MS-DRGs Under ICD-10: A Look at the Draft MS-DRG Mappings and CC Lists

Size: px
Start display at page:

Download "MS-DRGs Under ICD-10: A Look at the Draft MS-DRG Mappings and CC Lists"

Transcription

1 MS-DRGs Under ICD-10: A Look at the Draft MS-DRG Mappings and CC Lists Presented by: Lynn-Marie Wozniak, MS, RHIT April 25, 2013

2 Presentation Objectives By the completion of this webinar participants will be able to do (or know) the following: Review the process used to convert the MS-DRG Grouper from ICD-9-CM to ICD-10-CM/PCS Access and navigate the V30.0 Draft MS-DRG Manual to find specific MS- DRG criteria as well as MCC/CC lists, CC exclusions and surgical hierarchies. Recognize similarities and differences between the current MCC and CC lists and the ICD-10-CM based lists Identify the affect that the ICD-10-CM/PCS codes and the code mappings have on the assignment of cases to high volume MS-DRGs Determine which high-volume MS-DRGs will be most affected by the transition to ICD-10-CM/PCS

3 CMS MS-DRG Conversion Project: I-9 to I-10 Goal: to develop an ICD-10 MS-DRG grouper that produces the same results as the ICD-9-CM MS-DRG grouper Same MS-DRG structure Same MS-DRGs Same surgical hierarchy Same MS-DRG definitions and criteria Replaced all the ICD-9-CM code lists with corresponding ICD-10-CM/PCS lists

4 Process Used to Replace ICD-9-CM Code Lists with ICD-10- CM/PCS Code Lists in MS-DRG Grouper Goal: Include all possible ICD-10-CM/PCS codes in the converted MS-DRG Grouper ICD-10-CM/PCS codes that had a one-to-one mapping (GEMs) with an ICD-9-CM code were mapped to the same DRG(s) as the ICD-9-CM code. ICD-10-CM/PCS codes that did not have any mapping back to ICD-9-CM (about 500 codes) had an ICD-9-CM code assigned to them for grouping purposes by the experts involved in the conversion project ICD-10-CM/PCS codes that mapped to multiple ICD-9-CM codes that were assigned to different DRGs had to be reviewed and decision made as to where best to put them. If one of the ICD-9-CM codes was dominant by more than 20% in terms frequency of occurrence, the ICD-10-CM/PCS code was mapped to it, if not, ICD-10-CM/PCS code assigned to the closest matching ICD-9-CM codes in terms of definition and diagnoses classified to it.

5 ICD-10-CM to ICD-9-CM GEMS: Reverse Look-Up Sample of I-10 to 1-9 GEMS : COPD Codes J J J J J J J J J J J J J J J J J J ICD-10- CM Codes ICD-9- CM Codes

6 Mapping Example: MS-DRG 069 Transient Ischemia ICD-9-CM Codes PRINCIPAL DIAGNOSIS 4350 Basilar artery syndrome 4351 Vertebral artery syndrome 4352 Subclavian artery syndrome 4353 Vertebrobasilar artery syndrome 4358 Transient cerebral ischemia, NEC 4359 Transient cerebral ischemia, NOS 4371 Acute cerebrovascular insufficiency ICD-10-CM Codes PRINCIPAL DIAGNOSIS G450 Vertebro-basilar artery syndrome G451 Carotid artery syndrome (hemispheric) G452 Multiple and bilateral precerebral artery syndromes G458 Other transient cerebral ischemic attacks and related syndromes G459 Transient cerebral ischemic attack, unspecified G460 Middle cerebral artery syndrome G461 Anterior cerebral artery syndrome G462 Posterior cerebral artery syndrome I6781 Acute cerebrovascular insufficiency I6782 Cerebral ischemia I67841 Reversible cerebrovascular vasoconstriction syndrome I67848 Other cerebrovascular vasospasm and vasoconstriction I6789 Other cerebrovascular disease The ICD-10-CM principal diagnosis codes classified to MS-DRG 069 consist of all the ICD-10-CM codes in the GEMs that are mapped to the ICD-9-CM principal diagnosis codes in first column.

7 ICD-10-CM Codes That Do Not Map to any ICD-9-CM Code The experts involved in the conversion project mapped the ICD-10-CM codes that were not included in the GEMs to ICD-9-CM codes, MDCs and MS-DRGs. ICD-10-CM ICD-9-CM MDC and MS-DRG G43.2, Status migrainosus T36-50**6*, Underdosing (489 codes), , Migraine, unspecifed, without mention of intractable migraine with status migrainosus V58.69, Long-term (current) use of other medications Z66, Do not resusictate V68.89, Encounters for other specified administrative purpose Z67*, Blood type (10 codes) V68.89, Encounters for other specified administrative purpose MDC 1 Headaches (MS-DRGs ) MDC 23 Aftercare (MS-DRGs ) MDC 23 Other Factors Influencing Health Status (MS-DRG 951) MDC 23 Other Factors Influencing Health Status ( MS-DRG 951) CMS.gov/Medicare/Coding/ICD-10-MS-DRG Conversion Project.html: Converting MS-DRGs 26.0 to ICD-10-CM and ICD-10-PCS Updated 2/25/13 with new impact article [Zip.612KB]

8 Mapping Example: ICD-10-CM Code Mapped to More Than One ICD- 9-CM Code ICD-10-CM Code ICD-9-CM Codes MS-DRG List FY 2007 MedPAR Records K22.8 Other specified diseases of esophagus Includes: Hemorrhage of esophagus NOS Esophageal hemorrhage Major Esophageal Disorders (MS-DRGs ) 10,167 K22.8 Other specified diseases of esophagus Includes: Hemorrhage of esophagus NOS Other diseases of esophagus Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders (MS-DRGs ) 8,685 CMS.gov/Medicare/Coding/ICD-10-MS-DRG Conversion Project.html: Converting MS-DRGs 26.0 to ICD-10-CM and ICD-10-PCS Updated 2/25/13 with new impact article [Zip.612KB]

9 ICD-10-CM to ICD-9-CM GEMS: Reverse Look-Up Sample of I-10 to 1-9 GEMS : COPD Codes J J J J J J J J J J J J J J J J J J Sample of Reimbursement GEMS: COPD Codes J J J J J J J J J J J J J

10 Special Challenges Involving Mapping ICD-10-PCS Codes to ICD- 9-CM in MS-DRG Grouper Many to One Multiple ICD-10-PCS codes mapped to a single ICD-9-CM procedure code due to ICD-10-PCS having a separate version of a code for each body system/body part, and ICD-9-CM having only one code that does not specify body part In ICD-9-CM the single code is classified to multiple MS-DRGs. In ICD-10-PCS the codes were distributed among the MS-DRGs based on body system/body part in the code. Example 92.27, Implantation or insertion of radioactive elements (1 code, in 12 MDCs, 35 MS- DRGs) 0xHxx1Z, Root operation is Insertion, and the device is Radioactive Element and there is no qualifier, but the body system, body part and approach changeable. This equals dozens of codes. Project experts assigned the specific ICD-10-PCS implantation or insertion of radioactive element codes to the 12 MDCs and 35 MS- DRGs on the basis of the body system/part involved, matching it to each MDC and then the MS-DRGs within the MDC.

