THE CLOCK IS TICKING ARE YOU READY FOR. Objectives

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1 THE CLOCK IS TICKING ARE YOU READY FOR ICD-10-CM? CM? Lisa Selman-Holman, JD, BSN, RN, COS-C, HCS-O, HCS-D Andrea L. Manning, BS, RN, COS-C, HCS-D Objectives 2 Identify potentially significant implications of the transition to ICD- 10 and their impact on home health agencies. Explain key differences between ICD-9 and ICD-10 Discuss planning and implementation timelines for a successful transition to ICD-10. 1

2 3 Implementation Date: Oct. 1, 2014 ICD 10 Final Rule 4 Published September 5, 2012 Single implementation date for all users Date of service for all except inpatient settings Date of discharge for inpatient settings NO GRACE PERIOD 2

3 ICD 10 CM 5 October 1, 2014 What are we waiting on? 5010 already implemented OASIS C changes Case mix diagnoses Grouper logic changes Code Freeze No new codes for ICD-9-CM No new codes for ICD-10-CM CM But that doesn t mean no changes ICD-10-CM changes to the tabular and indices have been issued ICD-10-CM guideline changes were expected There will be a few new changes in the tabular and index for October 1, 2014 First REAL update will be October 1,

4 7 OPERATIONAL PREPARATION 8 ICD 10 is NOT just about CODING! Impact ALL healthcare entities across the care continuum including: hospitals, physicians, ambulatory care and all payer sources (Medicare, Medicaid, etc.) Impact entire agency. Do not assume current processes are adequate and effective Know where your agency currently stands operationally ICD-10-CM is NOT just a clinical operational issue. 4

5 9 Don t underestimate the impact of this transition! Failure to be fully prepared for ICD-10 can result in the following: Increased claims rejections and denials Increased delays in processing authorization and reimbursement claims Improper claims payment Cash flow issues Coding backlogs Compliance issues Decisions based on inaccurate data 10 Cost of the transition to ICD 10 CMS expects the home health industry as a whole to have an overall transition cost at $16.58 million dollars. You will need to determine the impact on your agency s budget in the following areas: Cost of training/education Updating forms/printing Consulting costs Staff time/loss of productivity Temp or contract staffing Data conversion Additional operational tools 5

6 11 Establish Realistic Timelines for the Transition Utilize the time between now and January 1, 2014 to conduct a thorough agency assessment, identify operational challenges, develop and implement operational solutions and provide high-level ICD-10-CM education You will not only be well prepared for ICD- 10, but your agency will operate much more smoothly and effectively in the meantime! 12 Recommended Timeline Overview rd Quarter Preparation and Planning Phase Establish Transition Team Establish Timelines th Quarter st Quarter Assessment Phase Current Operations Assessment ICD-10 Impact Assessment and Analysis Identify Areas for Improvement/Modification Development Phase Develop Operational Solutions and Strategies Initial Training nd Quarter th Quarter Develop Operational Solutions and Strategies st Quarter rd Quarter October 1, 2014 Implementation Phase Execute Operational Strategies and Solutions Testing Intense Training for Staff ICD-10-CM Implementation Date! 6

7 13 Assessment and Planning Now! Establish Implementation Team Establish Timelines Transition Team Purpose 14 Gather information and provide input through a multi-disciplinary team approach Oversee and drive all phases of the project Meet regularly with a specific to-do list. Meetings should be purposeful and effective. 7

8 15 Establish your ICD 10 CM Transition Team Depends on the size of your agency Choose people that others naturally follow (leaders) and have a positive attitude towards change All departments should be represented Consider outside vendors/consultants Identify a Program Chairman 16 Assessment Phase Q Q Current Operations Assessment ICD-10-CM Impact Assessment & Analysis Identify Areas for Improvement/Modification 8

9 Be prepared! 17 The importance of having strong, effective systems in place PRIOR to the implementation of ICD-10-CM cannot be overemphasized. Any operational or clinical weaknesses or inefficiencies that currently exists within your agency will only be magnified during the transition and implementation of a change with the magnitude and scope of ICD-10-CM. What to do first. 18 A thorough assessment of both internal and external processes, policies, people and technologies. Establish your agency s current level of efficiency and compliance. Some processes will need little or no adjustments t Some processes will need to undergo major modifications. 9

