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How To Find The Right ICD-10 Code

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Page 1: How To Find The Right ICD-10 Code
Page 2: How To Find The Right ICD-10 Code

ICD-10 Boot Camp

Part 3 - Code Selection Strategies

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Presented by Evan M. Gwilliam, DC MBA BS CPC CCPC NCICS CCCPC CPC-I MCS-P CPMA

Chief Product Officer

Page 3: How To Find The Right ICD-10 Code

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Dr. Evan Gwilliam

• Education• Bachelor’s of Science, Accounting - Brigham Young University• Master’s of Business Administration - Broadview University• Doctor of Chiropractic, Valedictorian - Palmer College of

Chiropractic

• Certifications• Certified Professional Coder (CPC) - AAPC• Nationally Certified Insurance Coding Specialist (NCICS) - NCCT• Certified Chiropractic Professional Coder (CCPC) - AAPC• ChiroCode Certified Chiropractic Professional Coder (CCCPC) -

ChiroCode• Certified Professional Coder – Instructor (CPC-I) - AAPC• Medical Compliance Specialist – Physician (MCS-P) - MCS• Certified Professional Medical Auditor (CPMA) – AAPC, NAMAS• Certified ICD-10 Trainer - AAPC

Page 4: How To Find The Right ICD-10 Code

Overview• Part 1 - ICD-10 fundamentals and navigation• Part 2 - Coding conventions and guidelines• Part 3 - ICD-10 code selection strategies• Part 4 - Documentation improvement

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Page 5: How To Find The Right ICD-10 Code

1. Common codes list(but don’t stop there!)

2. GEMs code map (don’t stop here either!)

3. Alphabetic Index(still not safe!)

Always confirm the code using the Tabular List

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Find the code

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1. Common Codes

Page 8: How To Find The Right ICD-10 Code

2. GEMs

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Page 9: How To Find The Right ICD-10 Code

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2. GEMsGeneral Equivalence Mappings (GEMs)

o Created by the National Center for Health Statistics, part of the CDC

o Forward maps from ICD-9 to ICD-10

o Backward maps from ICD-10 to ICD-9

o Approximations only

Page 10: How To Find The Right ICD-10 Code

3. Alphabetic Index

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Page 11: How To Find The Right ICD-10 Code

Example #1Patient is an 18-month old fussy, white female with a three-day history of otalgia, runny nose and fever of 100. There is no exposure to tobacco smoke. Otoscopic examination reveals acute serous otitis media of the right ear. Assessment: Acute serous otitis media, right ear. On September 30, 2015, the diagnosis is 381.01 Acute serous otitis media.

On October 1, 2015, it is:

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Page 12: How To Find The Right ICD-10 Code

1. Common codes list(but don’t stop there!)

2. GEMs code map (don’t stop here either!)

3. Alphabetic Index(still not safe!)

Always confirm the code using the Tabular List

12

Find the code

Page 13: How To Find The Right ICD-10 Code

1. Common Codes

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Page 14: How To Find The Right ICD-10 Code

1. Common codes list(but don’t stop there!)

2. GEMs code map (don’t stop here either!)

3. Alphabetic Index(still not safe!)

Always confirm the code using the Tabular List

14

Find the code

Page 15: How To Find The Right ICD-10 Code

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2. GEMs

Page 16: How To Find The Right ICD-10 Code

1. Common codes list(but don’t stop there!)

2. GEMs code map (don’t stop here either!)

3. Alphabetic Index(still not safe!)

Always confirm the code using the Tabular List

16

Find the code

Page 17: How To Find The Right ICD-10 Code

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3. Alphabetic Index

Page 18: How To Find The Right ICD-10 Code

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3. Alphabetic Index

Page 19: How To Find The Right ICD-10 Code

1. Common codes list(but don’t stop there!)

2. GEMs code map (don’t stop here either!)

3. Alphabetic Index(still not safe!)

Always confirm the code using the Tabular List

19

Find the code

Page 20: How To Find The Right ICD-10 Code

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Tabular List

Page 21: How To Find The Right ICD-10 Code

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Tabular List

Page 22: How To Find The Right ICD-10 Code

Example #1Patient is an 18-month old fussy, white female with a three-day history of otalgia, runny nose and fever of 100. There is no exposure to tobacco smoke. Otoscopic examination reveals acute serous otitis media of the right ear. Assessment: Acute serous otitis media, right ear. On September 30, 2015, the diagnosis is 381.01 Acute serous otitis media

On October 1, 2015, it is: H65.01 Acute serous otitis media, right ear

NOTE:• Common codes lists are just an expert guess• GEMs often leads to unspecified codes• Alphabetic Index often gives incomplete or multiple options 22

