ICD-10: Navigating the Change. Presented by: Shelley Garrett, CPC, CMC, CMOM, CMIS
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1 ICD-10: Navigating the Change Presented by: Shelley Garrett, CPC, CMC, CMOM, CMIS
2 A journey of a thousand miles begins with a single step -Confucius
3 5010 Conversion January 1, 2012
4 5010 Conversion Version 5010 adds benefits like patient verification and embedded links to the insurance company for denial resolution.
5 Talk to software vendors, clearinghouses, and billing companies as soon as possible. If you haven t been part of the testing, as for confirmation in writing.
6 ICD-10 October 1,
7 ICD-10-CM Diagnosis coding under this system uses 3-7 alpha (A-Z) and numeric (0-9) digits and full code titles, but the format is very similar to ICD-9-CM. 7
8 Previous ICD-10 Transitions Nordic countries (Denmark, Finland, Iceland, Norway, Sweden) United Kingdom 1997 France 1998 Australia 2000 Germany 2001 Canada 8
9 Why Now? Original transition date: October 1, 2011
10 Why Now? Quality and Outcome measurement tracking Pay-for-performance programs Reporting on use and effects of new medical technology Clinical, financial, and administrative performance measurement Clinical research Public health and bioterrorism monitoring
11 Per CMS ICD-9-CM, does not provide the necessary detail for patients medical conditions or the procedures and services performed. has outdated and obsolete terminology, uses outdated codes that produce inaccurate and limited data, and is inconsistent with current medical practice. It cannot accurately describe the diagnosis and inpatient procedures of care delivered in the 21 st century 11
12 Structural Difference ICD-10 Codes are alpha-numeric and can be 3-7 digits long. Examples: A78 Q fever A69.21 Meningitis due to Lyme disease S52.131A Displaced fracture of neck of right femur initial encounter for closed fracture. 12
13 Chapters of ICD-10 Chapter 1 (A00-B99) Certain infectious and parasitic diseases Chapter 2 (C00-D49) Neoplasms Chapter 3 (D50-D89) Diseases of the blood and blood forming organs and certain disorders involving the immune mechanism
14 Chapters of ICD-10 Chapter 4 (E00-E89) Endocrine, nutritional, and metabolic diseases Chapter 5 (F01-F99) Mental and behavioral disorders Chapter 6 (G00-G99) Diseases of the nervous system
15 Chapters of ICD-10 Chapter 7 (H00-H59) Diseases of the eye and adnexa Chapter 8 (H60-H95) Diseases of the ear and mastoid process Chapter 9 (I00-I99) Diseases of the circulatory system
16 Chapters of ICD-10 Chapter 10 (J00-J99) Diseases of the respiratory system Chapter 11 (K00-K94) Diseases of the digestive system Chapter 12 (L00-L99) Diseases of the skin and subcutaneous tissue
17 Chapters of ICD-10 Chapter 13 (M00-M99) Diseases of musculoskeletal system and connective tissue Chapter 14 (N00-N99) Diseases of the genitourinary system
18 Chapters of ICD-10 Chapter 15 (O00-O99) Pregnancy, childbirth, and the puerperium Chapter 16 (P00-P96) Certain conditions originating in the perinatal period Chapter 17 (Q00-Q99) Congenital malformations, deformations, and chromosomal abnormalities
19 Chapters of ICD-10 Chapter 18 (R00-R99) Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified Chapter 19 (S00-T88) Injury, poisoning and certain other consequence of external causes
20 Chapters of ICD-10 Chapter 20 (V00-Y99) External causes of morbidity Chapter 21 (Z00-Z99) Factors influencing health status and contact with health services
21 Problem with ICD-9-CM Fracture of femur Patient fractures left femur A week later Patient fractures right femur ICD-9-CM does not identify left versus right which could cause confusion 21
22 Solutions with ICD-10-CM ICD-10-CM does distinguish: Left versus right Initial encounter, subsequent encounter Routine healing, delayed healing, nonunion, or malunion
23 ICD-10 Laterality Example: S51.011A Laceration without foreign body right elbow, initial encounter H Central corneal ulcer, bilateral L Pressure ulcer of right elbow, stage II 23
24 Excludes Notes Excludes 1 not coded here (never used with the code) Example: Q03 Congenital Hydrocephalus has an Exclude 1 of Acquired Hydrocephalus Excludes 2 not included here (not part of the condition; it is acceptable to use both codes together if patient has both conditions) Example: L27.2 for dermatitis due to ingested food has an Excludes 2 of Dermatitis due to food in contact with skin (L23.6, L24.6, L25.4) 24