10 19 Everyone will be affected: Intake Process Billing/accounting / Quality Assurance Clinical processes Data entry/administrative support Leadership/management Coders Systems that will be affected: 20 IT systems Agency management software Other outside vendors (billing services, clearinghouses) Payers (Medicare, Medicaid, private insurance) 10

11 Referral Intake Process 21 Who is affected? Nurses and admin staff that process referrals received from outside sources (hospitals, physicians) What is the potential impact? Inaccurate coding and information from referral source Preliminary coding Data entry of referral information 22 Intake process Operational Analysis Does your agency have an effective Intake Process? Is it documented as part of a Process Manual? Is it updated as the process, systems or people change? How are referrals received? Fax, ? What criterion is used to evaluate appropriateness of a referral for evaluation? How is payer information verified and documented? Once the referral is accepted, hat process exists to staff the evaluation? How is communication with clinician, referral source and patient handled? Who is responsible? 11

12 Billing and Accounting 23 Who is affected? Staff responsible for: Pre billing audits Claims reviews Collections Appeals and denials Insurance verification and authorizations Potential Impact- Temporary increase in coding errors resulting in rejected claims. CMS estimates 10% increase Need to be prepared to handle increased rejections, denials, incorrectly submitted claims, RHHI issues and cash flow issues 24 Billing/Accounting Process Operation Analysis Does your agency have a documented, effective claims/billing/collections process? Do you conduct a pre-billing audit? What does that audit consist of? Who is responsible? How are audit findings communicated to billers? Who is responsible for handling identified problems and resolving them? How are claims rejections handled and by whom? What is your process for working A/R and ensuring payments are accurate and current? What is your average days to RAP? To Final Claim? 12

13 25 Clinical Case Management Process Who is affected? Nurses and Therapists who provide direct patient care and/or case management Potential impacts: Accurate completion of OASIS-C Diagnosis based 485/Plan of Care development 26 Clinical Case Management Operational Analysis What clinical processes does your agency currently have in place? Are they up to date? What method of training and orientation exists for new clinicians? Does your agency utilize standardized care pathways and patient teaching materials? How is your clinical department structured? What care model do you utilize? (office based Case Management, Field Case Managers, etc.) Is OASIS-C and ICD coding training an key component of training and education for clinicians? 13

14 27 Quality Assurance Process Analysis Does your agency have a documented, effective QA process? What is it comprised of? Who is responsible? Is there a Utilization/Review (UR) piece? What process exists to ensure appropriate and accurate completion of documentation, including OASIS-C and coding? Who is responsible for ensuring compliance with rules and regulations and keeping up with changes? What types of outcomes reports are run routinely? Who is responsible? 28 Agency Leadership/Management Clinical managers may be affected by changes in documentation requirements, forms, process, 485/POC development, OASIS-C changes as well as the actual ICD-10 coding changes. CFO will need to budget and monitor ICD-10 conversion costs from software upgrades and training to form revisions, as well as model for cash flow disruptions. May need to consider securing lines of credit. Administrators need to consider staffing needs, productivity impacts, and contingency plans like outsourcing partnerships. Strong project management will be key given all the moving parts necessary to make this transition successful. 14

15 29 Leadership/Management Analysis Do the managers in your agency have authority to identify yproblems AND make changes within their departments? Does your agency have a working organization chart clearly defining who is responsible for what? Do your non-clinical managers have a basic understanding of the home health industry? What kind of training and education process exists for Managers? Are the provided with the tools needed to be successful in their management role? Let s talk about your Coders! 30 Is accurate and appropriate ICD coding considered a high priority at your agency? If not, then why not? Who is responsible for coding in your agency and are they qualified? Do you employ or contract with certified and/or experienced coding specialists? Is coding just one more task added onto a very busy field RNs and Case Managers? 15