Page 23: How To Find The Right ICD-10 Code

1. Common codes list(but don’t stop there!)

2. GEMs code map (don’t stop here either!)

3. Alphabetic Index(still not safe!)

Always confirm the code using the Tabular List

23

Find the code

Page 24: How To Find The Right ICD-10 Code

The next step for converting to ICD-10

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1. Go to the Tabular Listo Look at the following:

1. Notes2. Includes and alternative wording3. Excludes14. Excludes25. Code Also, Code First, Use Additional6. Seventh character extensions

2. Repeat at the level of the code, then the subcategory, category, block, and chapter

3. Reverse map for confirmation if necessary

Page 25: How To Find The Right ICD-10 Code

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Tabular List

Page 26: How To Find The Right ICD-10 Code

Example #2This 30-year old white male sustained a right knee injury while playing basketball on Saturday. He was seen in our urgent care clinic and sent for MRI of the right knee to rule out meniscal tear. MRI revealed right bucket-handle medial meniscal tear and tear of the anterior cruciate ligament (ACL). Patient will be scheduled for surgery on Tuesday.

On September 30, 2015, the diagnosis is 836.0 Bucket handle tear, meniscus, knee

On October 1, 2015, it is:

26

Page 27: How To Find The Right ICD-10 Code

1. Common codes list(but don’t stop there!)

2. GEMs code map (don’t stop here either!)

3. Alphabetic Index(still not safe!)

Always confirm the code using the Tabular List

27

Find the code

Page 28: How To Find The Right ICD-10 Code

1. Common Codes

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?

Page 29: How To Find The Right ICD-10 Code

1. Common codes list(but don’t stop there!)

2. GEMs code map (don’t stop here either!)

3. Alphabetic Index(still not safe!)

Always confirm the code using the Tabular List

29

Find the code

Page 30: How To Find The Right ICD-10 Code

1. Common Codes

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2. GEMs

Page 31: How To Find The Right ICD-10 Code

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Tabular List

Page 32: How To Find The Right ICD-10 Code

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2. GEMs

Page 33: How To Find The Right ICD-10 Code

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Tabular List

Page 34: How To Find The Right ICD-10 Code

1. Common codes list(but don’t stop there!)

2. GEMs code map (don’t stop here either!)

3. Alphabetic Index(still not safe!)

Always confirm the code using the Tabular List

34

Find the code

Page 35: How To Find The Right ICD-10 Code

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3. Alphabetic Index

Page 36: How To Find The Right ICD-10 Code

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Tabular List

Page 37: How To Find The Right ICD-10 Code

The next step for converting to ICD-10

37

1. Go to the Tabular Listo Look at the following:

1. Notes2. Includes and alternative wording3. Excludes14. Excludes25. Code Also, Code First, Use Additional6. Seventh character extensions

2. Repeat at the level of the code, then the subcategory, category, block, and chapter

3. Reverse map for confirmation if necessary

Page 38: How To Find The Right ICD-10 Code

The next step for converting to ICD-10

38

1. Go to the Tabular Listo Look at the following:

1. Notes2. Includes and alternative wording3. Excludes14. Excludes25. Code Also, Code First, Use Additional6. Seventh character extensions

2. Repeat at the level of the code, then the subcategory, category, block, and chapter

3. Reverse map for confirmation if necessary

Page 39: How To Find The Right ICD-10 Code

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Tabular List

Page 40: How To Find The Right ICD-10 Code

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Tabular List

Page 41: How To Find The Right ICD-10 Code

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Tabular List

Page 42: How To Find The Right ICD-10 Code

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Page 43: How To Find The Right ICD-10 Code

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Page 44: How To Find The Right ICD-10 Code

The next step for converting to ICD-10

44

1. Go to the Tabular Listo Look at the following:

1. Notes2. Includes and alternative wording3. Excludes14. Excludes25. Code Also, Code First, Use Additional6. Seventh character extensions

2. Repeat at the level of the code, then the subcategory, category, block, and chapter

3. Reverse map for confirmation if necessary

Page 45: How To Find The Right ICD-10 Code

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Page 46: How To Find The Right ICD-10 Code

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Tabular List

Page 47: How To Find The Right ICD-10 Code

Example #2This 30-year old white male sustained a right knee injury while playing basketball on Saturday. He was seen in our urgent care clinic and sent for MRI of the right knee to rule out meniscal tear. MRI revealed right bucket-handle medial meniscal tear and tear of the anterior cruciate ligament (ACL). Patient will be scheduled for surgery on Tuesday.

On September 30, 2015, the diagnosis is 836.0 Bucket handle tear, meniscus, knee

On October 1, 2015, it is:S83.212A Bucket handle tear of medial meniscus, right knee

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Page 48: How To Find The Right ICD-10 Code

34 specialty specific ICD-10 books• More than 70 pages which

teach• Conventions• Guidelines• Implementation steps• Documentation

strategies• Provider Documentation

Guides• Specialty specific

• GEMs mapping• Alpha Index• Abridged Tabular List

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