NCHIMA 66th Annual Meeting€¦ · specific mappings ©2015 . Global use of ICD-10: Catching up with the industrialized world . Poland . Thailand . United States . Iceland . Denmark

NCHIMA 66th Annual Meeting

Diabetes and ICD-10, Improving Data Capture

May 4, 2016

Susie Harris, PhD, RHIA, CCS

and Ray Hylock, PhD

Agenda 1. Global use of ICD-10

2. Codes Used in this presentation

3. Background of the Diabetes Study

4. Outline the ICD-9-CM codes and descriptions to ICD-10-CM codes and descriptions for diabetes.

5. Explain the data that is uncaptured in the ICD-9-CM diabetes codes.

6. Explain the data that is captured in the ICD-10-CM diabetes codes.

7. Determine which classification system and terminologies, ICD-9-CM or ICD-10-CM, are more beneficial.

8. Understand examples of ICD-10-CM diabetes codes and how they provide more specificity of the data.

9. Understand the documentation issues that arise with the conversion of ICD-9-CM to ICD-10-CM.

10. Determine locations in the EHR that could contain additional information to assist in more specific mappings

©2015

Global use of ICD-10: Catching up with the industrialized world

Poland

Thailand

United States

Iceland

Denmark

Brazil

New Zealand

Argentina

Austria

Norway

Australia

Finland

Singapore

Canada

Sweden

China

Japan

Venezuela

Germany

Switzerland

Colombia

UK Ireland

Czech Republic The Netherlands

France

Costa Rica

Global use of ICD-10

Presenter

Presentation Notes

A more recent map

Codes Used in this Presentation

• ICD-9-CM Codes from a Diabetes Study, 250.00-250.99, were mapped to ICD-10-CM codes

©2015

Background of the Diabetes Study

Need for the Diabetes Study • A life-long disease with complex, daily, self-care needs • Prevalence: In 2000, 2.8% of the world population had

diabetes • Projected Prevalence: By 2030, 4.4% of the world population will

have diabetes • Over an eight year period ending in 2003, there was an 8.2%

increase in diabetes in North Carolina • Sixth leading cause of death • Accounts for over 200,000 deaths per year • Costs the nation $132 million per year • Average annual health care cost for a person with diabetes is

$13,243 compared to $2,560 for a person without diabetes

©2015

Background of the Diabetes Study

Participants • Surveys were mailed to 2,615 individuals

with diabetes from two medical databases in Eastern North Carolina with the International Classification of Diseases, Ninth Revision, Clinical Modification, Sixth Edition (ICD-9-CM) diagnosis codes of 250.00-250.99 and who were at least 18 years of age.

©2015

Purpose and Results of Diabetes Study

• The primary purpose of this study was to investigate whether persons with diabetes in Eastern North Carolina who use spirituality as a coping mechanism have better health conditions.

• The results in this study indicated that participants who use spirituality as a coping mechanism for their diabetes have significantly lower current mean A1c levels.

©2015

• Comparison of the structural differences between ICD-9-CM and ICD-10-CM

– ICD-9-CM ICD-10-CM

– 250: Diabetes Mellitus E10: Type 1 diabetes mellitus

– 250: Diabetes Mellitus E11: Type 2 diabetes mellitus

• ICD-10-CM codes for diabetes mellitus (DM) are combination codes that include the type of DM, the body system affected, and the complication affecting that body system as part of the code description

• A DM subcategory with other specified complications is also provided that includes codes for DM with diabetic neuropathic arthropathy, diabetic dermatitis, foot ulcer, other skin ulcer, periodontal disease, hypoglycemia, and hyperglycemia

• Many codes may be needed to describe all of the associated complications that the patient has from a particular category

• ICD-10-CM codes do not require an additional fifth digit to identify the type of diabetes mellitus and whether it is controlled or uncontrolled

• Sequencing of secondary diabetes codes in relation to the cause of the DM is assigned according to tabular instructions

