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May 19, 2015 Medtronic Cardiac Rhythm and Heart Failure ICD-10 Coding for Physicians

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Page 1: Medtronic Cardiac Rhythm and Heart Failure ICD-10 Coding ...May 19, 2015  · Need an ICD-10-CM Codebook? Physician offices can download a copy of the entire ICD-10-CM codebook from

May 19, 2015

Medtronic Cardiac Rhythm and Heart Failure

ICD-10 Coding for Physicians

Page 2: Medtronic Cardiac Rhythm and Heart Failure ICD-10 Coding ...May 19, 2015  · Need an ICD-10-CM Codebook? Physician offices can download a copy of the entire ICD-10-CM codebook from

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DisclaimerThis presentation is intended for educational use. Any duplication is prohibited without written consent of Medtronic’s Economics and Health Policy department. This information does 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 their 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.

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ICD-10-PCS Procedure Codes

ICD-10-CM Diagnosis Codes

Implementation Background

Implementation Issues

Appendix : Key Resources

Topics

Diagnosis Code Crosswalks

Questions

Attachment : Diagnosis Code Crosswalks

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ImplementationBackground

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Effective Date

ICD-10 goes into effect October 1, 2015.

ICD-10-CM for diagnosis codes and ICD-10-PCS for procedure codes go into effect together on the same date.

ICD-10 is effective by date of discharge, not by date of admission.

Use of ICD-10 in the United States was formally proposed in August 2008 and finalized in January 2009.

Implementation of ICD-10 was initially scheduled for October 2013 and has been postponed twice since then.

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Who Uses What

Provider Setting Diagnoses Procedures

Physicians Facility/Office ICD-10-CM CPT

Hospitals Outpatient ICD-10-CM CPT

ASCs Outpatient ICD-10-CM CPT

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

Physicians, hospitals and all other providers must use ICD-10 diagnosis codes.

Hospitals must also use ICD-10-PCS procedure codes for inpatient cases.

Implementation of ICD-10 does not affect use of CPT®.

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ICD-10-CM Diagnosis Codes

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Need an ICD-10-CM Codebook?

Physician offices can download a copy of the entire ICD-10-CM codebook from the CDC website:

This version is official, complete, current, and free.

Offices will need at least the Tabular and the Index.

The Tabular is the running list of diagnosis codes with their descriptions and instructions for use.

http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2105

ICD-10-CM diagnosis codes are administered by the Centers for Disease Control.

The codes are updated once a year on October 1.

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Codes are organized by chapter, mostly by body system. The chapters are virtually identical to those in ICD-9-CM.

Codes are alpha-numeric and can be 3 to 7 digits long.

Talpha

8number

2alpha or number

2 0 A

Category Details Extension

1T82.120ADisplacement of cardiac electrode, initial encounter

R 5 5 R55Syncope

I 5 0

2I50.23Acute on chronic systolic heart failure

3

Decimal

Diagnosis Code Structure

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Volume of Diagnosis Codes

ICD-9-CM14,567 codesICD-10-CM

69,823 codes

ICD-10-CM has far more diagnosis codes than ICD-9-CM and provides a greater level of specificity. Most physicians will use a small

subset of the total codes.

Many of the additional codes are due to laterality. Physicians do not use external cause codes.

There are still ‘unspecified’ codes.

Specialty societies have been very active in requesting new diagnosis codes with additional clinical detail.

Much of the additional specificity captured by ICD-10-CM diagnosis codes is already documented by physicians.

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Greater Specificity … Or Less

Some conditions that use the same code in ICD-9-CM are differentiated in ICD-10-CM and have separate codes.Example: Non-ischemic cardiomyopathy

ICD-9-CM ICD-10-CM

425.4

Otherprimarycardio-myopathies

I42.0 Dilated cardiomyopathy (congestive)I42.5 Other restrictive cardiomyopathy (constrictive cardiomyopathy)I42.8 Other cardiomyopathiesI42.9 Cardiomyopathy, unspecified

Example: Bifascicular blocks

ICD-9-CM ICD-10-CM 426.51 Right bundle branch block and left posterior fascicular block

I45.2 Bifascicular block426.52 Right bundle branch block and left anterior fascicular block 426.53 Bilateral bundle branch block, other

For some conditions though, it’s the opposite.

