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What Physicians Need To Know
• Claims for ambulatory and physician services provided on or after 10/1/2015 must use ICD-10-CM diagnosis codes.
• Hospital inpatient claims for discharges occurring on or after 10/1/2015 must use ICD-10-CM diagnosis codes.
• CPT Codes will continue to be used for physician inpatient and outpatient services and for hospital outpatient procedures.
• ICD-10-PCS – a NEW procedure coding classification system, must be used to code all inpatient procedures on Facility Claims for discharges on or after 10/1/15.
• ICD-9-CM codes must continue to be used for all dates of services on or before 9/30/2015.
• Further delays are not likely.
ICD-9 vs ICD-10 Diagnosis Codes
ICD-9-CM Diagnosis Codes ICD-10-CM Diagnosis Codes
3 to 5 digits 7 digits
Alpha “E” & “V” – 1st Character Alpha or numeric for any character
No place holder characters Include place holder characters (“x”)
Terminology Similar
Index and Tabular Structure Similar
Coding Guidelines Somewhat similar
Approximately 14,000 codes Approximately 69,000 codes
Severity parameters limited Extensive severity parameters
Does not include laterality Common definition of laterality
Combination codes limited Combination codes common
Number of Codes by Clinical Area
Clinical Area ICD-9 Codes ICD-10 Codes
Fractures 747 17,099
Poisoning and Toxic Effects 244 4,662
Pregnancy Related Conditions 1,104 2,155
Brain Injury 292 574
Diabetes 69 239
Migraine 40 44
Bleeding Disorders 26 29
Mood Related Disorders 78 71
Hypertensive Disease 33 14
End Stage Renal Disease 11 5
Chronic Respiratory Failure 7 4
Right vs. left
accounts for nearly ½
the increase in the #
of codes.
ICD-10-CM EnhancementsLocation and Laterality
ICD-9-CM Code Choices ICD-10 Code Choices
Cellulitis of upper arm and forearm. • Cellulitis of right axilla• Cellulitis of left axilla• Cellulitis of right upper limb• Cellulitis of left upper limb• Cellulitis of unspecified part of limb
250.61Type I Diabetes with
Neurological Manifestations
357.2Diabetic Polyneuropathy
E10.42Type I Diabetes Mellitus
with Diabetic Polyneuropathy
ICD-10-CM EnhancementsCombination Codes
ICD-10-CM EnhancementsAcuity, Type and Circumstances
Acuity Type Circumstances
• Acute• Chronic• Acute on Chronic
• Left Ventricular• Systolic• Diastolic• Combined
• Following Surgery• Due to Hypertension• Due to Chronic Kidney Disease
For example, a patient with dyspnea
referred for a chest x-ray to rule out
congestive heart failure.
Information Needed Required ICD-10 Documentation
• How did the injury occur?• What type of injury was sustained?• What activity was taking place?• When did the injury occur in
relation to this encounter?• Where was the patient when the
injury occurred?• Why was the activity happening?
32-year-old female S/P external fixation right displaced pilon fracture due to jumping from her second story bedroom window in a suicide attempt. Fracture shows nonunion four weeks post op.
Here for additional surgical intervention.
ICD-10-CM EnhancementsCircumstances Surrounding Injuries
For example, fracture
resulting from suicide
attempt.
Anemia Cardiomyopathy Headache
• Nutritional• Hemolytic• Aplastic• Blood Loss
• Dilated/Congestive• Obstructive
Non-obstructive• Endomyocardial fibrosis
• Cluster• Tension• Post-traumatic• Drug-induced
ICD-10-CM EnhancementsType
The specific type of a patient’s disease may
impact treatment and medical necessity for
services rendered.
DIABETES COPD CANCER ARTHRITIS
• Skin Ulcers• Gout• Kidney
Disease• PVD• Eye Problems
• Malnutrition• Pneumonia• Musculoskeletal
Changes• CHF
• Anemia• Depression• Malnutrition• Thrombosis
• Lung Disease• Heart Disease• Skin Problems• Sickle Cell
Disease• Hypothyroidism
ICD-10-CM EnhancementsUnderlying and Associated Conditions
Accurate and complete documentation
includes underlying or associated conditions
and their impact on diagnostic findings.
Major Changes in ICD-10-CM
Acuity
Circumstances Surrounding Injuries
Combination Codes
Identification Affected Fetus
Laterality
Site
Trimester
Type
Underlying and associated Conditions
ICD-10-CM EnhancementsSpecificity and Granularity
Using Sign/Symptom and Unspecified Codes
• Sign/symptom and “unspecified” codes have acceptable, even necessary, uses.
• If a definitive diagnosis has not been established by the end of the encounter, it is appropriate to report codes for signs and/or symptoms in lieu of a definitive diagnosis.
• When sufficient clinical information is not known or available about a particular health condition, it is acceptable to report the appropriate “unspecified” code.
• It is inappropriate to select a SPECIFIC code that is not supported by the medical record documentation.
Training for Physicians
Dates Method Content
Nov 2014 – Jan 2015 Department Meetings
Introduction/Overview
Jan 2015 – Mar 2015 Web-based OverviewService Specific DocumentationFuture Order EntryDiagnosis Assistant
Mar 2015 – Jun 2015 Classroom Documenting for ICD10 using the Electronic Health Record
Jun 2015 – Sep 2015 Web-based OverviewDocumenting Operative and Procedure Notes for ICD-10-PCS
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