92.8x Other specified place



Activity

• Y93.0x - Injured while engaged in sports activity

• Y93.1 - Injured while engaged in leisure activity

• Y93.3x - Injured while engaged in other types of work

• Y93.4 - Injured while resting, sleeping, eating or engaging in other vital activities

• Y93.8 - Injured while engaged in personal hygiene

• Y93.9 - Injured during unspecified activity


63

Factors Influencing Health Status and Contact with Health Service

• New Features

• Z72 Problems related to lifestyle

– Z72.3 Lack of physical exercise

– Z72.4 Inappropriate diet and eating habits

• Z73 Problems related to life-management difficulty

– Z73.1 Type A behavior pattern

– Z73.2 Lack of relaxation and leisure


64

Unspecified Codes

• Surveys indicate that as much as 50% of physician documentation cannot be coded to appropriate level of specificity with ICD-10


65

Unspecified Codes

• Sometimes the use of unspecified codes makes sense – Early in the course of evaluation

– Secondary diagnoses not directly being treated by that provider but impacts that encounter

– Generalist vs specialist

• Payers are discouraging the use of unspecified codes – When providers review their severity and risk scores it may

impact their reimbursement because it won’t have the specificity in their codes that are needed to justify higher levels and better reimbursement

66

Ordering Diagnostic/Therapeutic Services

• Governmental and third party payers require the performing provider (hospital ancillary departments, outpatient freestanding centers, independent labs, etc.) to provide ICD9/10 codes for outpatient diagnostic and/or therapeutic testing/services that they perform and submit for payment on behalf of your patients

• These providers rely on the ordering physician to submit the appropriate diagnosis code at the time of ordering to establish medical necessity for the test ordered

Copyright © 2015 Confidential and Proprietary Information

Communication

• Hospital ancillary departments depend on the referring physician to give the order for and the reason behind services

• They are also dependent on the physician for pertinent information related to an ordered exam

• With ICD10 codes, it is not the amount of information required from the referring physician but the specificity of the information that will determine payment


68

Key Updates to Infectious and Parasitic Diseases (A00-B99)

• Terminology change - the term Sepsis has replaced the term Septicemia

• Urosepsis is a nonspecific term and is not coded in ICD-10-CM. Coding guidelines direct the coder to query the provider for clarification if this term is used

• Infections resistant to antibiotics require the use of an additional code for any associated drug resistance only if the infection code does not identify drug resistance (Z16 category, resistance to antimicrobial drugs if the infection code does not identify drug resistance)

• The codes have been expanded to reflect manifestations of the disease

69

West Nile Virus (manifestation example)

ICD-9-CM ICD-10-CM

066.40 West Nile fever, unspecified 066.41 West Nile fever with encephalitis 066.42 West Nile fever with other neurologic manifestation

A92.30 West Nile fever infection , unspecified A92.31 West Nile fever infection with encephalitis A92.32 West Nile infection with other neurologic manifestation *Use additional code to specify the neurologic manifestation: A92.39 West Nile virus with other complications **Use additional code to specify the other conditions: A93.8 Other specified arthropod-borne viral fevers A94 Unspecified arthropod-borne viral fever

Copyright c 2015 Confidential and Proprietary Information

Key Updates for Neoplasms (C00-D49)

• This section contains code expansions

• Many codes in this section instruct us to Use An Additional code

• Significant expansions or revisions are related to: – laterality for some of the neoplasm sites

– Malignant neoplasm of the male breast

– The use of an additional code to identify estrogen receptor status (Z17.0, Z17.1)

71

Neoplasm Documentation Neoplasm Documentation Awareness

Documentation should include: • Behavior - Malignant (primary, secondary, in-situ) - Document any secondary sites - Benign - Unspecified behavior - Of certain histological behavior • Laterality (right/left) • Anatomical site (topography) • Other condition(s) associated with malignancy – (dehydration, anemia, etc.) • Complication(s) associated with neoplasm • Include estrogen receptor status (if applicable) • History of: - Has the malignancy been excised or eradicated? - Is there still treatment being provided for the primary and/or secondary site? - Is there evidence of remaining malignancy at the primary site? • Document any associated diagnoses/conditions


72

Neoplasms

• Overlapping sites • Laterality – Left vs. Right • C50.2 Malignant neoplasm, of upper-inner

quadrant of breast) – C50.21 Malignant neoplasm of upper-inner quadrant

of breast, female • C50.211 Malignant neoplasm of upper-inner quadrant of

right female breast • C50.212 Malignant neoplasm of upper-inner quadrant of left

female breast • C50.219 Malignant neoplasm of upper-inner quadrant of

unspecified female breast



CA of Breast

ICD-9-CM ICD-10-CM

174.9 Malignant neoplasm of breast (female, unspecified)

C50.919 Malignant neoplasm of unspecified site of unspecified female breast * Use additional code to identify estrogen receptor status (Z17.0, Z17.1)


74

Key Updates for Diseases of Blood & Blood Forming Organs (D50-D89)

• Anemia is the most common condition included in this section. The use of specific terminology is important in applying codes for this condition

• Procedural complications affecting the spleen are included in this section

75

Anemia Anemia Documentation Awareness

• Documentation of Anemia should include the type of anemia: -- Nutritional -- Hemolytic -- Aplastic -- Due to blood loss -- Other (please specify) • Include in documentation if Anemia is due to nutrition or mineral deficits, resulting in a nutritional anemia • Document if the Anemia is due to a neoplasm (primary and/or secondary) • Document whether the ANEMIA is “related to or due to” chemo or radiotherapy treatments • Document any “cause–and-effect” relationship between the intervention and the blood or immune disorder • Document the specific drug if anemia is drug-induced • Link any laboratory findings to a related diagnosis (if appropriate) • Document any associated diagnoses/conditions