11 Special Challenges Involving Mapping ICD-10-PCS Codes to ICD- 9-CM in MS-DRG Grouper MDC Body System Map CMS.gov/Medicare/Coding/ICD-10-MS-DRG Conversion Project.html: Converting MS-DRGs 26.0 to ICD-10-CM and ICD-10-PCS Updated 2/25/13 with new impact article [Zip.612KB] APPENDIX B

12 Special Challenges Involving Mapping ICD-10-PCS Codes to ICD- 9-CM in MS-DRG Grouper One to Many For ICD-10 codes that translate to multiple single ICD-9 codes in the GEMs, one ICD-9 code was selected for reimbursement purposes. For ICD-10 codes that translate to multiple ICD-9 clusters in the GEMs, one ICD-9 cluster was selected for reimbursement purposes. The mapping of one ICD-10 may require as many as six ICD-9 codes to reproduce the meaning of the ICD-10 code. In such cases, where an ICD-10 code maps to an ICD-9 cluster, all the codes in the cluster were included.

13 Examples of ICD-10-PCS Mapped to ICD-9-CM Code Clusters

14 Converting the CC and MCC Lists from ICD-9-CM to ICD-10-CM Start with ICD-10-CM to ICD-9-CM GEMS Flag all the ICD-9-CM codes on the GEMS that are on the CC or MCC list Select all the ICD-10-CM codes that are mapped to an ICD-9-CM CC and MCC code for the ICD- 10-CM CC and MCC List. If map to multiple CC codes it is a CC If map to multiple MCC codes it is a MCC If map to a CC and an MCC, or a CC and a non- CC, then dominant code was picked. If no dominant code, expert panel picked. ICD-10-CM Codes (Put all the codes that are mapped to ICD- 9-CM CCs or MCCs on the CC or MCC list) ICD-9-CM Codes (flag all the codes on the CC and MCC list)

15 Results of CC and MCC List Conversions Conversion Summary MCC CC Total ICD-9-CM CCs and MCCs on List 1,592 3,427 5,019 ICD-10-CM Codes Auto-translated 3,152 13,594 16,845 ICD-10-CM List Conflicts 99 (82 resolved based on frequency; 17 resolved by expert panel) ICD-9-CM CCs and MCCs with no corresponding ICD-10-CM Codes (examples: Uncontrolled diabetes codes, GI ulcers with obstructions, Multiple unspecified injury codes) CMS.gov/Medicare/Coding/ICD-10-MS-DRG Conversion Project.html: Converting MS-DRGs 26.0 to ICD-10-CM and ICD-10-PCS Updated 2/25/13 with new impact article [Zip.612KB]

16 Principal Diagnosis is Its Own CC Cytomegaloviral hepatitis Sickle-cell disease with acute chest syndrome Diabetes mellitus with diabetic peripheral angiopathy with gangrene Atherosclerotic heart disease with unstable angina pectoris Atherosclerosis of leg(s) with ulceration/gangrene of thigh/calf/ankle/foot/other/unspecified site Raynaud's syndrome with gangrene Crohn's disease with intestinal obstruction/fistula/abscess Colitis(ulcerative) (chronic) (pan) (left-sided) with intestinal obstruction/fistula/abscess Inflammatory polyps of colon with intestinal obstruction/fistula/abscess Diverticulitis of small/large intestine with perforation and abscess w/ or w/o bleeding Calculus of bile duct with (acute) (chronic) cholangitis, with or without obstruction Reiter's disease (specify site(s)) Rheumatoid myopathy with rheumatoid arthritis (specify site(s)) Endocarditis/pericarditis in systemic lupus erythematosus Dermatopolymyositis/polymyositis with myopathy Systemic sclerosis with lung involvement/ myopathy Sicca syndrome with myopathy Osteonecrosis in diseases classified elsewhere (specify site(s)) Chronic obstructive pyelonephritis Gestational edema with proteinuria (specify trimester) Encounter for aftercare following transplant (specify organ(s))

17 Principal Diagnosis is Its Own MCC Anthrax, candidal, erysipelothrix, gonococcal or listerial sepsis Whooping cough due to Bordetella pertussis/parapertussis/other Bordetella species with pneumonia Cytomegaloviral pneumonitis or pancreatitis Invasive pulmonary aspergillosis Cerebral cryptococcosis Ascariasis pneumonia Septic/saddle/other pulmonary embolism with acute cor pulmonale Alcoholic hepatic failure with coma Toxic liver disease with hepatic necrosis, with coma Acute and subacute, or chronic hepatic failure with coma Pressure ulcer (specify site), stage 3 or stage 4 Severe sepsis with septic shock Traumatic cerebral edema without loss of consciousness, initial encounter Traumatic cerebral edema with loss of consciousness, (specify time), initial encounter

18 Other Issues That Had to be Resolved During Conversion Mapped 1 st, 2 nd and 3 rd trimester OBcodes to antepartum codes with 5 th digit 3. Mapped delivery codes to OB codes with 5 th digit 2, and post-partum to OB codes with 5 th digit 4 Mapped subsequent and sequela encounter codes to Aftercare and Late effect codes OB Codes Subsequent and Sequela Antepartum codes Delivery codes Postpartum codes Aftercare codes Late effect codes

19 Example of Other Issues: MS-DRGs , Revision of Hip and Knee Replacement Joint revision procedure codes mapped to ICD-9-CM codes in three different MS-DRGs Required combinations of ICD-10-CM codes to get cases to go to revision MS-DRGs Example: 0SR90J5 Replacement of Right Hip Joint with Synthetic Substitute, Metal on Polyethylene, Open Approach And 0SP90JZ, Removal of Synthetic Substitute from Right Hip Joint, Open Approach

20 Example of Other Issues: MS-DRGs (partial list)

21 CMS.gov Website

22 CMS.gov/Medicare

23 CMS.gov/Medicare ICD-10 link

24 CMS.gov/Medicare/ICD-10

25 CMS.gov/Medicare/ICD-10/GEMS

26 CMS.gov/Medicare/ICD-10/Conversion Project

27 CMS.gov/Medicare/ICD-10/Conversion Project

28 MS-DRG Manual Table of Contents

29 Index to MS-DRGs

30 MS-DRG 069: Transient Ischemia

31 MS-DRG Manual Table of Contents

32 MDC 4: MS-DRG Chart

33 MS-DRGs 207 and 208 Code Lists and Grouper Logic

34 MS-DRG Manual Table of Contents

35 Appendix A: List of MS-DRGs

36 Appendix B: Diagnosis Code/MDC/MS-DRG Index

37 Appendix C: CC and MCC Exclusion List

38 Appendix C: Pop-up Exclusion List

39 Appendix D: Surgical Hierarchy MDC 06,Diseases & Disorders of the Digestive System Surgical Hierarchy MS-DRGs Stomach, Esophageal and Duodenal Procedures Major Small and Large Bowel Procedures Rectal Resection Peritoneal Adhesiolysis Appendectomy Minor Small and Large Bowel Procedures Anal and Stomal Procedures Hernia Procedures Other Digestive System O.R. Procedures

40 Appendix E: Operating Room Procedures and Procedure Code/MS-DRG Index Tables of Procedure Code Combinations Required for Specific MS-DRGS Pacemaker Lead/Device Reference Table Cardioverter-Defibrillator Lead(s)/Generator Reference Table Kidney/Pancreas Transplant Reference Table Intracardiac Lead/Device Reference Table Heart Assist System Table Major Brain Device Implant Table Neurotransmitter/Neurostimulator Table

