ICD-10-CM. What Do These Items Have In Common? Killer Bees 1984 Y2k Ice-Free Polar Cap by 2013 Code Ability Seminars ©2014

ICD-10-CM

What Do These Items Have In Common?

Killer Bees 1984 Y2k Ice-Free Polar Cap by 2013

Code Ability Seminars ©2014Code Ability Seminars ©2014

Predictions That Never Came True


Killer Bees

Expected to reach the U.S. in the 1980s, but delayed 10 years."The Swarm": A huge swarm of deadly African bees spreads terror over American cities by killing thousands of people. Weekly Reader.

By 2013, the number of deaths is minuscule. The Centers for Disease Control doesn’t find enough to make a separate category for killer-bee-related deaths. 2013: 1 death in Central Texas.


1984

Orwell’s vision of a post-atomic dictatorship in which every individual would be monitored

ceaselessly by means of the telescreen.


Y2k

Predictions of a Y2K computer bug; it was to crash many computers, and malfunctions would

cause major catastrophes worldwide and society would cease to function.


Ice-Free Polar Cap in 2013

In 2007, British Broadcasting Corporation reported the Arctic would be ice-free in summer 2013, citing U.S. scientist Wieslaw Maslowski. (Naval Post Graduate School)

Al Gore cited Maslowski's analysis in his acceptance speech at the Nobel Peace Prize ceremony in 2007.

In summer 2013, the Arctic had 533,000 more square miles of ice than the same time in 2012 – a 29% increase.


ICD-10 Predictions

"The implementation of ICD-10 will be the most significant, costly event that we will

experience" (J.Rumpakis, Review of Optometry 1/15/09)


ICD-10 Predictions

"To upgrade to ICD-10 will cost a small practice (3 docs) $83,290”

(Nachimson Advisors)


ICD-10 Predictions

"The cost will be up to 10 times more than the $600 per physician that the U.S Dept. of Health

& Human Services has assumed" (American Academy of Professional Coders)


ICD-10 Predictions

"The cost of switching to ICD-10 will be about $20"

(Alan Homestead OD)


What Is ICD-10-CM

International Classification of Diseases, Tenth Revision, Clinical Modification

General information:www.cdc.gov/nchs/icd/icd10cm.htm


Who CreatedWho Created

National Center for Health Statistics (under Centers for Disease Control and Prevention)

developed & maintains ICD-10-CM

Who created & owns CPT?


Who AffectedWho Affected

Everyone covered by HIPAA, including providers and payers who do not deal with Medicare claims.

Claims submitted electronically to any payer.

HIPAA = Health Insurance Portability and Accountability HIPAA = Health Insurance Portability and Accountability Act Act


WhyWhyBetter data for:– Measuring quality, safety, and efficacy of care– Designing payment systems & processing claims for payment– Conducting research, epidemiological studies, and clinical trials– Setting health policy– Operational & strategic planning & designing healthcare delivery systems– Monitoring resource utilization– Improving clinical, financial, and administrative performance– Preventing and detecting healthcare fraud and abuse– Tracking public health and risks


WhyWhyIn 2012, AMA advocated to halt of implementation of ICD-10.

AMA CEO James Madara: the move will "create significant burdens on the practice of medicine with no direct benefit to individual patient care."

What was the AOA position?What was the AOA position?


WhenWhen

In 2009, Dept of Health and Human Services published regulation requiring replacement of ICD-9-CM with ICD-10-CM.

Implementation Date: Oct 1, 2014

What does “Implementation Date” mean?


WhenWhen

IMPORTANTClaims with Date Of Service before Oct 1, 2014 must use ICD-9.

Claims with Date Of Service Oct 1, 2014 (or later) must use ICD-10. Claims for services provided before October 1, 2014 must use ICD-9 even if they are submitted after the compliance date.


WhenWhen

"After the compliance date, ICD-9 codes will not be accepted and any transactions with ICD-9 codes will be rejected." American Medical Association

False.


ICD-9 vs. ICD-10ICD-9 vs. ICD-10

ICD-10 code can contain more than one diagnosis – called combination codes.

Example:E11.311 Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema


ICD-9 vs. ICD-10ICD-9 vs. ICD-10

Combined diagnosis/symptom codes.

More specificity (longer code) to identify etiology, anatomic site, severity.

Laterality.

3 - 7 characters (ICD-9 = 3 to 5 characters).


