Tips hints to prepare for the HCS D ICD 10 certification exam · 5|Tips & hints to prepare for the HCS‐D ICD‐10 certification exam Legal and Ethics • Understanding and applying

1 |Tips & hints to prepare for the HCS‐D ICD‐10 certification exam

Tips & hints to prepare for the HCS‐D ICD‐10 certification exam

Megan Gustafson, HCS‐D


Generalities• ICD‐10 Certification Exam:

– 80 multiple choice questions

– 3.0 hours

– Passing percentage – 74% (changes each year)

• Recertification:

– Annually

– 20 CEU’s

10 from online self assessment reviews

10 from other educational activities (e.g. webinars, conferences)

• Testing whether the coder knows the conventions and the guidelines so principles may be applied correctly


ICD‐10 Content Areas

• Assign Accurate Diagnosis Codes 65%

• Ensure that all Activities are done in a Legal and Ethical Manner 15%

• Collect Patient Documentation 10%

• Collaborate with Clinicians Physicians and Administrators 10%


Collect Patient Documentation

• Coder collects the OASIS assessment, physician H&P, medication record, F2F documentation and the hospital discharge summary.

• Which of these is the least important in the coding process?


Legal and Ethics

• Understanding and applying legal and ethical issues related to coding

• Example: Administrator says to you, the coder, reimbursement is down last quarter and they have determined it is because of your coding. From now on, the administrator says, you should always code HTN as a combination code to capture the clinical points

• What should the coder do?


Collaboration with Clinician

• The OASIS assessment has the pressure ulcer section completed indicating the patient has a stage 3 pressure ulcer. The narrative states the patient has a stage 3 diabetic ulcer. In speaking with the nurse, she says, it’s a diabetic ulcer, code it as such.

• What should the coder do?


OASIS, Coding and Relationship to PPS

OASIS data set used to collect assessment data for case mix adjustment

ALL diagnoses must match across three forms – 485, OASIS, and claim form (UB‐04)

Diagnoses must match on RAP and final claim

Coding on OASIS: M1011, M1017, M1021, M1023

Codes in M1021/M1023 and UB‐04 (claim) must be compliant with Official Coding Guidelines

Know the definitions of primary and secondary diagnoses


M1021a…

Primary (chief) reason for skilled services

Main focus of care


What we know about M1023b‐f

• Secondary diagnoses – Those addressed in the POC

– Co‐morbidities that will impact or be impacted by the POC even if no home health treatment

– Avoid listing those of historical interest only

• There may be more secondary diagnoses than there are M1023 spots. (Other pertinent diagnoses)


Diagnoses and Degree of Symptom Control

OASIS requires Degree of Symptom Controlratings from 0‐4Do not sequence according to degree of symptom controlNo degree of symptom control ratings on test

List diagnoses in M1021/M1023 based on the seriousness of condition to the home health plan of care

Clinician determines diagnoses, Degree of Symptom Control and sequence.A coder may assign a code.


Basics• Implementation date?

• First real update?

• Codes have to match on the OASIS, POC and claim

• Read information on OASIS Correction– What happens if one document requires correction?

– Who has to approve corrections?

• Documentation to be reviewed for coding: history and physical, any referral information, including physician orders, assessment, medication list. F2F may not be available for a lengthy period of time.


Basics• The assessing clinician should choose the primary focus of care and the secondary diagnoses.

• OASIS M1011—Diagnoses actively treated

• OASIS M1017—Don’t list diagnoses if completely resolved (simplified)


Conventions & Guidelines• Excludes 1 and Excludes 2 notes

• Includes

• 7th character

– What is the default?

• Laterality—right, left, bilateral. Don’t use right AND left when there is a bilateral choice.

• Combination codes

– Diabetic manifestations

– Combination infections such as Staph

– pneumonia


Conventions & Guidelines• Sequencing:

• Etiology/manifestations

– What are the conventions?

• Code first…

• Use additional code…

• Code also…

• Guidelines

• Sequelae sequencing


Sequela• General Rule: Code what you see first and the sequela code (original injury with an S or original illness, e.g. polio) comes later.

• G81.11 Spastic hemiplegia affecting right dominant side

• S06.5x9S Traumatic subdural hemorrhage with loss of consciousness of unspecified duration, sequela

• Code the sequela code first when what you ‘see’ cannot go first (manifestation code).

• E64.3 Sequela of rickets

• M49.82 Spondylopathy in diseases classified elsewhere

• Sequelae of cerebrovascular accidents• I69.398 Other Sequelae of cerebrovascular accident

• M62.81 Muscle weakness


Assumed Relationships

• No assumed relationship between diabetes and gangrene

• No assumed relationship between diabetes and osteomyelitis

• Assumed relationships in ICD‐10:

– Hypertension and CKD

– Osteoporosis and fractures

– ASHD (CAD) and angina


Diagnoses based on information from physician (provider)

• Confirmed, verified

• Diagnoses supported by documentation before assigning and after assignment (interventions on the POC and implemented in notes)

• Exceptions:

– BMI,

– pressure ulcer stage,

– severity of non‐pressure ulcers


A and B Codes Made Simple

• A codes generally are coded first (sepsis)

• B codes 95, 96 and 97 are sequenced after what is infected.