41 Appendix E: Intracardiac Lead Table

42 Appendix E: O.R. Procedures and Procedure Code/MS-DRG Index OHB8XZZ, Excision, Skin, Buttocks 0HB8XZZ Peripheral and Cranial Nerve and Other Nervous System Procedures 0HB8XZZ 02 Extraocular Procedures Except Orbit 0HB8XZZ Other Ear, Nose, Mouth and Throat O.R. Procedures 0HB8XZZ Other Respiratory System O.R. Procedures 0HB8XZZ 05 Other Circulatory O.R. Procedures 0HB8XZZ Other Digestive System O.R. Procedures 0HB8XZZ Other Hepatobiliary or Pancreas O.R. Procedures 0HB8XZZ Wound Debridement and Skin Graft Except Hand, for Musculoskeletal and Connective Tissue Disorders 0HB8XZZ Skin Debridement 0HB8XZZ Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders 0HB8XZZ Other Kidney and Urinary Tract Procedures 0HB8XZZ Other Male Reproductive System O.R. Procedures 0HB8XZZ Other Female Reproductive System O.R. Procedures 0HB8XZZ Other O.R. Procedures of the Blood and Blood Forming Organs 0HB8XZZ Wound Debridements for Injuries 0HB8XZZ Extensive Burns or Full Thickness Burns with MV 96+Hours 0HB8XZZ Full Thickness Burns 0HB8XZZ Other O.R. Procedures for Multiple Significant Trauma

43 MS-DRG Manual Table of Contents

44 Appendix I: Hospital Acquired Conditions (HACS) List

45 Impact of MS-DRG Conversion to ICD-10-CM/PCS on DRG Assignment Recoded FY2010 MedPAR data into ICD-10-CM/PCS using GEMS and many project specific rules to ensure correctness of code mapping and regrouped them using v30.0 ICD-10 MS-DRG Grouper 99% of cases assigned to same MS-DRG 1% of cases assigned to a different MS-DRG 45% to higher weighted MS-DRGs 75% of shifts to higher weighted MS-DRGs due to gaining a CC or MCC 55% to lower weighted MS-DRGs 40% of shifts to lower weighted MS-DRGs due to losing a CC or MCC

46 Top MS-DRGs with Positive Shifts DRG 011, Tracheostomy for face, mouth and neck dx w/ MCC 037, Extracranial procedures w MCC 066, Intracranial hemorrhage or cerebral infarction w/o CC/MCC 812, Red blood cell disorders w/mcc Reason for Shift Tracheostomy coded separately from radical larngectomy in ICD-10- CM so more cases with MCC moving into Trach MS-DRGs Shift of more cases into MS-DRG because of changes in MCC exclusion lists. Cases shifted out of the w/o CC or MCC to higher weighted MS-DRGs with CCs. Mostly cases with multiple CVA codes including CVAs that mapped to ICD-9-CM code which is not excluded as a CC with other CVA codes. ICD-10-CM coding guidelines put malignancy first and anemia second. MS-DRG lost cases to other higher weighted cancer MS-DRGs

47 Top MS-DRGs with Negative Shifts MS-DRG 981, Extensive O.R. procedures unrelated to PDX with MCC 391, Esophagitis, gastroenteritis & misc. digestive disorders with MCC Reason for Shift Most of the shifting is due to loss of an MCC About 90% of the weight change is due to ICD-10-CM code K22.8, Other diseases of esophagus being mapped to in the reimbursement mapping. It goes to a lower weighted MS-DRG. 885, Psychoses , Major depression is mapped to F32.9 which is classified to lower weighted MS-DRG , COPD with CC Due to reclassification of COPD and asthma codes and the new combinations not counting as CCs for each other as often. 974, HIV with major related condition with MCC In ICD-10-CM sepsis codes in category A41, but mapped to which is excluded as MCC for MS-DRG , Heart failure and shock with CC All cases with CC Malignant hypertension, mapped to I10, Essential hypertension which is not a CC.

48 References Mills, R.E., Butler, R.R., Averill, R.F., McCullough, E.C., Bao, M.Z., Impact of the Transition to ICD-10 on Medicare Inpatient Hospital Payments. 3M Health Information Systems, Wallingford CT. Mills, Ron. Estimating the Impact of the Transition to ICD-10 on Medicare Inpatient Hospital Payments. Center for Medicare and Medicaid Services, Agenda: ICD-9-CM Coordination and Maintenance Committee, March 5, Accessed: April 23, Centers for Medicare and Medicaid Services: Draft ICD-10-CM/PCS DRGv30 definitions manual. Modified : February 13, Accessed: April 23, Converting MS-DRGs 26.0 to ICD-10-CM and ICD-10-PCS Updated 2/25/13 with new impact article. Accessed: April 23, Project.html 2013 General Equivalence Mappings Diagnosis Codes and Guide. Accessed: April 23, General Equivalence Mappings Procedure Codes and Guide. Accessed: April 23, Reimbursement Mappings Diagnosis Codes and Guide. Accessed: April 23, Reimbursement Mappings Procedure Codes and Guide. Accessed: April 23,

49 Thank you for attending our webinar. You will receive an within the week providing a link to the CE Certificate, the webinar recording and the Slides.

The Top 20 ICD-10 Documentation Issues That Cause DRG Changes

The Top 20 ICD-10 Documentation Issues That Cause DRG Changes 7th Annual Association for Clinical Documentation Improvement Specialists Conference The Top 20 ICD-10 Documentation Issues That Cause DRG Changes Donna Smith, RHIA Project Manager, Consulting Services

More information

PHC4 35 Diseases, Procedures, and Medical Conditions for which Laboratory Data is Required Effective 10/1/2015

PHC4 35 Diseases, Procedures, and Medical Conditions for which Laboratory Data is Required Effective 10/1/2015 PHC4 35 Diseases, Procedures, and Medical Conditions for which Laboratory Data is Required Effective 10/1/2015 Laboratory data is to be submitted for discharges in the following conditions: 1. Heart Attack

More information

Estimating the Impact of the Transition to ICD-10 on Medicare Inpatient Hospital Payments

Estimating the Impact of the Transition to ICD-10 on Medicare Inpatient Hospital Payments Estimating the Impact of the Transition to ICD-10 on Medicare Inpatient Hospital Payments ICD-10 Coordination and Maintenance Committee March 18, 2015 Objective To estimate the impact on aggregate IPPS

More information

Certified Registered Nurse Anesthetist ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for CRNA s and Top 25 Codes

Certified Registered Nurse Anesthetist ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for CRNA s and Top 25 Codes Certified Registered Nurse Anesthetist ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for CRNA s and Top 25 Codes Chapter 2 Neoplasms (C00-D49) Classification improvements Code expansions Significant

More information

Stroke Coding Issues Presentation to: NorthEast Cerebrovascular Consortium

Stroke Coding Issues Presentation to: NorthEast Cerebrovascular Consortium Stroke Coding Issues Presentation to: NorthEast Cerebrovascular Consortium October 30, 2008 Barry Libman, RHIA, CCS, CCS-P President, Barry Libman Inc. Stroke Coding Issues Outline Medical record documentation

More information

Certified Clinical Documentation Specialist Examination Content Outline - 2016

Certified Clinical Documentation Specialist Examination Content Outline - 2016 Certified Clinical Documentation Specialist Examination Content Outline - 2016 1. Healthcare Regulations, Reimbursement, and Documentation Requirements Related to the Inpatient Prospective Payment System

More information

The Why and How of a CDI Program. Deb Neville, RHIA, CCS-P, Elsevier/MC Strategies Donna Bonno, CPC- CPC-I, QuadraMed September 12, 2012