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ICD-10 Guidelines

Guidelines for use of ICD-10-CM are offered by multiple sources, but two sources are mandatory:

The ICD-10 Official Guidelines for Coding and Reporting

Physicians only need to use the diagnosis guidelines (there’s a separate set of official guidelines for procedures)

Instructions within the ICD-10 codebook itself

Use of these guidelines is mandated under HIPAA.

The guidelines can be found at:

Physicians will be most interested in Section IV: Diagnostic Coding

http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2105

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Diagnosis Code Crosswalks

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General Equivalence MappingsCDC posts General Equivalence Mappings (GEMs) on its website. These are a useful tool for going back-and-forth between ICD-9-CM codes and ICD-10 codes.

The first GEM goes forward from ICD-9 to ICD-10.

Both GEMs are updated once a year.

The second GEM goes backward from ICD-10 to ICD-9.

The GEMs can be found at: http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2105

Although GEMs are useful, CDC and CMS strongly recommend using the ICD-10-CM codebook directly, as studies have consistently indicated that this is most accurate.

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Crosswalk: Heart Failure

ICD-9-CM ICD-10-CM 402.01 Hypertensive heart disease, malignant, with heart failure

I11.0 Hypertensive heart disease with heart failure402.11 Hypertensive heart disease, benign, with heart failure

402.91 Hypertensive heart disease, unspecified, with heart failure

404.01Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified

I13.0

Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease

404.11Hypertensive heart and chronic kidney disease, benign, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified

404.91Hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified

404.03Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end stage renal disease

I13.2

Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease

404.13Hypertensive heart and chronic kidney disease, benign, with heart failure and chronic kidney disease stage V or end stage renal disease

404.93Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end stage renal disease

Hypertensive Heart Disease with Heart Failure

There’s no distinction between malignant and benign hypertension. The specific type of heart failure is coded separately.

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Crosswalk: Heart FailureICD-9-CM ICD-10-CM

428.0 Congestive heart failure, unspecified I50.9 Heart failure, unspecified 428.1 Left heart failure I50.1 Left ventricular failure 428.20 Systolic heart failure, unspecified I50.20 Unspecified systolic (congestive) heart failure428.21 Acute systolic heart failure I50.21 Acute systolic (congestive) heart failure428.22 Chronic systolic heart failure I50.22 Chronic systolic (congestive) heart failure428.23 Acute on chronic systolic heart failure I50.23 Acute on chronic systolic (congestive) heart failure428.30 Unspecified diastolic heart failure I50.30 Unspecified diastolic (congestive) heart failure428.31 Acute diastolic heart failure I50.31 Acute diastolic (congestive) heart failure428.32 Chronic diastolic heart failure I50.32 Chronic diastolic (congestive) heart failure428.33 Acute on chronic diastolic heart failure I50.33 Acute on chronic diastolic (congestive) heart failure

428.40 Unspecified combined systolic and diastolic heart failure I50.40 Unspecified combined systolic (congestive) and diastolic

(congestive) heart failure

428.41 Acute combined systolic and diastolic heart failure I50.41 Acute combined systolic (congestive) and diastolic

(congestive) heart failure

428.42 Chronic combined systolic and diastolic heart failure I50.42 Chronic combined systolic (congestive) and diastolic

(congestive) heart failure

428.43 Acute on chronic combined systolic and diastolic heart failure I50.43 Acute on chronic combined systolic (congestive) and

diastolic (congestive) heart failure428.9 Unspecified heart failure I50.9 Heart failure, unspecified

Documentation must still specify if the heart failure is acute or chronic, systolic or diastolic.

