ICD 10

Presented by:

Rhonda Anderson, RHIA, President

Anderson Health Information Systems, Inc.

OBJECTIVES

• Participants will identify:– Dates for New ICD-10– Documentation support– New terms encounter principal diagnosis re-

defined– Some general coding guidelines– .

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FINAL REGULATION

• January 15, 2009 Final Regulation Released• EXCHANGE the ICD-9 for the ICD-10 by

October, 1, 2013 – 2014?• ICD-10 for billing purposes as far as ability to

accept the code known as “5010” is required by October 2011

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HIPAA

Assigning ICD-10 diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA)

HIPAA has evolved from HIPAA – 1996, to (HIPAA-II) HITECH which relates to security and breaches

And most recently HIPAA Transactions 5010

ICD-10 Code Set 4

WHO IS AFFECTED??

• All inpatient and outpatient facility visits as well as freestanding providers and ancillary services “that means all of us really” who provide services and bill for them under Medicare, MediCal and private insurances. Current Procedural

• Terminology (CPT) is still used for the Physician and some services, but they must have a diagnosis that is ICD-10 Complaint

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Benefits

• More specific coding system • Reflects medical advancements • Standardization, UK implemented in 1995

used worldwide

What do you think?

The U.S. is the only industrialized nation that has not yet implemented ICD-10?

True What is the date for implementation of ICD-1010/1/2013 OR 2014?ICD-10-CM has more chapters than ICD-9-CMTrue ICD10 has 21 chapters while ICD-9-CM only had

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ICD-9 vs ICD 10 What are the differences?

ICD-9 ……• 3-5 characters in length• Approximately 14,000 codes• First digit may be alpha (E or V) or numeric• Digits 2-5 are numeric• Always at least three digits• Decimal placed after the first three characters• Limited space for new codes

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ICD-9-CM DIAGNOSIS CODES -2

• Lacks detail• Lacks laterality, difficult to analyze, dated,

non-specific and does not adequately define diagnoses needed for medical research

• Does not support interoperability because it is not used in other countries.

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ICD-10-CM DIAGNOSIS CODES – FORMAT & STRUCTURE

• 3-7 characters in length• Over 69,000 codes • Digit 1 is always alpha, digit 2 is always

numeric, 3-7 are alpha or numeric• Decimal placed after the first 3 characters• All letters used except “U”• Flexible for adding new codes• Very specific• Has laterality

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ICD-10 STRUCTURE

• Index and Tabular list similar to ICD-9• ICD-10 index larger, Categories, subcategories

and codes are contacted in the tabular list.• More combined codes i.e. diabetic retinopathy• More specificity i.e. Alzheimer’s disease with

specific details of early or late onset

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CONVENTIONS FOR THE ICD-10-CM

• General rules for use of the classification independent of the guidelines– Alphabetic Index and Tabular List

• Alphabetic Index – List of terms and their corresponding code

• Tabular List – chronological list of codes divided into chapters based on body system/condition

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CONVENTIONS FOR THE ICD-10-CM -2

• General rules for use of the classification independent of the guidelines– Format and Structure

• Three character category that has no further subdivision is equivalent to a code

• Subcategories are either 4 or 5 characters• Codes may be 3, 4, 5, 6 or 7 characters

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CODE FORMAT

• ICD-10 Code Format

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ICD-9-CM Code Format ICD-10-CM Code Format

                                                      

    

                                                  

                                 

NO MORE V CODES

• Former V=codes • are now

Z=codes

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Some of the differences

274 –Gout ICD-10-CM = M10

250 – Diabetes ICD-10-CM= E10 Type 1 E12 Type 2 E13 Other

Aftercare

• Aftercare Z code is not to be used with injuries.

• The acute injury code with the appropriate seventh character (for subsequent encounter)

Let’s take a look

Aftercare for fracture of right upper arm V54.11Aftercare fracture – code to fracture with

extension D Fracture arm (upper) see also fracture,

humerus, shaft) S42.30 S42.301(right arm) S42.301D (subsequent encounter for fracture with routine healing)

• Right Hip replacement:• Now:

• V54.81 Aftercare following joint replacement• V43.64 Joint replacement, hip

• Then: Z47.1 Aftercare following joint replacement surgery Z96.6 Presence of right artificial hip joint

DIABETIC RETINOPATHYNow: 250.50, 362.01

Then: E11.319 Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema

Deep vein thrombosis patient on Coumadin Now = 453.40, V58.61

Then= I82.409 Could be more specific with laterality Long Term use of Coumadin = Z79.01

Therapy

ICD-10-CM does not provide a separate code for physical,

occupational and speech therapy

You will no longer code admission for rehab services V57

With ICD-10-CM you will only code the pertinent diagnoses

What now?????

• Resident admitted for physical therapy following CABG.

• ICD-10-CM codes • Z48.812 Aftercare following surgery (for) (on),

circulatory system • Z95.1 Status (post) aortocoronary bypass

Status post Lt BKA. Admitted for dressing changes following resolved infection of the amputation stump

Z48.01 Aftercare, following surgery, attention to dressings, surgical Z89.52 Absence (of) (organ or part) (complete partial), extremity(acquired), lower, below knee

Stage 3 decubitus ulcer to Rt. Ankle with gangrene I96 Gangrene lower extremity L89.513 Decubitus ulcer of Rt. Ankle Stage 3

Late effects of CVA

• I69 = Sequelae of Cerebrovascular Disease

• Admission for OT and PT due to left hemiplegia of non-dominant side secondary to a recent CVA

• I69.354 Hemiplegia and hemiparesis following cerebral infarction affecting left nondominant side