The Why and How of a CDI Program. Deb Neville, RHIA, CCS-P, Elsevier/MC Strategies Donna Bonno, CPC- CPC-I, QuadraMed September 12, 2012 The Why and How of a CDI Program Deb Neville, RHIA, CCS-P, Elsevier/MC Strategies Donna Bonno, CPC- CPC-I, QuadraMed September 12, 2012 Objectives Understand the reasons behind a Clinical Documentation

More information

Home Health Care ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Home Health Care and Top 20 codes

Home Health Care ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Home Health Care and Top 20 codes Home Health Care ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Home Health Care and Top 20 codes Chapter 4: Endocrine, Nutritional and Metabolic Diseases (E00-E99) ICD-10-CM diabetes mellitus

More information

ICD-10 Executive Action Guide:

ICD-10 Executive Action Guide: ICD-10 Executive Action Guide: A Roadmap to Ensuring a Successful Transition to a New Coding System 1 March 2014 American Hospital Association Introduction Transformative change initiatives such as the

More information

MASSACHUSETTS RESIDENTS CENTRAL MA. Acute Care Hospital Utilization Trends in Massachusetts FY2009-2012

MASSACHUSETTS RESIDENTS CENTRAL MA. Acute Care Hospital Utilization Trends in Massachusetts FY2009-2012 ACUTE CARE HOSPITAL UTILIZATION TRENDS I N MASSACHUSETTS FY2009-2012 MASSACHUSETTS RESIDENTS CENTRAL MA Introduction The Center for Health Information and Analysis (CHIA) is publishing these inpatient,

More information

MDC 1 DISEASES AND DISORDERS OF THE NERVOUS SYSTEM Implantation of chemotherapeutic agent Intracranial stents

MDC 1 DISEASES AND DISORDERS OF THE NERVOUS SYSTEM Implantation of chemotherapeutic agent Intracranial stents To assist the readers in identifying all changes that were made to the MS-DRGs as a result of comments, we developed the attached table that summaries those changes. MS-DRG Summary Table PRE-MDC Intestinal

More information

MS-DRG Shift in an ICD-10 World. Hawaii HIMA March 2015 Audio Webinar March 4th, 2015

MS-DRG Shift in an ICD-10 World. Hawaii HIMA March 2015 Audio Webinar March 4th, 2015 MS-DRG Shift in an ICD-10 World Hawaii HIMA March 2015 Audio Webinar March 4th, 2015 Speaker Gloryanne Bryant, BS, RHIA, RHIT, CCS, CDIP, CCDS 30+ year HIM Professional and Leader California Health Information

More information

Hospital-based SNF Coding Tip Sheet: Top 25 codes and ICD-10 Chapter Overview

Hospital-based SNF Coding Tip Sheet: Top 25 codes and ICD-10 Chapter Overview Hospital-based SNF Coding Tip Sheet: Top 25 codes and Chapter Overview Chapter 5 - Mental, Behavioral and Neurodevelopmental Disorders (F00-F99) Classification improvements (different categories) expansions:

More information

ICD-10 Transition & Implementation Information

ICD-10 Transition & Implementation Information ICD-10 Transition & Implementation Information I ICD-10 Implementation Compliance Date: October 1, 2015 ICD-10-CM diagnoses codes will be used by all providers in every health care setting. ICD-10-PCS

More information

HCIM ICD-10 Training Online Course Catalog August 2015

HCIM ICD-10 Training Online Course Catalog August 2015 HCIM ICD-10 Training Online Course Catalog August 2015 Course/Content Duration Quiz Duration CME Credits Assessments: Assessment: Provider - Baseline - E/M Emergency Department 45 5/1/2015 Assessment:

More information

Guidelines Most Significantly Affected Under ICD-10-CM. May 29, 2013

Guidelines Most Significantly Affected Under ICD-10-CM. May 29, 2013 Guidelines Most Significantly Affected Under ICD-10-CM May 29, 2013 Guidelines Most Significantly Affected Under ICD-10-CM A look at the new system and how it compares to ICD-9-CM Presented by Therese

More information

Supplemental Technical Information

Supplemental Technical Information An Introductory Analysis of Potentially Preventable Health Care Events in Minnesota Overview Supplemental Technical Information This document provides additional technical information on the 3M Health

More information

MASSACHUSETTS RESIDENTS NORTHEAST MA. Acute Care Hospital Utilization Trends in Massachusetts FY2009-2012

MASSACHUSETTS RESIDENTS NORTHEAST MA. Acute Care Hospital Utilization Trends in Massachusetts FY2009-2012 ACUTE CARE HOSPITAL UTILIZATION TRENDS I N MASSACHUSETTS FY2009-2012 MASSACHUSETTS RESIDENTS NORTHEAST MA Introduction The Center for Health Information and Analysis (CHIA) is publishing these inpatient,

More information

Real World Experience In Recoding Charts In ICD-10

Real World Experience In Recoding Charts In ICD-10 Real World Experience In Recoding Charts In ICD-10 By Karen G. Youmans, MPA, RHIA, CCS President, YES HIM Consulting, Inc. YES HIM Consulting, Inc. OVERVIEW AND BACKGROUND INFORMATION During April-May

More information

Alameda Alliance for Heath ICD-9 to ICD-10 TRANSLATION CODES E10.10

Alameda Alliance for Heath ICD-9 to ICD-10 TRANSLATION CODES E10.10 DIABETES ICD-9 CM ICD-9 CM Volume 1 - Diagnosis Description ICD-10 CM - Diagnosis Code ICD-10 CM - Diagnosis Description 250.00 Diabetes mellitus without mention of complication, type II or unspecified

More information

Bellagio, Las Vegas November 26-28, 2012. Kelly Canter, BA, RHIT, CCS ICD-10 MS-DRG Update

Bellagio, Las Vegas November 26-28, 2012. Kelly Canter, BA, RHIT, CCS ICD-10 MS-DRG Update Bellagio, Las Vegas November 26-28, 2012 Kelly Canter, BA, RHIT, CCS ICD-10 MS-DRG Update Agenda MS-DRG Basics The Transition of the MS-DRGs from ICD-9 to ICD-10 Guideline changes from ICD-9 to ICD-10

More information

ICD-10 Preparation for Non- Coders in the Revenue Cycle

ICD-10 Preparation for Non- Coders in the Revenue Cycle ICD-10 Preparation for Non- Coders in the Revenue Cycle September 24, 2015 Arkansas HFMA Revenue Cycle Seminar Susan Wallace, MEd, RHIA, CCS, CCDS, CDIP, FAHIMA Program Objectives Explain the impact of

More information

Getting Ready for ICD-10. Part 2: ICD-10 Coding

Getting Ready for ICD-10. Part 2: ICD-10 Coding Getting Ready for ICD-10 Part 2: ICD-10 Coding Introduction In the United States, on October 1, 2015 the ICD 9 code set used to report medical diagnoses and inpatient procedures will be replaced by International

More information

Head Start to Implementation: Preparing Now for ICD-10 (Focus on PCS)

Head Start to Implementation: Preparing Now for ICD-10 (Focus on PCS) Head Start to Implementation: Preparing Now for ICD-10 (Focus on PCS) 3M 2008. All rights reserved. Marc Berlinguet, MD, MPH, CSPQ- International Medical Manager, 3M HIS Spain, September 15 and 16, 2009