ICD-10-CM Coding of Diabetes

Presenter

Presentation Notes

In order to understand diabetes coding in ICD-10-CM, it's worth making a comparison of the structural differences between ICD-9-CM and ICD-10-CM. Diabetes codes in ICD-10-CM are combination codes that include the type of diabetes, the body system affected, and the complication affecting that body system as part of the code description. A subcategory for diabetes mellitus with other specified complications is also provided which includes codes for diabetes mellitus with diabetic neuropathic arthropathy, diabetic dermatitis, foot ulcer, other skin ulcer, periodontal disease, hypoglycemia, and hyperglycemia. Many codes may be needed to describe all of the associated complications that the patient has from a particular category. Unlike ICD-9-CM, ICD-10-CM codes do not require an additional fifth digit to identify the type of diabetes mellitus and whether it is controlled or uncontrolled. Also, sequencing of secondary diabetes codes in relation to the cause of the diabetes mellitus is assigned according to tabular instructions. Source: Becks, Lori,R.H.I.A., A.H.I.M.A. (2014). Coding for diabetes. Medical Economics, 91(11), 46-48. Retrieved from http://search.proquest.com.jproxy.lib.ecu.edu/docview/15421264 87?accountid=10639

• ICD-9-CM has approximately 31 diabetes codes – 250 category code

• ICD-10-CM has approximately 318 codes for diabetes

mellitus including gestational diabetes mellitus

• ICD-10-CM has approximately 119 diabetes codes in the E10 and E11 category codes which will be our focus for this presentation

• ICD-10-CM coding of diabetes mellitus will require documentation with greater specificity and detail

Diabetes codes

Presenter

Presentation Notes

4. Outline the ICD-9-CM codes and descriptions to ICD-10-CM codes and descriptions for diabetes. �

• E11.21 – Type 2 diabetes mellitus with diabetic nephropathy (583.81)

OR • E11.22

– Type 2 diabetes mellitus with diabetic chronic kidney disease (585.1-6, 9)

• N18.1 – Chronic Kidney Disease, stage 1 • N18.2 – Chronic Kidney Disease, stage 2 (mild) • N18.3 – Chronic Kidney Disease, stage 3 (moderate) • N18.4 – Chronic Kidney Disease, stage 4 (severe) • N18.5– Chronic Kidney Disease, stage 5 • N18.6– End stage renal disease

OR • E11.29

– Type 2 diabetes mellitus with other diabetic kidney complication

250.40 DIABETES WITH RENAL MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS

UNCONTROLLED

Presenter

Presentation Notes

5. Explain the data that is uncaptured in the ICD-9-CM diabetes codes. IN THIS EXAMPLE, THE ICD-9-CM CODE, 250.40 , WE KNOW THIS IS TYPE 2 OR UNSPECIFIED. WE ARE MISSING VALUABLE DATA WITH THE TYPE OF DIABETES BEING UNSPECIFIED. 6. Explain the data that is captured in the ICD-10-CM diabetes codes. WITH THE ICD-10-CM CODES IN THIS EXAMPLE, WE ARE ABLE TO USE ONE CODE TO CAPTURE DM AND THE MANIFESTATIONS. 7. Determine which classification system and terminologies, ICD-9-CM or ICD-10-CM, are more beneficial. WHICH SYSTEM, ICD-9-CM or ICD-10-CM, DO YOU THINK IS MORE BENEFICIAL? 8. Understand examples of ICD-10-CM diabetes codes and how they provide more specificity of the data. CAN YOU SEE HOW ICD-10-CM CAPTURE AND REPRESENT MORE INFORMATION? IN A MORE EFFICIENT WAY? 9. Understand the documentation issues that arise with the conversion of ICD-9-CM to ICD-10-CM. IN ORDER FOR IT TO BE CODED, WE MUST HAVE DOCUMENTATION.

• E10.21 – Type 1 diabetes mellitus with diabetic nephropathy (583.81)

OR • E10.22

– Type 1 diabetes mellitus with diabetic chronic kidney disease (585.1-6, 9)

• N18.1 – Chronic Kidney Disease, stage 1 • N18.2 – Chronic Kidney Disease, stage 2 (mild) • N18.3 – Chronic Kidney Disease, stage 3 (moderate) • N18.4 – Chronic Kidney Disease, stage 4 (severe) • N18.5– Chronic Kidney Disease, stage 5 • N18.6– End stage renal disease