16 More on coding. 31 How confident are you that the coding in your agency is accurate and appropriate? p What QA and review processes take place prior to OASIS-C and claims submission? What is the quality and quantity of the training your agency provides to staff responsible for this critical function? Is there a coding gpiece in your orientation process? How does your average HHRG compare to those agencies that utilize certified coders? Are you leaving revenue on the table through inaccurate coding practices? 32 Benefits of certified coders and coding specialists The purpose of home health agencies is to provide appropriate, p quality patient care to those we serve, right? There is an expectation that agency field staff will provide the highest level of quality care. Is it realistic to also expect those same clinicians to have abilities as a coding specialist? Utilizing certified coding specialists will improve your coding accuracy and compliance and likely l your reimbursement as well. It will also afford your clinicians more time and resources to care for their patients. 16

17 Don t put it off 33 This is just the beginning of the dialog for the upcoming ICD-10-CM CM transition. It is important that you stay abreast of what is happening, as this change will have a tremendous impact on your agency. Delaying putting this transition on our radar will only contribute to the challenges that will eventually need to be faced. Just do it! 34 ~"The best way to get something done is to begin." ~ 17

18 35 The Clinical Aspects What about ICD 11? House of Delegates adopted a policy to evaluate ICD-11 as a potential alternative to replace ICD-9 It took the US eight years to adapt the WHO version of ICD-10 and create ICD-10-CM for use in this country Regardless of the benefits of ICD-11, the US would need a national version to allow for the annual updating required by Congress and US stakeholders. Assuming that the development timeline for a national version or clinical modification of ICD-11 could be cut in half down to four years, it would then take an additional two years to get through the HIPAA rulemaking process. As with ICD-10-CM/PCS, the industry would want at least a three year period for converting systems to ICD-11. Assuming that ICD-11 becomes available on schedule from WHO in 2016, then the earliest the U.S. could move to ICD-11 would be 2025, or 13 years from now. 18

19 Tabular Chapters 37 A,B Infectious and parasitic diseases C Neoplasms D Neoplasms & blood and blood forming organs E Endocrine, nutritional, and metabolic F Mental and behavioral disorders G Nervous system H Eye and adnexa, ear and mastoid process I Circulatory system J Respiratory system K Digestive system Tabular Chapters 38 L Skin and subcutaneous tissue M Musculoskeletal and connective tissue N Genitourinary system O Pregnancy, childbirth, and the puerperium P Perinatal period Q Congenital malformations, deformations and chromosomal abnormalities R Symptoms, signs and abnormal clinical and laboratory findings 19

20 39 Tabular Chapters S,T Injury, poisoning and certain other consequences of external causes U Reserved by WHO for emergency codes V,W,X,Y External causes of morbidity - How were they hurt * - Where they were when they were hurt - What activity were they doing - External cause status Z Factors influencing health status and contact with health services Note: * only required external cause code in HH Coding and 7 th Character 40 Alpha (Except U) 2-7 Numeric or Alpha Additional Characters XAMS ØX X2. X 6 X 5 X x XA Category Etiology, anatomic site, severity Added code extensions (7 th character) for obstetrics, injuries, and external causes of injury 3 7 Characters 20

21 41 Overview Official Conventions Placeholder X 42 Addition of dummy placeholder X is used in certain codes to: Allow for future expansion Fill out empty characters when a code contains fewer than 6 characters and a 7 th character applies 21

22 43 Example Addition of 7 th Character Used in certain chapters to provide information about the characteristic of the encounter Must always be used in the 7 th character position If a code has an applicable 7 th character, the code must be reported with an appropriate 7 th character value in order to be valid Excludes Notes 44 Excludes 1: An excludes 1 note is a pure excludes note. It means NOT CODED HERE Indicates the code excluded should never be used at the same time as the code above the Excludes 1 notes. Is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition Excludes 2 An excludes 2 note represents not included here. Indicates the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time 22

23 45 Excludes Note Example J18.Ø Bronchopneumonia, unspecified organism Excludes1: hypostatic bronchopneumonia (J18.2) lipid pneumonia (J69.1) Excludes2: acute bronchiolitis (J21.-) chronic bronchiolitis (J44.9) Sequencing 46 ICD-10-CM coding guideline I.A.17 states a code also note instructs t that t two codes may be required to fully describe a condition, but this note does not provide sequencing direction. In contrast, the Code First/Use Additional Code notes provide sequencing order of the codes. 23