76

Anemia

ICD-9-CM ICD-10-CM

285.9 Anemia, unspecified D64.9 *Anemia, unspecified

*There are more specific code choice selections available in ICD-10-CM. These include:

D64.81 Anemia due to antineoplastic chemotherapy

D63.0 Anemia in neoplastic disease

D61.1 Aplastic anemia due to antineoplastic chemotherapy


77

Key Updates for Endocrine, Nutritional & Metabolic Disorders (E00-E89)

• Many codes in this section instruct us to Use An Additional Code • ICD-10-CM Diabetes Mellitus codes are now combination codes

that include the type of diabetes (1 or 2), the body system affected and complications affecting the body system.

• As many codes within a particular category as are necessary to describe all of the complications of the disease may be used.

• Diabetes Mellitus (E08-E13) is no longer classified as controlled or uncontrolled in ICD-10- CM.

• ICD-10-CM there are 5 category codes for Diabetes Mellitus: – E08 – Diabetes Mellitus due to underlying conditions – E09 - Drug or chemical induced Diabetes Mellitus – E10 – Type 1 Diabetes Mellitus – E11 - Type 2 Diabetes Mellitus – E13 - Other specified Diabetes Mellitus

78

Key Updates for Endocrine, Nutritional & Metabolic Disorders (E00-E89)

– Overweight and obesity codes:

• The classification for overweight and obesity has been expanded in ICD-10-CM to include:

– Obesity due to excess calories

– Morbid (severe) obesity due to excess calories

– Drug induced obesity

– Morbid (severe) obesity due to alveolar hypoventilation

– Overweight

– An additional code (Z68 category) is used to identify the body mass index (BMI), if known

79

80

Diabetes Mellitus ICD-9-CM ICD-10-CM

Type • Type I • Type 2 • Secondary diabetes mellitus

Type • Type 1 • Type 2 • Drug/chemical induced • Due to underlying condition • Specified Type

Control • Controlled • Uncontrolled

Control • Inadequately controlled • Out of control • Poorly controlled • Hypoglycemia • Hyperglycemia

Manifestation/Complication • Hyperosmolarity • Ketoacidosis • Neurological manifestations • Other coma • Peripheral circulatory disorder • Renal Manifestations • Other specified manifestations • Without Complications

Manifestation/Complication • Arthropathy • Circulatory complications • Hyperosmolarity • Hypoglycemia • Ketoacidosis • Kidney complications • Neurological complications • Ophthalmic complications • Oral complications • Skin complications • Without complications

Insulin Use Insulin Use • No longer required for Type 1 • For Type 2 any long-term or current use is reported

Diabetes Mellitus

ICD-9-CM Code ICD-10-CM Code(s)

250.00 – Diabetes mellitus without mention of complications type II or unspecified type, not states as controlled

E11.9 – Type 2 diabetes mellitus without complications

Diabetes Mellitus Documentation Awareness

Capturing the correct code for Diabetes Mellitus requires clear and precise documentation of the underlying cause. Diabetes mellitus codes in ICD-10 reflect combination codes. The components of the combination codes are: • Type of Diabetes • Body System Affected • Specified complications/manifestations affecting the body system

81

82


Type of Diabetes • Drug or Chemical Induced (E09) – (anticonvulsants; antihypertensive drugs

including diuretics and beta blockers; antipsychotic drugs including lithium and antidepressants; antiretroviral drugs; chemotherapy drugs; hormone supplements including anabolic steroids, contraceptives, estrogen, growth hormones and hormones for prostate cancer)

• Due to an underlying condition (E08) • Type I diabetes (E10) – controlled/not specified; uncontrolled • Type 2 diabetes (E11) – controlled/not specified; uncontrolled • Other specified diabetes (E13) – secondary diabetes mellitus –

controlled/not specified; uncontrolled

For Type 2 diabetes mellitus and secondary diabetes mellitus, any long-term or current use of insulin is reported as an additional code. You may report more than one diabetes code for patients with multiple complications or when multiple body systems are affected as a result of the diabetes. Secondary diabetes is defined as a diabetic condition with an underlying cause other than genetics or environmental conditions (includes due to drugs, chemicals, medical conditions, surgical procedures or trauma)

Diabetes


Body System Affected • Circulatory complications • Hyperosmolarity • Kidney complications • Ketoacidosis • Other coma • Neurological complications • Ophthalmic complications • Other specified complications/manifestations • Unspecified complications/manifestations • Without complications/manifestations

83

84


Specified complications/manifestations affecting the body system

• Circulatory complications – peripheral • Hyperosmolarity • Hypoglycemia (with or without coma) • Kidney complications – diabetic nephropathy; chronic kidney disease; other • Ketoacidosis – with or without coma • Neurological complications – amyotrophy; autonomic polyneuropathy;

mononeuropathy, polyneuropathy; other; unspecified • Ophthalmic complications – diabetic retinopathy (mild, moderate or severe

nonproliferative with or without macular edema); diabetic cataract; other • Other specified complications/manifestations – skin complications (dermatitis,

foot ulcer; other skin ulcer; other skin complications; oral complications (periodontal disease; other)

• Unspecified complications/manifestations • Without complications/manifestations

Key Updates for Mental, Behavioral, Neurodevelopment Disorders (F01-F99)

• Classification improvements (different categories) • Code expansions: – Most notably, Other Isolated or Specific

Phobias • Updates to medical terminology: • – Bipolar I disorder, single manic episode will change to manic

episode • – Undersocialized conduct disorders, aggressive will become

Conduct disorder childhood-onset type • Nicotine dependence updated to identify specific tobacco

products (cigarettes, chewing tobacco, and other tobacco) • ICD-10-CM does not provide separate “history” codes for

alcohol and drug abuse. These conditions are identified as “in remission.”