OR • E10.29

– Type 1 diabetes mellitus with other diabetic kidney complication

250.41 Diabetes with renal manifestations, Type I [juvenile type], not stated as controlled

Presenter

Presentation Notes

5. Explain the data that is uncaptured in the ICD-9-CM diabetes codes. IN THIS EXAMPLE, THE ICD-9-CM CODE, 250.41, WE KNOW THIS IS TYPE 1 OR UNSPECIFIED. WE ARE MISSING VALUABLE DATA WITH THE TYPE OF DIABETES BEING UNSPECIFIED. 6. Explain the data that is captured in the ICD-10-CM diabetes codes. WITH THE ICD-10-CM CODES IN THIS EXAMPLE, WE ARE ABLE TO USE ONE CODE TO CAPTURE DM AND THE MANIFESTATIONS. 7. Determine which classification system and terminologies, ICD-9-CM or ICD-10-CM, are more beneficial. WHICH SYSTEM, ICD-9-CM or ICD-10-CM, DO YOU THINK IS MORE BENEFICIAL? 8. Understand examples of ICD-10-CM diabetes codes and how they provide more specificity of the data. CAN YOU SEE HOW ICD-10-CM CAPTURE AND REPRESENT MORE INFORMATION? IN A MORE EFFICIENT WAY? 9. Understand the documentation issues that arise with the conversion of ICD-9-CM to ICD-10-CM. IN ORDER FOR IT TO BE CODED, WE MUST HAVE DOCUMENTATION.

• E11.311 – Type 2 diabetes mellitus with unspecified diabetic retinopathy (362.01) with macular edema (362.07)

• E11.319 – Type 2 diabetes mellitus with unspecified diabetic retinopathy (362.01) without macular edema

• E11.321 – Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy (362.04) with macular edema (362.07)

• E11.329 – Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy (362.04) without macular edema

• E11.331 – Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy (362.05) with macular edema

(362.07) • E11.339

– Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy (362.05) without macular edema • E11.341

– Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy (362.06) with macular edema (362.07) • E11.349

– Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy (362.06) without macular edema • E11.351

– Type 2 diabetes mellitus with proliferative diabetic retinopathy (362.02) with macular edema (362.07) • E11.359

– Type 2 diabetes mellitus with proliferative diabetic retinopathy (362.02) without macular edema • E11.36

– Type 2 diabetes mellitus with diabetic cataract (366.41) • E11.39

– Type 2 diabetes mellitus with other diabetic ophthalmic complication

250.50 DIABETES WITH OPHTHALMIC MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED

Presenter

Presentation Notes

HERE ARE MORE EXAMPLES AND YOU CAN SEE THE SAME PATTERN FROM THE PREVIOUS EXAMPLES 5. Explain the data that is uncaptured in the ICD-9-CM diabetes codes. IN THIS EXAMPLE, THE ICD-9-CM CODE, 250.50 , WE KNOW THIS IS TYPE 2 OR UNSPECIFIED. WE ARE MISSING VALUABLE DATA WITH THE TYPE OF DIABETES BEING UNSPECIFIED. 6. Explain the data that is captured in the ICD-10-CM diabetes codes. WITH THE ICD-10-CM CODES IN THIS EXAMPLE, WE ARE ABLE TO USE ONE CODE TO CAPTURE DM AND THE MANIFESTATIONS++++WITH THE ICD-9-CM SYSTEM, WE WOULD HAVE TO USE TWO OR THREE CODES TO CAPTURE THE DATA 7. Determine which classification system and terminologies, ICD-9-CM or ICD-10-CM, are more beneficial. WHICH SYSTEM, ICD-9-CM or ICD-10-CM, DO YOU THINK IS MORE BENEFICIAL? 8. Understand examples of ICD-10-CM diabetes codes and how they provide more specificity of the data. CAN YOU SEE HOW ICD-10-CM CAPTURE AND REPRESENT MORE INFORMATION? IN A MORE EFFICIENT WAY? 9. Understand the documentation issues that arise with the conversion of ICD-9-CM to ICD-10-CM. IN ORDER FOR IT TO BE CODED, WE MUST HAVE DOCUMENTATION.