More information

MEDICAL POLICY No. 91104-R7 DETOXIFICATION I. POLICY/CRITERIA

MEDICAL POLICY No. 91104-R7 DETOXIFICATION I. POLICY/CRITERIA DETOXIFICATION MEDICAL POLICY Effective Date: January 7, 2013 Review Dates: 1/93, 2/97, 4/99, 2/01, 12/01, 2/02, 2/03, 1/04, 1/05, 12/05, 12/06, 12/07, 12/08, 12/09, 12/10, 12/11, 12/12, 12/13, 11/14 Date

More information

ICD-10-CM/PCS Implementation and General Equivalence Mappings (Crosswalks) Overview

ICD-10-CM/PCS Implementation and General Equivalence Mappings (Crosswalks) Overview ICD-10-CM/PCS Implementation and General Equivalence Mappings (Crosswalks) Overview 1 Pat Brooks, RHIA Senior Technical Advisor Hospital and Ambulatory Policy Group Center for Medicare Management Centers

More information

Diagnosis Coding Definitions. Learning Objectives

Diagnosis Coding Definitions. Learning Objectives Advanced Principal Diagnosis/Principal Procedure and Sequencing Considerations in ICD-10- CM and ICD-10-PCS HCPro, Inc., Danvers, Mass.: Jennifer Avery, CCS, CPC-H, CPC, CPC-I Senior Regulatory Specialist

More information

MASSACHUSETTS RESIDENTS WESTERN MA. Acute Care Hospital Utilization Trends in Massachusetts FY2009-2012

MASSACHUSETTS RESIDENTS WESTERN MA. Acute Care Hospital Utilization Trends in Massachusetts FY2009-2012 ACUTE CARE HOSPITAL UTILIZATION TRENDS I N MASSACHUSETTS FY2009-2012 MASSACHUSETTS RESIDENTS WESTERN MA Introduction The Center for Health Information and Analysis (CHIA) is publishing these inpatient,

More information

ICD-9-CM/ICD-10-CM Codes for MNT

ICD-9-CM/ICD-10-CM Codes for MNT / Codes for MNT ICD (International Classification of Diseases) codes are used by physicians and medical coders to assign medical diagnoses to individual patients. It is not within the scope of practice

More information

ICD-10 Provider Preparation

ICD-10 Provider Preparation ICD-10 Provider Preparation After browsing this slide deck, the viewer will become more familiar with the following information: What are the origins of ICD-10? Why transition to ICD-10? Why ICD-10 matters.

More information

CHAPTER 9 DISEASES OF THE CIRCULATORY SYSTEM (I00-I99)

CHAPTER 9 DISEASES OF THE CIRCULATORY SYSTEM (I00-I99) CHAPTER 9 DISEASES OF THE CIRCULATORY SYSTEM (I00-I99) March 2014 2014 MVP Health Care, Inc. CHAPTER 9 CHAPTER SPECIFIC CATEGORY CODE BLOCKS I00-I02 Acute rheumatic fever I05-I09 Chronic rheumatic heart

More information

Speaking ICD-10-CM. The New Coding Language. COPD documented with a more specific respiratory condition falls under one code category: J44.0-J44.

Speaking ICD-10-CM. The New Coding Language. COPD documented with a more specific respiratory condition falls under one code category: J44.0-J44. Speaking : Chronic Obstructive Pulmonary Disease (COPD) COPD documented with a more specific respiratory condition falls under multiple code categories: 491.20-491.22 Obstructive chronic bronchitis 493.20-493.22

More information

Common Pathology Diagnoses: ICD-9 to ICD-10 Mapping

Common Pathology Diagnoses: ICD-9 to ICD-10 Mapping PERFORMANCE THAT MATTERS NUMBER OF CODES 14,000 69,000 ICD-9 DIAGNOSIS CODES ICD-10 DIAGNOSIS CODES CODE STRUCTURE ICD-9-CM CODE FORMAT ICD-10-CM CODE FORMAT X X X X X X X X X X X X CATEGORY ETIOLOGY,

More information

What is Data Analytics and How Does it Help Prepare Providers for ICD-10?

What is Data Analytics and How Does it Help Prepare Providers for ICD-10? What is Data Analytics and How Does it Help Prepare Providers for ICD-10? June 2013 Kim Charland, BA, RHIT, CCS Senior Vice President of Clinical Consulting Services Panacea Healthcare Solutions, Inc.

More information

Module 9: Diseases of the Endocrine System and Nutritional Disorders Exercises

Module 9: Diseases of the Endocrine System and Nutritional Disorders Exercises Module 9: Diseases of the Endocrine System and Nutritional Disorders Exercises 1. An 86 year old male with brittle Type I DM is admitted for orthopedic surgery. The physician documents in the operative

More information

Coding in Germany - The Use of ICD-10 for Diagnoses

Coding in Germany - The Use of ICD-10 for Diagnoses Coding in Germany - The Use of ICD-10 for Diagnoses Dr. Thomas Mansky, TU Berlin Th. Mansky, HIMSS 2012 1 DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do

More information

ICD-9-CM coding for patients with Spinal Cord Injury*

ICD-9-CM coding for patients with Spinal Cord Injury* ICD-9-CM coding for patients with Spinal Cord Injury* indicates intervening codes have been left out of this list. OTHER DISORDERS OF THE CENTRAL NERVOUS SYSTEM (340-349) 344 Other paralytic syndromes

More information

Pathology ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Pathology and Top 25 codes

Pathology ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Pathology and Top 25 codes Pathology ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Pathology and Top 25 codes Chapter 2 Neoplasms (C00-D49) Classification improvements Code expansions Significant expansions or revisions

More information

E08.621 Diabetes mellitus due to underlying condition with foot ulcer E09.621 Drug or chemical induced diabetes mellitus with foot ulcer E10.10 Type 1 diabetes mellitus with ketoacidosis without coma E10.11

More information

Medicare Advantage Risk Adjustment Data Validation CMS-HCC Pilot Study. Report to Medicare Advantage Organizations

Medicare Advantage Risk Adjustment Data Validation CMS-HCC Pilot Study. Report to Medicare Advantage Organizations Medicare Advantage Risk Adjustment Data Validation CMS-HCC Pilot Study Report to Medicare Advantage Organizations JULY 27, 2004 JULY 27, 2004 PAGE 1 Medicare Advantage Risk Adjustment Data Validation CMS-HCC

More information

ICD-10 Update and Top Ten Professional Diagnoses* 2014 Blue Cross Blue Shield of Michigan

ICD-10 Update and Top Ten Professional Diagnoses* 2014 Blue Cross Blue Shield of Michigan ICD-10 Update and Top Ten Professional Diagnoses* 2014 Blue Cross Blue Shield of Michigan *NOTE: The information in this document is not intended to impart legal advice. This overview is intended as an

More information

Medical Surgical Nursing (Elsevier)

Medical Surgical Nursing (Elsevier) 1 of 6 I. The Musculoskeletal System Medical Surgical Nursing (Elsevier) 1. Med/Surg: Musculoskeletal System: The Comprehensive Health History 2. Med/Surg: Musculoskeletal System: A Nursing Approach to

More information

Introduction to ICD - 10. Andrea Devlin, CPMA, CPC Alta Partners, LLC 2015

Introduction to ICD - 10. Andrea Devlin, CPMA, CPC Alta Partners, LLC 2015 Introduction to ICD - 10 Andrea Devlin, CPMA, CPC Alta Partners, LLC 2015 Agenda Introduction Benefits of ICD-10 Features of ICD-10 ICD-9 vs. ICD-10 ICD-10 Structure Question & Answer Introducing ICD-10