“Congestive” heart failure does not have its own code.

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Crosswalk: Conduction Disorders

ICD-9-CM ICD-10-CM 426.0 AV block, complete I44.2 Atrioventricular block, complete426.10 AV block, unspecified I44.30 Unspecified atrioventricular block426.11 AV block, first degree I44.0 Atrioventricular block, first degree426.12 AV block, Mobitz II I44.1 Atrioventricular block, second degree426.13 AV block, other second degree

Atrioventricular Block

Bundle Branch BlocksICD-9-CM ICD-10-CM

426.2 Left bundle branch hemiblockI44.4 Left anterior fascicular block I44.5 Left posterior fascicular block

I44.60 Unspecified fascicular block

426.3 Other left bundle branch block I44.69 Other fascicular block I44.7 Left bundle branch block, unspecified

426.4 Right bundle branch block I45.0 Right fascicular block

I45.10 Unspecified right bundle branch block I45.19 Other right bundle branch block

426.50 Bundle branch block, unspecified I45.4 Nonspecific intraventricular block (BBB NOS)426.51 RBBB and left posterior fascicular block

I45.2 Bifascicular block426.52 RBBB and left anterior fascicular block 426.53 Bilateral bundle branch block, other426.54 Trifascicular block I45.3 Trifascicular block

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Crosswalk: Conduction Disorders

ICD-9-CM ICD-10-CM 426.7 Anomalous atrioventricular excitation (WPW) I45.6 Pre-excitation syndrome (WPW) (LGL)426.81 Lown-Ganong-Levine syndrome (LGL)426.82 Long QT syndrome I45.81 Long QT syndrome 426.89 Other specified conduction disorders I45.89 Other specified conduction disorders 426.9 Conduction disorder, unspecified I45.9 Conduction disorder, unspecified

Other BlocksICD-9-CM ICD-10-CM

426.6 Other heart block I45.5 Other specified heart block

Other Conduction Disorders

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Crosswalk: Arrhythmias Tachycardia

ICD-9-CM ICD-10-CM

427.0 Paroxysmal supraventricular tachycardia I47.1 Supraventricular tachycardia (includes AVNRT)I49.2 Junctional premature depolarization

427.1 Paroxysmal ventricular tachycardia I47.0 Re-entry ventricular arrhythmia I47.2 Ventricular tachycardia

427.2 Paroxysmal tachycardia, unspecified I47.9 Paroxysmal tachycardia, unspecified 785.0 Tachycardia, unspecified R00.0 Tachycardia, unspecified

“Paroxysmal” does not need to be documented SVT and VT.

Atrial Fibrillation and FlutterICD-9-CM ICD-10-CM

427.31 Atrial fibrillation

I48.0 Paroxysmal atrial fibrillationI48.1 Persistent atrial fibrillationI48.2 Chronic atrial fibrillation

I48.91 Unspecified atrial fibrillation

427.32 Atrial flutterI48.3 Typical atrial flutter (type I)I48.4 Atypical atrial flutter (type II)

I48.92 Unspecified atrial flutter

Documentation should specify the type of atrial fibrillation, and the abbreviation “PAF” should be avoided.

Tachycardia that’s unspecified is assigned to symptom code R00.0.

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Crosswalk: Arrhythmias Ventricular Fibrillation and Flutter

ICD-9-CM ICD-10-CM 427.41 Ventricular fibrillation I49.01 Ventricular fibrillation427.42 Ventricular flutter I49.02 Ventricular flutter

Particularly for surgical patients, documentation should specify bradycardia as “sick sinus syndrome” or “tachycardia-bradycardia syndrome”.

BradycardiaICD-9-CM ICD-10-CM

427.81 Sinoatrial node dysfunction (SSS) I49.5 Sick sinus syndrome (tachy-brady syndrome)— R00.1 Bradycardia, unspecified

Bradycardia that is unspecified or documented only as “sinoatrial bradycardia” or “sinus bradycardia” is assigned to symptom code R00.1.