• E10.311 – Type 1 diabetes mellitus with unspecified diabetic retinopathy (362.01) with macular edema (362.07)

• E10.319 – Type 1 diabetes mellitus with unspecified diabetic retinopathy (362.01) without macular edema

• E10.321 – Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy (362.04) with macular edema (362.07)

• E10.329 – Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy (362.04) without macular edema

• E10.331 – Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy (362.05) with macular edema

(362.07) • E10.339

– Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy (362.05) without macular edema • E10.341

– Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy (362.06) with macular edema (362.07) • E10.349

– Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy (362.06) without macular edema • E10.351

– Type 1 diabetes mellitus with proliferative diabetic retinopathy (362.02) with macular edema (362.07) • E10.359

– Type 1 diabetes mellitus with proliferative diabetic retinopathy (362.02) without macular edema • E10.36

– Type 1 diabetes mellitus with diabetic cataract (366.41) • E10.39

– Type 1 diabetes mellitus with other diabetic ophthalmic complication

250.51 DIABETES WITH OPHTHALMIC MANIFESTATIONS, TYPE I [JUVENILE TYPE], NOT STATED AS UNCONTROLLED

Presenter

Presentation Notes

HERE ARE MORE EXAMPLES AND YOU CAN SEE THE SAME PATTERN FROM THE PREVIOUS EXAMPLES 5. Explain the data that is uncaptured in the ICD-9-CM diabetes codes. IN THIS EXAMPLE, THE ICD-9-CM CODE, 250.51 , WE KNOW THIS IS TYPE 1 OR UNSPECIFIED. WE ARE MISSING VALUABLE DATA WITH THE TYPE OF DIABETES BEING UNSPECIFIED. 6. Explain the data that is captured in the ICD-10-CM diabetes codes. WITH THE ICD-10-CM CODES IN THIS EXAMPLE, WE ARE ABLE TO USE ONE CODE TO CAPTURE DM AND THE MANIFESTATIONS++++WITH THE ICD-9-CM SYSTEM, WE WOULD HAVE TO USE TWO OR THREE CODES TO CAPTURE THE DATA 7. Determine which classification system and terminologies, ICD-9-CM or ICD-10-CM, are more beneficial. WHICH SYSTEM, ICD-9-CM or ICD-10-CM, DO YOU THINK IS MORE BENEFICIAL? 8. Understand examples of ICD-10-CM diabetes codes and how they provide more specificity of the data. CAN YOU SEE HOW ICD-10-CM CAPTURE AND REPRESENT MORE INFORMATION? IN A MORE EFFICIENT WAY? 9. Understand the documentation issues that arise with the conversion of ICD-9-CM to ICD-10-CM. IN ORDER FOR IT TO BE CODED, WE MUST HAVE DOCUMENTATION.

• (E11.311 – Type 2 diabetes mellitus with unspecified diabetic retinopathy (362.01-362.07) with

macular edema (362.07)

OR • E11.319

– Type 2 diabetes mellitus with unspecified diabetic retinopathy (362.01-362.07) without macular edema

OR • E11.36

– Type 2 diabetes mellitus with diabetic cataract (366.41)

OR • E11.39

– Type 2 diabetes mellitus with other diabetic ophthalmic complication)

AND • E11.65

– Type 2 diabetes mellitus with hyperglycemia (790.29)

250.52 DIABETES WITH OPHTHALMIC MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, UNCONTROLLED

Presenter

Presentation Notes

HERE ARE MORE EXAMPLES AND YOU CAN SEE THE SAME PATTERN FROM THE PREVIOUS EXAMPLES 5. Explain the data that is uncaptured in the ICD-9-CM diabetes codes. IN THIS EXAMPLE, THE ICD-9-CM CODE, 250.52, WE KNOW THIS IS TYPE 2 OR UNSPECIFIED. WE ARE MISSING VALUABLE DATA WITH THE TYPE OF DIABETES BEING UNSPECIFIED. 6. Explain the data that is captured in the ICD-10-CM diabetes codes. WITH THE ICD-10-CM CODES IN THIS EXAMPLE, WE ARE ABLE TO USE ONE CODE TO CAPTURE DM AND THE MANIFESTATIONS++++WITH THE ICD-9-CM SYSTEM, WE WOULD HAVE TO USE TWO OR THREE CODES TO CAPTURE THE DATA 7. Determine which classification system and terminologies, ICD-9-CM or ICD-10-CM, are more beneficial. WHICH SYSTEM, ICD-9-CM or ICD-10-CM, DO YOU THINK IS MORE BENEFICIAL? 8. Understand examples of ICD-10-CM diabetes codes and how they provide more specificity of the data. CAN YOU SEE HOW ICD-10-CM CAPTURE AND REPRESENT MORE INFORMATION? IN A MORE EFFICIENT WAY? 9. Understand the documentation issues that arise with the conversion of ICD-9-CM to ICD-10-CM. IN ORDER FOR IT TO BE CODED, WE MUST HAVE DOCUMENTATION.