85

Attention Deficit Hyperactivity Disorder (ADHD)

ICD-9-CM ICD-10-CM

314.00 ADD w/o mention of hyperactivity

F90.0 ADHD, predominantly inattentive type

314.01 ADD w/ mention of hyperactivity

F90.1 ADHD, predominantly hyperactive type

F90.2 ADHD, combined type

F90.8 ADHD, other type

F90.9 ADHD, unspecified type

Note: codes within this category may be used regardless of the age of a patient. These disorders generally have onset within the childhood or adolescent years, but may continue throughout life or not be diagnosed until adulthood. ADD & ADHD is now classified at just ADHD

Key Updates for Diseases of the Nervous System (G00-G99)

• Classification improvements (significant changes to sleep disorders)

• Code expansions (e.g. Alzheimer’s, headaches) • Updates to medical terminology (epilepsy,

seizures) • Codes for TIA are now included in the nervous

system chapter, rather than circulatory • Codes for migraine have been expanded to fifth

and sixth characters to indicate if the migraine is intractable and to provide additional specificity within the code description

87

Headache Headache Documentation Tips

Headache Document type: - Cluster - Vascular - Tension-type - Post-traumatic - Drug-induced (specify drug) - Other Document: - Intractable - Not intractable Document timing: - Episodic - Chronic - Episodic paroxysmal hemicrania - Chronic paroxysmal hemicrania - Short lasting unilateral


Headache

ICD-9-CM ICD-10-CM

784.0 Headache R51 Headache G44.10 Vascular headache, NEC, not intractable G4411 Vascular headache, NEC, intractable


Migraine

Document type: - Migraine w/ aura - Migraine w/o aura - Hemiplegic migraine - Persistent migraine aura w/o cerebral infarction - Persistent migraine aura w/ cerebral infarction - Chronic migraine Identify when migraine is due to drugs and specify the drug Document: - With status migrainosus - Without status migrainosus - Intractable - Not intractable Identify when migraine is associated with seizures or cerebral infarction


Migraine

ICD-9-CM ICD-10-CM

346.31 Hemiplegic migraine, with intractable migraine, so stated, without mention of status migrainosus

G43.419 Hemiplegic migraine, intractable, without status migrainosus

346.32 Hemiplegic migraine, without mention of intractable migraine with status migrainosus

G43.401 Hemiplegic migraine, not intractable, with status migrainosus

346.33 Hemiplegic migraine, with intractable migraine, so stated, with status migrainosus

G43.411 Hemiplegic migraine, intractable, with status migrainosus

346.40 Menstrual migraine, without mention of intractable migraine without mention of status migrainosus

G43.829 Menstrual migraine, not intractable, without status migrainosus


Migraine (cont’d)

ICD-9-CM ID-10-CM

346.41 Menstrual migraine, with intractable migraine, so stated, without mention of status migrainosus

G43.839 Menstrual migraine, intractable, without status migrainosus

346.42 Menstrual migraine, without mention of intractable migraine with status migrainosus 346.43 Menstrual migraine, with intractable migraine, so stated, with status migrainosus 346.50 Persistent migraine aura without cerebral infarction, without mention of intractable migraine without mention of status migrainosus

G43.821 Menstrual migraine, not intractable, with status migrainosus G43.831 Menstrual migraine, intractable, with status migrainosus G43.509 Persistent migraine aura without cerebral infarction, not intractable, without status migrainosus


Migraine (cont’d)

ICD-9-CM ICD-10-CM

346.51 Persistent migraine aura without cerebral infarction, with intractable migraine, so stated, without mention of status migrainosus

G43.519 Persistent migraine aura without cerebral infarction, intractable, without status migrainosus *There are additional codes to further describe migraine.


Key Updates for Eye and Adnexa (H00-H59)

• Terminology improvements (bringing terms up to date)

• Many codes in this section instruct us to Use An Additional code

• Revisions to identify laterality: – Many of the codes have laterality designation and,

in some instances bilateral designation for diseases of the eye

– A code for unspecified site is also provided

94

Key Updates for the Ear & Mastoid Process (H60-H95)

• There is greater specificity and detail in the codes • Many of the codes have laterality designation • Many conditions in this section (e.g. otitis media) tell

us to Use An Additional Code to identify: – Exposure to environmental tobacco smoke (Z77.22) – Exposure to tobacco smoke in the perinatal period

(P96.81) – History of tobacco use (Z87.891) – Occupational tobacco exposure to environmental tobacco

smoke (Z57.31) – Tobacco dependence (F17.-) – Tobacco use (Z72.0)

95

Chronic Suppurative Otitis Media

ICD-9-CM ICD-10-CM

382.3 Unspecified chronic suppurative otitis media

H66.3x1 Other chronic suppurative otitis media, right ear H66.3x2 Other chronic suppurative otitis media, left ear H66.3x3 Other chronic suppurative otitis media, bilateral H66.3x9 Other chronic suppurative otitis media, unspecified ear *Use additional code for any associated perforated tympanic membrane (H72-)


Chronic Suppurative Otitis Media

ICD-9-CM ICD-10-CM

• Use additional code to identify: Exposure to environmental tobacco smoke (Z77.22)