24 Laterality 47 For bilateral sites, the final character of the code indicates laterality. If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side An unspecified code is also provided should the side not be identified in the medical record 48 Laterality Example Osteoarthritis M16.Ø Bilateral primary osteoarthritis of hip M16.11 Unilateral primary osteoarthritis, right hip M16.12 Unilateral primary osteoarthritis, left hip 24

25 49 Clinical Documentation Improvement Dependent somewhat on improvement in physician documentation OASIS If injury, need to know how that injury happened. If late effect of injury, need to know how that injury happened. Laterality 50 Common Home Health Diagnosis i Specific Examples 25

26 51 Diabetes 52 Diabetes Mellitus E10 E1Ø: Type 1 DM Includes: - brittle diabetes (mellitus) - diabetes (mellitus) due to autoimmune process - diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destruction -idiopathic diabetes (mellitus) - juvenile onset diabetes (mellitus) - ketosis-prone diabetes (mellitus) Note: no code first or use additional insulin code 26

27 53 Excludes 1 Diabetes Mellitus E10 E1Ø: Type I DM - diabetes mellitus due to underlying condition (EØ8.-) - drug or chemical induced diabetes mellitus (EØ9.-) - gestational diabetes (O24.4-) - hyperglycemia NOS (R73.9) - neonatal diabetes mellitus (P7Ø.2) - postpancreatectomy diabetes mellitus (E13.-) - postprocedural diabetes mellitus (E13.-) - secondary diabetes mellitus NEC (E13.-) - type 2 diabetes mellitus (E11.-) 54 Diabetes Mellitus E1Ø Example Type I insulin dependent diabetic admitted for management of new meds related to exacerbation of macular edema and mild nonproliferative retinopathy related to the diabetes. 27

28 55 Diabetes Mellitus E1Ø Answer M1Ø2Ø: E1Ø.321 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema Note: Combination code includes all aspects of disease 56 Diabetes Mellitus E11 E11: Type II Diabetes Mellitus Includes: - diabetes (mellitus) due to insulin secretory defect - diabetes NOS - insulin resistant diabetes (mellitus) Use an additional code for insulin use (Z79.4) 28

29 57 Excludes1: Diabetes Mellitus E11 E11: Type II Diabetes Mellitus - diabetes mellitus due to underlying condition (EØ8-) - drug or chemical induced diabetes mellitus (EØ9.-) - gestational diabetes (O24.4-) - neonatal diabetes mellitus (P7Ø.2) - postpancreatectomy diabetes mellitus (E13.-) - postprocedural diabetes mellitus (E13.-) - secondary diabetes mellitus NEC (E13.-) - type 1 diabetes mellitus (E1Ø.-) 58 Diabetes Mellitus E11 Example Patient was admitted for uncontrolled diabetes type II with neuropathy. Patient takes insulin 29

30 59 Diabetes Mellitus E11 Answer M1Ø2Ø: E11.4Ø Type II diabetes mellitus with diabetic neuropathy, unspecified M1Ø22: E11.65 Type II diabetes mellitus with hyperglycemia M1Ø22: Z79.4 Long term current use insulin Note: alpha instruction: out of control - code to Diabetes, by type, with hyperglycemia Neuropathy is coded unspecified. Polyneuropathy is a specific code E Diabetes Mellitus E11 Example Patient was admitted for diabetes type II with gangrene. Patient takes insulin 30

31 61 Diabetes Mellitus E11 Answer M1Ø2Ø: E11.52 Type II diabetes mellitus with diabetic peripheral angiopathy with gangrene M1Ø22: Z79.4 Long term current use insulin 62 Diabetes Mellitus E11 Example Patient was admitted for diabetes type II with Charcot s foot. Patient takes insulin for his uncontrolled diabetes. 31