• E08.51 Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy without gangrene

• E08.52 Diabetes mellitus due to underlying condition

with diabetic peripheral angiopathy with gangrene • E08.59 Diabetes mellitus due to underlying condition

with other circulatory complications

E08.5_ DIABETES MELLITUS DUE TO UNDER UNDERLYING CONDITION WITH CIRCULATORY COMPLICATIONS

Presenter

Presentation Notes

E08.5 DIABETES MELLITUS DUE TO UNDER UNDERLYING CONDITION WITH CIRCULATORY COMPLICATIONS 6. Explain the data that is captured in the ICD-10-CM diabetes codes. WITH THE ICD-10-CM CODES IN THIS EXAMPLE, WE ARE ABLE TO USE ONE CODE TO CAPTURE DM AND THE UNDERLYING CAUSE OF THE DM WITH +ONE CODE+ 7. WHICH SYSTEM, DO YOU THINK WOULD BE MORE BENEFICIAL? 8. Understand examples of ICD-10-CM diabetes codes and how they provide more specificity of the data. CAN YOU SEE HOW ICD-10-CM CAPTURE AND REPRESENT MORE INFORMATION? IN A MORE EFFICIENT WAY? 9. Understand the documentation issues that arise with the conversion of ICD-9-CM to ICD-10-CM. IN ORDER FOR IT TO BE CODED, WE MUST HAVE DOCUMENTATION.

• E09.51 Drug or chemical induced diabetes mellitus with diabetic peripheral angiopahty without gangrene

• E09.52 Drug or chemical induced diabetes mellitus

with diabetic peripheral angiopahty with gangrene • E09.59 Drug or chemical induced diabetes mellitus

with other circulatory complications

E09.5_ DRUG OR CHEMICAL INDUCED DIABETES MELLITUS WITH CIRCULATORY COMPLICATIONS

Presenter

Presentation Notes

E09.5_ DRUG OR CHEMICAL INDUCED DIABETES MELLITUS WITH CIRCULATORY COMPLICATIONS 6. Explain the data that is captured in the ICD-10-CM diabetes codes. WITH THE ICD-10-CM CODES IN THIS EXAMPLE, WE ARE ABLE TO USE ONE CODE TO CAPTURE DM AND THE UNDERLYING CAUSE OF THE DM WITH +ONE CODE+ 7. WHICH SYSTEM, DO YOU THINK WOULD BE MORE BENEFICIAL? 8. Understand examples of ICD-10-CM diabetes codes and how they provide more specificity of the data. CAN YOU SEE HOW ICD-10-CM CAPTURE AND REPRESENT MORE INFORMATION? IN A MORE EFFICIENT WAY? 9. Understand the documentation issues that arise with the conversion of ICD-9-CM to ICD-10-CM. IN ORDER FOR IT TO BE CODED, WE MUST HAVE DOCUMENTATION.

Case 1: Inpatient admission

• The patient fell at his single-family home and was unable to get up. Neighbors found him several hours later, and he does not remember any circumstances surrounding the event. Blood sugars were monitored, and a diagnosis of diabetes mellitus was given. It became rapidly evident to the attending physician that, even with dietary restriction, the patient would need insulin therapy to lower his blood sugar level. Insulin therapy was started. The only other positive finding was beta-Streptococcus group B, which grew from the urine culture and was treated with oral antibiotics.

• Discharge diagnoses: 1) New onset type 2 diabetes mellitus, out of control; 2) urinary tract infection with beta-Streptococcus

Presenter

Presentation Notes

E11.22 Type 2 diabetes mellitus with diabetic chronic kidney disease 583.81 N39.0 UTI, site not specified�B95.1 Streptococcus, group B, as the cause of the diseases classified elsewhere�W19.xxxA Unspecified fall, initial encounter�Y92.099 Unspecified place in other non-institutional residence as the place of occurrence of the external cause

Case 2: Outpatient Clinic Visit • The patient with Type 2 diabetes was status post

cadaveric kidney and pancreatic transplants. He was being seen for follow-up of a recent below-the-knee amputation (BKA) of the foot and non-healing, gangrenous ulcer on his left foot secondary to diabetic peripheral vascular disease. The patient also has diabetic retinopathy with macular edema. The operative site was healing very nicely, and there was no evidence of infection