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Crosswalk: Arrhythmias Other Arrhythmias

ICD-9-CM ICD-10-CM 427.60 Premature beats, unspecified I49.40 Unspecified premature depolarization 427.61 Supraventricular premature beats I49.1 Atrial premature depolarization

427.69 Other premature beats I49.3 Ventricular premature depolarizationI49.49 Other premature depolarization

427.89 Other specified cardiac dysrhythmias I49.8 Other specified cardiac arrhythmias427.9 Cardiac dysrhythmia, unspecified I49.9 Cardiac arrhythmia, unspecified 794.31 Abnormal electrocardiogram R94.31 Abnormal electrocardiogram

Cardiac Arrest (Sudden Cardiac Death) ICD-9-CM ICD-10-CM

427.5 Cardiac arrestI46.2 Cardiac arrest due to underlying cardiac conditionI46.8 Cardiac arrest due to other underlying condition I46.9 Cardiac arrest, cause unspecified

If the underlying cause is known, it should be documented and coded separately. The cause code is sequenced before code I46.-.

ICD-9-CM ICD-10-CM

V12.53 Personal history of sudden cardiac arrest (SCD) (successfully resuscitated) Z86.74 Personal history of sudden cardiac arrest (SCD)

(successfully resuscitated)

V17.41 Family history of sudden cardiac death (SCD) Z82.41 Family history of sudden cardiac death

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ICD-9-CM410.0x Acute myocardial infarction, of anterolateral wall 410.1x Acute myocardial infarction, of other anterior wall 410.2x Acute myocardial infarction, of inferolateral wall410.3x Acute myocardial infarction, of inferoposterior wall410.4x Acute myocardial infarction, of other inferior wall 410.5x Acute myocardial infarction, of other lateral wall410.6x Acute myocardial infarction, true posterior wall 410.7x Acute myocardial infarction, subendocardial (NSTEMI)410.8x Acute myocardial infarction, of other specified sites 410.9x Acute myocardial infarction, unspecified site

Crosswalk: Acute Myocardial Infarction

AMI: ICD-9-CM

AMI: ICD-10-CM

Episode of care is not identified per se. AMI is differentiated between initial AMI (I21) and subsequent AMI (I22) The AMI site identifies the specific coronary artery involved.

ICD-10-CM handles acute myocardial infarction differently from ICD-9-CM.

5th digit

0 – unspecified episode of care

1 – initial episode of care

2 – subsequent episode of care

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Initial AMI (I21)

Crosswalk: Acute Myocardial Infarction

Documentation should specify the coronary artery or wall involved.

ICD-10-CMI21.01 ST elevation (STEMI) myocardial infarction involving left main coronary arteryI21.02 ST elevation (STEMI) myocardial infarction involving left anterior descending coronary arteryI21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall I21.11 ST elevation (STEMI) myocardial infarction involving right coronary arteryI21.19 ST elevation (STEMI) myocardial infarction involving other coronary arteryI21.21 ST elevation (STEMI) myocardial infarction involving left circumflex coronary arteryI21.29 ST elevation (STEMI) myocardial infarction involving other sitesI21.3 ST elevation (STEMI) myocardial infarction of unspecified site I21.4 Non-ST elevation (NSTEMI) myocardial infarction

Initial AMI codes continue to be assigned to encounters for continued care, including transfer to another hospital or post-acute setting, while the AMI is within 28 days of onset.

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Crosswalk: Acute Myocardial Infarction

ICD-10-CMI22.0 Subsequent ST elevation (STEMI) myocardial infarction of anterior wallI22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wallI22.2 Subsequent non-ST elevation (NSTEMI) myocardial infarctionI22.8 Subsequent ST elevation (STEMI) myocardial infarction of other sitesI22.9 Subsequent ST elevation (STEMI) myocardial infarction of unspecified site

Subsequent AMI (I22)

A subsequent AMI is a new AMI that occurs within 28 days of a previous AMI, regardless of site.

