Upload
gordon-black
View
225
Download
0
Embed Size (px)
Citation preview
Gastroenterology
ICD-10 CM Training
• ICD-10-CM will be valid for dates of service on or after October 1, 2015– Outpatient dates of service of October 1, 2015 and
beyond. – Inpatient hospital service claims, is effective for dates of
discharge after September 30, 2015
ICD-10-CM Compliance Dates
• Covered Entities– Everyone covered by the Health Insurance Portability
Accountability Act (HIPPA)
• Non-Covered Entities– Worker’s Compensation– Auto Insurance– Non covered HIPAA entities are exempt but are
encouraged to adapt the new code set
Covered and Non-Covered Entities
• 21 Chapters• Alpha-numeric codes; not case-sensitive
– Codes begin with Alpha letter, A-Z, excluding U– Common errors
• I verses 1• O verses 0
• “X” Placeholder• 3 to 7 characters
– Decimal following 3rd character
ICD-10 Code Structure
• Placeholder “X”– Used for future expansion of a code– Fills in empty characters when a 6th and/or 7th character
apply– The placeholder may be used in different scenarios but
should never serve as the final character.
Example: W19.XXXA Unspecified fall, Initial Encounter
ICD-10 Code Structure
• 7th Character– Provides specified information regarding the clinical visit– Is required for certain categories and must be reported in
the seventh position– May be alpha or numeric– Has different meanings depending on the coding category
ICD-10 Code Structure
• Laterality– Some ICD-10-CM codes indicate laterality, specifying
whether the condition occurs on the left, right or is bilateral.
– If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side.
– If the side is not identified in the medical record, assign the code for the unspecified side.
OGCR section 1.B.13
ICD-10 Code Structure
• “Other” Codes– Codes titled “other” or “other specified” are for use when
the information in the medical record provides detail for which a specific code does not exist.
• “Unspecified” Codes– Codes titled “unspecified” are for use when the
information in the medical record is insufficient to assign a more specific code.
OGCR section 1.A.9.a.b
ICD-10 Code Structure
• Excludes Notes– Excludes1
• A type 1 Excludes note is a pure excludes note• It means “NOT CODED HERE”• The code excluded should never be used at the same time• When two conditions cannot occur together
– Excludes2• Represents “Not included here”• The condition excluded is not part of the condition represented
by the code• It is acceptable to use both the code and the excluded code
together, when appropriateOGCR section 1.A.12.a.b
ICD-10 Structure
• “Code First” and “Use Additional Code”– ICD-10 has a coding convention that requires the
underlying condition be sequenced first followed by the manifestation.
– These instructional notes indicate the proper sequencing order of the codes.
OGCR section 1.A.13
• The “-” indicates there are additional reporting options
ICD-10 Code Structure
Most Common Diagnosis Codes
Encounter for screening for malignant neoplasm of colonICD-9 Code ICD-10 Code Description Excludes1 Excludes2
V76.51 Z12.11 Encounter for screening for malignant neoplasm of colon
• examinations related to pregnancy and reproduction (Z30-Z36, Z39.-)
• encounter for diagnostic examination-code to sign or symptom
N/A
There are more specific code choice selections below:
Z12.10
Z12.12
Z12.13
Use additional code to identify any family history of malignant neoplasm (Z80.-)
• Nonspecific abnormal findings disclosed at the time of these examinations are classified to categories R70-R94.
• Screening is the testing for disease or disease precursors in asymptomatic individuals so that early detection and treatment can be provided for those who test positive for the disease.
