May 2011 Preparing for ICD-10 for Hospitals Copyright 2011 Medtronic

May 2011

Preparing for ICD-10for Hospitals

Copyright 2011 Medtronic

2

Notices


These coding suggestions and coverage guidelines do not replace seeking coding advice from the payer and/or your coding staff. The ultimate responsibility for correct coding lies with the provider of services. Please contact your local payer for interpretation of the appropriate codes to use for specific procedures. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other third party payers as to the correct form of billing or the amount that will be paid to providers of service.

See NCD 20.8 for Medicare covered indications for pacemakers and NCD 20.4 for Medicare covered indications for defibrillators.

3

CEUs for Coders


AAPCThis program has the prior approval of the American Academy of Professional Coders (AAPC) for 2 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor. AAPC Index# MTI0329110337A.

AHIMAThis program has been approved for 2 continuing education units for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).

A survey will be sent out to all registered participants a few days after the session. The CEU certificates will be included in the survey as attachments for those who listened to the entire session.

4

Background

ICD-10-PCS Procedure Codes

ICD-10-CM Diagnosis Codes

Appendix

Topics

DRGs under ICD-10


Preparing for ICD-10An Introduction to ICD-10 for Cardiovascular

Background

Copyright 2011 Medtronic 5

Components of ICD-10

ICD-10 has two main components:

ICD-10-CM is for diagnosis codes and includes a tabular list, an index, and tables for drugs and neoplasms.

ICD-10-PCS is for procedure codes and includes code tables and an index.

There are other materials that are also officially part of the classification system, including:

GEMs Body Part Key Device Key

Official Guidelines for Coding and Reporting ICD-10-PCS Reference Manual

6Copyright 2011 Medtronic

This Is Going to Happen

ICD-10 was adopted as the national standard under HIPAA and its use is mandatory

The effective date for implementation is October 1, 2013

Provider

Setting Diagnoses Procedures

Hospitals Inpatient ICD-10-CM ICD-10-PCS

Hospitals Outpatient ICD-10-CM CPT®

ASCs Outpatient ICD-10-CM CPT®

Physicians Facility/Office ICD-10-CM CPT®

Which components of ICD-10 must be used depends on the type of provider:


(Federal Register, January 16, 2009, pp.3328-3362)

ICD-10 Freeze

Starting October 1, 2011, all codes in ICD-10 will be frozen for 3 years.

The ICD-10 Coordination and Maintenance Committee announced the freeze to allow a period of stability for programming, publishing, and training for implementation of ICD-10.

Limited updates may take place on October 1, 2012 and October 1, 2013 for new technologies and new diseases

The deadline for submitting change requests prior to the freeze has already passed

The C&M Committee will continue to meet during the freeze

Regular annual updates will resume on October 1, 2014


GEMS

The General Equivalence Mappings are a very useful tool for translating between ICD-9-CM and ICD-10.

The “forward” GEM converts current ICD-9-CM codes to their equivalent ICD-10 codes

The “backward” GEM converts ICD-10 codes back to ICD-9-CM codes

While very handy, GEMS are not a substitute for learning ICD-10. They’re intended for use in converting large databases, not for coding individual cases.


Limits of GEMS

Particularly for procedure codes, many ICD-9-CM codes convert to far more than one ICD-10 code.

Example: 37.95, implantation of ICD lead(s)

In making the transition to ICD-10, the best way to use the GEMs is either as a starting place or for confirmation.

ICD-9-CM ICD-10-PCS

3795 02H63ME

3795 02H73ME

3795 02HK3ME

3795 02HL3ME

3795 02HN0ME

3795 02HN4ME

Some codes convert to a “cluster” rather than one-for-one

There are other limits in GEMs conversion of ICD-9-CM codes to ICD-10:

Some codes don’t convert directly to ICD-10 at all

Some conversions are theoretically possible but unlikely




Format of ICD-10-CM Diagnosis Codes

The format of ICD-10-CM has several new features:

Codes can be from 3 to 7 characters long

The first digit is always a letter (only “U” is not used)

The second and third digits are always numbers

The fourth to seventh digits can be letters or numbers

A decimal is placed after the third digit

Examples

I11.0 Hypertensive heart disease with heart failure

T82.120A Displacement of cardiac electrode, initial encounter

R55 Syncope


Greater Specificity

ICD-10-CM has far more diagnosis codes than ICD-9-CM.

