ICD-10 Overview Practice Resources, LLC 2015 Practice Resources, LLC 20151

ICD-10 OverviewICD-10 Overview

Practice Resources, LLC2015

Practice Resources, LLC 2015 1

A new diagnosis coding system is coming to your practice.

• ICD-10-CM will replace ICD-9-CM as a HIPAA-named code set.– Final Rule published Jan. 16, 2009– Compliance date: October 1, 2015


Implementation Dates

• Single implementation date of the ICD-10 code sets for all users.

–ICD-9 will not be accepted for DOS on or after 10/1/15–ICD-9 will be required for DOS prior to 10/1/15


Why The Change?

• Our current coding system is more than 30 years old and is outdated.– Many categories are full.– Some terms and classifications are

outdated/obsolete.– Not descriptive enough for all current uses.


The Advantage

• The change to ICD-10 will allow the U.S. to compare data internationally

– Track the incidence and spread of disease and treatment.

• The transition to ICD-10 is a means to incorporate the U.S., into a stronger international health care community that promotes improved patient outcomes, expanded research opportunities, lower health care costs and a healthier population overall.


Other Benefits

• Added detail:– Streamlined payment with decreasing delays and

pended claims. – Reduce volume of rejected claims and

inappropriate denials.– Positive impact on revenue cycles.– Can support refined reimbursement models that

reimburse for more complex conditions.


The transition to ICD-10-CM will be a very big change.

• ICD-9 contains 17,000 codes• ICD-10-CM contains more about 70,000 codes

• Physicians will continue to use CPT for coding procedures.


ICD-10-CM: Structural Differences

• B07 Viral warts• R03.0 Elevated blood pressure, without diagnosis of HTN• E11.65 DM Type 2, with hyperglycemia• S00.412 Abrasion of left ear• T36.0x1a Poisoning by penicillin, accidental (unintentional),initial

encounter.– All start with a letter– Can be 3-7 characters– Decimal after 1st 3 characters.– Left vs. right– Place holders (x)


ICD-10-CM: Similarities

• ICD-9-CM 429.3 Cardiomegaly• ICD-10-CM I51.7 Cardiomegaly

– GEMS • General Equivalency Mapping


ICD-10-CM: Differences

• Hypertension– ICD-9:• 401.0 Malignant hypertension• 401.1 Benign hypertension• 401.9 Unspecified hypertension

– ICD-10:• I10: Essential (primary) hypertension


ICD-10-CM: Great Differences

• ICD-9: 274.0x Gouty arthropathy– 274.00 Gouty arthropathy, unspecified– 274.01 Acute gouty arthropathy– 274.02 Chronic gouty arthropathy, without mention of tophus– 274.03 Chronic gouty arthropathy, with tophus

• ICD-10:– M10.0x Idiopathic gout (24 codes)– M10.1x Lead-induced gout (24 codes)– M10.2x Drug-induced gout (24 codes)– M10.3x Gout due to renal impairment (24 codes)– M10.4x Other secondary gout (24 codes)

– Unspecified, shoulder, elbow, wrist, hand, hip, knee, ankle and foot, vertebrae, multiple sites

– Right, left, unspecified



• Some codes are quite different• ICD-9: 555.x Crohn’s Disease (see also Enteritis, regional)

– 555.0 Regional enteritis, small intestine (ICD-9)– 555.1 Regional enteritis, large intestine (ICD-9)– 555.2 Regional enteritis, small with large (ICD-9)– 555.9 Unspecified regional enteritis

• ICD-10: K50 Crohn’s disease– K50 Crohn’s disease (ICD-10)

• There are 28 separate codes with axes for site (large, small, combined unspecified) with complications of fistula, obstruction, bleeding abscess, other or none) K50.00 – K50.919


ICD-10-CM - Granularity

• Granularity: Refers to the level of hierarchy and the amount of information it provides to the diagnostic description– 230.0 Carcinoma in situ of lip, oral cavity, and pharynx (ICD-9)

– D00.01 Carcinoma in situ of labial mucosa and vermilion border– D00.02 Carcinoma in situ of buccal mucosa– D00.03 Carcinoma in situ of gingiva and edentulous alveolar ridge– D00.04 Carcinoma in situ of soft palate– D00.05 Carcinoma in situ of hard palate– D00.06 Carcinoma in situ of floor of mouth– D00.07 Carcinoma in situ of tongue– D00.08 Carcinoma in situ of pharynx.