Documentation Tips
Colon & Appendix Benign NeoplasmICD-9 Code ICD-10 Code Description Excludes1 Excludes2
211.3 D12.0 Benign neoplasm of cecum • benign carcinoid tumors of the large intestine, and rectum (D3A.02-)
There are more specific code choices:
D12.1 Benign neoplasm of appendix
• benign carcinoid tumors of the large intestine, and rectum (D3A.02-)
• benign carcinoid tumor of the appendix (D3A.020)
D12.6 Benign neoplasm of colon, unspecified
• benign carcinoid tumors of the large intestine, and rectum (D3A.02-)
• inflammatory polyp of colon (K51.4-)
• polyp of colon NOS (K63.5)K63.5 Polyp of colon • adenomatous polyp of colon
(D12.6)• inflammatory polyp of colon
(K51.4-)• polyposis of colon (D12.6)
Abdominal painICD-9 Code ICD-10 Code Description Excludes1 Excludes2
789.00 R10.9 Unspecified abdominal pain
• renal colic (N23) • dorsalgia (M54.-)• flatulence and
related conditions (R14.-)
There are more specific code choice selections below:
789.00 R10.0 Acute abdomen
789.09 R10.10 Upper abdominal pain, unspecified
789.01 R10.11 Right upper quadrant pain
789.02 R10.12 Left upper quadrant pain
789.06 R10.13 Epigastric pain
789.09 R10.2 Pelvic and perineal pain
789.09 R10.30 Lower abdominal pain, unspecified
789.03 R10.31 Right lower quadrant pain
789.04 R10.32 Left lower quadrant pain
789.05 R10.33 Periumbilical pain
789.61 R10.81- Other abdominal pain
789.61 R10.82- Rebound abdominal tenderness
Abdominal Pain Documentation Tips
• Document specific location:– LLQ, LUQ, RUQ, RLQ – Periumbilical – Epigastric – Generalized (R10.84)– Colic (R10.83)– Acute abdominal pain (R10.0)– Abdominal tenderness (R10.811-R10.819)– Rebound abdominal pain (R10.821-R10.829)
Personal history of colonic polypsICD-9 Code ICD-10 Code Description Excludes1 Excludes2
V12.72 Z86.010 Personal history of colonic polyps
N/A • personal history of malignant neoplasms (Z85.-)
Code first any follow-up examination after treatment (Z09)
• There are two types of history Z codes, personal and family. Personal history codes explain a patient’s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring.
• Personal history codes may be used in conjunction with follow-up codes and family history codes may be used in conjunction with screening codes to explain the need for a test or procedure. History codes are also acceptable on any medical record regardless of the reason for visit. A history of an illness, even if no longer present, is important information that may alter the type of treatment ordered.
Documentation Tips
Dysphagia, unspecifiedICD-9 Code ICD-10 Code Description Excludes1 Excludes2
787.20 R13.0 Aphagia • Psychogenic aphagia (F50.9)
• Psychogenic dysphagia (F45.8)
N/A
R13.10** Dysphagia, unspecified
N/A
**Code first, if applicable, dysphagia following cerebrovascular disease (I69. with final characters -91)
There are more specific code choice selections below:
787.21 R13.11 Dysphagia, oral phase
787.22 R13.12 Dysphagia, oropharyngeal phase
787.23 R13.13 Dysphagia, pharyngeal phase
787.24 R13.14 Dysphagia, pharyngoesophageal phase
787.29 R13.19 Other dysphagiaCervical dysphagiaNeurogenic dysphagia
• Document phase:– Oral – Oropharyngeal – Pharyngeal – Pharyngo-esophageal
• Document if sequelae of nontraumatic hemorrhage: – specify type:
• Subarachnoid• Intracerebral • Intracranial
• Document if sequelae of: – Cerebral infarction – Cerebrovascular disease
Dysphagia Documentation Tips
Family history of malignant neoplasm of digestive organsICD-9 Code ICD-10 Code Description Excludes1 Excludes2
V16.0 Z80.0 Family history of malignant neoplasm of digestive organs
N/A N/A
Code also any follow-up examination (Z08-Z09)
• Z80.3 is considered unacceptable as a principal diagnosis as it describes a circumstance which influences an individual's health status but not a current illness or injury, or the diagnosis may not be a specific manifestation but may be due to an underlying cause.
• Family history codes are for use when a patient has a family member(s) who has had a particular disease that causes the patient to be at higher risk of also contracting the disease.
• Personal history codes may be used in conjunction with follow-up codes and family history codes may be used in conjunction with screening codes to explain the need for a test or procedure. History codes are also acceptable on any medical record regardless of the reason for visit. A history of an illness, even if no longer present, is important information that may alter the type of treatment ordered.