32 63 Diabetes Mellitus E11 Answer M1Ø2Ø: E Type II diabetes mellitus with diabetic neuropathic arthropathy M1Ø22: E11.65 Type II diabetes with hyperglycemia M1Ø22: Z79.4 Long term current use insulin 64 Ulcers 32

33 65 Pressure Ulcer Example Patient admitted with a stage III pressure ulcer to left heel. A stage II pressure ulcer to right heel. The stage III wound dis gangrenous. 66 Pressure Ulcer Answer M1Ø2Ø: I96 Gangrenous cellulitis M1Ø22: L Pressure ulcer of left heel, stage 3 M1Ø22: L Pressure ulcer of right heel, stage 2 Note: Code first any associated gangrene (I96) 33

34 Pressure Ulcers 67 The patient has a Stage 3 on the right buttock and a Stage 4 on right shoulder blade. There is a suspected DTI on the right heel. He also has Type 2 diabetes and failure to thrive. Dressing changes on Stage 3 and Stage 4. Pressure relief for DTI with no dressings. Answer 68 ICD-10-CM Code Description L Pressure ulcer R upper back Stage 4 L Pressure ulcer R buttock Stage 3 E11.9 Type 2 diabetes without complications R62.7 Failure to thrive, adult L Pressure ulcer R heel, unstageable Z48.00 Non surgical dressing change 34

35 69 Arterial Ulcer Example Patient admitted with arterial skin ulcer of left calf due to atherosclerosis 70 Arterial Ulcer Answer M1Ø2Ø: I7Ø.242 Atherosclerosis of native arteries of left leg with ulceration of calf M1Ø22: L Non pressure ulcer of left calf limited to skin Note: Reason for ulcer if known should Note: Reason for ulcer, if known, should be sequenced first Note: Codes available for severity of ulcer 35

36 71 Ulcer Severity L Non-pressure chronic ulcer of left calf -1Non-pressure chronic ulcer of left calf limited to breakdown of skin -2Non-pressure chronic ulcer of left calf with fat layer exposed -3Non-pressure chronic ulcer of left calf with necrosis of muscle -4Non-pressure chronic ulcer of left calf with necrosis of bone -9Non-pressure chronic ulcer of left calf with unspecified severity 72 Injuries 36

37 Injuries 73 No aftercare code for injuries A = Initial encounter nter D = Subsequent encounter S = Sequela Required to add the external cause code for how the injury happened for home care 74 Open Wound Example Patient admitted for wound care to lacerated right forearm due to falling from moving motorized mobility scooter. 37

38 75 Open Wound Answer M1Ø2Ø: S51.811D Laceration without foreign body of right forearm M1Ø22: VØØ.831D Fall from moving motorized mobility scooter Note: Fall from non moving motorized mobility scooter WØ5.2xxD 76 Acute Burn Example Patient admitted for wound care due to second degree burn of left foot due to hot bath water 38

39 77 Acute Burn Answer M1Ø2Ø: T25.222D Burn of second degree of left foot M1Ø22: X11.ØxxD Contact with hot bath water Note: 5 th and 6 th character x required Note: 7th character required 78 Sequela (Late Effect) Burn Example Patient admitted for PT and OT due to joint contracture after the healing of a third degree burn to the right foot when the hot oil from a fry kettle poured on his foot at the restaurant at which he worked. Sequela are coded with a S 7 th character. 39

40 79 Sequela (Late Effect) Burn Answer M1Ø2Ø: M Joint contracture right foot M1Ø22: T25.321S Burn of third degree of right foot, sequela M1Ø22: X1Ø.2xxS Contact with hot oil, sequela The condition or nature of the sequela is sequenced first. The sequela code is sequenced second. Note: 5 th and 6 th character x required Note: 7th character required 80 Traumatic Hip Fracture Example Patient admitted for aftercare of traumatic right hip fracture after falling out of wheelchair 40

41 81 Traumatic Hip Fracture Answer M1Ø2Ø: S72.ØØ1D Subsequent encounter for closed fracture of unspecified part of neck of right femur with routine healing M1Ø22: WØ5.ØxxD Fall from wheelchair Note: A fracture not indicated as opened or closed should be coded d to closed 82 Example 7 th Character Fractures A = Initial encounter for closed fracture B = Initial encounter for open fracture D = Subsequent encounter for fracture with routine healing G = Subsequent encounter for fracture with delayed healing K = Subsequent encounter for fracture with nonunion P = Subsequent encounter for fracture with malunion S = Sequela 41