More information

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services GENERAL EQUIVALENCE MAPPINGS FREQUENTLY ASKED QUESTIONS

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services GENERAL EQUIVALENCE MAPPINGS FREQUENTLY ASKED QUESTIONS DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services GENERAL EQUIVALENCE MAPPINGS FREQUENTLY ASKED QUESTIONS ICN 901743 June 2015 This publication provides the following information

More information

Limited Pay Policy (L-222B) - Underwriting Guidelines

Limited Pay Policy (L-222B) - Underwriting Guidelines Limited Pay Policy (L-222B) - Underwriting Guidelines 1 Addiction/Abuser Drug - Past or Present Presently Recovered - AA for last 2 years 2 Aids 3 Alcoholic Presently Recovered - AA for last 2 years 4

More information

Introduction to Mapping Tool 2015 ICD 9 CM and ICD 10 CM/PCS

Introduction to Mapping Tool 2015 ICD 9 CM and ICD 10 CM/PCS MapIT (developed by AHRQ*) Introduction to Mapping Tool 2015 ICD 9 CM and ICD 10 CM/PCS *http://www.qualityindicators.ahrq.gov/resources/toolkits.aspx Introduction Ginger Cox, RHIT, CCS, ICD-9/10 Coding

More information

Welcome to ICD-10 CLINICAL CLOSE-UP

Welcome to ICD-10 CLINICAL CLOSE-UP Welcome to ICD-10 CLINICAL CLOSE-UP Topics ICD-10 Overview About ICD-10 Why ICD-10 Matters ICD-9 vs ICD-10 Clinical Close-Up ICD-10 Documentation GEMs Mapping Tool GEMS vs Coding Manual Bi-Directional

More information

ICD-10 Implementation: No Margin, No Mission

ICD-10 Implementation: No Margin, No Mission ICD-10 Implementation: No Margin, No Mission October 6, 2014 Subtitle: ICD-WHEN? Page 0 Agenda ICD10 Background ICD9 ICD10 Transition ICD10 Assessment Tasks ICD10 Assessment Considerations ICD-10 Areas

More information

Best of AHA Coding Clinic for ICD 10 CM. Disclaimer

Best of AHA Coding Clinic for ICD 10 CM. Disclaimer Best of AHA Coding Clinic for ICD 10 CM Wednesday, June 18, 2014 12:00 1:00pm CST Nelly Leon Chisen, RHIA, Director of Coding and Classification, AHA Anita Rapier, RHIT, CCS, Senior Coding Consultant,

More information

MS-DRG NEWS. Reporting Secondary Diagnoses that Impact MS-DRG Payment

MS-DRG NEWS. Reporting Secondary Diagnoses that Impact MS-DRG Payment MS- Effective 10/01/12 Inside this issue: Impact of Reporting Accuracy Impact More Than Payment 2 3 MCC s 4 Common CC s 5 Avoid Non- Specific Terminology 6 Reporting Secondary Diagnoses that Impact MS-DRG

More information

APPENDIX A NEUROLOGIST S GUIDE TO USING ICD-9-CM CODES FOR CEREBROVASCULAR DISEASES INTRODUCTION

APPENDIX A NEUROLOGIST S GUIDE TO USING ICD-9-CM CODES FOR CEREBROVASCULAR DISEASES INTRODUCTION APPENDIX A NEUROLOGIST S GUIDE TO USING ICD-9-CM CODES FOR CEREBROVASCULAR DISEASES INTRODUCTION ICD-9-CM codes for cerebrovascular diseases is not user friendly. This presentation is designed to assist

More information

Kathryn DeVault, RHIA, CCS, CCS-P Director, HIM Solutions, AHIMA

Kathryn DeVault, RHIA, CCS, CCS-P Director, HIM Solutions, AHIMA ICD-10-CM: Let s Code, Part II Kathryn DeVault, RHIA, CCS, CCS-P Director, HIM Solutions, AHIMA Agenda Coding questions answered Review of ICD-10-CM coding scenarios ICD-10-CM Coding Questions Coding Questions...

More information

NCD for Lipids Testing

NCD for Lipids Testing Applicable CPT Code(s): NCD for Lipids Testing 80061 Lipid panel 82465 Cholesterol, serum or whole blood, total 83700 Lipoprotein, blood; electrophoretic separation and quantitation 83701 Lipoprotein blood;

More information

ICD-10 Clinical Documentation Requirements

ICD-10 Clinical Documentation Requirements ICD-10 Clinical Documentation Requirements Presented by: Joe Nichols MD Date: Dec 20, 2013 Agenda Getting beyond resistance Business Impacts Why is good documentation important? Getting from assessment

More information

Quality Scorecard overall heart attack care overall heart failure overall pneumonia care overall surgical infection rate patient safety survival

Quality Scorecard overall heart attack care overall heart failure overall pneumonia care overall surgical infection rate patient safety survival Quality Scorecard s are required to report quality statistics to the s for Medicare and Medicaid Services (CMS) and the Department of Health (DOH). This information is made available at www.hospitalcompare.hhs.gov

More information

Healthcare Financial Management Association Southern California. Implementation of MS-DRGs. November 20, 2008

Healthcare Financial Management Association Southern California. Implementation of MS-DRGs. November 20, 2008 Healthcare Financial Management Association Southern California Implementation of MS-DRGs November 20, 2008 John Valenta, CPA, MBA, Director Health Sciences Regulatory Practice Deloitte & Touche LLP Agenda

More information

ICD-10 Impact on Provider Reimbursement

ICD-10 Impact on Provider Reimbursement ICD-10 Impact on Provider Reimbursement By October 1, 2013, entities covered by the Health Insurance Portability and Accountability Act (HIPAA), including health plans, healthcare clearinghouses, and healthcare

More information

Introduction to ICD-10-CM. An Introduction to the Transition from ICD-9-CM to ICD-10-CM

Introduction to ICD-10-CM. An Introduction to the Transition from ICD-9-CM to ICD-10-CM Introduction to ICD-10-CM An Introduction to the Transition from ICD-9-CM to ICD-10-CM 1 Purpose Explain why the transition from ICD-9-CM to ICD- 10-CM is needed Describe the differences between ICD-9-CM

More information

Breaking the Code: ICD-9-CM Coding in Details

Breaking the Code: ICD-9-CM Coding in Details Breaking the Code: ICD-9-CM Coding in Details ICD-9-CM diagnosis codes are 3- to 5-digit codes used to describe the clinical reason for a patient s treatment. They do not describe the service performed,

More information

Anesthesia ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Anesthesia and Top 25 Codes

Anesthesia ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Anesthesia and Top 25 Codes Anesthesia ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Anesthesia and Top 25 Codes Chapter 2 Neoplasms (C00-D49) Classification improvements Code expansions Significant expansions or

More information

All notifications, trigger diagnosis, LCM reports, pre certification reports, etc. should be sent to: notifications@ihcrisksolutions.