Documentation Tips
Diverticular disease of intestineICD-9 Code ICD-10 Code Description Excludes1 Excludes2
562 K57.9- Diverticular disease of intestine, part unspecified,
• congenital diverticulum of intestine (Q43.8)
• Meckel's diverticulum (Q43.0)
• diverticulum of appendix (K38.2)
There are more specific code choice selections below:
K57.0- Diverticulitis of small intestine with perforation and abscess
K57.1- Diverticular disease of small intestine without perforation or abscess
K57.2- Diverticulitis of large intestine with perforation and abscess
K57.3- Diverticular disease of large intestine without perforation or abscess
K57.4- Diverticulitis of both small and large intestine with perforation and abscess
K57.5- Diverticular disease of both small and large intestine without perforation or abscess
K57.8- Diverticulitis of intestine, part unspecified, with perforation and abscess
Identify:• With or without bleeding• Small and/or large intestine• Perforation and/or Abscess
Documentation Tips
Gastro-Esophageal Reflux DiseaseICD-9 Code ICD-10 Code Description Excludes1 Excludes2
530.81 K21.9 Gastro-esophageal reflux disease without esophagitis
• Esophageal reflux NOS
Newborn esophageal reflux (P78.83)
N/A
There are more specific code choice selections below:
530.11 K21.0 Gastro-esophageal reflux disease with esophagitis
– Identify with or without esophagitis
GERD Documentation Tips
GastroenteritisICD-9 Code ICD-10 Code Description Excludes1 Excludes2
787.91 K52.2 Allergic and dietetic gastroenteritis and colitis
Use additional code to identify type of food allergy (Z91.01-, Z91.02-)
N/A N/A
K52.89 Other specified noninfective gastroenteritis and colitis
N/A N/A
R19.7 Diarrhea, unspecified • acute abdomen (R10.0)• functional diarrhea (K59.1)• neonatal diarrhea (P78.3)• psychogenic diarrhea (F45.8)
N/A
There are more specific code choice selections below:
558.1 K52.0 Gastroenteritis and colitis due to radiation
535.70535.71535.41
K52.81 Eosinophilic gastritis or gastroenteritisEosinophilic enteritis
Barrett's esophagusICD-9 Code ICD-10 Code Description Excludes1 Excludes2
530.85 K22.70 Barrett's esophagus without dysplasia
Applicable to:• Barrett's esophagus
NOS
• Barrett's ulcer (K22.1)
• malignant neoplasm of esophagus (C15.-)
N/A
There are more specific code choice selections below:
K22.710 Barrett's esophagus with low grade dysplasia
K22.711 Barrett's esophagus with high grade dysplasia
K22.719 Barrett's esophagus with dysplasia, unspecified
Identify:– With or without dysplasia– Type of dysplasia
Documentation Tips
Benign neoplasm of rectum and anal canalICD-9 Code ICD-10 Code Description Excludes1 Excludes2
211.4 D12.7 Benign neoplasm of rectosigmoid junction
N/A N/A
211.4 D12.8 Benign neoplasm of rectum • benign carcinoid tumor of the rectum (D3A.026)
N/A
211.4 D12.9 Benign neoplasm of anus and anal canal
Applicable to:• Benign neoplasm of
anus NOS
• benign neoplasm of anal margin (D22.5, D23.5)
• benign neoplasm of anal skin (D22.5, D23.5)
• benign neoplasm of perianal skin (D22.5, D23.5)
N/A
Calculus of bile duct without cholangitis or cholecystitis ICD-9 Code ICD-10 Code Description Excludes1 Excludes2
574.50 K80.50 Calculus of bile duct without cholangitis or cholecystitis without obstruction
• retained cholelithiasis following cholecystectomy (K91.86)
N/A
574.51 K80.51 Calculus of bile duct without cholangitis or cholecystitis with obstruction
Gastrointestinal hemorrhageICD-9 Code ICD-10 Code Description Excludes1 Excludes2
578.9 K92.2 Gastrointestinal hemorrhage, unspecified
Applicable to:• Gastric hemorrhage
NOS• Intestinal hemorrhage
NOS
• neonatal gastrointestinal hemorrhage (P54.0-P54.3)
• acute hemorrhagic gastritis (K29.01)
• hemorrhage of anus and rectum (K62.5)
• angiodysplasia of stomach with hemorrhage (K31.811)
• diverticular disease with hemorrhage (K57.-)
• gastritis and duodenitis with hemorrhage (K29.-)
• peptic ulcer with hemorrhage (K25-K28)
N/A
Gastritis ICD-9 Code ICD-10 Code Description Excludes1 Excludes2
535.00 K29.00 Acute gastritis without bleeding
• eosinophilic gastritis or gastroenteritis (K52.81)
• Zollinger-Ellison syndrome (E16.4)
N/A
There are more specific code choice selections below:
535.01 K29.01 Acute gastritis with bleeding
535.30 K29.20 Alcoholic gastritis without bleeding
535.31 K29.21 Alcoholic gastritis with bleeding
535.10535.40
