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ICDICD--10 CODING: THE GOOD,10 CODING: THE GOOD,THE BAD, AND WHAT YOUTHE BAD, AND WHAT YOUNEED TO KNOWNEED TO KNOW NOW NOW

TRANSITION YOUR MEDICAL DIAGNOSISTRANSITION YOUR MEDICAL DIAGNOSISCODING FROM ICD9 TO ICD10CODING FROM ICD9 TO ICD10

SuzanneSuzanne Leder Leder, BA,, BA, M.Phil.M.Phil., CPC, COBGC, CPC, COBGC

Wires Manager Wires Manager Executive Editor of the ObExecutive Editor of the Ob- -gyn Coding Alert gyn Coding Alert

suzannel@inhealthcare.comsuzannel@inhealthcare.com

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(That¶s me on the right!)

Suzanne Leder, BA, M.Phil., CPC, COBGCEditor of the Ob-gyn Coding Alert 2

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Trivia: The year Munch painted this was the year the first incarnation of ICD ² or the International Statistical Classification of Diseases andRelated Health Problems ² was introduced.

(Edvard Munch, T he Scream , 1893)3

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Steps to Tak e NowSteps to Tak e Now

Taking small steps n ow means that you¶ll beahead of the game before October 1, 2013 hits.P art B Insider : CMS¶s Stewart Streimer during aCMS-sponsored Open Door Forum said,³[October 1, 2013] is really the drop-dead date for those of you that have familiarized yourselveswith the Final Rule regarding ICD-10 « but there

are a lot of things that must happen before then,and I expect many of the payers may evenrequire ICD-10 codes before then so a sufficientamount of testing can take place.´

WARNING:

You won¶t haveany grace period.

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Ag e nd aAg e nd a

How will ICD-10 affect you?Why should you get to know ICD-10

codes now?Why are we switching from ICD-9 to ICD-10?What do I have to learn for ICD-10? Whatwill remain the same?What do the changes look like?What steps should I take right now?

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How ICDHow ICD--10 will aff ect YOU10 will aff ect YOU

You¶ll throw out your ICD-9 book and start using a new one. ICD-9will grow from its current 17,000 codes to more than 141,000!

Exam p le : Ob-gyn coders are used to using V22.0 for µsupervision of a normalfirst pregnancy.¶ As of October 1, 2013, we¶ll have to choose from somebizarre-looking Z34.xx codes and specify trimester.

Productivity : It will take longer for you to code your claims in ICD-10. You¶ll have to ask your physicians to clarify their documentation.You¶ll probably see an increase in billing inquiries from payers.You¶ll also probably encounter an increased number of adjustmentsand pended or suspended claims.

CPC recertificationIf you start learning ICD-10 now, then we¶ll be in more demand. Inother words, being on the cutting edge means that you¶re moremarketable in the medical coding healthcare field.

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Histo ry o f ICD (mai n po in ts) :Histo ry o f ICD (mai n po in ts) :

1893 : Frenchphysician,

JacqueBertillon

presents hisidea

1898 : APHArecommendCanada,

Mexico, andUS adopt it

1948 : Wehave ICD-6

1979 : USadoptedICD-9

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Cou n tries who h av e a d opte d Cou n tries who h av e a d opte d

ICDICD--10:10:

Australia(1998)

Canada(2000)

France(2005)

Germany

Korea

Sweden

Thailand

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Wh a t¶s so ba d ab out ICDWh a t¶s so ba d ab out ICD--9?9?

It¶s running out of room!

ICD10 has more capability for growth, thanks to letter asthe first digit :Exam p le :

ICD-9 Osteoporosis = 733.01ICD-10 Osteoporosis = M81.0

ICD10 will also have up to 7 digits : Exam p le : Abrasion of unspecified hand; initial encounter : S60.519a Abrasion of unspecified hand; subsequent encounter : S60.519d

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Wh a t¶s so gr e a t ab out ICDWh a t¶s so gr e a t ab out ICD--10?10?

More information relevant to ambulatory andmanaged careCombo codes for diagnosis/symptoms

Exam p le : If a patient has severe sepsis with shock,you would report 995.92 (Severe sepsis ) and 785.52(Septic shock). For ICD-10, you¶ll have a consolidatedcode : R65.21 (Severe sepsis with shock ).