All notifications, trigger diagnosis, LCM reports, pre certification reports, etc. should be sent to: notifications@ihcrisksolutions. Dear Business Partner: Please take a few minutes to review the contents of our Claims Kit. It provides key instructions for identifying and reporting specific and aggregate claim information to IHC Risk

More information

Physician and other health professional services

Physician and other health professional services O n l i n e A p p e n d i x e s 4 Physician and other health professional services 4-A O n l i n e A p p e n d i x Access to physician and other health professional services 4 a1 Access to physician care

More information

ICD-10-CM Official Guidelines for Coding and Reporting

ICD-10-CM Official Guidelines for Coding and Reporting 2013 Narrative changes appear in bold text Items underlined have been moved within the guidelines since the 2012 version Italics are used to indicate revisions to heading changes The Centers for Medicare

More information

ADVANCE NOTICE OF EXCESS CLAIM REPORT

ADVANCE NOTICE OF EXCESS CLAIM REPORT ADVANCE NOTICE OF EXCESS CLAIM REPORT Please provide the following information for claimants that 15,000 or more is expected to be paid on. Group Name: Pooling Point: Effective Date: Claimant Information

More information

Using the ICD-10-CM. The Alphabetic Index helps you determine which section to refer to in the Tabular List. It does not always provide the full code.

Using the ICD-10-CM. The Alphabetic Index helps you determine which section to refer to in the Tabular List. It does not always provide the full code. Using the ICD-10-CM Selecting the Correct Code To determine the correct International Classification of Diseases, 10 Edition, Clinical Modification (ICD-10-CM) code, follow these two steps: Step 1: Look

More information

ICD-10 Data Analytics: What Are The Results Showing and How Should We Use Them To Educate Physicians and Staff

ICD-10 Data Analytics: What Are The Results Showing and How Should We Use Them To Educate Physicians and Staff ICD-10 Data Analytics: What Are The Results Showing and How Should We Use Them To Educate Physicians and Staff June 19, 2014 Presented By: Kim Charland, BA, RHIT, CCS Senior Vice President Clinical Innovation

More information

ICD-10: Navigating the Change. Presented by: Shelley Garrett, CPC, CMC, CMOM, CMIS

ICD-10: Navigating the Change. Presented by: Shelley Garrett, CPC, CMC, CMOM, CMIS ICD-10: Navigating the Change Presented by: Shelley Garrett, CPC, CMC, CMOM, CMIS A journey of a thousand miles begins with a single step -Confucius 5010 Conversion January 1, 2012 5010 Conversion Version

More information

ADVANCE NOTICE OF EXCESS CLAIM REPORT

ADVANCE NOTICE OF EXCESS CLAIM REPORT ADVANCE NOTICE OF EXCESS CLAIM REPORT Please provide the following information for excess claims which have paid at 15,000 or more. Group Name: Effective Date: Claimant Information Employee Name: DOB:

More information

ICD-10-CM Coding Overview AHCA Spring Convention & Trade Show April 21-23, 2015

ICD-10-CM Coding Overview AHCA Spring Convention & Trade Show April 21-23, 2015 ICD-10-CM Coding Overview AHCA Spring Convention & Trade Show April 21-23, 2015 1 Why the Conversion to ICD-10-CM? ICD-10-CM provides more specific data than ICD-9-CM Better reflection of current medical

More information

ICD-10... What Are You Waiting For?

ICD-10... What Are You Waiting For? ICD-10... What Are You Waiting For? What is it? International classification for all general epidemiological, many health management purposes, and clinical use Published by the World Health Organization

More information

Description Code Recommendation Description Code. All natural death 001-799 IPH All natural death A00-R99

Description Code Recommendation Description Code. All natural death 001-799 IPH All natural death A00-R99 Natural death Description Code Recommendation Description Code All natural death 001-799 IPH All natural death A00-R99 Infectious and parasitic diseases 001-139 CDC, EUROSTAT, CBS & VG Infectious and parasitic

More information

How To Fill Out A Health Declaration

How To Fill Out A Health Declaration The English translation has no legal force and is provided to the customer for convenience only. The Dutch health declaration should be filled in. Health declaration for occupational disability insurance

More information

Risk Adjustment Coding/Documentation Checklist

Risk Adjustment Coding/Documentation Checklist Risk Adjustment Coding/Documentation Checklist The following list should be used to ensure that all member and diagnosis-related information is reported, and all the member s chronic conditions are documented

More information

Dallas Neurosurgical and Spine Associates, P.A Patient Health History

Dallas Neurosurgical and Spine Associates, P.A Patient Health History Dallas Neurosurgical and Spine Associates, P.A Patient Health History DOB: Date: Reason for your visit (Chief complaint): Past Medical History Please check corresponding box if you have ever had any of

More information

It s Time to Transition to ICD-10

It s Time to Transition to ICD-10 July 22, 2015 It s Time to Transition to ICD-10 What do the changes mean to your SNF? Presented by: Linda S. Little, RN-BSN Clinical Consultant HMM Consulting Office: (631) 265-6289 E-Mail: llittle@horanmm.com

More information

UW MEDICINE ICD-10. DRG Root Cause Analysis June 2014

UW MEDICINE ICD-10. DRG Root Cause Analysis June 2014 UW MEDICINE ICD-10 DRG Root Cause Analysis June 2014 INTRODUCTION As medical charts are coded in ICD-10 and ICD-9, sometimes the DRG will shift. It is important to understand the cause of these shifts

More information

ICD-10-CM KEVIN SOLINSKY, CPC, CPC-I, CEDC, CEMC PRESIDENT HEALTHCARE CODING CONSULTANTS, LLC 480-200-4590

ICD-10-CM KEVIN SOLINSKY, CPC, CPC-I, CEDC, CEMC PRESIDENT HEALTHCARE CODING CONSULTANTS, LLC 480-200-4590 ICD-10-CM KEVIN SOLINSKY, CPC, CPC-I, CEDC, CEMC PRESIDENT HEALTHCARE CODING CONSULTANTS, LLC 480-200-4590 ICD-10 FINAL RULE Implementation date October 1, 2014. ICD-9-CM codes will not be accepted by

More information

FY2015 Final Hospital Inpatient Rule Summary

FY2015 Final Hospital Inpatient Rule Summary FY2015 Final Hospital Inpatient Rule Summary Interventional Cardiology (IC) Peripheral Interventions (PI) Rhythm Management (RM) On August 4, 2014, the Centers for Medicare & Medicaid Services (CMS) released

More information

Cardiology ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Cardiology

Cardiology ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Cardiology Cardiology ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Cardiology Chapter 4: Endocrine, Nutritional, and Metabolic Diseases (E00-E89) The diabetes mellitus codes are combination codes

More information

Advanced Procedure and Diagnosis Sequencing in ICD-10

Advanced Procedure and Diagnosis Sequencing in ICD-10 Advanced Procedure and Diagnosis Sequencing in ICD-10 Live webcast presented on: September 17, 2013 Copyright Information Copyright 2013 HCPro, Inc. The Advanced Procedure and Diagnosis Sequencing in ICD-10

More information

Preparing for ICD-10: Understanding the Basics of ICD-10-PCS. Nelly Leon-Chisen, RHIA Director, Coding and Classification

Preparing for ICD-10: Understanding the Basics of ICD-10-PCS. Nelly Leon-Chisen, RHIA Director, Coding and Classification Preparing for ICD-10: Understanding the Basics of ICD-10-PCS Nelly Leon-Chisen, RHIA Director, Coding and Classification Learning Objectives Learn the basics of ICD-10-PCS code selection and how to navigate

More information

Electronic Health Records Next Chapter: Best Practices, Checklists, and Guidelines ICD-10 and Small Practices April 30, 2014.

