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October, 2012
ICD-10-CM/PCSWhat does it mean to us?
Lynda Starbuck, MS, RHIA, C-CDIAHIMA Approved ICD-10-CM/PCS Trainer
ICD-10 TimelineOctober 1, 2011 - Last full update to ICD-9-
CM and ICD-10 (revised with implementation delay)
January 1, 2012 - 5010 electronic claims submission
October 1, 2014 - ICD-10 codes required on all discharges (NEW DATE)
October, 2012
October, 2012
ICD-10-CM/PCS What is it?ICD-10-CM
US clinical modification of the World Health Organization’s ICD-10Diagnostic coding system (no procedure codes)
ICD-10-PCSDeveloped under contract by CMS specifically to replace the ICD-9-CM procedural coding system
ICD-10-CM Code StructureAlphanumericUp to 7 charactersPlace holders of “x” are used when code is
5 characters and needs a seventh character code extension
21 chapters and codes are dispersed differently
V and E codes are incorporated into the main code
October, 2012
October, 2012
ICD-10-CM Code ExtensionsCODE
S73.011A– Posterior subluxation, right hip, initial encounter
064.0XX1- Obstructed labor due to incomplete rotation of fetal head, fetus 1 of multiple
MEANING
Initial encounter, subsequent encounter, sequela
Fetus number
October, 2012
ICD-9-CMFull Code Titles
ICD-9-CM
802. Fracture malar, maxillary and zygoma bones- 802.4 Closed- 802.5 Open
ICD-10-CM S02.4
- S02.40 – Fracture of malar, maxillary, and zygoma bones, unspecified- S02.400 Malar Fracture, unspec.- S02.401 Maxillary Fracture, unspecified- S02.402 Zygomatic fracture, unspecified- S02.41 LeFort fracture - S02.411 LeFort I fracture - S02.412 LeFort II fracture - S02.413 LeFort III fracture
October, 2012
New FeaturesCombination codes for conditions and
common symptoms or manifestationsCombination codes for poisonings and
external causesAdded lateralityExpanded codes (injury, diabetes,
alcohol/substance abuse, postoperative complications)
Impending/threatening condition codes
Injuries grouped by anatomical site rather than injury category
Official Coding Guidelines Chapter SpecificInfectious Disease
- Urosepsis is a non-specific term – no reference in the alpha index- Post-procedural infection by procedure
Mental and Behavioral Disorders- Added disorders due to psychoactive substance use
Nervous System and Sense Organs- Hemiplegia/hemiparesis – new rule for
dominant vs. non-dominant sides
October, 2012
Chapter Specific Guidelines continued…Circulatory System
- MI timeframes reduced to 4 weeks vs. 8- Causal relationship assumed between CAD and Angina
Obstetrics- Trimester indicated in code (or weeks of
gestation)- Fetal extension – used to distinguish to
which fetus complication applies
October, 2012
Chapter Specific Guidelines continued…Injuries
- Code extensions used to indicate what phase of care the patient is receiving (initial, subsequent, or sequela)
Adverse effects / Poisonings- Includes under-dosing- Codes indicate how the adverse effect
occurred
October, 2012
October, 2012
ICD-10-PCSCode Structure 1st character is the Section2nd character is the Body System
3rd character is the Root Operation4th character is the Body Part 5th character is the Approach6th character is the Device7th character is the Qualifier
ICD-10-PCS Code ExamplePTCA with Stent RCA
- Root Term – Dilation= Dilation
- Artery >> Coronary
>> Four or more sites 0273
>> One site 0270>> Three sites 0272>> Two sites 0271
October, 2012
ICD-10-PCS Code Example… 027 table
October, 2012
ICD-10-PCS Obstetric Delivery- ForcepsExtraction –pulling or stripping out or off
all or a portion of a body part (10D)- Products of Conception (10DO) - Via Natural or Artificial Opening (10DO7)
- No Device (10D07Z)>> Qualifier – Mid Forceps-4ICD-10-PCS Code 10D07Z4
October, 2012
October, 2012
Impact of ICD-10-CM/PCSHospitalsPotentially have the most system
changesAdvantage in added detail (to identify
severity and reduced billing paperwork)Large learning curve for coders (no
Coding Clinic guidance as of Oct.,2013)More physician specificity required –
thus more queriesDRG ‘s / CC’s / MCC’s – have not been
formulated for ICD-10 codes.
October, 2012
IMPACTHealthcare Providers
Non-inpatient facilities including physician offices will only use ICD-10-CM, not ICD-10-PCS
CPT will continue to be used by Part B providers to describe procedures (all outpatient claims)
Physicians will be asked to document specificity and detail
Physicians offices will have to learn ICD-10-CM (diagnosis only)
Training and new materials costRevising Super Bills
Staff Training and PreparationLimited knowledge to Business office,
Registration staff, Radiology, Lab, Unit secretaries, and IT staff who support coding software.
Intermediate knowledge to Hospital Administration, Physicians, Finance, Rehabs, Home Health, Hospice, Case Management, and Outpatient Diagnostic coders
High levels of knowledge to Inpatient coders, Outpatient Surgical Coders, Quality, Chief Medical Officer, Educators, Documentation Improvement Managers, and CDI Staff/Nurses.