System # Diagnosis Codes

ICD-9-CM 14,025

ICD-10-CM 68,069

Greater specificity for injuries, including site, type, and encounter

Laterality (left, right, bilateral)

Specificity for device complications, including encounter

The majority of new codes involve:


Heart Block

The heart block codes in ICD-10-CM are quite similar to those in ICD-9-CM.

I44 Atrioventricular and left bundle-branch block

I44.0 Atrioventricular block, first degree

I44.1 Atrioventricular block, second degreeAtrioventricular block, type I and IIMobitz block, type I and IISecond degree block, type I and IIWenckebach's block

I44.2 Atrioventricular block, completeComplete heart block NOSThird degree block

………………………………………

Complete heart block retains a distinct code, which remains a CC

ICD-10-CM doesn’t make a distinction between Mobitz and other second degree blocks


I45 Other conduction disorders

I45.2 Bifascicular block

I45.3 Trifascicular block

I45.6 Pre-excitation syndromeLown-Ganong-Levine syndromeWolff-Parkinson-White syndrome

………………………………………

I45.8 Other specified conduction disorders

I45.81 Long QT syndrome

I45.89 Other specified conduction disordersAtrioventricular dissociationInterference dissociationNonparoxysmal AV nodal tachycardia

Other Conduction Disorders

Other codes for pacemaker and defibrillator indications related to conduction are located in I45.

Codes for bifascicular and trifascicular blocks were actually

simplified; the codes reflect pacemaker indications and also remain CCs

Long QT syndrome retains a distinct code, as needed to reflect the defibrillator indication


Paroxysmal Tachycardia

Note: As in ICD-9-CM, tachycardia not otherwise specified is assigned to a symptom code.

I47 Paroxysmal tachycardia

I47.0 Re-entry ventricular arrhythmia

I47.1 Supraventricular tachycardiaAtrial paroxysmal tachycardiaAtrioventricular paroxysmal tachycardiaJunctional paroxysmal tachycardiaNodal paroxysmal tachycardia

I47.2 Ventricular tachycardia

I47.9 Paroxysmal tachycardia unspecified

Re-entry ventricular arrhythmia has its own code

Note that I47.0 and I47.1 are not assigned

VT is an indication for defibrillators and remains a CC


for AVNRT (atrioventricular nodal reentrant tachycardia)

Atrial Fibrillation and Flutter

Like ICD-9-CM, the current version of ICD-10-CM has just two codes for atrial fibrillation and flutter.

I48 Atrial fibrillation and flutter

I48.0 Atrial fibrillation

I48.1 Atrial flutter

However, it is likely that this will be expanded on October 1, 2011 to capture more detail.

WHO is updating the international version of ICD-10 for these codes and the US must maintain compatibility. A proposal was recently presented before the C&M Committee to create specific codes within I48 for atrial fibrillation documented as:

Persistent Permanent


http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htmMarch 9-10, 2011 proposals, pages 48-50

Paroxysmal First episode

Other Cardiac Arrhythmias

I49 Ventricular fibrillation and flutter

I49.0 Ventricular fibrillation and flutter

I49.01 Ventricular fibrillationI49.02 Ventricular flutter

I49.1 Atrial premature beats

I49.2 Junctional premature depolarization

I49.3 Ventricular premature depolarization

……………………………………

I49.5 Sick sinus syndromeTachycardia-bradycardia syndrome

I49.8 Other specified cardiac arrhythmias

I49.9 Cardiac arrhythmia unspecified

According to the index, AVNRT is assigned to I49.8

SSS retains a distinct code, as needed to reflect the pacemaker indication

VF is a defibrillator indication and

remains an MCC


The depolarization codes are new

Heart Failure

ICD-10-CM has no code for “congestive heart failure” per se; it is included in I50.9 for unspecified heart failure

ICD-10-CM codes for heart failure are essentially the same as the ICD-9-CM codes. This is actually by intent.

When any form of pulmonary edema (acute, chronic, unspecified) is present with heart failure, L50.1 for left ventricular failure is assigned

“Congestive” is a non-essential term for heart failure

In addition to being a CC or MCC, heart failure is a major indication for defibrillators and bi-ventricular devices.