• Exposure to tobacco smoke in the perinatal period (P96.81)

• History of tobacco use (Z87.891) • Occupational exposure to

environmental tobacco smoke (Z57.31) Tobacco dependence (F17-)

• Tobacco use (Z72.0)


Perforation of Tympanic Membrane

ICD-9-CM ICD-10-CM

384.20 Perforation of tympanic membrane, unspecified

H72.90 Unspecified perforation of tympanic membrane, unspecified ear ** Code first any associated otitis media (H65-, H66.1-, H66.2-, H66.3-, H66.4-, H66.9-, H67-) H72.91 Unspecified perforation of tympanic membrane, right ear H72.92 Unspecified perforation of tympanic membrane, left ear H72.93 Unspecified perforation of tympanic membrane, bilateral



ICD-9-CM ICD-10-CM

** There are more specific code choice selections available in ICD-10-CM. These include: H72.00 Central perforation of tympanic membrane, unspecified ear H72.01 Central perforation of tympanic membrane, right ear H72.02 Central perforation of tympanic membrane, left ear H72.03 Central perforation of tympanic membrane, bilateral H72.10 Attic perforation of tympanic membrane, unspecified ear H72.11 Attic perforation of tympanic membrane, right ear



ICD-9-CM ICD-10-CM

H72.12 Attic perforation of tympanic membrane, left ear H72.13 Attic perforation of tympanic membrane, bilateral H72.2x1 Other marginal perforations of tympanic membrane, right ear H72.2x2 Other marginal perforations of tympanic membrane, left ear H72.2x3 Other marginal perforations of tympanic membrane, bilateral H72.2x9 Other marginal perforations of tympanic membrane, unspecified ear



ICD-9-CM ICD-10-CM

H72.811 Multiple perforations of tympanic membrane, right ear H72.812 Multiple perforations of tympanic membrane, left ear H72.813 Multiple perforations of tympanic membrane, bilateral H72.819 Multiple perforations of tympanic membrane, unspecified ear H72.821 Total perforations of tympanic membrane, right ear H72.822 Total perforations of tympanic membrane, left ear H72.823 Total perforations of tympanic membrane, bilateral H72.829 Total perforations of tympanic membrane, unspecified ear

Key Updates to Diseases of the Circulatory System (I00-I99)

• The time frame for assigning the acute MI code is four (4) weeks in ICD-10-CM

• A new category has been added for coding a subsequent acute MI, which is an MI that occurs within 28 days (4 weeks) of a previous acute MI

• Terminology used to describe several cardiovascular conditions has been revised to reflect more current medical practice

• Many codes in this section instruct us to Use An Additional Code • A major change is the classification of hypertension, which in ICD-9-

CM was classified by type: – Benign, Malignant or Unspecified

• That classification is not required in ICD-10-CM • There is only one code for hypertension I10 - Essential (Primary) Hypertension

102

Coronary Artery Disease (CAD)

ICD-9-CM ICD-10-CM

414.01 Coronary artery disease, native vessel 411.1 Unstable angina

I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina

I25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm

I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris

I25.119 Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris

I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris

103

Key Updates for Diseases of the Respiratory System (J00-J99)

• Modifications have been made to specific categories that bring the terminology up-to-date with current medical practice

– Emphysema now contains codes with panlobular and centrilobular in their description

• Asthma is now classified as mild intermittent, mild persistent, moderate persistent and severe persistent

• Many codes in this section instruct us to Use An Additional Code

104

Asthma Severity

Asthma Severity Frequency of Daytime Symptoms

Intermittent Less than or equal to 2 times per week.

Mild Persistent More than 2 times per week.

Moderate Persistent Daily. May restrict physical activity.

Severe Persistent Throughout the day. Frequent severe attacks limiting ability to breathe.

105

Key Updates for Diseases of the Respiratory System (J00-J99) continued…

• Specificity increased for diseases like influenza, acute bronchitis

• Coding notes updated to require the coder to include information about tobacco use/dependence, where applicable

• Procedural complications that affect the respiratory system are now included

106

Documentation Awareness Tips

Asthma Documentation Awareness Acuity: e.g. acute, chronic

Cause: e.g. exercise induced, cough variant, related to smoking, chemical or particulate cause, occupational

Severity (for persistent asthma patients)

e.g. mild, moderate or severe persistent

Temporal factors e.g. intermittent, persistent, status asthmaticus, acute exacerbation

Asthma

ICD-9-CM ICD-10-CM

493.01 Extrinsic asthma with status asthmaticus J45.21 Mild intermittent asthma with acute exacerbation

493.02 Extrinsic asthma with acute exacerbation

J45.22 Mild intermittent asthma with status asthmaticus

493.11 Intrinsic asthma with status asthmaticus J45.31 Mild persistent asthma with acute exacerbation

493.12 Intrinsic asthma with acute exacerbation J45.32 Mild persistent asthma with status asthmaticus

493.21 Chronic obstructive asthma with status asthmaticus

J45.41 Moderate persistent asthma with acute exacerbation

493.22 Chronic obstructive asthma with acute exacerbation

J45.42 Moderate persistent asthma with status asthmaticus

493.81 Exercise induced bronchospasm J45.51 Severe persistent asthma with acute exacerbation

493.82 Cough variant asthma J45.52 Severe persistent asthma with status asthmaticus

Asthma ICD-9-CM ICD-10-CM

493.91 Asthma, unspecified with status asthmaticus

J45.901 Unspecified asthma with acute exacerbation*

493.92 Asthma, unspecified with acute exacerbation

J45.902 Unspecified with status asthmaticus*

J45.909 Unspecified asthma, uncomplicated*

J44.0 COPD with acute lower respiratory infection

** 5th digit of each code represents unspecified

J44.1 COPD with acute exacerbation

J45.990 Exercise induced bronchospasm

J45.991 Cough variant asthma

** 5th digit of 0 is uncomplicated except for unspecified J45.909

• *Use additional code to identify: • Exposure to environmental tobacco smoke (Z77.22) • Exposure to tobacco smoke in perinatal period (P96.81) • History of tobacco use (Z87.891) • Occupational exposure to environmental tobacco smoke (Z57.31) • Tobacco dependence (F17-) • Tobacco use (Z72.0-)