42 83 Osteoporosis With Fracture Example Patient admitted for aftercare of pathological fractured vertebra due to age related osteoporosis. Documentation indicates patient had previous healed pathological fracture of humerus due to osteoporosis 84 Osteoporosis With Fracture Answer M1Ø2Ø: M8Ø.Ø8xD Age related osteoporosis with current pathological fracture, vertebra subsequent encounter M1Ø22: Z87.31Ø Personal history of healed osteoporosis fracture Note: Age related osteoporosis is separate category from other osteoporosis Note: Pathological fracture is separate category from osteoporosis fracture 42

43 85 Osteoporosis Fracture Definition Fragility fracture is defined as a fracture sustained with trauma no more than a fall from a standing height or less that occurs under circumstances that would not cause a fracture in a normal healthy bone 86 Circulatory 43

44 87 CVA Example Patient admitted for CVA with right sided hemiparesis 88 CVA Example M1Ø2Ø: I Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side Note: Should the affected side be documented, but not specified as dominant or non-dominant and the classification system does not indicate a default, code selection as follows: For ambidextrous patients, the default should be dominant If the left side is affected, the default is non dominant If the right side is affected, the default is dominant 44

45 Code a CVA Example 89 The patient is admitted to home care with dysphagia, dysphasia, and ataxia following cerebral infarction. ICD-10-CM Code Description Code a CVA Example 90 The patient is admitted to home care with dysphagia, dysphasia, and ataxia following cerebral infarction. ICD-10-CM Code Description I Ataxia following CVA I Dysphagia following CVA R13.10 Dysphagia, unspecified I Dysphasia following CVA 45

46 91 Myocardial Infarction Example Patient admitted to home health with new diagnosis of CAD after acute MI 5 weeks ago. Patient is no longer having symptoms 92 Myocardial Infarction Answer M1Ø2Ø: I25.1Ø Atherosclerotic heart disease of native coronary artery without angina M1Ø22: I25.2 Old healed MI N t ICD 1Ø d fi iti t MI 4 Note: ICD-1Ø definition acute MI = 4 weeks ICD-9 definition acute MI = 8 weeks 46

47 Myocardial Infarction Example 93 Patient was treated for an inferior wall MI in last 3 weeks and then was readmitted to hospital for anterior wall MI. He is being admitted to home care for O and A of unstable angina and his CAD and teaching on his multiple new cardiac meds. Myocardial Infarction Answers 94 M1Ø2Ø: I25.11Ø AHD with unstable angina M1Ø22: I21.19 MI other coronary artery inferior wall M1Ø22: I22.Ø MI of anterior wall M1Ø22: Z Other long term (current) drug therapy 47

48 Notes 95 Angina is considered integral to CAD unless otherwise noted by the physician. A MI is coded as I21.- in the first 4 weeks. If the patient has a second MI in the first 4 weeks, it is coded d with I22.- The sequencing of the I21 and I22 codes depends on the circumstances of the encounter. Hypertension 96 I10 Essential hypertension I11 Hypertensive Heart Disease Use additional code for heart failure (I50.-) I12 Hypertensive Chronic Kidney Disease Use additional code for CKD (N18.-) I13 Hypertensive Heart and Chronic Kidney Disease Use additional code for heart failure Use additional code for CKD No malignant or benign 48

49 Examples to code 97 Hypertensive chronic diastolic heart failure I11.0 Hypertensive heart disease with heart failure I50.32 Chronic diastolic (congestive) heart failure Hypertension I10 Hypertension Hypertension and ESRD on dialysis i I12.0 Hypertensive CKD with Stage 5 or ESRD N18.6 ESRD Z99.2 dialysis status 98 Nervous System 49