The main differences are:


Heart Failure Code Structure

I50 Heart failure

I50.1 Left ventricular failure

I50.2 Systolic (congestive) heart failure

I50.20 Unspecified systolic (congestive) heart failure I50.21 Acute systolic (congestive) heart failureI50.22 Chronic systolic (congestive) heart failureI50.23 Acute on chronic systolic (congestive) heart failure

I50.3 Diastolic (congestive) heart failure

I50.30 Unspecified diastolic (congestive) heart failure I50.31 Acute diastolic (congestive) heart failureI50.32 Chronic diastolic (congestive) heart failureI50.33 Acute on chronic diastolic (congestive) heart failure

I50.4 Combined systolic (congestive) and diastolic (congestive) heart failure

I50.40 Unspecified combined (congestive) heart failure I50.41 Acute combined (congestive) heart failureI50.42 Chronic combined (congestive) heart failureI50.43 Acute on chronic combined (congestive) heart failure

I50.9 Heart failure, unspecified

CCs and MCCs remain the same

Because it is coded to I50.1, pulmonary edema is a CC rather than an MCC


Heart Failure Due to Hypertension

ICD-10-CM maintains the current coding practices for heart failure due to hypertension.

I11 Hypertensive heart disease

I11.0 Hypertensive heart disease with heart failureHypertensive heart failure

Use additional code to identify type of heart failure (I50.-)

I11.9 Hypertensive heart disease without heart failure

ICD-10-CM does not differentiate between benign, malignant, and unspecified

hypertensive disease

ICD-10-CM has similar codes for hypertensive heart and chronic kidney disease.


An additional code is used from I50 to show the type of heart failure

Chest Pain

Chest pain codes are both reorganized and expanded.

ICD-10-CM more clearly differentiates anterior

chest wall pain from types of respiratory- related pain

R07 Pain in throat and chest

R07.0 Pain in throat

R07.1 Chest pain on breathingPainful respiration

R07.2 Precordial pain

R07.8 Other chest pain

R07.81 Pleurodynia

R07.82 Intercostal pain

R07.89 Other chest painAnterior chest wall pain

R07.9 Chest pain unspecified


According to the index, code R07.89 also classifies chest

pressure, tightness, and discomfort

Coronary Artery Disease

There are over 35 codes for CAD, reflecting different types of vessels as well as combination codes for CAD with angina.


Category I25.1 is for CAD of native coronary vessels

Category I25.7 is CAD of other coronary vessels with anginaSubcategory Vessel Type

I25.70 Coronary artery bypass graft(s), unspecified type

I25.71 Coronary artery bypass graft(s), autologous vein

I25.72 Coronary artery bypass graft(s), autologous artery

I25.73 Coronary artery bypass graft(s), nonautologous biological

I25.75 Coronary artery, native, transplanted heart

I25.76 Coronary artery bypass graft(s), transplanted heart

I25.79 Coronary artery bypass graft(s), other type

Category I25.8 is CAD of other coronary vessels without angina

CAD of Native Coronary Arteries


Subcategory I25.11 shows the basic structure for the combination codes for CAD with angina.

I25.1 Atherosclerotic heart disease of native coronary arteryCoronary artery disease

I25.10 ASHD of native coronary artery without angina pectoris

I25.11 ASHD of native coronary artery with angina pectoris

I25.110 ASHD of native coronary artery with unstable angina pectoris

I25.111 ASHD of native coronary artery with angina pectoris with documented spasm

I25.112 ASHD of native coronary artery with other forms of angina pectoris

I25.119 ASHD of native coronary artery with unspecified angina pectoris

ICD-10-CM assumes a causal relationship between angina and atherosclerosis.

Acute Myocardial Infarction

The ICD-10-CM AMI codes have several key differences from the AMI codes in ICD-9-CM.