ExamplesExamples

Most eye codes start with “H”


ExamplesExamples

367.9 Unspecified disorder of refraction & accomodation comparable to

H52.7 Unspecified disorder of refraction

(no laterality)

(myopia, hyperopia, astigmatism: all have laterality)


ExamplesExamples

365.00 Preglaucoma, unspecified comparable to

H40.001 Preglaucoma, unspecified, right eyeH40.002 Preglaucoma, unspecified, left eyeH40.003 Preglaucoma, unspecified, bilateralH40.009 Preglaucoma, unspecified, unspecified eye

(1 = right, 2 = left, 3 = bilateral)(9 is not "unspecified" as general rule)


ExamplesExamples

366.10 Senile cataract comparable to

H25.9 Unspecified age-related cataract

(no laterality)


ExamplesExamples

366.16 Nuclear sclerosis comparable to

H25.10 Age-related nuclear cataract, unspecified eyeH25.11 Age-related nuclear cataract, right eyeH25.12 Age-related nuclear cataract, left eyeH25.13 Age-related nuclear cataract, bilateral

(1 = right, 2 = left, 3 = bilateral)(0 is not "unspecified" as general rule)


ExamplesExamples

362.51 Nonexudative senile macular degeneration, dry comparable to

H35.31 Nonexudative age-related macular degeneration

(no laterality)


ExamplesExamples

Symptoms


ExamplesExamples

379.91 Pain in or around eye

comparable to

H57.10 Ocular pain, unspecified eyeH57.11 Ocular pain, right eyeH57.12 Ocular pain, left eyeH57.13 Ocular pain, bilateral


ExamplesExamples

784.0 Headache comparable to

R51 Headache

(no laterality)

(R = Symptoms, Signs, Abnormal Findings)


ExamplesExamples

250.00 Diabetes mellitus without mention of complication, type 2 or unspecified type, not stated as uncontrolled

comparable to

E13.9 Other specified diabetes mellitus without complications

(E = Endocrine, nutritional, metabolic disease)


ExamplesExamples

250.50 Diabetes with opthalmic manifestations, type 2 or unspecified type, not stated as uncontrolled

comparable to

E13.8 Other diabetes mellitus with unspecified complications


ExamplesExamples

362.01 Background diabetic retinopathy

comparable to

E13.39 Other specified diabetes mellitus with other diabetic ophthalmic complication

(many many choices)(was in eye section, now in diabetes section)


ExamplesExamples

918.1 Abrasion, cornea

comparable to

S05.00XA Injury of conjunctiva and corneal abrasion without foreign body, unspecified eye, initial encounteror

S05.00XD Injury of conjunctiva and corneal abrasion without foreign body, unspecified eye, subsequent encounter


ExamplesExamples

S = S = Injury, poisoning and certain other consequences of external causes

””55thth” character:” character:

0 = unspecified eye0 = unspecified eye

1 = right eye1 = right eye

2 = left eye2 = left eye


ExamplesExamples

““66thth”” character: character:

X – space saverX – space saver


ExamplesExamples

““77thth”” character is to be added to S05 codes character is to be added to S05 codes

A - initial encounterA - initial encounter

D - subsequent encounterD - subsequent encounter

S – sequelaS – sequela


ExamplesExamples

930.0 Foreign body, cornea

comparable to

T15.00XA Foreign body in cornea, unspecified eye, initial encounteror

T15.00XD Foreign body in cornea, unspecified eye, subsequent encounter


ExamplesExamples

T = T = Injury, poisoning & certain other consequences of external causes

””55thth” character:” character:

0 = unspecified eye0 = unspecified eye

1 = right eye1 = right eye

2 = left eye2 = left eye


ExamplesExamples

““66thth”” character: character:

X = space saverX = space saver


ExamplesExamples

““77thth”” character is to be added to T15 codes character is to be added to T15 codes

A - initial encounterA - initial encounter

D - subsequent encounterD - subsequent encounter

S – sequelaS – sequela


ExamplesExamples

V58.69 Long term use of other medications

comparable to

Z79.899 Other long term drug therapy (Z = Factors influencing health status and contact with health services


How To Find a CodeHow To Find a Code

Crosswalking with:

General Equivalency Mappings (GEMs)

Maps ICD-9 to ICD-10 & vice versa.



GEMs “attempt to find corresponding codes between the two code sets”.

GEMs do not provide an exact crosswalk between codes.

An exact one-to-one match of ICD-9 and ICD-10 codes cannot be made.



GEM:www.cdc.gov/nchs/icd/icd10cm.htm File w/ 2 columns

Other sources: www.aapc.com/icd-10/codes Enter ICD-9 or ICD-10 code, it finds comparable code www.icd10data.com Alphabetical and numeric converter.



Or



Stat ICD-10 app

Free

$20 Alphabetical search

Save frequently used codes



Create document w/commonly used ICD-9s

Cross reference ICD-9’s w/GEMs or AAPC website.


Where To Get ICD-10-CMWhere To Get ICD-10-CM

www.cdc.gov/nchs/icd/icd10cm.htm

DownloadDownload

ICD-10-CM PDF FormatICD-10-CM PDF Format


Documents

ICD-10-CM. What Do These Items Have In Common? Killer Bees 1984 Y2k Ice-Free Polar Cap by 2013 Code Ability Seminars ©2014