• Diagnosis: 1) Status post left foot amputation (Encounter), 2) status post kidney and pancreas transplants, 3) retinopathy, 4) diabetes mellitus

Presenter

Presentation Notes

Z09 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm�Z47.81 Encounter for orthopedic aftercare following surgical amputation E11.319 Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema Z94.0 Kidney transplant status, organ �Z94.83 Pancreas transplant status, organ�Z89.432 Acquired absence of left foot

Enhanced Mapping

Assistive EHR Mapping Locations • Billing (CPT, HCPCS) • Diseases and Problem Lists (ICD-9-CM v1 & v2, NLP) • Discharge Summaries (NLP) • History and Physicals (NLP, ICD-9-CM v1 and v2, RxNorm) • Medication Lists/Notes (NLP, RxNorm) • Office/Encounter Notes (NLP) • Operative Notes (NLP) • Pathology/Laboratory Reports (NLP, LOINC/Values) • Procedures/Notes (NLP, ICD-9-CM v3, CDT, Optometry

Procedure Codes) • Progress Notes (NLP)

Example Minimal Logical Model

Additional Assistive Mapping Sources

• Non-EHR Data Sources • Personal Health Records (PHR’s) • Health Information Exchanges (HIE’s)

• Mapping Sources • General Equivalence Mappings (GEM) • Unified Medical Language System (UMLS) • Domain experts • Research

• Recent publications, diagnostic tools, open-source data sources (eMERGE and PheKB) • eMERGE is a nationally organized and funded consortium seeking to develop methods and best

practices for the utilization of EHRs in genomic research • One output is a phenotype, which, in this case, in an EHR definition of a particular disease of

syndrome • PheKB is a knowledge repository for said phenotypes (not exclusive to eMERGE)

Potential Issues • No process is 100% accurate • Definitions vary by researcher • Natural Language Processing (NLP) in the health domain is very

challenging • Context awareness (regex vs negex)

– “The patient does not exhibit signs of macular edema.” • Temporal awareness

– E.g., mentioned in a note one encounter as a possibility, then negated the next encounter in a different note

• Conflicting data • Ambiguity (defaulting)

– E.g., not enough data

Useful Tools • General Equivalence Mapping (GEM) ICD-9-CM to ICD-10-CM and vice-versa (CMS)

– Predefined mappings (basic)

• ICD-9-CM Diagnosis and Procedure code full titles (CMS) – For expanding the search using like title terms

• Failed search for manifestation code(s) 585.1-6, 9 “chronic kidney disease” • Exploration: search for alternative diagnoses of “chronic kidney disease” – 285.21, 403.00, 403.01,

403.10, 403.11, 403.90, 403.91, 404.00-3, 404.10-13, 404.90-93

– Note: can do the same for CPT, RxNorm, etc. if desired

• UMLS – CPT, ICD-9-CM, ICD-10-CM/PCS, RxNorm, LOINC, MeSH, SNOMED CT

• Clinical NLP engine – cTAKES, MetaMap, MedLEE

• Database Management System or EHR access – For research, most likely a secondary database (e.g., EpicClarity)

• Familiarity with a programming language (e.g., Java) and SQL

De facto ICD-9-CM to ICD-10-CM Mapping

• Use CMS’s GEM files – ICD-9-CM to ICD-10-CM: forward search – ICD-9-CM as key

• Approximate one-to-one mapping 25040 E1129 10000

• Approximate one-to-many mapping 25042 E1121 10111 25042 E1165 10112

– ICD-10-CM to ICD-9-CM: reverse search – ICD-9-CM as value • There might be one ICD-9-CM to ICD-10-CM mapping, but ICD-10-CM to ICD-9-CM

might provide several, more specific alternatives if additional data is present • E1121 25040 10000

E1122 25040 10000 E1129 25040 10000

• 25042 does not exist in the file

– Co-occurring ICD-9-CM’s and/or manifestation codes

250.40 DIABETES WITH RENAL MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED

• GEM (within E10-11) – ICD-9-CM to ICD-10-CM (forward search)

• E11.29: Type 2 diabetes mellitus with other diabetic kidney complications

DEFAULT

– ICD-10-CM to ICD-9-CM (reverse search) • E11.21: Type 2 diabetes mellitus with diabetic nephropathy