ICD-10-CM differentiates primarily between anterior wall and inferior wall, then by the coronary artery involved

ICD-10-CM does not differentiate by episode of care

Rather than 8 weeks, acute MI is defined as a duration of 4 weeks (28 days) or less from onset

ICD-10-CM has distinct categories for the initial MI and for subsequent re-infarction


Subsequent Infarction

I22 Subsequent STEMI and NSTEMI myocardial infarction

I22.0 Subsequent STEMI of anterior wall

I22.1 Subsequent STEMI of inferior wall

I22.2 Subsequent NSTEMI

I22.8 Subsequent STEMI of other sites

I22.9 Subsequent STEMI of unspecified site

Codes in I22 are used for a repeat infarction within 4 weeks (28 days) of a previous AMI, regardless of site.

Codes in I22 are never used alone; they are always used with a code from I21

The I22 code is sequenced first if the repeat AMI leads to a second admission, or after the I21 code if it occurs during the same admission as the initial AMI


Cardiomyopathy

Cardiomyopathy, an indication for defibrillators, has expanded codes for greater specificity.

Ischemic cardiomyopathy has

its own code, distinct from other forms of chronic ischemic

heart disease

I25.5 Ischemic cardiomyopathy

I42 Cardiomyopathy

I42.0 Dilated cardiomyopathyCongestive cardiomyopathy

I42.1 Obstructive hypertrophic cardiomyopathy

I42.2 Other hypertrophic cardiomyopathyNon-obstructive ……………………………………

I42.5 Other restrictive cardiomyopathy……………………………………

I42.8 Other cardiomyopathies

I42.9 Cardiomyopathy unspecified

Congestive, restrictive and non-obstructive hypertrophic

cardiomyopathy have their own codes,

all CCs28Copyright 2011 Medtronic

Non-Rheumatic Valve Disorders

In ICD-10-CM, each valve has its own code category.

I35 Non-rheumatic aortic valve disorders

I35.0 Non-rheumatic aortic (valve) stenosis

I35.1 Non-rheumatic aortic (valve) insufficiencyNon-rheumatic aortic (valve) incompetenceNon-rheumatic aortic (valve) regurgitation

I35.2 Non-rheumatic aortic (valve) stenosis with insufficiency

I35.8 Other non-rheumatic aortic valve disorders

I35.9 Non-rheumatic aortic valve disorder unspecified


Within each category, there are distinct codes for each specific

type of valve disorder

Category Valve

I34 Mitral

I35 Aortic

I36 Tricuspid

I37 Pulmonary

Historical Conditions

As with ICD-9-CM, historical conditions which are indications for defibrillators are distinctly identified in ICD-10-CM.

I25.2 Old myocardial infarction

This has its own code in chronic ischemic heart disease

Z86.74 Personal history of sudden cardiac arrestPersonal history of sudden cardiac death successfully resuscitated

Old Myocardial Infarction

History of SCD

Family and personal history are separately identified

Z82.41 Family history of sudden cardiac death


Attention to Cardiac Device

Like ICD-9-CM, ICD-10-CM has specific codes for use when the encounter focuses on attention to a device rather than the underlying condition, as in:

Routine device replacement, eg. end-of-battery life

Z45.0 Encounter for adjustment and management of cardiac device

Z45.01 Encounter for adjustment/management of cardiac pacemaker

Z45.010 Encounter for checking and testing pacemaker pulse generatorEncounter for replacing cardiac pacemaker pulse generator [battery]

Z45.018 Encounter for adj/mgt of other part of cardiac pacemaker

Z45.02 Encounter for adj/mgt of automatic implantable cardiac defibrillator

Z45.09 Encounter for adj/mgt of other cardiac device

Encounter for device interrogation or programming


Device Complications

ICD-10-CM continues to classify device complications as mechanical, infection, and other (non-mechanical).

Definitions are the same as ICD-9-CM for mechanical (eg. breakdown) and other non-mechanical (eg. pain)

Mechanical complication codes are defined as electrode vs generator, rather than by the type of device

The nature of the mechanical complication is more specific, eg. breakdown, displacement or other complication

The nature of the non-mechanical complication is also more specific, eg. embolism, hemorrhage


Device Complication Code Structure

T82.1 Mechanical complication of cardiac electronic device

T82.11 Breakdown (mechanical) of cardiac electronic device

T82.110 Breakdown of cardiac electrodeT82.111 Breakdown of cardiac pulse generatorT82.118 Breakdown of other cardiac electronic device

T82.12 Displacement of cardiac electronic device

T82.120 Displacement of cardiac electrodeT82.121 Displacement of cardiac pulse generatorT82.128 Displacement of other cardiac electronic device

…………………………………………………

T82.7 Infection/inflammatory reaction to other cardiac devices

………………………………………………….

