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8/5/2016
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Two‐partwebinarseries:ICD‐10‐CMDiagnosisCodeGuidelines,Sequencing,andCodeReportingofferedbytheMTFlexGrant
PART‐ 2August18,201611:00am– 12:00pmMSTLisa Rae Roper, MA, MHA, CCS‐P, CPC, CPC‐I, PCS, FAHIMA
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Disclaimer• This session is designed to provide educational information regarding subject matter covered. It is provided with the understanding that neither the presenter is engaged in rendering legal, accounting, or other professional service. If legal advice or other expert assistance is required, the services of a competent professional should be obtained.
• Every reasonable effort has been taken to ensure the educational information provided is accurate.
• Applying best practices and achieving results will vary for each hospital, facility, and clinical situation.
• The views expressed in this session are strictly those of the presenter and do not necessarily represent official positions from other organizations; except where noted with reference or resource information. 2
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• At the end of this session participants will be able to:
• Identify ICD‐10‐CM guidelines
• Determine code sequence
• Identify hot topics in ICD‐10‐CM Chapters 13‐21
• Locate ICD‐10‐CM files for 2017
• Locate resources
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I‐10‐CMChapters1.Infectious and Parasitic Diseases 2.Neoplasms 3.Diseases of the Blood and Blood‐Forming Organs 4.Endocrine, Nutritional and Metabolic Diseases 5.Mental and Behavioral Disorders 6.Diseases of the Nervous System 7.Diseases of the Eye and Adnexa 8.Diseases of the Ear and Mastoid Process 9.Diseases of the Circulatory System 10.Diseases of the Respiratory System 11.Diseases of the Digestive System 12.Diseases of the Skin and Subcutaneous Tissue
13.Diseases of the Musculoskeletal System and Connective Tissue 14.Diseases of the Genitourinary System 15.Pregnancy, Childbirth and the Puerperium 16.Newborn (Perinatal) 17.Congenital Malformations, Deformations and Chromosomal Abnormalities 18.Symptoms, Signs and Abnormal Clinical and Laboratory Findings 19.Injury, Poisoning and Certain Other Consequences of External Causes 20.External Causes of Morbidity 21.Factors Influencing Health Status
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13.DiseasesoftheMusculoskeletalSystemandConnectiveTissueGuidelines: Site and Laterality
The sites represent the bone, joint or the muscle involved
• M71.121 Other infective bursitis, right elbow
Some codes have “multiple sites”
• M06.09 Rheumatoid arthritis without rheumatoid factor, multiple sites
If code does not have multiple sites then report multiple codes
• M46.24 Osteomyelitis of vertebra, thoracic region
• M46.26 Osteomyelitis of vertebra, lumbar region 6
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13.(cont.)
Notice the addition for levels of the spine. 7
New Category Watch for guidelines
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13.(cont.)Watch for guidelines for this new category
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13.(cont.)
Old bucket handle tear right medial meniscus
(chronic or recurrent)
M23.203 (Chapter 13)
Initial encounter, for Acute traumatic buckle handle tear right medial meniscus
S83.211A (Chapter 19)• http://www.miamisportsmedicine.com/MeniscalInjury.html
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14.DiseasesoftheGenitourinarySystem
Example of additions to provide more clarification in reporting conditions
REVISED to new chapter!
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14.(cont.) Revision for Clarity
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14.(cont.)Laterality and TYPE of cyst…
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15.Pregnancy,ChildbirthandthePuerperiumTrimesters defined beginning of Chapter 15
Guidelines:
Final character for trimester 15.a.3
Conditions with trimesters or “in‐childbirth” • O88.211 – O88.219, O88.22 childbirth, O88.23 puerperium
• Admit at 21 weeks gestation• O21.2 – Late vomiting of pregnancy (after 20 complete weeks)
Selection of trimester for inpatient admission encompasses more than one trimester 15.a.4
Code should be assigned on basis of trimester when the complication developed, not the trimester of discharge
Patient admitted at 27 weeks 6 days gestation for hemorrhaging from complete placenta previa; three days after admission at 28 weeks one‐day patient is discharged
• O44.12 Complete placenta previa with hemorrhage, second trimester (revised file 2017)
• Z3A.27 Weeks gestation 27 (revised file 2017 “if known”)14
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15.(cont.)Example – Revise to (note…..complicating)
Who Is at Risk for Eclampsia?If you have or have had severe preeclampsia, you may be at risk for eclampsia.Other risk factors for seizures during pregnancy include:hypertension (high blood pressure)headachesover age 35under age 20pregnant with twinspregnant for the first timehistory of poor diet or malnutritiondiabetes or another condition that affects your blood vesselshttp://www.healthline.com/health/eclampsia#Overview1
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15.(cont.) Example – Addition of codes for more clarification regarding gestational DM controlled by oral drugs
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15.(cont.)Example – Addition of codes and definition of perineal laceration during delivery.