Tobacco Dependence and Abuse

ICD-9-CM ICD-10-CM

305.1 Tobacco abuse/dependence

F17.211 Nicotine dependence , cigarettes, in remission

F17.213 Nicotine dependence, cigarettes, with withdrawal

F17.218 Nicotine dependence, cigarettes, with other nicotine-induced disorders

F17.221 Nicotine dependence , chewing tobacco, in remission

F17.223 Nicotine dependence, chewing tobacco, with withdrawal

F17.228 Nicotine dependence, chewing tobacco, with other nicotine-induced disorders

Z72.0 Tobacco use

110

Key Updates for Diseases of the Digestive System (K00-K95)

• A number of new subcategories have been added to this chapter

• Hernia with both gangrene and obstruction is classified to Hernia with gangrene

• Codes for Crohn’s disease have been expanded to specify site, if a complication is present, and what that complication is


• Some terminology changes and revisions to the classification of specific digestive conditions have occurred in ICD-10-CM as well.

– The term hemorrhage is used when referring to ulcers.

– The term bleeding is used when classifying gastritis, duodenitis, diverticulosis and diverticulitis

111

Clinical Documentation Awareness Tips

Enteritis / Crohn’s Documentation Awareness Site: e.g. small, large, both

With complication: e.g. abscess, fistula, intestinal obstruction, rectal bleeding

Enteritis / Crohn’s Disease

ICD-9-CM ICD-10-CM

555.9 Regional enteritis of unspecified site

K50.90 Crohn’s disease, unspecified, without complications ** Use additional code to identify manifestations, such as: pyoderma gangrenosum (L88) * There are more specific code choice selections available in ICD-10-CM. These include: K50.00 Crohn’s disease of small intestine without complications


Crohn’s Disease

ICD-9-CM ICD-10-CM

K50.011 Crohn’s disease of small intestine with rectal bleeding K50.012 Crohn’s disease of small intestine with intestinal obstruction K50.013 Crohn’s disease of small intestine with fistula K50.014 Crohn’s disease of small intestine with abscess K50.018 Crohn’s disease of small intestine with other complication K50.019 Crohn’s disease of small intestine with unspecified complications


Crohn’s Disease

ICD-9-CM ICD-10-CM

K50.10 Crohn’s disease of large intestine without complications K50.111 Crohn’s disease of large intestine with rectal bleeding K50.112 Crohn’s disease of large intestine with intestinal obstruction K50.113 Crohn’s disease of large intestine with fistula K50.114 Crohn’s disease of large intestine with abscess K50.118 Crohn’s disease of large intestine with other complication


Crohn’s Disease

ICD-9-CM ICD-10-CM

K50.119 Crohn’s disease of large intestine with unspecified complications K50.80 Crohn’s disease of both small and large intestine without complications K50.811 Crohn’s disease of both small and large intestine with rectal bleeding K50.812 Crohn’s disease of both small and large intestine with intestinal obstruction K50.813 Crohn’s disease of both small and large intestine with fistula K50.814 Crohn’s disease of both small and large intestine with abscess


Crohn’s Disease

ICD-9-CM ICD-10-CM

K50.818 Crohn’s disease of both small and large intestine with other complication K50.819 Crohn’s disease of both small and large intestine with unspecified complications K50.911 Crohn’s disease, unspecified, with rectal bleeding K50.912 Crohn’s disease, unspecified, with intestinal obstruction K50.913 Crohn’s disease, unspecified, with fistula K50.914 Crohn’s disease, unspecified, with abscess K50.918 Crohn’s disease, unspecified, with other complication K50.919 Crohn’s disease, unspecified, with unspecified complications

Key Updates for Diseases of the Skin and Subcutaneous System (L00-L99)

• This section has been restructured to include groups of diseases that are related to one another – Assume causal condition with any condition listed below with Lower Extremity

ulcer • Atherosclerosis of Lower Extremity • Chronic venous hypertension • Diabetic ulcers • Postphlebitic syndrome • Postthrombotic syndrome • Varicose ulcer • Any associated gangrene

• Unlike ICD-9 codes, pressure ulcer codes are now combination codes that identify the site and stage of the ulcer.