T82.8 Other specified complications of cardiac/vascular devices

T82.84 Pain from cardiac and vascular devices

T82.847 Pain from cardiac devices, implants and graftsT82.848 Pain from vascular devices, implants and grafts

…………………………………………………..

All codes require a 7th digit for episode of care

All codes are CCs but only for the initial episode of care


A initial encounter D subsequent encounterS sequela

ICD-10-CM Coding Guidelines

Codes aren’t complete without uniform guidelines on usage.

As with ICD-9-CM, there is a set of “ICD-10-CM Official Guidelines for Coding and Reporting”

Use of the Official Guidelines is mandatory under HIPAA

The Official Guidelines are still in draft form but will be finalized prior to October 1, 2013

The quarterly journal Coding Clinic® will also continue

Coding Clinic® will begin addressing ICD-10 guidance in advance of the 2013

implementation date




A New Concept

ICD-10-PCS is completely unlike ICD-9-CM, or any other coding system for that matter.

All terms, particularly root operations, have standard definitions

Within a section, each character represents a standard element

There are very few defaults

Key characteristics are:

Codes are not assigned, they are built character-by-character from tables of values


Format of ICD-10-PCS Codes

The format of ICD-10-PCS is a complete departure from the past.

All codes are 7 characters long, without exception

All codes are alphanumeric (letters “I” and “O” are not used)

There are no decimal points

Examples

027034Z Dilation of Coronary Artery, One Site, with Drug-Eluting Intraluminal Device, Percutaneous Approach

0JH60P5 Insertion of CRT-D Pulse Generator into Subcutaneous Tissue/Fascia, Chest, Open Approach


Character Counts!

1 2 3 4 5 6 7

sectionbody system

root operation approach qualifierbody part device

In section “0”, Medical and Surgical procedures, the character meanings are:

Body system, eg. urinary, GI, respiratory, upper arteries

Root operation, eg. bypass, dilation, destruction

Body part, eg. left external iliac artery, duodenum, sacrum

Approach, eg. open, endoscopic via natural opening

Device, eg. infusion device, cardiac lead, tissue expander


Coding Character by Character

1 Section

Body system

Root operation

Approach

Qualifier

Body part

Device

2

3

4

5

6

7

0

2

7

3

0

4

Z

Medical & Surgical

Heart & Great Vessels

Dilation

Percutaneous

No Qualifier

Coronary Artery, One Site

Drug-Eluting Intraluminal Device



Code Table Example: PTCA and Stent


02703DZ Dilation of Coronary Artery, One Site, with Intraluminal Device, Percutaneous Approach

PTCA with drug-eluting stent

PTCA with non-drug-eluting (bare metal) stent


Insertion of CRDM Generators

Pacemaker: 0JH60P2

Defibrillator: 0JH60P4

CRT-P (BiV): 0JH60P3

CRT-D (BiV): 0JH60P5


Insertion of CRDM Leads

Pacemaker leads, RA and RV, transvenous:02H63MA, 02HK3MA

Defibrillator leads, RV, epicardial placement:02HN0ME

CRT-P leads, RA and RV, transvenous:02H63MA, 02HK3MA

CRT-D leads, RA, RV, and LV via the CS, transvenous:02H63ME, 02HK3ME, 02H43ME


Codes for CRDM Systems

Unlike ICD-9-CM, ICD-10-PCS does not have codes for implantation of an entire device system. Instead, components are coded individually.

Implantation of dual chamber pacemaker with transvenous RA and RV leads

Generator 0JH60P2

RA lead 02H63MA

RV lead 02H6KMA

Implantation of CRT-D with transvenous RA and RV leads, and transvenous LV lead via the coronary sinus

Generator 0JH60P5RA lead 02H63MERV lead 02HK3MELV (CS) lead 02H43ME


Replacement of Device

Instead, device replacement in ICD-10-PCS takes two codes:

Insertion of the new device, using operation H-Insertion

Removal of the old device, using operation P-Removal

Removal codes contain less detail than Insertion codes.