Codes from I22 cannot be assigned alone. They must always be assigned with a code from I21. Sequencing of the codes depends on the circumstances.

Old AMI

ICD-9-CM ICD-10-CM 412 Old myocardial infarction I25.2 Old myocardial infarction

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Crosswalk: Other Heart Disorders

ICD-9-CM ICD-10-CM

414.8 Other specified forms of chronic ischemic heart disease (used for ischemic cardiomyopathy) I25.5 Ischemic cardiomyopathy

425.11 Hypertrophic obstructive cardiomyopathy I42.1 Obstructive hypertrophic cardiomyopathy

425.4 Other primary cardiomyopathies

I42.0 Dilated cardiomyopathy (congestive)

I42.5 Other restrictive cardiomyopathy (constrictive cardiomyopathy)

I42.8 Other cardiomyopathiesI42.9 Cardiomyopathy, unspecified

Cardiomyopathy

ShockICD-9-CM ICD-10-CM

785.50 Shock, unspecified R57.9 Shock, unspecified 785.51 Cardiogenic shock R57.0 Cardiogenic shock

785.59 Shock, other R57.1 Hypovolemic shock R57.8 Other shock

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Crosswalk: SymptomsSyncope

ICD-9-CM ICD-10-CM 780.2 Syncope R55 Syncope

Chest PainICD-9-CM ICD-10-CM

786.50 Chest pain, unspecified R07.9 Chest pain, unspecified 786.51 Precordial pain R07.2 Precordial pain786.59 Chest pain , other R07.89 Other chest pain

Other SymptomsICD-9-CM ICD-10-CM

780.4 Dizziness R42 Dizziness785.1 Palpitations R00.2 Palpitations

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Crosswalk: Cerebrovascular Disorders

ICD-9-CM ICD-10-CM

434.91 Cerebral artery occlusion, unspecified (used for cryptogenic ischemic stroke) I63.9 Cerebral infarction, unspecified

Cryptogenic Stroke

ICD-9-CM ICD-10-CM 435.9 Unspecified transient cerebral ischemia G45.9 Transient cerebral ischemic attack, unspecified

Transient Cerebral Ischemia

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Crosswalk: Device Complications

ICD-9-CM ICD-10-CM

996.01

996.04

Mechanical complication due to cardiac pacemaker

Mechanical complication due to implantable defibrillator

T82.110A Breakdown (mechanical) of cardiac electrode, initial encounterT82.111A Breakdown (mechanical) of cardiac pulse generator, initial encounterT82.118A Breakdown (mechanical) of other cardiac electronic device, initial encounterT82.120A Displacement of cardiac electrode, initial encounterT82.121A Displacement of cardiac pulse generator, initial encounterT82.128A Displacement of other cardiac electronic device, initial encounterT82.190A Other mechanical complication of cardiac electrode, initial encounterT82.191A Other mechanical complication of cardiac pulse generator, initial encounterT82.198A Other mechanical complication of other cardiac electronic device, initial encounter

Mechanical Complication of Pacemaker and Defibrillator

Mechanical complication is defined the same way in ICD-10-CM as it is in ICD-9-CM. Breakage of device Malposition of device Leakage of device

Mechanical obstruction of device Perforation of device Protrusion of device

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Crosswalk: Device Complications Infection of implanted cardiac device

ICD-9-CM ICD-10-CM

996.61Infection due to cardiac device, implant and graft

T82.7xxA Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter

Other complications

“x” is a placeholder. This code is only four digits but extension “A” must always be in the 7th position. So “x” holds the empty 5th and 6th positions.

A diagnosis of “failed” device must be further specified.