Electronic Health Records Next Chapter: Best Practices, Checklists, and Guidelines ICD-10 and Small Practices April 30, 2014. Electronic Health Records Next Chapter: Best Practices, Checklists, and Guidelines ICD-10 and Small Practices April 30, 2014 Fallon Health Plan Christine Grondalski, Director Risk Adjustment & Analytics

More information

SECTION 4 COSTS FOR INPATIENT HOSPITAL STAYS HIGHLIGHTS

SECTION 4 COSTS FOR INPATIENT HOSPITAL STAYS HIGHLIGHTS SECTION 4 COSTS FOR INPATIENT HOSPITAL STAYS EXHIBIT 4.1 Cost by Principal Diagnosis... 44 EXHIBIT 4.2 Cost Factors Accounting for Growth by Principal Diagnosis... 47 EXHIBIT 4.3 Cost by Age... 49 EXHIBIT

More information

Changes in Diagnostic-Related Groups/Level-of-Care Inpatient and Outpatient Reimbursement Methodologies

Changes in Diagnostic-Related Groups/Level-of-Care Inpatient and Outpatient Reimbursement Methodologies M E D I C A I D B U L L E T I N B T 1 9 9 9 0 2 A P R I L 1, 1 9 9 9 To: Subject: All Indiana Medicaid Acute Care Hospitals, Freestanding Psychiatric Hospitals, Rehabilitation Hospitals, Distinct Part

More information

Risk Adjustment Factor (RAF) RADV June 1 st 2016

Risk Adjustment Factor (RAF) RADV June 1 st 2016 Risk Adjustment Factor (RAF) RADV June 1 st 2016 Disclaimer The information presented herein is for information purposes only. HIMS BMG Coding and Compliance Education has prepared this education using

More information

OFFICE OF INSPECTOR GENERAL

OFFICE OF INSPECTOR GENERAL DEPARTMEN1" OF HEALTH MITI H Ur-..1AN SERVICES OFFICE OF INSPECTOR GENERAL WASHINGTON, DC 20201 JUL 2 9 2013 TO: Marilyn Tavenner Administrator Centers for Medicare & Medicaid Services FROM: Stuart Wright-

More information

We have made the following changes to the Critical Illness events covered under our group critical illness policy.

We have made the following changes to the Critical Illness events covered under our group critical illness policy. We have made the following changes to the Critical Illness events covered under our group critical illness policy. March 2015 Because everyone needs a back-up plan 7 New critical illness events added to

More information

Life Protection Quotation

Life Protection Quotation Life Protection Quotation Prepared For: Date: 03/06/2013 Life Type: Single Life Quote Type: Specified Illness Cover Only QUOTATION DETAILS Male, 43 (01/Jan/1970), Non-Smoker, Specified Illness 124000 Monthly

More information

Tony Matejicka, DO, MPH, FACP Medical Director Coding and Utilization August 20, 2012

Tony Matejicka, DO, MPH, FACP Medical Director Coding and Utilization August 20, 2012 Tony Matejicka, DO, MPH, FACP Medical Director Coding and Utilization August 20, 2012 Understand the history of CMS to appreciate our clinical disconnect from Medicare reimbursement. Recognize terms from

More information

ICD-9-CM Official Guidelines for Coding and Reporting

ICD-9-CM Official Guidelines for Coding and Reporting Narrative changes appear in bold text Items underlined have been moved within the guidelines since April 2005 The guidelines include the updated V Code Table The Centers for Medicare and Medicaid Services

More information

ICD 10 CM: Presented by:

ICD 10 CM: Presented by: ICD 10 CM: Presented by: ICD-10-CM Mission 2014 Why ICD-10? Mechanics of ICD-10 Why ICD-10? Why are we doing this? Here is an excerpt taken from the final ruling [T]he ICD-10 code sets provide a standard

More information

LIPID PANEL CHOLESTEROL LIPOPROTEIN, ELECTROPHORETIC SEPARATION LIPOPROTEIN, DIRECT MEASUREMENT (HDL) LDL DIRECT TRIGLYCERIDES

LIPID PANEL CHOLESTEROL LIPOPROTEIN, ELECTROPHORETIC SEPARATION LIPOPROTEIN, DIRECT MEASUREMENT (HDL) LDL DIRECT TRIGLYCERIDES Test Code Test Name CPT CHOL Cholesterol, Serum 82465 HDL HDL, (High Density Lipoprotein) 83718 TRIG Triglycerides, Serum 84478 FTRIG Triglycerides (Fluid) 84478 LIPID Lipid Panel 80061 LDL LDL (Low Density

More information

Patient Information Form Pain Management Center at Phoebe

Patient Information Form Pain Management Center at Phoebe Patient Information Form Pain Management Center at Phoebe Please complete the following form, so that we may facilitate your visit Occupation: or (circle) Retired, Disabled Homemaker, Full time student

More information

2016 PERITONEAL DIALYSIS CATHETERS CODING AND REIMBURSEMENT GUIDE

2016 PERITONEAL DIALYSIS CATHETERS CODING AND REIMBURSEMENT GUIDE 2016 PERITONEAL DIALYSIS CATHETERS CODING AND REIMBURSEMENT GUIDE Contents Overview of Peritoneal Dialysis 2 Physician Reimbursement for Peritoneal Dialysis s Under Resource-based Relative Value Scale

More information

Coding in the Long Term Acute Care Setting

Coding in the Long Term Acute Care Setting Coding in the Long Term Acute Care Setting Audio Seminar/Webinar October 18, 2007 Practical Tools for Seminar Learning Copyright 2007 American Health Information Management Association. All rights reserved.

More information

Medical Records - Where Can I Find My Information?

Medical Records - Where Can I Find My Information? Feasibility Surveys Where am I going to get all of this info? Judith Spilker RN, BSN Adm. Director StrokeNet Kathleen Alwell RN, BSN Asst. Dir. Epidemiology Research RCC 14, Partnering with your sites

More information

2FORMATS AND CONVENTIONS

2FORMATS AND CONVENTIONS 2FORMATS AND CONVENTIONS OF DIAGNOSIS CODING SYSTEMS Learning Outcomes After completing this chapter, students should be able to 2.1 Explain the layout of the ICD-9-CM and ICD-10-CM manuals. 2.2 Differentiate

More information

CHAPTER 2. Neoplasms (C00-D49) March 2014. 2014 MVP Health Care, Inc.

CHAPTER 2. Neoplasms (C00-D49) March 2014. 2014 MVP Health Care, Inc. Neoplasms (C00-D49) March 2014 2014 MVP Health Care, Inc. CHAPTER SPECIFIC CATEGORY CODE BLOCKS C00-C14 Malignant neoplasms of lip, oral cavity and pharynx C15-C26 Malignant neoplasms of digestive organs

More information

Basic ICD-10-CM Documentation and Coding. Effective date: October 1, 2015. Presented by: Jenna Glenn, CPC May 6, 2015 1

Basic ICD-10-CM Documentation and Coding. Effective date: October 1, 2015. Presented by: Jenna Glenn, CPC May 6, 2015 1 Basic ICD-10-CM Documentation and Coding Effective date: October 1, 2015 Presented by: Jenna Glenn, CPC May 6, 2015 1 Objectives Overview on what is ICD-10-CM Changes from ICD-9-CM to ICD-10-CM Importance

More information

Critical PROVIDER FIELD UNDERWRITING GUIDE & RATE BOOK

Critical PROVIDER FIELD UNDERWRITING GUIDE & RATE BOOK G T L Critical PROVIDER FIELD UNDERWRITING GUIDE & RATE BOOK 10 OR 20 YEAR RENEWABLE TERM LIFE INSURANCE WITH A CRITICAL ILLNESS ACCELERATED BENEFIT RIDER WHICH PROVIDES CASH BENEFITS FOR 18 CRITICAL CONDITIONS

More information