Root operation W-Revision is also not used to code replacement of devices. It’s for correcting an existing device, eg. repositioning a lead.

Root operation R-Replacement is not used to code replacement of devices. It’s used for replacing a native body part with a device, eg. valve replacement.


Removal of CRDM Generators

PacemakerDefibrillatorCRT-P (BiV)CRT-D (BiV)

0JPT0PZ


Removal of CRDM Leads

02PA3MZ

PacemakerDefibrillatorCRT-P (BiV)CRT-D (BiV)

Any chamber or location


Replacement of Rhythm Devices

When a device is replaced, eg. end-of-battery life, complication, or upgrade, Insertion and Removal codes are used together.

Replacement of defibrillator generator due to end-of-life

Insertion of new generator 0JH60P4Removal of old generator 0JPT0PZ

Upgrade of pacemaker to CRT-D (replacement of generator, new LV lead via coronary sinus, retention of existing RA and RV leads)

Insertion of new CRT-D generator0JH60P5

Removal of old pacer generator0JPT0PZ

Insertion of LV lead via CS02H43ME

Replacement of broken CRT-D RV lead, transvenous

Insertion of new lead02HK3MERemoval of old lead 02PA3MZ


Diagnostic EPS

Diagnostic EPS : 4A023FZ

It is essential to use code 4A023FZ to obtain correct DRG assignment for EPS

The ICD-10-PCS Reference Manual uses EPS as an example of root operation K-Map but the example is incomplete


* See the Appendix for table 02K for mapping and table 025 for EP ablation

Cardiac Catheterization

RHC: 4A023N6 LHC: 4A023N7 R&L HC: 4A023N8

It’s essential to use code 4A023N~ to obtain correct DRG assignment, particularly when the cardiac cath is performed with other CRDM and cardiac procedures

Additional codes are assigned from table B20 or B21 for angiography of the heart and coronary arteries


* See the Appendix for table B21 as used for arteriography of the heart/coronary arteries

PTCA : What is a Site?

A “site” does not equal a single coronary artery Interventions at distinct sites within the same coronary artery are coded as multiple sites, but multiple stents in the same coronary artery may or may not be different sites

Angioplasty of two distinct sites in the LAD each with a drug-eluting stent, LCx with a drug-eluting stent, and angioplasty of RCA without stent: 027234Z, 02703ZZ

Different interventions require separate codes


Atherectomy

In ICD-9-CM, angioplasty and atherectomy use the same code but in ICD-10-PCS, they are separate codes

Angioplasty is coded to root operation 7-Dilation but atherectomy is coded to root operation C-Extirpation

No guidelines have been published yet but presumably, if both angioplasty and atherectomy take place within the same vessel, both are coded


CABG

Device refers to grafts obtained from patients (eg. SVG) or cadavers, or as products; no device is direct anastomosis

The qualifier refers to the origin of the bypass, ie.

source of the new blood flow Separate codes are assigned

for each bypass that uses a different device or qualifier


Aorta-coronary bypass, one site, with SVG: 021009W

RIMA-coronary artery bypass, one site: 02100Z8

Valve Replacement

This is a true replacement for coding purposes because the new valve physically takes over the place and thefunction of the native valve


Replacement of aortic valve with porcine valve: 02RF08Z

Replacement of mitral valve with mechanical valve: 02RG0JZ

Greater Specificity

ICD-10-PCS has far more procedure codes than ICD-9-CM.

System # Procedure Codes

ICD-9-CM 3,824

ICD-10-PCS 72,589

The structure of ICD-10-PCS has key consequences in:

The sheer volume of codes can be daunting at first but some constructs are far less likely than others.

ease of expansion for new procedures and technologies

greater depth of clinical documentation and knowledge required to assign codes


ICD-10-PCS Coding Guidelines

The ICD-10-PCS Reference Manual contains an appendix with draft procedure coding guidelines

Guideline use is mandatory under HIPAA

Coding Clinic® will address procedure code issues as well

The ICD-10-PCS Reference Manual also contains many helpful examples

CMS is developing an ICD-10-PCS Device Key with trade names to help users choose the correct device value

An ICD-10-PCS Body Part Key is available to help users choose the correct value for specific anatomic structures


DRGs under ICD-10


MS-DRG Conversion


CMS’s stated objective in the MS-DRG conversion is:

“for data coded in ICD-10, the ICD-10 MS-DRGs would assign the same MS-DRG had the same case been coded using ICD-9-CM codes”

In other words, CMS is not taking advantage of the ICD-10 transition to make changes to MS-DRG assignments.