K29.30 Chronic superficial gastritis without bleeding
535.11535.41
K29.31 Chronic superficial gastritis with bleeding
535.10 K29.40 Chronic atrophic gastritis without bleeding
535.11 K29.41 Chronic atrophic gastritis with bleeding
535.10 K29.50 Unspecified chronic gastritis without bleeding
535.11 K29.51 Unspecified chronic gastritis with bleeding
535.20535.40
K29.60 Other gastritis without bleeding
535.20535.40
K29.61 Other gastritis with bleeding
535.50 K29.70 Gastritis, unspecified, without bleeding
535.51 K29.71 Gastritis, unspecified, with bleeding
DuodenitisICD-9 Code ICD-10 Code Description Excludes1 Excludes2
535.60 K29.80 Duodenitis without bleeding
535.61 K29.81 Duodenitis with bleeding
Gastritis and duodenitisICD-9 Code ICD-10 Code Description Excludes1 Excludes2
535.61 K29.81 Gastroduodenitis, unspecified, without bleeding
535.61 K29.81 Gastroduodenitis, unspecified, with bleeding
• Document acuity: – - Acute or Chronic
• Differentiate between: – Gastritis – Gastroduodenitis– Duodenitis
• Document type: – Alcoholic – Superficial – Atrophic
• Document any related hemorrhage • Document any alcohol or drug use, abuse, dependence or past history • Specify name of medication or drug with purpose of its use
Gastritis Documentation Tips
On October 01, 2015 we will monitor claims for date of service rules
• Outpatient claims cannot have crossover dates • Outpatient claims will be coded according to date of
service• Inpatient facility claims will be coded per date of discharge
We will monitor claims to resolve any unanticipated problems with the submission process
Monitor Claims
• We will monitor for claim denials• We will monitor editing trends for ICD-10 Coding
guidelines• We will provide feedback to the physicians regarding
supporting documentation requirements • We will monitor WC or Liability carriers for published
rules on use of ICD-9 or ICD-10 code sets
Claim Denial and Management
• Client will need to update – Templates– Order Sets– Superbills– Favorites
• Future Orders– Remove ICD-9 code add ICD-10 code
Client Responsibilities
All Conditions treated or assessed must be documented in the medical record. In addition to the documentation tips reviewed, below are more areas to document that will ensure proper ICD-10-CM code selection.
• Site specificity• Document notation of qualifiers
– Exacerbation– Manifestations– Relapse– Status– Stages
• Indicate acute or chronic• Indicate underlying or external cause factors
– Medication– Smoke– Accidents– Mechanical failure
• Laterality– Bilateral– Right – Left
Documentation – Start Now
• Episode of Care for injuries, poisoning, external causes and other conditions– Initial Encounter
• Use while the patient is receiving active treatment of the condition– Active treatment includes surgical treatment, an emergency encounter, and
evaluation and treatment by a new physician
– Subsequent Encounter• Used on encounter after the patient has received active treatment of
the condition and is receiving routine care for the condition during the healing or recovery phase.
– Medication adjustments, aftercare, device adjustments, cast change
– Sequela• Used for complications or conditions that arise as a direct result of a
condition, late effect
Documentation – Start Now
• Combination codes that capture– Etiology and manifestation– Related conditions– Disease, injury or other medical condition and
complications– Disease or other medical conditions and common signs or
symptoms
• Add ICD-10 Codes to patient Problem List
Documentation – Start Now
UnderdosingUnderdosing refers to taking less of a medication than is prescribed by a provider or a manufacturer’s instruction. For underdosing, assign the code from categories T36-T50 (fifth or sixth character “6”).
Codes for underdosing should never be assigned as principal or first-listed codes. If a patient has a relapse or exacerbation of the medical condition for which the drug is prescribed because of the reduction in dose, then the medical condition itself should be coded.
Noncompliance (Z91.12-, Z91.13-) or complication of care (Y63.6-Y63.9) codes are to be used with an underdosing code to indicate intent, if known.
OGCR Section 1.C.19.e.5.c
Official Guidelines for Coding and Reporting
Centers for Disease Control and Prevention (ICD-10-CM)http://www.cdc.gov/nchs/icd/icd10cm.htm
Questions