– ICD-10-CM to ICD-9-CM: 250.40

• E11.22: Type 2 diabetes mellitus with diabetic chronic kidney disease

– ICD-10-CM to ICD-9-CM: 250.40

• E11.29: Type 2 diabetes mellitus with other diabetic kidney complications

– ICD-10-CM to ICD-9-CM: 250.40


• Additional information – E11.21: Type 2 diabetes mellitus with diabetic nephropathy

• ICD-9-CM to ICD-10-CM for a value of E11.21 specifically requires 250.42 with manifestation 583.81, so it is eliminated

– E11.22: Type 2 diabetes mellitus with diabetic chronic kidney disease

• Manifestation code(s): 585.1-6, 9 • Potential sources: diseases, problem list, associated notes (negation

check)

– E11.29: Type 2 diabetes mellitus with other diabetic kidney complications

• Default, no additional information required


• Example – Patient X is assigned 250.40 in the Problem List without a manifestation code – No additional information is present, so default to E11.29

– If exploration is allowed: • Search for “chronic kidney disease”: 285.21, 403.00, 403.01, 403.10, 403.11, 403.90,

403.91, 404.00-3, 404.10-13, 404.90-93 • A positive hit favors E11.22 over E11.29 (this essentially adds information to the mix, so

it must be validated) • Continuing with the example, Patient X is diagnosed with 403.90 Hypertensive chronic

kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified

• Result: E11.22 is now favored over the default E11.29 – Potential explanation: assigned 250.40 then 403.90 some time later without an update to the

problem list for 250.40


• GEM (within E10-11) – ICD-9-CM to ICD-10-CM (forward search)

• E11.311 OR E11.319 OR E11.36 OR E11.39 • AND E11.65: Type 2 diabetes mellitus with hyperglycemia DEFAULT: E11.39 (most generic) + E11.65

– ICD-10-CM to ICD-9-CM (reverse search) – only the OR’s are in question • E11.311: Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular

edema – ICD-10-CM to ICD-9-CM: 250.50 + 362.01 + 362.07

• E11.319: Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema

– ICD-10-CM to ICD-9-CM: 250.50 + 362.01

• E11.36: Type 2 diabetes mellitus with diabetic cataract – ICD-10-CM to ICD-9-CM: 250.50 + 366.41

• E11.39: Type 2 diabetes mellitus with other diabetic ophthalmic complication – ICD-10-CM to ICD-9-CM: 250.50

• Note: 250.50 (“not stated as uncontrolled”) + E11.65 = 250.52 (“uncontrolled”) per GEM


• Additional information – E11.311 (partial) and E11.319

• Check for 362.01 AND/OR • Implement the eMERGE Diabetic Retinopathy phenotype (find those undiagnosed)

– 362.01-07 or 362.10 (must be careful as 362.07 distinguishes E11.311 from E11.319), or any terms related to their definitions

• Potential sources : diseases, problem list, and associated notes (negation check)

– E11.311: Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema

• Previous plus 362.07 • Potential sources : diseases, problem list, and associated notes (negation check)

– E11.36: Type 2 diabetes mellitus with diabetic cataract • Potential sources : diseases, problem list, and associated notes (negation check)

– E11.39: Type 2 diabetes mellitus with other diabetic ophthalmic complication • Default, no additional information required


• Simple example – Patient X is assigned 250.52 in the Problem List and a manifestation

code of 366.41 (diabetic cataract) – supports E11.36 – E11.36 requires 250.50 + 366.41, 250.50 + E11.65 + 366.41 = 250.52 +

366.41 – Therefore, the mapping is valid: 250.52 + 366.41 => E11.36 + E11.65


• More complex example – Patient Y is assigned 250.52 in the Problem List with no manifestation code – Unspecified diabetic retinopathy (362.01), macular edema (362.07), and diabetic cataract

(366.41) are not located using their ICD-9-CM codes – Without additional information, default to E11.39

– Retinopathy: • An exploratory search using the eMERGE diabetic retinopathy phenotype produces a match: 362.03 –

favors E11.319 with partial fulfillment of E11.311

– Macular edema: • The patient has an optometry department encounter with the following excerpt from the encounter

note: “The patient does not exhibit signs of macular edema.” • Using NLP and negex, E11.311 is removed from contention with an express cause instead of simple

“lack of evidenced to support or refute”