DRG titles and concepts are unchanged. The conversion is strictly about the codes used, not about the MS-DRG structure itself.

(See the Appendix for the link)

DRG Grouper Version

The final version of the MS-DRG Grouper with ICD-10 codes is subject to the formal rule-making process


CMS has gone through two iterations of the MS-DRG Grouper using ICD-10 codes:

Although ICD-10 codes will be final in October 2011, the MS-DRG Grouper for ICD-10 is still in draft form.

V26 (FY 2009) was released for public comment in 2009

V28 (FY 2011) was released in February 2011 and comments are currently being taken

V29 (FY 2012) is expected to be released in October 2011

CC/MCC Lists


In keeping with the objective of assigning the same DRGs, all conditions that are CCs/MCCs in ICD-9-CM are also CCs/MCCs in ICD-10-CM.

In some cases where ICD-10-CM codes reflect combined conditions, an automatic CC or MCC DRG is assigned

In conflicts where an ICD-10-CM code could be either a CC or an MCC, designation was based on frequency data

New codes were factored into the CC Exclusion List

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

Example: I22.~, subsequent AMI, is excluded as an MCC when I21.~, initial AMI, is the principal diagnosis


Qualifier Z for Lead Insertion

Don’t default to qualifier Z!

Pacemaker DRGs are assigned when qualifier Z is used

Be sure to assign qualifier A for all pacemaker and CRT-P leads and qualifier E for all defibrillator and CRT-D leads


Different DRGs?

Be alert to unexpected DRGs.

Check the ICD-10 codes assigned, with attention to the value for each character and the need for multiple codes

If the ICD-10 DRG assigned to a particular case is different from the ICD-9-CM DRG, either the codes are incorrect or the DRG structure is flawed.

Verify the DRG assignment manually

Medtronic can assist in DRG verification and in notifying CMS about discrepant DRG logic.

Appendix


Key Websites

The CDC and CMS have a wealth of educational materials and resources available on-line, both for implementation of ICD-10 and the MS-DRG conversion.

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

ICD-10-CM tabular and index

diagnosis code GEMS

draft ICD-10-CM coding guidelines



Key Websites

http://www.cms.gov/ICD10/11b_2011_ICD10PCS.asp#TopOfPage

ICD-10-PCS tables and index

procedure code GEMS

ICD-10-PCS Reference Manual



Key Websites


Hospital payment impact analysis

http://www.cms.gov/ICD10/17_ICD10_MS_DRG_Conversion_Project.asp#TopOfPage

DRGs

MS-DRG Grouper in ICD-10 (manual)

MS-DRG Grouper in ICD-10 (pilot software)

Table 02K: Mapping

Table 02K is used for cardiac mapping, eg. 02K83ZZ


This does not represent a full electrophysiologic study

For EPS plus cardiac mapping, two codes must be used:

one from table 4A0 for the electrophysiologic study

one from table 02K for mapping

Table 025: Electrophysiologic Ablation

Endovascular EP ablation of arrhythmogenic focus in LA: 02573ZZ

Endovascular EP ablation of atrioventricular node: 02583ZZ


Table B21: Heart Angiography

Arteriography of native coronary arteries with high osmolar contrast: B2110ZZ


Left ventriculography with low osmolar contrast: B2150ZZ

When performed with a cardiac catheterization, these codes are assigned separately

Coding Hotlines


You can contact Medtronic for assistance with coding and reimbursement issues.

Cardiac Rhythm Disease Management(866) 877-4102, option 1

Vascular(877) 347-9662

Structural Heart(866) 616-8400

Question Time


We hope this was informative. If you have any comments or questions,

please send us an email at:[email protected]

Thanks for Participating!


Medtronic Inc.Minneapolis, MN www.medtronic.com

Documents

May 2011 Preparing for ICD-10 for Hospitals Copyright 2011 Medtronic