ICD-9-CM ICD-10-CM

996.72

Other complicationdue to other cardiac device, implant and graft

T82.817A Embolism of cardiac prosthetic devices, implants and grafts, initial encounterT82.827A Fibrosis of cardiac prosthetic devices, implants and grafts, initial encounterT82.837A Hemorrhage of cardiac prosthetic devices, implants, grafts, initial encounterT82.847A Pain from cardiac prosthetic devices, implants and grafts, initial encounterT82.857A Stenosis of cardiac prosthetic devices, implants and grafts, initial encounterT82.867A Thrombosis of cardiac prosthetic devices, implants, grafts, initial encounter

T82.897A Other specified complication of cardiac prosthetic devices, implants and grafts, initial encounter

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Crosswalk: Encounters and Status

Use Z45.- for encounters for device replacement due to expected end-of-life and expected device removal (eg, end of surveillance). These types of encounters are not coded as complications.

ICD-9-CM ICD-10-CM

V53.31 Fitting and adjustment of cardiac pacemakerZ45.010 Encounter for checking and testing of cardiac

pacemaker pulse generator [battery]

Z45.018 Encounter for adjustment and management of other part of cardiac pacemaker

V53.32 Fitting and adjustment of automatic implantable cardiac defibrillator Z45.02 Encounter for adjustment and management of

automatic implantable cardiac defibrillator

V53.39 Fitting and adjustment of other cardiac device Z45.09 Encounter for adjustment and management of othercardiac device

Encounters

ICD-9-CM ICD-10-CM

V45.01 Cardiac pacemaker in situ Z95.0 Presence of cardiac pacemaker

V45.02 Automatic implantable cardiac defibrillator in situ Z95.810 Presence of automatic (implantable) cardiac

defibrillatorV45.09 Other specified cardiac device in situ Z95.818 Presence of other cardiac implants and grafts

Device Status

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ICD-10-PCSProcedure Codes

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ICD-10-PCS Format

ICD-10-PCS procedure codes are administered by CMS.

Codes are alpha-numeric and are always 7 digits long.

Each position in an ICD-10-PCS procedure code represents a distinct element.

1 2 3 4 5 6 7

sectionbody system

root operation approach qualifierbody part device

There are virtually no unspecified or default codes. ICD-10-PCS uses standardized definitions throughout.

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Structure of ICD-10-PCS Codes In ICD-10-PCS, codes are not assigned per se. They are

constructed, character by character. Rather than a Tabular list of codes, ICD-10-PCS displays

tables from which values for each position are selected.

Defibrillator generator: Evera0JH608Z Insertion of defibrillator generator, into chest subcutaneous tissue and fascia, open approach

CRT-D generator: Viva 0JH609Z Insertion of cardiac resynchronization defibrillator pulse generator into chest subcutaneous tissue and fascia, open approach

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ICD-10-PCS Terminology

Pulmonary vein isolation (ie. for atrial fibrillation)02583ZZ Destruction of conduction mechanism, percutaneous approach

“It is the coder’s responsibility to determine what the documentation in the medical record equates to in the PCS definitions. The physician is not expected to use the terms used in PCS code descriptions…”

No need to document Destruction, keep documenting PVI or ablation No need to document Percutaneous Endoscopic, thoracoscopic is fine

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Volume of Procedure Codes ICD-10-PCS has far more procedure codes than ICD-9-CM and provides much greater specificity. Full system CRT-D

ICD-9-CM 1 code ICD-10-PCS 4 codes

ICD-9-CM3,882 codesICD-10-PCS71,962 codes

CRT-D generator with transvenous RA, RV, LV leads

02H63KZ Insertion of defibrillator lead into right atrium, percutaneous approach02HK3KZ Insertion of defibrillator lead into right ventricle, percutaneous approach02H43KZ Insertion of defibrillator lead into coronary vein, percutaneous approach

0JH609Z Insertion of CRT-D generator into chest subcutaneous tissue, open approach

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Implementation Issues

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Documentation PracticesICD-10 raises the bar on specificity in documentation for diagnoses.