• These categories are provided for use as supplementary or additional codes to identify the infectious agent(s) in diseases classified elsewhere.


Neoplasms

• Anemia and neoplasms

– Anemia associated with neoplasm

– Anemia as adverse effects of treatments

• Neoplasms in a transplanted organ

• Typical neoplasms—primary and secondary sites

• History

• Remission


Diabetes

• Types and manifestations

• Combination codes except for:

– CKD

– Gastroparesis

– Ulcers

– Osteomyelitis

• Read and understand the guidelines


Circulatory• Angina and ASHD/CAD

• MI for how long?

• I21 for initial MI and I22 for subsequent MIs

• Default codes for MIs when no site is specified

• Site is more important than STEMI and NSTEMI

• Heart failure—types

– Systolic heart failure and CHF coded as…???


COPD

• Pay attention to includes notes

• Pay attention to excludes 1 and excludes 2 notes

• Should always reference alpha index to see where it leads you.

• Lower respiratory infec on ≠ exacerba on

• May code J44.1 with a J44.0.


Skin• Different types of ulcers

– Diabetic ulcers– Pressure ulcers– Venous stasis ulcers– Arterial ulcers

‐ limited to breakdown of skin‐ fat layer exposed‐ necrosis of muscle‐ necrosis of bone‐ unspecified severity


Symptoms, Signs,…

• Do not code signs and symptoms that are integral to the condition

– Unless there is an instruction to also code symptoms

• If not integral to the condition, code separately

• If integral and from chapter 18, with an instructional note, code after the definitive condition


Injuries and Poisonings

• Poisonings

• Adverse effects, such as allergic reactions

• Underdosing

• All require 7th character


Injuries and Poisonings

• 7th character for injuries

• 7th character for fractures

– No aftercare—choose ‘D’ as 7th character

• Fractures

– Other defaults

• Displaced

• Closed

– Trauma vs pathologic


Complications

• Identified or verified by the physician

– Cannot be coded based on OASIS responses

• Catheter associated UTIs

• Joint replacements/explantations

• Ostomy complications


Common Mistakes

• Missing or incorrect 7th character based on information available

• Not reading the includes/excludes notes

• Use of NOS when specific information is available

• Laterality—right, left, bilateral. Don’t use right AND left when there is a bilateral choice.

• Combination codes– Diabetic manifestations

– Combination infections such as Staph pneumonia


Read All Questions Carefully

Underline, highlight important instructions

You may assume that scenarios are describing physician‐confirmed

diagnoses


What is the primary focus of care in the

scenario?


Do NOT Upcode!!!


Look up all codes, unless you’re absolutely sure of the code and

instructional notes!


Read all the notes, especially those regarding exclusions, 5th, 6th, and 7th

character requirements, ‘code first’ and ‘use additional code.’

REMEMBER…read everything…it all means something!


Pay attention to M1021, M1023Pay attention to 2015 guidelines


Multiple choice

Eliminate the wrong answers

Choose the best answer


Types of Questions

Which of the following is an example of…?

Which of the following is the correct sequence?

Which of the following is true?Which of the following is correct?

Which of the following is false?Which of the following is incorrect?Note: If any part of the statement is not true, then the whole thing

is not true!


Be sure to use a currentcoding manual!

IDs and books will be checked

No Sticky Notes are allowedNo Electronic Devices are allowed


What’s Allowed

• Electronic code look‐up systems are NOT allowed in the testing room. A hard copy coding manual is the only allowed resource.

• The hard copy coding manual may have tabular section dividers (A through Z) that are affixed.

• You may have annotations written on the coding manual pages including the notes pages at the back of the manual but they must be free of any notes containing coding rules and guidelines from other reference materials (for example, Coding Clinic, Home Health ICD‐10‐CM Coding Answers, and similar materials).


What’s Not Allowed

• NOT ALLOWED:

• Alphabetical section dividers

• Post‐It notes

• Loose papers or any other papers attached by any means

• The testing center staff or exam proctor reserves the right to deny code books that contain excessive writing and information that may give the candidate an unfair advantage.





What Questions Do You Have?

Megan Gustafson, HCS‐DExecutive Editor, Diagnosis Coding Pro for Home Health

Junior Product Manager, Coding DivisionDecision Health

Link to presentation materials:

http://decisionhealth.com/ahcc/webinars/09‐17‐15/dlAHCC091715.html

[email protected]

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Tips hints to prepare for the HCS D ICD 10 certification exam · 5|Tips & hints to prepare for the HCS‐D ICD‐10 certification exam Legal and Ethics • Understanding and applying