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16.Newborn(Perinatal)
Chapter 16 revision from (suspected to be) ….to affected
See code category Z05 (Chapter 21) for suspected conditions
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16.(cont.)Guidelines2016
C.16.d
C.16.e
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17.CongenitalMalformations,DeformationsandChromosomalAbnormalities
Addition specific codes for congenital malformation of the aorta
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18.Symptoms,SignsandAbnormalClinicalandLaboratoryFindings• Added to Chapter 18:
• National Institute of Health Stroke Scale (NIHSS) scores
• Microscopic hematuria
• Expansion of total Glasgow Coma Score
• Bacteriuria
• Abnormal radiologic findings on diagnostic imaging,
• And, expansion of abnormal Prostate Specific Antigen (PSA)
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18.(cont.)Example2017changes
Score 0 – 42*Reference: calculator to obtain a clinical scores
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19.Injury,PoisoningandCertainOtherConsequencesofExternalCauses
• Changes include:
• Significant additions for fractures to bones of skull, fracture types of the foot
• Title revisions to complications involving prosthetic devices
• New stenosis of cardiac stent codes
• Additions to complication types including breakdown, displacement, infection, erosion, exposure, pain, fibrosis, thrombosis, and leakage
Watch for guidelines with fractures and expanded 7th digits characters!
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19.(Cont.)ReviewTypesofFractures
Guidelines 19.c A fracture not indicated as open or closed should be coded to closed.
A fracture not indicated whether displaced or not displaced should be coded to displaced.
19.c.1Initial vs. Subsequent encounter for traumatic fractures
Appropriate 7th character
S82 Fracture of lower leg, including ankle (Open fracture designates are based on Gustilo open fracture classification)
http://www.childrenshospital.org/conditions‐and‐treatments/conditions/fractures/symptoms‐and‐causes
http://www.orthopaedicsone.com/display/Main/Gustilo+open+fracture+classification
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19.(Cont.)
S82.852A Displacement trimalleolarfracture of left lower leg, initial encounter for closed fracture (e.g.; surgical procedure)
S82.852D Subsequent encounter for closed fracture with routine healing (e.g.; change of cast)
S82.852D Subsequent encounter for closed fracture with routine healing (e.g.; cast removed)
• Aftercare Z codes should not be used for aftercare for traumatic fractures. For aftercare assign the acute fracture code with the appropriate 7th character. (Guidelines 19.c.1)
• Assign the external cause code, with the appropriate 7th character…. for each encounter where injury or condition is being treated. (Guideline 20.a.2)
http://cfile24.uf.tistory.com/image/224E024C556C668F204719
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19.(Cont.)Condition(s) caused by a drug or other substance when used
• Adverse effects, correctly (Guideline 19.e.5.a)
• Poisoning, incorrectly (Guideline 19.e.5.b)
Condition(s) caused by taking less of a medication than prescribed or by manufacturer’s instructions
• Underdosing (Guideline 19.e.5.c)
Condition(s) caused by ingestion or contact with a harmful substance
• Toxic effect (Guideline 19.e.5.d)
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19.(Cont.)
Underdosing situations are:
Reported with (T36‐T50) category of ICD‐10‐CM “underdosing”;
Differentiated with fifth or sixth character of “6”;
Represented by non‐compliance with prescribed treatment.
Reasons for underdosing:
Intentional Due Financial Hardship (Z91.120)Unintentional Due to Age‐Related Debility (Z91.130)Intentional/Unintentional Other Reason (Z91.128/Z91.138)NOS (Z91.14)
• External Cause of Morbidity, Underdosing(Y63.6, Y63.8‐Y63.9) due to non‐administration of a necessary drug or failure in dosage during surgical and medical care
Example: Patient in ER cut down dosing of Digoxin due to financial hardship
Diagnosis: Relapse of acute systolic congestive heart failure due to low dose of Digoxin
I50.21
T46.0X6A
Z91.120
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20.ExternalCausesofMorbidity• Examples of updates
• Added some vehicular accident codes (extensive revision of definitions of transport vehicles)…..These definitions are found at the beginning of the chapter and should be reviewed
• Block Added X50 Overexertion and strenuous or repetitive movements
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21.FactorsInfluencingHealthStatus
Chapter 21 changes…..
• Observation of newborn for various conditions
• Hormone malignancy status
• Encounter for prophylactic medications
• Encounter for contraceptives
• Gestational carrier status
• Conversion of endoscopic procedures to open
• Long term use of oral hypoglycemic drugs
Watch for guidelines in this chapter for definitions and sequence of codes.
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21.(Cont.)Code range Z05.0 – Z05.9Notice…these codes are for suspected diseases or conditions ruled out
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Resources• Meddcape
• http://reference.medscape.com/calculator/nih‐stroke‐score
• Healthline• http://www.healthline.com/health/eclampsia#Overview1
• Mayo Clinic• http://www.mayoclinic.org/diseases‐conditions/high‐blood‐pressure/expert‐
answers/hypertensive‐crisis/faq‐20058491
• Journal of AHIMA (Code Cracker)• http://journal.ahima.org/category/blogs/code‐cracker/
• The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis‐3)” Published in JAMA• JAMA. 2016;315(8):801‐810. doi:10.1001/jama.2016.0287. • http://jama.jamanetwork.com/article.aspx?articleid=2492881
• Centers for Disease Control and Prevention (CDC)• http://www.cdc.gov/nchs/icd/icd10cm_maintenance.htm
• Centers for Medicare and Medicaid Services (CMS)• https://www.cms.gov/Medicare/Coding/ICD10/2017‐ICD‐10‐CM‐and‐
GEMs.html• https://www.cms.gov/medicare/coding/icd10/downloads/2016‐icd‐10‐cm‐
guidelines.pdf 33
ThankyouforattendingPart2
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