• Procedural complications of the skin and subcutaneous tissue have been enhanced

118

Non-pressure Chronic Ulcer Left Heel and Midfoot Open into Dermis

ICD-9-CM ICD-10-CM

707.14 Ulcer of heel and midfoot L97.421 Non-pressure chronic ulcer of the left heel and midfoot limited to breakdown of skin

Key Updates for Diseases of the Musculoskeletal System and Connective System (M00-M99)

• Site and laterality designations

• Three different causes for pathological fractures:

– Neoplastic disease,

– Osteoporosis, and

– other specified disease

• The 7th character describes type of encounter, or the state of a fractures’ healing and any sequelae. Some codes in this chapter will have the 7th character applied

120

Scoliosis

Scoliosis Documentation Tips

• Identify the type of scoliosis: o Idiopathic - Infantile - Juvenile - Adolescent - Other o Secondary - Neuromuscular - Other o Thoracogenic o Other form o Unspecified • Identify site: o Cervical o Cervicothoracic o Thoracic o Thoracolumbar o Lumbar o Lumbosacral o Sacral/sacrococcygeal (only applies to infantile idiopathic scoliosis) o Site unspecified

Scoliosis

ICD-9-CM ICD-10-CM

737.30 Scoliosis (and kyphocoliosis) idiopathic

M41.112 Juvenile idiopathic scoliosis, cervical region

M41.113 Juvenile idiopathic scoliosis, cervicothoracic region

M41.114 Juvenile idiopathic scoliosis, thoracic region

M41.115 Juvenile idiopathic scoliosis, thoracolumbar region

M41.116 Juvenile idiopathic scoliosis, lumbar region

M41.117 Juvenile idiopathic scoliosis, lumbosacral region

M41.119 Juvenile idiopathic scoliosis, site unspecified


Scoliosis

ICD-9-CM ICD-10-CM

M41.122 Adolescent idiopathic scoliosis, cervical region

M41.123 Adolescent idiopathic scoliosis, cervicothoracic region

M41.124 Adolescent idiopathic scoliosis, thoracic region

M41.125 Adolescent idiopathic scoliosis, thoracolumbar region

M41.126 Adolescent idiopathic scoliosis, lumbar region

M41.127 Adolescent idiopathic scoliosis, lumbosacral region

M41.129 Adolescent idiopathic scoliosis, site unspecified


Scoliosis

ICD-9-CM ICD-10-CM

M41.20 Other idiopathic scoliosis, site unspecified

M41.22 Other idiopathic scoliosis, cervical region

M41.23 Other idiopathic scoliosis, cervicothoracic region

M41.24 Other idiopathic scoliosis, thoracic region

M41.25 Other idiopathic scoliosis, thoracolumbar region

M41.26 Other idiopathic scoliosis, lumbar region

M41.27 Other idiopathic scoliosis, lumbosacral region


Key Updates to Diseases of the Genitourinary System (N00-N99)

• Procedural complications affecting the genitourinary system have been added

• Some of the category specificity is based on the gender of the patient

• Laterality was added to identify conditions under the N60 category – benign mammary dysplasia

• Many conditions in this section instruct us to Use An Additional Code

125

BPH

ICD-9-CM ICD-10-CM

600.01 Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS)

Two codes are required in ICD-10-CM: N40.1 Enlarged prostate with lower urinary tract symptoms (LUTS); AND N13.8 Other obstructive and reflux uropathy ** Note under N40.1 states – Use additional code for associated symptoms, when specified:

126

Associated BPH Symptoms

ICD-10-CM

• Incomplete bladder emptying (R39.14) • Nocturia (R35.1) • Straining on urination (R39.16) • Urinary frequency (R35.0) • Urinary hesitancy (R39.11) • Urinary incontinence (N39.4-) • Urinary obstruction (N13.8) • Urinary retention (R33.8) • Urinary urgency (R39.15) • Weak urinary stream (R39.12)

127

BPH

ICD-9-CM ICD-10-CM

** Note under N13.8 (other obstructive and reflux uropathy) states – Code first, if applicable, any causal condition, such as: • Enlarged prostate (N40.1)

128

Key Updates for Pregnancy, Childbirth, and the Puerperium (O00-O9A)

• The final character in most codes in this section indicates trimester of pregnancy, rather than the current episode of care as in ICD-9-CM.

• Trimesters are defined as: – First trimester – less than 14 weeks 0 days – Second trimester – 14 weeks 0 days to less than 28 weeks

0 days – Third trimester – 28 weeks 0 days until delivery

• Supervision of care for high-risk pregnancy is now classified to this section


129

Delivery

ICD-9-CM ICD-10-CM

650 Delivery, normal 654.21 Cesarean previous, delivery with or without mention of antepartum condition 669.71 Delivery, cesarean, NOS, delivered with and without mention of antepartum condition

O80 Encounter for full-term uncomplicated delivery O34.21 Maternal care for scar from previous cesarean delivery • Code first any associated obstructed

labor (O65.5) • Use additional code for specific

condition

Copyright c 2015 Medkoder, LLC Confidential and Proprietary Information

Key Updates for Certain Conditions Originating in the Perinatal Period (P00-P96)

• Different codes are used for “light for gestational age” and “small for gestational age”.

• Codes for assigning birth trauma have been expanded to include more specificity.

131


Poor Fetal Growth Documentation Awareness ICD-9-CM ICD-10-CM

• Poor fetal growth • Light-for dates

• Light-for-dates • Small-for-dates

• Small-for-dates • Small-and-light-for dates

• Fetal growth retardation - Intrauterine growth retardation

• Fetal (intrauterine) malnutrition not light or small for gestational age

• With or without fetal malnutrition • Newborn affected by slow intrauterine growth, unspecified

