Proper Prepping Isn’t as Bad as You Think · ICD-10-CM recertification • Credentialing and certifying organizations –Verify knowledge is current –Assess ICD-10-CM knowledge

2015 AAPC HEALTHCON, Las Vegas NV

Julie Orton Van, CPC, CPC-P, CEMC Product Manager – Coding Solutions

ICD-10-CM Recertification Prep: Proper Prepping Isn’t as Bad as You Think

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 2

Publisher’s Notice:

Although we have tried to include accurate and comprehensive information in this presentation, please remember it is not intended as legal or other professional advice.


Focus and agenda

• ICD-10-CM recertification • Use and application of ICD-10-CM • What to prep

–What do you need –Tips and tricks to test-taking

• Bonus content Extra study materials


ICD-10-CM recertification • Credentialing and certifying

organizations – Verify knowledge is current – Assess ICD-10-CM knowledge and ability

to apply correctly – Requirements vary by organization

• AHIMA — CEUs – Up to 18 CEUs required

• AAPC — Proficiency Assessment – Timed 75-question – Unlimited time, 150-question with

prerequisite AAPC approved training • See other organization websites for specific

information

• Employe-required verification of knowledge – May use established testing or their own

Use and application of ICD-10-CM

Complete ICD-10-CM training from a credible source


Use and application of ICD-10-CM

• Conventions for ICD-10-CM • ICD-10-CM Official Guidelines for Coding and Reporting Section 1.A.

• Three to seven characters • Placeholder character: X • NEC vs NOS

–NEC — “other specified” –NOS — equivalent of unspecified

• And — “and” or “or” • With — “associated with” or “due to”


Use and application of ICD-10-CM (continued) • Pull out the ICD-10-CM Guidelines • Get the most recent version • Get out your highlighter • Look at ALL the sections

–You need to know the guidelines for all specialties, not just your own

• Let’s review a few critical guidelines


Use and application of ICD-10-CM (continued) • Includes Notes

–Gives examples of included content

• Inclusion Terms –Synonyms –Other specified terms –Conditions assigned to that code


Use and application of ICD-10-CM (continued) •Excludes Notes

–Excludes 1 — “NOT CODED HERE” •Two conditions cannot occur together

– Congenital and acquired –Excludes 2 — “Not included here”

•Not part of the condition represented by the code –May be appropriate to report together when both exist


• Etiology and manifestation –“Code first” – “Use additional code”

• Underlying condition is sequenced first followed by the manifestation

• Etiology states “use additional code”

• Manifestation states “code first” • Use these guidelines even if the code description does not state “in diseases classified elsewhere”

• In the index, manifestation codes are listed with etiology codes in brackets

Use and application of ICD-10-CM (continued)


Use and application of ICD-10-CM (continued) • Etiology and manifestation

• In the index, manifestation codes are listed with etiology codes in brackets

• Always use the Code first and Use additional code guidelines

• Used to identify other conditions that require multiple codes –Code if applicable –Sequela, complication, obstetrics


Use and application of ICD-10-CM (continued) • “Code also”

–This instruction is separate from code first and use additional code –Two codes may be required –There is no sequencing direction


• Default codes –A code listed next to a main

term –Condition that is most

commonly associated with the main term

–Unspecified code for that condition

– If condition is documented without additional information use the default code



• Signs and symptoms –Appropriate when a definitive

diagnosis has not be established

–Use specific diagnosis when supported by documentation

– If definitive diagnosis is not established by end of encounter

• Unspecified codes –Use when sufficient information

isn’t known or available –Use when they reflect what is

known about the patient’s condition

–Do not select a more specific code if the information is not in the documentation • Additional testing to determine type of bacteria



• Conditions integral part of disease process –Signs and symptoms that are

associated with a disease process are not separately coded

–Code sign and symptom only if instructed in the classification

• Conditions NOT integral part of disease process –Additional signs and symptoms

not associated with disease are coded when present


• J30.2 Other seasonal allergic rhinitis

• R06.2 Wheezing Excludes1 asthma (J45.-)


Use and application of ICD-10-CM (continued) • Acute and Chronic

–Must be listed in diagnostic statement –Can report both if there are separate entries and both documented

• Must be at same indentation level –Sequence acute (subacute) first


• Combination code – A combination code is a single

code • To report two diagnosis • Diagnosis with associated secondary

process or manifestation • Diagnosis with associated

complication – Report only the combination code

• Fully identifies diagnostic condition • Alphabetic Index direction

– Use additional code only if the combination code lack needed specificity • Manifestation • Complication