50 Code these 99 Parkinson s G20 Multiple sclerosis G35 Spastic hemiplegia of the left side after CHI and subdural hemorrhage in 1988 after he fell off a ladder G81.14 S06.5x9S W11.xxxS Quadriplegia after a spinal cord injury at C6 one year ago when the auto he was driving ran into a tree. H&P mentions complete lesion. G82.53 Quadriplegia S14.116S Complete lesion C6 V47.52xS Driver of other car collision with fixed or stationary object 100 Neoplasms and Blood Disorders 50

51 101 Anemia Due To Neoplasm Example Patient admitted for management of anemia related to colon cancer. The focus of care is the anemia. 102 Anemia Due To Neoplasm Answer M1Ø2Ø: C18.9 Colon cancer unspecified M1Ø22: D63.Ø Anemia in neoplastic disease Note: Different sequencing in ICD-9 51

52 103 Antineoplastic Chemotherapy Anemia Example Patient admitted for management of anemia related to chemotherapy due to colon cancer. The focus of care is the anemia. 104 Antineoplastic Chemotherapy Anemia Answer M1Ø2Ø: D64.81 Anemia due to antineoplastic chemotherapy M1Ø22: T45.1x5D Adverse effect of antineoplastic and immunosuppressive drugs subsequent M1Ø22: C18.9 Colon cancer unspecified 52

53 Neoplasm Example 105 Patient with history of prostate cancer and mets to the right femur has pathological fx with routine healing to the right femur. He is admitted for therapy and nursing for O & A, strengthening, g, transfers and pain management. He is taking Morphine for pain. Neoplasm Answers 106 M1Ø2Ø: M84.551D Pathological fracture in neoplastic disease, right femur, routine healing M1Ø22: C79.51 Secondary malignant neoplasm, bone M1Ø22: G89.3 Neoplasm related pain M1Ø22: Z85.46 History of prostate t ca M1Ø22: Z Long term (current) use of opiate analgesic 53

54 107 Aftercare & Post surgical Complications i Remember 108 No aftercare codes for trauma or fractures We don t know what CMS will do with OASIS and the use of M

55 Example 109 Patient had left BKA for diabetic gangrene. Providing aftercare, observation and assessment and dressing changes. ICD-10-CM Description M1024 (3) M1024(4) Answers 110 ICD-10-CM Description M1024 M1024(4 (3) ) Z47.81 Aftercare amputation E11.51 DM w/peripheral angiopathy wo gangrene Z Acquired absence of left leg below knee Z48 01 E t f E

56 Same patient, but. 111 The amputation site is infected (MRSA) and necrosed. Orders are to continue to provide care to the surgical wound and dressing changes. ICD-10-CM Description T87.54 Necrosis s of amp stump, LLE T87.44 Infection of amp stump, LLE B95.62 MRSA (cause of diseases classified elsewhere) Aftercare 112 The patient had a cholecystectomy due to acute cholecystitis. She also has a history of breast cancer and is taking Tamoxifen prophylactically. She s had some problems with urinary retention after surgery. You are to DC the indwelling catheter and attempt to instruct on intermittent cath. 56

57 113 Answers ICD-10-CM Description M1024 (3) M1024 4) Z Aftercare following digestive system surgery R33.9 Urinary retention, unspecified Z46.6 Fitting and adjustment of urinary catheter Z Long term use of Tamoxifen Z85.3 History of breast cancer K Same patient but one of the surgical wounds is dehisced ICD-10-CM Description M1024 (3) M1024(4) T81.31xD Disruption of external surg wound R33.9 Urinary retention, unspecified Z46.66 Fitting and adjustment of urinary catheter Z Long term use of Tamoxifen Z85.3 History of breast cancer 57

58 Selman Holman & Associates, LLC 115 Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, HCS-O AHIMA Approved ICD-10-CM/PCS Trainer AHIMA ICD-10-CM Ambassador Home Health Insight Consulting, Education and Products CoDR Coding Done Right 606 N. Bell Ave. Denton, Texas fax Manning Healthcare Group, Inc. Andrea L. Manning, BS, RN, HCS-D, COS-C Home Health Consulting Coding Services Education Leadership Coaching P.O. Box 1008 Talkeetna, Alaska cell 58

59 What questions do you have?