Expanded injury codesTrimester infoExpanded alcohol/substance abuse codesExpanded post-op complication codes

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Wh a t¶s the d iff e r e n ce b etwee n ICDWh a t¶s the d iff e r e n ce b etwee n ICD--9 a nd ICD9 a nd ICD--1010b es id es µmo r e r oo m ¶a nd gr e a te r spec ific ity?b es id es µmo r e r oo m ¶a nd gr e a te r spec ific ity?

ICD-10 is a three-volume set; ICD-9 is a two-volume set.Vo lu m e 1: Cause of DeathVo lu m e 2: Descriptions, Guidelines, and Coding rulesVo lu m e 3: Table of Drugs and Chemicals

You¶ll search under alphanumeric categories rather thannumeric categories.You¶ll have to reacquaint yourself with the chapters.Titles will change.Conditions have been regrouped.

Mortality rules changed.Bilateral sites have a new laterality.Exam p le : If your physician sees a patient for a follow-up visit where heexamines an abscess of a burso on the right wrist. You would report M71.031.Notice how the last digit is ³1.´ If this was for the left wrist, you would reportM71.032.

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Wh a t d o I n ot h av e to r eWh a t d o I n ot h av e to r e --le ar n f o r le ar n f o r ICDICD--10?10?

Indented formatRubric system

IndexTabular conventionIncludes notesInclusion termsExceptionsNeoplasm table

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ICDICD--10 Exam p le 110 Exam p le 1

The physician sees a Medicare patient withosteoporosis who has a pathological humerusfracture.

ICD-9: You would report 733.11 (P athological fracture of humerus ) and 733.01 (Senileosteoporosis ).

ICD-10: You would report M80.021d (Subsequent encounter for fracture with routine healing,

postmenopausal osteoporosis with current pathologic fracture, right humerus ).

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ICDICD--10 Exam p le 210 Exam p le 2 A patient presents to your office with a prolapse of theanterior vaginal wall, which is commonly called a cystocele.

ICD-9: You would report 618.01 (P rolapse of vaginal wallswithout mention of uterine prolapse; cystocele, midline ) or 618.02 (« cystocele, lateral ).

ICD-10: When your diagnosis code system changes : Code618.01 will become N81.10 (Cystocele, unspecified ) or N81.11 (Cystocele, midline ). Code 618.02 will becomeN81.12 (Cystocele, lateral ).

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ICDICD--10 Exam p le 310 Exam p le 3Your physician treats a patient for a lower back pressure ulcer.

ICD-9: You should report 707.03 (P ressure ulcer; lower back ) and anadditional code from 707.20-707.25 (P ressure ulcer stages «) to identifythe pressure ulcer stage :

707.20 -- P ressure ulcer, unspecified stage707.21 -- P ressure ulcer stage I 707.22 -- P ressure ulcer stage II 707.23 -- P ressure ulcer stage III 707.24 -- P ressure ulcer stage IV 707.25 -- P ressure ulcer, unstageable .

ICD-10: You don¶t have enough information. You need to know whether theulcer is on the left or right. You¶ll report a single code. Some options will be(but are not limited to) :

L89.131 (P ressure ulcer of right lower back, stage I )L89.141 (P ressure ulcer of left lower back, stage I ).

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ACTION PLANACTION PLAN16

Identify medical record documentation improvement opportunitiesLearn the basic structure, organization, and unique features of ICD-10Test yourself using ICD-10 codes

Work with software vendors

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Check out a brand new ICD-10-CM QuickReference Information sheet, which can help youprepare for the change. The guide is available atwww.cms.hhs.gov/icd10 . You can also click ³CMSsponsored calls´ on the left, followed by the ³2010ICD-10 Conference Calls´ download.www.cms.hhs.gov/ICD10/02k_2010_ICD_10_CM.aspReview ICD10 guidelines (which are alreadywritten) in addition to learning the new codes :

http ://www.cdc.gov/nchs/icd/icd10cm.htm#10updat

ICDICD--10 R esou r ces10 R esou r ces17

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ThankYOU!

Helping coders, helpHelping coders, helpphysicians!physicians!

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Supercoder.com

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