Examples

• Acute Hepatitis with Hepatic Coma • ICD-9-CM = 070.41• ICD-10-CM =B17.11

• Alzheimer’s Disease with Behavioral Disturbance

• ICD-9-CM = 331.0, 294.11• ICD-10-CM = F02.81

Examples

Stage 4 pressure ulcer of the sacrum

ICD-9-CM = 707.03 707.24

ICD-10-CM = L89.154

ICD 10 “HAS TWO PARTS”

• ICD-10 CM = Clinical Modification• ICD-10 PCS = Procedural Code System (used

for procedures, operations within the hospital inpatient setting i.e., acute hospital)

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ICD-10 has 21 Chapters

• Chapter 1- Certain Infectious & Parasitic Diseases (A00-B99)

• Chapter 2-Neoplasms (C00-D49)• Chapter 3- Diseases Blood & Blood Forming

Organs & disorders Immune System (D50-D89)• Chapter 4- Endocrine, Nutritional and

Metabolic Diseases (E00-E89)

CHAPTERS 5 – 8

• Chapter 5 – Mental (F00-F99)• Chapter 6 – Diseases of Nervous System (G00-

G99)• Chapter 7 – Disease s of Eye and Adnexa (H00-

H59)• Chapter 8 – Disease of Ear and Mastoid (H60-

H95)

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Chapters 9-12

• Chapter 9- Diseases of the Circulatory System (I00-I99)

• Chapter 10- Diseases of the Respiratory System (J00-J99)

• Chapter 11- Diseases of the Digestive System (K00-K94)

• Chapter 12-Diseases of the skin and Subcutaneous Tissue (L00-L99)

Chapters 13-16

• Chapter 13- Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)

• Chapter 14- Diseases of the Genitourinary System (N00-N99)

• Chapter 15- Conditions Related to Pregnancy and Childbirth (O00-O99)

• Chapter 16- Conditions Originating in the Perinatal Period (P00-P96)

Chapters 17-20

• Chapter 17- Congenital Malformations, Deformations, & Chromosomal Abnormalities (Q00-Q99)

• Chapter 18- Symptoms, Signs & Abnormal Clinical & Laboratory Findings (R00-R99)

• Chapter 19- Injury, Poisoning & Certain Other Consequences of External Causes (S00-T88)

• Chapter 20- External Causes of Morbidity (V00-Y99)

Chapter 21

• Chapter 21- Factors Influencing Health Status & Contact with Health Services (Z00-Z99)

CONVENTIONS FOR THE ICD-10-CM -3

• General rules for use of the classification independent of the guidelines– 7th Characters

• Certain ICD-10-Cm categories have applicable 7th characters

• Required for all codes within the category or as instructed by the notes in the Tabular List

• Must always be the 7th character in the data field• If a code that requires a7th character is not 6

characters, a placeholder X must be used to fill in the empty characters

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Example

• 7th characters for a fracture - A = initial encounter for fracture - D = Subsequent encounter for fracture with routine healing - G = Subsequent encounter for fracture with delayed healing - K = Subsequent encounter for fracture with non-union - P = Subsequent encounter for fracture with malunion - S= Sequela

It’s in the details…..

• Coma scale - Eyes open- Best verbal response- Best motor response

CODE STRUCTURE OF ICD-10• ICD-10 Codes may consist of up to 7 digits, with the 7th

digit extensions representing visit encounter or sequel for injuries or external causes.

• In some cases the place holder “X” will be used to expand the code and accommodate the 7th character

• Example: • Pathological vertebral fracture due to age related

osteoporosis (Subsequent encounter with delayed healing

• M80.80XG

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ICD-10-CM DIAGNOSIS CODES-2

• Specificity improves coding accuracy and depth of data for analysis

• Detail improves the accuracy of data used in medical research

• Supports interoperability and the exchange of health care data between other countries and the U.S.

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ICD-10 NEW FEATURES -2

• Added Laterality– C50.212 Malignant neoplasm of upper-inner

quadrant of left female breast– L80.213, Pressure Ulcer of right hip, Stage III

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LET’S SEE SOME CODES

Hypertensive Retinopathy◦H35.03 Hypertensive Retinopathy◦031-Right eye, 032, left eye, 033, bilateral,

◦039 unspecified (and this would be a ?? For billing most likely)!!

◦ I10, Essential Primary Hypertension

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ABBREVIATIONS

• NEC – “Not elsewhere classifiable• Punctuation

– [ ] Brackets– ( ) Parentheses

• Use of “and”• “Other” or “other specified” • “Unspecified”• “Includes Notes”• “Inclusion Terms”

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ABBREVIATIONS -2

• “Excludes Notes”• “Code first”, “Use additional code” and “elsewhere

notes”• “And”, “and” or “or”• “With”• “See”, “see also”• “Code also note”• “Default codes”• “Syndromes”

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PRINCIPAL DIAGNOSIS -6

• Complications of surgery and other medical care– Is sequenced as the principal diagnosis

• Uncertain Diagnosis– “probable”, “suspected”, “likely”, “questionable”, “possible”, or

“still to be ruled out”, or other similar terms indicating uncertainty, code the condition as if it existed/established

– Applicable only to inpatient admissions to short-term, acute, long-term care & psychiatric hospitals

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Focus

DOCUMENTATION

TIMELINE

• 10/01/2011 – Last major update to ICD-9-CM and ICD10-CM/PCS

• 10/01/2012 – Limited changes to ICD-9-CM and ICD-10CM/PCS

• 10/01/2013 ICD-10-CM/PCS Implemented

References

• http://www.cdc.gov/nchs/icd/icd10cm.htm• http://www.cdc.gov/nchs/icd/icd9cm.htm

Questions and Answers