• Birthweight in grams - Unspecified to >2,500 gms

• Birthweight in grams - Unspecified to 2,499 gms

Copyright ©2015 Confidential and Proprietary Information

Poor Fetal Growth – Perinatal Period

ICD-9-CM ICD-10-CM

Newborn light for gestational age P05.00 …… unspecified weight P05.01 …… less than 500 grams P05.02 …… 500-749 grams P05.03 …… 750-999 grams P05.04 …… 1000-1249 grams P05.05 …… 1250-1499 grams P05.06 …… 1500-1749 grams P05.07 …… 1750-1999 grams P05.08 …… 2000-2499 grams


http://www.icd10data.com/ICD10CM/Codes/P00-P96/P05-P08/P05-/P05.00












ICD-9-CM ICD-10-CM

Newborn small for gestational age P05.10 …… unspecified weight P05.11 …… less than 500 grams P05.12 …… 500-749 grams P05.13 …… 750-999 grams P05.14 …… 1000-1249 grams P05.15 …… 1250-1499 grams P05.16 …… 1500-1749 grams P05.17 …… 1750-1999 grams P05.18 …… 2000-2499 grams













ICD-9-CM ICD-10-CM

764.9 Poor fetal growth NEC P05.9 Newborn affected by fetal (intrauterine) growth retardation

P05.2 Newborn affected by fetal (intrauterine) malnutrition not light or small for gestational age


Key Updates for Congenital Malformations, Deformations and Chromosomal Abnormalities (Q00-Q99)

• This section includes modifications to specific categories that bring the terminology up-to-date with current medical practice

• Code expansion includes more specificity

136

Congenital Anomalies of Skull and Face Bones

ICD-9-CM ICD-10-CM

756.0 Congenital anomalies of skull and face bones

Q75.0 Craniosynostosis Q75.1 Craniofascial dysotosis Q75.2 Hypertelorism Q75.3 Macrocephaly Q75.4 Mandibulofacial dysostosis Q75.5 Oculomandibular dysostosis Q75.8 Other specified congenital malformations of skull and face bones Q75.9 Congenital malformation of skull and face bones, unspecified Q87.0 Congenital malformation syndromes predominantly affecting facial appearance


Key Updates for Symptoms, Signs, and Abnormal Clinical & Laboratory Findings, NEC (R00-R99)

• There are many categories in this section that could be designated as:

– Not otherwise specified

– Unknown etiology, or

– Transient

• Codes to identify a patient’s coma scale

• Repeated falls are coded to a symptom code in ICD-10-CM (was a V code in ICD-9-CM).

• Numerous combination codes identify both the definitive diagnosis and common symptoms of that diagnosis

• Abnormal findings (laboratory, x-ray, pathologic, and other diagnostic results) are not coded and reported unless the provider indicates their clinical significance. If the findings are outside the normal range and the attending provider has ordered other tests to evaluate the condition or prescribed treatment, it is appropriate to ask the provider whether the abnormal findings should be added 138

Chest Pain

ICD-9-CM ICD-10-CM

786.50 Chest pain, unspecified R07.1 Chest pain on breathing

786.82 Painful respiration R07.2 Precordial pain

786.59 Other R07.81 Pleurodynia

R07.82 Intercostal pain

R07.89 Other chest pain

R07.9 *Chest pain, unspecified

*Codes with a greater degree of specificity should be considered first

139 Copyright © 2015 MEDKODER LLC


Key Updates for Injury, Poisoning &

Certain other Consequences of External Causes (S00-T88)

• Injuries are grouped by body part rather than category of injury as they were in ICD-9-CM

• Laterality is specified in this section • ICD-10-CM introduces a 7th character requirement that describes

the type of encounter. Most categories in this section use the 7th character requirement

• Most categories in this section have three 7th character values to choose from: – A - Initial encounter – D - Subsequent encounter – S - Sequela

• For traumatic fractures, there are additional 7th character requirements depending upon the type of fracture, and complication. Some of these character descriptions are based on the Gustilo open fracture classification.

140

Key Updates for Injury, Poisoning & Certain other Consequences of External Causes (S00-T88)

• As discussed previously in this presentation, codes for Underdosing are new in this section in ICD-10-CM

• Underdosing refers to taking less of a medication than is prescribed by a provider or less than the manufacturer’s instructions

• Codes for underdosing should not be assigned as principal or first-listed codes

141


Open Wound Documentation Awareness Wounds/lacerations require a higher specificity in ICD-10

Type e.g. puncture, open bite

Location e.g. thumb, index, ring, little, middle

Laterality e.g. left, right

Involvement

e.g. With nail damage, with foreign body

Don’t forget the 7th character! • A Initial encounter • D Subsequent encounter • S Sequela

Code also any associated wound infection

Note: Each finger has a code set specific to the finger.