• Reporting HIV –HIV-related conditions

• Neoplasms • Diabetes mellitus

–Type –Insulin –In pregnancy

• Nervous system • Pain

–Transient –Controlled/uncontrolled

• Hypertension –Secondary hypertension

• Acute myocardial infarction • COPD • Chronic kidney disease

–Stages • Obstetrics

–Trimesters • Coma

–Scale • Fractures • Burns • Z codes

Bonus Content at end of slide deck



What to prep • Read the section notes in the Official Guidelines

–Highlight what you think is critical or a little tricky –Signs and symptoms –Sequencing –Look in the index –Rule out –Facility versus physician guidelines –Combination codes vs. single code


What to prep (continued) • Look at the combination of the codes

–Incomplete codes –Look up the codes that are different –Look at the sequencing –Check laterality –Look up terms –Look it up in the index

•Terms are sometimes only listed in the index


What to prep (continued) • Resources to use

–ICD-10-CM or PCS book –Current guidelines — for the year you are taking the test

•Don’t use 2015 guidelines if you are taking the 2014 version –Anatomy book –Dictionary –AHA Coding Clinic –GEM mapping: be careful, as the mapping may not be exact


What to prep (continued) • Tips for taking a multiple-choice test

–Read the full question –Look for the little details — all the words –Think of the right answer before you look at the possible

choices –Look up the codes that are different and eliminate those that

are not correct –Your first choice is often correct –Do not leave any questions blank –If you get stuck on one, note it and come back at the end –Well-prepared exams do not try to trick you with the question

wording


What to prep (continued) • Tips and tricks

–Same code more than once •Look at the codes with only one character different

–Laterality –Sequencing


What to prep (continued) • Be rested • Have the required time undisturbed

–Guidelines –Coding conventions –Coding scenarios

• Have snacks and beverages ready • Plan a break if you need one


What is the AAPC ICD-10-CM Proficiency Assessment

• Assessment to verify your knowledge of ICD-10-CM coding • This assessment covers the diagnostic code set (CM) only • Does NOT include PCS • Required to maintain AAPC credentials

–Only need to pass once regardless of number of credentials or certifications from AAPC

• Completion date is still listed as December 31, 2015 • Not recognized by other credentialing or certifying

organizations


Practice, practice, and more practice

Thank you.

Contact information

Julie Orton Van, CPC, CPC-P, CEMC, Product Manager — Coding Solutions

801-982-3430

[email protected]

mailto:[email protected]

BONUS CONTENT

Extra study materials for ICD-10 Recertification Preparation


Use and Application of ICD-10-CM • Reporting HIV

–Code only IF confirmed –Encounter for HIV testing

• Screening – Z11.4, Encounter for screening for human immunodeficiency virus [HIV]

• Testing with signs and symptoms – report the symptoms • Counseling pre and post-test – Z71.7, Human immunodeficiency virus [HIV] counseling

– Inconclusive HIV serology - R75, Inconclusive laboratory evidence of human immunodeficiency virus [HIV]

–HIV-related conditions • B20, Human immunodeficiency virus [HIV disease • Additional codes for all reported HIV-related conditions

–Seen for unrelated condition • Report code for unrelated condition • Additional code B20


• Neoplasms –Encounter for treatment of

malignancy • Primary code is the malignancy

–Treatment of secondary site only • Primary code is the secondary site

–Encounter for surgical treatment • Primary code is malignancy

–Encounter for treatment • Chemotherapy, immunotherapy, radiation with a code from Z51.-

–Dehydration • Report first only if that is the only treatment at that encounter

Use and Application of ICD-10-CM (continued)


• Neoplasms –Anemia – malignancy

• Malignancy followed by anemia –Anemia – treatment (radiation,

chemotherapy, immunotherapy) • Treatment of anemia report anemia

• Secondary code is adverse effect for chemotherapy

• Secondary code is complication for radiation therapy



• Neoplasms –In pregnant patient

• Primary code is O9A.1- –Current vs personal history

• Report malignancy – Excised but additional

treatment needed – Current/active treatment

• Report history – No further treatment – No evidence of existing

primary malignancy



• Diabetes mellitus – Type of diabetes

• Type 1 “most type 1 diabetics develop the condition before reaching puberty”

• Type 2 “caused by the body's inability to respond to insulin that is produced, called insulin resistance” The Coders Dictionary