Culprit lesion or site of acute myocardial infarction Type of cardiomyopathy: ischemic/non-ischemic, congestive, constrictive Acuity and type of heart failure: acute/chronic, systolic/diastolic Type of atrial fibrillation: paroxysmal, persistent, chronic Type of atrial flutter: type I, type II Nature of bradycardia: SSS, tachycardia-bradycardia syndrome Nature of tachycardia: SVT, VT, AVNRT Device complication: true complication or expected end-of-life? Nature of device complication: stenosis, breakdown, premature depletion

Documentation for Diagnosis Specificity

“PAF”

“device failure”

“tachycardia”“CHF”

“bradycardia”

“STEMI” (unspecified)

“decompensated HF”

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Documentation Practices

Take note of coder queries requesting additional information and include those details in similar cases going forward.

http://www.roadto10.org/action-plan/phase-2-train/primer-cardiology/ CMS has a useful primer for cardiology documentation:

Conventional or resynchronization pacemaker or defibrillator Exact anatomic location of subcutaneous devices: chest, back, abdominal wall Specific name and model of devices used

Documentation for Procedure Specificity

ICD-10 also raises the bar on specificity in documentation for procedures.

Other documentation considerations

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Coverage IssuesCMS has converted its NCDs and ICD-10-CM codes are already being displayed on LCDs and on private payers’ medical policies.

Be aware that the specificity of ICD-10-CM may allow payers to now enforce existing coverage rules more stringently.

Identify the practice’s largest payers and check the codes on their on-line medical polices for familiarity as well as omissions.

Alert the payer to possible discrepancies.

Check practice superbills against payer policies for differences.

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Practice Implementation Checklist1. Lay out a plan Identify which ICD-9 codes you use heavily Identify the staff that need to be trained in coding and/or documentation Contact vendors to learn their plans, ICD-10 related costs to the practice, and

resources available to the practice Contact the specialty society for any resources available to the practice Visit the CMS website for useful tools and materials

2. Get trained Buy or download an ICD-10 diagnosis codebook Arrange and implement ICD-10 coding training for staff Arrange and obtain documentation training for physicians and other clinicians Crosswalk common diagnosis codes to ICD-10 and identify new requirements or

differences in essential documentation Sign up for key CMS webinars to increase understanding of the ICD-10 environment

3. Update internal practice tools Convert superbills to ICD-10 Convert other materials to ICD-10, such as authorizations, orders and referrals Identify common code-related causes for current claim denials and identify areas where

ICD-10's specificity in documentation and code assignment can address this Obtain payer medical polices with ICD-10 codes for comparison

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4. Work with vendors and payers Arrange and implement ICD-10 software upgrades Train staff on use of new software, either directly or via the

vendor Identify EHR documentation templates and assess how they

support ICD-10 specificity for claims submission and medical necessity

Engage payers on any discrepancies and omissions in ICD-10 coding for medical policies

Identify if payers anticipate any changes in processing and payment due to ICD-10

Identify availability of testing with major payers

5. Test the process Perform testing on systems within the practice Perform end-to-end testing with vendors and/or payers Identify and correct issues raised during testing Educate staff on the impact of ICD-10 to payer edits, adjudication, and other claims

elements to processes within the practice Repeat!

Practice Implementation Checklist

http://coalitionforicd10.org/2015/01/12/you-can-do-it-guide-to-physician-icd-10-conversion/

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Appendix

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Key Websites CDC and CMS have a wealth of resources and educational materials available on-line for physician practices.

http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2105• ICD-10-CM Tabular and Index

• Diagnosis code GEMS• Official ICD-10-CM guidelines

http://www.roadto10.org/

CDC

CMS• Webcasts

• Templates for assessing vendors, billing services, payers • FAQs on ICD-10

• Specialty references (common codes, documentation primers)• Customizable practice action plans

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Medtronic Contacts Medtronic is available to assist with your ICD-10 questions and issues.

Hotline: 1-866-877-4102

Email us:[email protected]

We’re here to

help make this

transition smoother for you

Visit the CRHF reimbursement website at:www.medtronic.com/crdmreimbursement

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Questions