– E11.319 requires 250.50 + 362.01 ≈ 250.50 + 362.03, 250.50 + E11.65 + 362.03 = 250.52 + 362.03

– Therefore, the mapping favors E11.319 (with eMERGE support for E11.319 and NLP refutation of E11.311) over the default E11.39

Prototype


• Simple example – Patient X is assigned 250.52 in the Problem List and a manifestation

code of 366.41 (diabetic cataract) – supports E11.36 – E11.36 requires 250.50 + 366.41, 250.50 + E11.65 + 366.41 = 250.52 +

366.41 – Therefore, the mapping is valid: 250.52 + 366.41 => E11.36 + E11.65


• More complex example – Patient Y is assigned 250.52 in the Problem List with no

manifestation code

– Unspecified diabetic retinopathy (362.01), macular edema (362.07), and diabetic cataract (366.41) are not located using their ICD-9-CM codes

– Without additional information, default to E11.39


– Retinopathy: • An expanded search using the eMERGE diabetic retinopathy phenotype

produces a match: 362.03 – favors E11.319 with partial fulfillment of E11.311


– Macular edema: • The patient has an optometry department encounter with the following excerpt from the

encounter note: “The patient does not exhibit signs of macular edema.”

• Using NLP and negex, E11.311 is removed from contention with an express cause instead of simple “lack of evidenced to support or refute”


– Retinopathy: Both E11.319 and E11.311 match

– Macular edema: Negation for E11.311

– Thus, E11.319 is favored

Review of the Agenda 1. Global use of ICD-10

2. Codes Used in this presentation

3. Background of the Diabetes Study

4. Outline the ICD-9-CM codes and descriptions to ICD-10-CM codes and descriptions for diabetes.

5. Explain the data that is uncaptured in the ICD-9-CM diabetes codes.

6. Explain the data that is captured in the ICD-10-CM diabetes codes.

7. Determine which classification system and terminologies, ICD-9-CM or ICD-10-CM, are more beneficial.

8. Understand examples of ICD-10-CM diabetes codes and how they provide more specificity of the data.

9. Understand the documentation issues that arise with the conversion of ICD-9-CM to ICD-10-CM.

10. Determine locations in the EHR that could contain additional information to assist in more specific mappings

©2015

Questions or Comments?

References Becks, Lori, RHIA, AHIMA. (2014). Coding for diabetes. Medical Economics, 91(11), 46-48. Retrieved from http://search.proquest.com.jproxy.lib.ecu.edu/docview/1542126487?accountid=10639 Center for Medicare & Medicaid Services. General Equivalence Mappings. http://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-CM-and- GEMs.html. Accessed: May 30, 2015. DiSantostefano, J. (2010). ICD-10 coding for diabetes mellitus. The Journal for Nurse Practitioners, 6(7), 553-554. http://dx.doi.org/10.1016/j.nurpra.2010.04.001 Harris, S. T. (2009). The impact of a spirituality on persons with diabetes: The impact of spirituality on health conditions of persons with diabetes in Eastern North Carolina. Koln, Germany: LAP Lambert Academic Publishing. eMERGE Network. Electronic Medical Records and Genomics (eMERGE). https://emerge.mc.vanderbilt.edu/ Accessed: May 30, 2015. National Library of Medicine. MetaMap. http://metamap.nlm.nih.gov/ Accessed: May 30, 2015.

http://search.proquest.com.jproxy.lib.ecu.edu/docview/1542126487?accountid=10639

http://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-CM-and-GEMs.html

http://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-CM-and-GEMs.html

http://dx.doi.org/10.1016/j.nurpra.2010.04.001

https://emerge.mc.vanderbilt.edu/

https://emerge.mc.vanderbilt.edu/

http://metamap.nlm.nih.gov/

http://metamap.nlm.nih.gov/

Contact Information

Susie Harris, PhD, RHIA, CCS [email protected] Ray Hylock, PhD [email protected] http://www.ecu.edu/cs-dhs/hsim/hiim.cfm

Presenter

Presentation Notes

mailto:[email protected]

mailto:[email protected]

http://www.ecu.edu/cs-dhs/hsim/hiim.cfm



Documents

NCHIMA 66th Annual Meeting€¦ · specific mappings ©2015 . Global use of ICD-10: Catching up with the industrialized world . Poland . Thailand . United States . Iceland . Denmark