• “If the type of diabetes mellitus is not documented in the medical record the default is Ell.-, Type 2 diabetes mellitus.” I.C.4.a.2

– Insulin – NOT the only indicator of type 1 • Treatment with insulin without mention

of type 1 is codes to E11 • Long term use report Z79.4, Long-

term (current) use of insulin



Use and Application of ICD-10-CM (continued) • Diabetes Mellitus

–Secondary diabetes mellitus •E08, Diabetes mellitus due to underlying condition •E09, Drug or chemical induced diabetes mellitus •E13, Other specified diabetes mellitus •See tabular list for sequencing

• Diabetes Mellitus in pregnancy see Section I.C.15 –Pre-existing diabetes report

•O21, Diabetes mellitus in pregnancy, childbirth, and the puerperium •Appropriate diabetes codes (E08-E13)

–Gestational (pregnancy induced) diabetes report •O24.410-O24.439

–Abnormal glucose tolerance test in pregnancy •O99.810-O99.815


Use and Application of ICD-10-CM (continued) • Nervous system • For G81 Hemiplegia and hemiparesis • For G83 Other paralytic syndromes

–Dominant/nondominant side –Affected side document, not state dominant or nondominant

• Ambidextrous patient, default is dominant • Left side, default is nondominant • Right side, default is dominant


Use and Application of ICD-10-CM (continued) • Pain – Category G89

–Do not use if definitive (underlying) diagnosis known • May use if encounter is for pain control/management • Treatment for underlying condition is reported

– Do not also code G89.- –May be principal or first listed

• Pain control/management encounter • Insertion of device for pain control

–Site specific pain • Is Primary or first listed if treating definitive diagnosis • G89 may be used to identify acute or chronic condition

–Chronic pain G89.2 • No time use providers documentation

–Chronic pain syndrome G89.4


Use and Application of ICD-10-CM (continued) • Hypertension – I10 • Hypertension with heart disease

–I11 with a heart condition classified to I50, I51.- • Hypertensive chronic kidney disease

–I12 with a condition classifiable to N18 • Hypertensive heart and chronic kidney disease

–I13 with both • Hypertensive cerebrovascular disease

–Code first from category I60-I69 • Hypertensive retinopathy

–H35.0 with I10-I15 Sequencing based upon reason for encounter


Use and Application of ICD-10-CM (continued) • Secondary hypertension

–I15 • Transient hypertension

–R03.0 elevated blood pressure only –O13.- gestational hypertension –O14.- Pre-eclampsia

• Controlled hypertension –I10-I15

• Uncontrolled hypertension –I10-I15


• Acute myocardial infarction (AMI) –STEMI I21.0-I21.1 –NSTEMI I21.4 –Unspecified acute MI I21.3 –Subsequent acute MI I22

•Sequenced according to circumstance of encounter



• COPD –Uncomplicated or acute

exacerbation (J44 and J45) • Acute respiratory failure

J96.- –Sequencing dependent upon

other comorbidities



• Chronic kidney disease –Based upon severity –May have after kidney

transplant use both •N18.- •Z94.0, Kidney transplant status

• Stage 1 • Stage 2 – mild • Stage 3 – moderate • Stage 4 – Severe • Stage 5 – • End stage renal disease

(ESRD)



• Obstetrics –Sequence first

•Exception is when pregnancy is incidental

–Use “O” codes only for mother

–Final character for the trimester

–Outcome of delivery use appropriate 7th character

–Normal delivery without complication O80



• Symptom codes used when definite diagnosis not established (confirmed)

• Report symptom with definitive diagnosis if not routinely associated

• Some combination codes include symptoms

• Coma –Use appropriate 6th and 7th

characters



• Fractures –Watch for the appropriate 7th

character –May vary by specific three

character code



• Burns and corrosions • Reported by depth • Assign code for each site

burned • Sequence highest degree of

burn first when multiple burns

• Use appropriate 7th character

• Report T31 or T32 for body surface



Use and Application of ICD-10-CM (continued) • Z codes

–May be used in any health care setting –May be first listed or secondary code –Identify history of –Encounter for specific treatment or care

•Chemotherapy/radiation therapy •Counseling •Donors •Screening •Follow up •Aftercare

Documents

Proper Prepping Isn’t as Bad as You Think · ICD-10-CM recertification • Credentialing and certifying organizations –Verify knowledge is current –Assess ICD-10-CM knowledge