• 810.02 Closed fracture of shaft of clavicle

– S42.021A Displaced closed fx, shaft right clavicle, initial encounter

– S42.022A Displaced closed fx, shaft left clavicle, initial encounter

– S42.023A Displaced closed fx, unspecified clavicle, initial encounter

– S42.024A Nondisplaced closed fx, shaft right clavicle, initial encounter

– S42.025A Nondisplaced closed fx, shaft left clavicle, initial encounter

– S42.026A Nondisplaced closed fx unspecified clavicle, initial encounter


ICD-9-CM: Hyperlipidemia

• 272.xDisorders of Lipid Metabolism– 272.0 Pure hypercholesterolemia– 272.1 Pure hyperglyceridemia– 272.2 Mixed hyperlipidemia– 272.3 Hyperchylomicronemia– 272.4 Other and Unspecified hyperlipidemia– 272.5 Lipoprotein deficiencies– 272.6 Lipodystrophy– 272.7 Lipidoses– 272.8 Other disorders of lipoid metabolism


ICD-10-CM: Hyperlipidemia• E78.0 Pure hypercholesterolemia• E78.1 Pure hyperglyceridemia• E78.2 Mixed hyperlipidemia• E78.3 Hyperchylomicronemia• E78.4 Other hyperlipidemia• E78.5 Hyperlipidemia, unspecified• E78.6 Lipoprotein deficiency• E78.7x Disorders of bile acid and cholesterol metabolism

– E78.79 Disorders of bile acid and cholesterol metabolism, unspecified– E78.71 Barth syndrome– E78.72 Smith-Lemil-Opitz syndrome– E78.79 Other disorders of bile acid and cholesterol metabolism

• E78.8x Other disorders of lipoprotein metabolism– E78.81 Lipoid – E78.89 Other lipoprotein metabolism disorders– E78.9 Disorder of lipoprotein metabolism, unspecified


ICD-9-CM: Open Wound Hand

• Open wound of hand except finger(s) alone– 882.0 without mention of complication– 882.1 Complicated– 882.2 with tendon involvement


ICD-10-CM Open Wound Hand• 45 different choices to pick from

S61.401_ Unspecified open wound right handS61.402_ Unspecified open wound left handS61.409_ Unspecified open wound of unspecified handS61.411_ Laceration w/out foreign body right handS61.412_ Laceration w/out foreign body left handS61.419_ Laceration w/out foreign body unspecified handS61.421_ Laceration w/foreign body right handS61.422_ Laceration w/foreign body left handS61.429_ Laceration w/foreign body unspecified handS61.431_ Puncture wound w/out foreign body right handS61.432_ Puncture wound w/out foreign body left handS61.439_ Puncture wound w/out foreign body unspecified handS61.441_ Puncture wound w/foreign body right handS61.442_ Puncture wound w/foreign body left handS61.449_ Puncture wound w/foreign body unspecified hand

Each of these codes have option of A (initial) D (subsequent) or S (sequela) in the 7th character.


Unspecified Codes

• There will still be unspecified codes for ICD-10-CM. We are advising offices not to utilize them when a more specific diagnosis is available.


Inpatient Services That Overlap

• Patient is admitted on September 29, 2015• Same patient is discharged on October 2, 2015• Separate claims will be needed

– 1 claim for 29th & 30th with ICD-9 codes– 1 claim for 1st & 2nd with ICD-10 codes


Documentation Improvement

• Successfully embracing ICD-10 boils down to meticulous documentation.– How can we help you?– Rely on certified coders and ancillary staff.

– The solution is not to train physicians in ICD-10 coding but to show them the clinical documentation requirements that align with their specialty and are needed for the hospital to provide quality patient care and be successful in transitioning to ICD-10.


Will your office be ready?

Do you frequently need to ask your office for diagnosis codes?

Is your office aware of these ICD-10 changes?

What can you do to help with the transition?


The Most Critical Issue For Practices

• Assess the status of your organization.– Assign an ICD-10-CM implementation team.– Determine the readiness of software vendors.– Consider workflow changes that may be needed.– Practice clinical documentation improvement based on changes.– Determine staffing needs.– Develop a training plan.– Determine the readiness of referring providers.– Determine the readiness of your payers.– Consider reimbursement delays.


Help educate yourself!

• Review medical policies frequently used• Review the top 50 diagnosis for your office• ICD-10 Cheat Sheets on SharePoint• Look at some mapping conversions

ICD9/ICD10– Chart Central in Medent– ICD9data.com– Medicare website


Additional information

• NYS W/C is adopting the ICD-10-CM• Medent Version 22.0 will have edits for ICD-10• Websites: – www.roadto10.org – www.icd9data.com – www.icd10watch.com– www.cms.gov/Medicare/coding/ICD10/index.htm

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http://www.roadto10.org/

http://www.icd9data.com/

http://www.icd10watch.com/

http://www.cms.gov/Medicare/coding/ICD10/index.html

http://www.cms.gov/Medicare/coding/ICD10/index.html

QUESTIONS?


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ICD-10 Overview Practice Resources, LLC 2015 Practice Resources, LLC 20151