October, 2012
What should we be doing now?Conduct an ICD-10 update once a month in
RAC/UR CommitteeCDI Chart Reviews – early identification of
high-impact areasCreation of Queries for ICD-10 in relation to
top 10-15 DRG’s
October, 2012
Impact of ICD 10 CMAcute Care HospitalsRequired to use ICD-10-CM and ICD-10-PCSPotentially have the most system changesAdvantage in added detail (to identify severity
and reduce billing paperwork)Coder productivity is predicted to decrease by
1/3 for potentially up to 2 years.Medical Staff will be required to document more
accurately
October, 2012
IMPACT continued…Coding System Changes
- Data trending challenges include maintenance of crosswalks among coding systems for longitudinal data analysis and the potential for faulty decisions due to distorted, inaccurate, or misinterpreted data
Other Healthcare Providers-Non-inpatient facilities including physician offices will only use ICD-10-CM, not ICD-10-PCS-CPT will continue to be used by Part B providers to describe procedures (outpatient claims)
October, 2012
Why ICD 10 Is Worth The TroubleMoving to the new code sets will permit improved efficiencies and
lower administrative costs due to replacement of a dysfunctional classification system. This in turn allows:
Increased use of automated tools to facilitate the coding process Decreased claims submission or claims adjudication costs Fewer rejected and improper reimbursement claims Greater interoperability Decreased need for manual review of health records to meet the
information needs of payers, researchers, and other data mining purposes
Decreased need for large research organizations to maintain dual classification systems (one for reimbursement and one for research)
Reduced coding errors Reduced labor costs and increased productivity Increased ability to prevent and detect healthcare fraud and
abuse
October, 2012
ICD 10 Training ProposalICD 10 IntroductionExplanation of ICD 10, Benefits/Goals,
Expectations, Deadlines (We suggest that All attend)
Location: Webinar or on-site. Time expectation: 45 minute to 1 hour
plus 15 min for test. Up to 3 separate sessions to allow for time
constraints of attendees.
October, 2012
Track 1:ICD History; ICD 10 basics; Comparison to
ICD 9; ICD 10 structure and format; Conventions and Guidelines.
Medical Terminology
Basic Anatomy and Physiology
Advanced Anatomy and Physiology
October, 2012
Track 2:ICD History; ICD 10 basics;
Comparison to ICD 9; ICD 10 structure and format; Conventions and Guidelines.
Advanced Anatomy and Physiology
October, 2012
Track 3:ICD History; ICD 10 basics; Comparison to ICD 9; ICD
10 structure and format; Conventions and Guidelines.
CDI: What’s in it for me? Provider and facility profiling; Value based purchasing of Healthcare
CDI : What is CDI and the requirements under ICD 10
CDI: OP and IP documentation Tips under ICD 10
CDI: Comparison of documentation of common diagnoses under ICD 19 and ICD 10
October, 2012
Track 4: ICD History; ICD 10 basics; Comparison to ICD 9; ICD 10
structure and format; Conventions and Guidelines.
Financial Implications and Reimbursement under ICD 10
Assess ICD 10 impact on claims processing and productivity
Identifying front-end edits based on the new ICD 10 code logic
Develop action plans for post implementation payment issues (includes cross-walking both coding systems)
Assess ICD 10 impact on both the inpatient and outpatient revenue cycles
Update medical necessity coverage determination policiesOctober, 2012
Track 5:ICD History; ICD 10 basics; Comparison to ICD 9; ICD
10 structure and format; Conventions and Guidelines.
Coding Essentials for ICD 10
Assess ICD 10 impact on both internal and external review criteria
Assess impact on Trauma Registries, Tumor Registries, and other clinical research provided to external agencies.
Training clinic staff and coders in basic ICD-10-CM
coding (ICD-10-PCS if necessary)
October, 2012
WHO SHOULD ATTEND WHICH TRACK? (Suggestions only)
ICD 10 Introduction: Hospital/Clinic Staff wide attendanceTrack 1: Nurses, coders, Transcriptionists, Radiology, Lab,
Case management, Utilization ReviewTrack 2: Nurses, coders, Transcriptionists, Radiology, Lab,
Case management, Utilization ReviewTrack 3: Physicians, Nurses, Case Management, Utilization
Review Committee , HIM StaffTrack 4: HIM Staff, Case Management, Utilization Review,
Business office/Finance, AdministrationTrack 5: HIM staff, UR committee, Coders, Business Office
Note: There will be a short test after every session for every topic in each track.
October, 2012
Webinars and on-site training sessions will be presented by:
Terrance Govender MD, MBBCh, CHBC, C-CDI
HCCS - Director of Medical Consulting
Lynda Starbuck MS, RHIA, C-CDI AHIMA Certified ICD-10 Trainer
HCCS -VP Coding Services
October, 2012
ReferencesICD-10-CM/PCS – The Complete Official
Draft Code Set, Draft 2011MLN Matters/CMSCDI: Improve Documentation Now for
Effective Transition Later – HCPro, Inc. "Why ICD-10 Is Worth the Trouble." Journal
of AHIMA 79, no.3 (March 2008): 24-29.AHIMA ICD-10-CM/PCS Update (April, 2011)Journal of AHIMA (2011 and 2012)
October, 2012