Open Wound Finger ICD-9-CM ICD-10-CM

883.0 Open wound finger(s) w/o mention of complication

S61.011- Laceration w/o FB of right thumb w/o damage to the nail

883.1 Open wound finger(s) w/ complication

S61012- Laceration w/o FB of left thumb w/o damage to the nail

883.2 Open wound finger(s) w tendon involvement

S61.021- Laceration w/ FB of right thumb w/o damage to the nail

S61.022- Laceration w/ FB of left thumb w/o damage to the nail

S61.031- Puncture wound w/o FB of right thumb w/o damage to nail

S61.032- Puncture wound w/o FB of left thumb w/o damage to nail

S61.041 -Puncture wound w/ FB of right thumb w/o damage to nail

S61.042- Puncture wound w/ FB of left thumb w/o damage to nail

S61.051- Open bite of right thumb w/o damage to nail

S61.052- Open bite of right thumb w/o damage to nail

Open Wound Finger (cont’d) ICD-9-CM ICD-10-CM

883.0 Open wound finger(s) w/o mention of complication

S61.111- Laceration w/o FB of right thumb w/ damage to the nail

883.1 Open wound finger(s) w/ complication

S61.112- Laceration w/o FB of left thumb w/damage to the nail

883.2 Open wound finger(s) w tendon involvement

S61.121- Laceration w/ FB of right thumb w/ damage to the nail

S61.122- Laceration w/ FB of left thumb w/ damage to the nail

S61.131- Puncture wound w/o FB of right thumb w/ damage to nail

S61.132- Puncture wound w/o FB of left thumb w/ damage to nail

S61.141 -Puncture wound w/ FB of right thumb w/ damage to nail

S61.142- Puncture wound w/ FB of left thumb w/ damage to nail

S61.151- Open bite of right thumb w/ damage to nail

S61.152- Open bite of right thumb w/ damage to nail

Allergy

ICD-9-CM ICD-10-CM

The appropriate ICD-9-CM code assignment is dependent on the patient’s response to the food allergy: • 558.3 gastrointestinal manifestation • 477.1 allergic rhinitis • 691.8 atopic food allergy • 693.1 dermatitis due to food taken

internally • 995.7 other adverse food reactions • *Also assign additional codes to

identify the type of reaction

T78.1- Allergy food (any, ingested) (Other adverse food reactions, not elsewhere classified) NOTE: The appropriate 7th character is to be added to each code from category T78 A Initial encounter D Subsequent encounter S Sequela e.g. T78.1xxA *Use additional code to identify the type of reaction


Anaphylactic Reaction Due to Food

ICD-9-CM ICD-10-CM

995.6x Anaphylactic shock 995.60, due to unspecified food; • 995.61, due to peanuts; • 995.62, due to crustaceans; • 995.63, due to fruits and vegetables; • 995.64, due to tree nuts and seeds; • 995.65, due to fish; • 995.66, due to food additives; • 995.67, due to milk products; • 995.68, due to eggs; and • 995.69, due to other specified food.

T78.00- Anaphylactic reaction due to unspecified food T78.01- Anaphylactic reaction due to peanuts T78.02- Anaphylactic reaction due to shellfish (crustaceans) T78.03- Anaphylactic reaction due to other fish T78.04- Anaphylactic reaction due to fruits and vegetables T78.05- Anaphylactic reaction due to tree nuts and seeds


Anaphylactic Reaction Due to Food

ICD-9-CM ICD-10-CM

T78.06- Anaphylactic reaction due to food additives T78.07- Anaphylactic reaction due to milk and dairy products T78.08- Anaphylactic reaction due to eggs T78.09- Anaphylactic reaction due to other food products NOTE: The appropriate 7th character is to be added to each code from category T78 A Initial encounter D Subsequent encounter S Sequela


Key Updates for External Causes of Morbidity (V00-Y99)

• External cause codes are intended to provide data for injury research and evaluation of injury prevention strategies

• Codes capture how the injury or health condition was caused, the intent, the place where the event occurred, the activity of the patient at the time of the event, and the person’s status

• Codes that are secondary codes are for use in any health care setting – These codes are not used as a principal (or first-listed)

diagnosis.

148

Bitten by an Alligator

ICD-9-CM ICD-10-CM

E906.3 Bite of other animal except arthropod

V58.01xA Bitten by Alligator, initial encounter *The appropriate 7th character is to be added to each code from Category V58 A – initial encounter D – subsequent encounter S - Sequela

Key Updates for Factors Influencing Health Status & Contact With Health Services (Z00-Z99)

• These codes are used in any healthcare setting • Z codes may be used as first listed (physician) or principal

diagnosis code (inpatient setting), or secondary code, depending on the circumstances of the encounter.

• Certain Z codes may only be used as first listed or principal diagnosis in certain situations. Refer to Official Coding Guidelines for details.

• This section contains categories which include contact/exposure, vaccinations, status, history, observation, screening, aftercare, follow-up, donor, counseling, encounters for obstetrical and reproductive services, newborn and infants, routine and administrative and miscellaneous

150

Vaccinations

• Z23 Encounters for immunizations

– Encounters for vaccination has one code in ICD-10 unlike ICD-9

– It is still important to document the specific vaccination given to accurately report the CPT code and which immunization the patient received

151

Recommendations

• Ensure ICD-10 role based education for new employees to prevent errors from cycling through to the back-end

• Maintain and keep current on payer manual updates, medical policies, newsletters and bulletins

– Pre-authorizations

– Coverage rules, medical necessity indications

Recommendations

• Address current backlogs (followup, collections, denials) prior to ICD-10 implementation as there will be increased followup with payers with ICD-10 issues

• Trend type of code rejections or denials

• Share denial outcomes with staff focusing on ICD-10 gaps that created denials

• Monitor and evaluate process changes

Training & Education Resources

• Medkoder, LLC - http://www.medkoder.com - [email protected] - [email protected] • AAPC - http://www.aapc.com • AHIMA - http://www.ahima.org • CMS

– http://www.cms.gov/Medicare/Coding/ICD10/Index.html – http://www.roadto10.org

Copyright © 2015


http://www.medkoder.com/

mailto:[email protected]

http://www.aapc.com/

http://www.ahima.org/

http://www.cms.gov/Medicare/Coding/ICD10/Index.html

http://www.roadto10.org/

Questions


155

Thank You!

MEDKODER

200 Greenleaves Blvd. Suite 7

Mandeville, LA 70448

985-778-0962 phone | 800-421-9418 fax

[email protected]

[email protected]

[email protected]

http://medkoder.com


156

http://medkoder.com/

Documents

ICD-10-CM Training for Medical Office Staff - Touro Infirmary · ICD-10-CM Training for Medical Office Staff ... medical data code sets ... • •ICD-10-CM Coding Manual