25 Examples of Changes in Structure Diabetes E09.52 Drug or chemical induced DM with diabetic peripheral angiopathy with gangrene E10.11 Type I DM with ketoacidosis with coma E11.41 Type 2 DM with diabetic mononeuropathy 25
26 Procedure Complications D78.01 Intraoperative hemorrhage and hematoma of spleen complicating a procedure on the spleen T Obstruction due to foreign body accidently left in body following endoscopic examination T Adhesions due to foreign body accidently left in body following aspiration, puncture or other catheterization 26
27 Changes to ICD-10 Combination codes: Manifestations Poisonings External causes Added extensions: Episodes of Care Trimesters Healing Status 27
28 Changes continued Injuries are grouped by anatomical site rather than type of injury Changes in categories to different chapters Placeholders of X for codes requiring an extension Changes in definitions: Acute MI is now 4 weeks instead of 8 weeks
29 Extensions: Fracture Codes 7 TH Character identifies if the fx is open or closed for an initial encounter or if a subsequent encounter is for routine healing, delayed healing nonunion, malunion, or sequelae. The extensions are: A B D G K P S Initial encounter for closed fx Initial encounter for open fx Subsequent encounter for fx with routine healing Subsequent encounter for fx with delayed healing Subsequent encounter for fx with nonunion Subsequent encounter for fx with malunion Sequelae Example: S42.321A Displaced transverse fx of shaft of humerus, right arm, initial encounter for closed fx 29
30 Full Code Titles ICD-9-CM: 142 Malignant neoplasm of gum Upper gum Lower gum ICD-10-CM: C03 Malignant neoplasm of gum C03.0 C03.1 Malignant neoplasm of upper gum Malignant neoplasm of lower gum 30
31 Combination Codes Combination codes for poisoning and the external cause: T Poisoning by aspirin, accidental (unintentional) T Poisoning by aspirin, intentional self-harm T Poisoning by aspirin, assault 31
32 Combination Codes Combination codes for conditions and common symptom examples: I Arteriosclerotic heart disease of native coronary artery with unstable angina pectoris K Crohn s disease of small intestine with fistula 32
33 General Equlivance Mapping (GEM) I-10 Description Correlation I-9 Description Unequal Axis of Classification A Salmonella meningitis = Salmonella meningitis None C92.01 Acute myeloid leukemia, in remission = Myeloid leukemia, acute, in remission None O Spotting complicating pregnancy, first trimester Not = Spotting complicating pregnancy, unspec. Episode of care Stage of pregnancy (I-10) Vs Episode of care (I-9) O Spotting complicating pregnancy, second trimester Not = Spotting complicating pregnancy, delivered O Spotting complicating pregnancy, third trimester Not = Spotting complicating pregnancy, antepartum 33
34 Implementation Checklist Create internal transition team to formulate benchmarks for transition Contact software vendor and clearinghouse regarding the HIPAA 5010 conversion-compliance deadline: January 1,
35 Implementation Checklist Budget for the known and unknown: software updates, new system, education, consultations, decreased productivity, recertification, etc. Review free resources for additional help: World Health Organization (WHO), Center for Disease Control (CDC) and Centers for Medicare and Medicaid Services (CMS)
36 Implementation Checklist Review cheat sheet as a comparison to new ICD-10 codes Review provider documentation to decide what needs to be done to help facilitate a smooth transition and compliant documentation. Seek help from your physician/providers on ways you may better help them with this transition with templates, education, etc.
37 Implementation Checklist Decide who should receive education and to explain why what they do is important to the process. Inform staff on changes as they occur and seek their input on the process. Emphasize the positives during the transition-remember, the leader sets the tone
38 Implementation Checklist October 1, 2013 There will be no grace period extended.
39 WEB RESOURCES CMS General ICD-10 Information ICD-10 Notice of Proposed Rulemaking nds/01_transactionsandcodesetsregulations.as p ICD-10-CM Coding System ICD 10 CM.asp# 39
40 WEB RESOURCES CDC and WHO General ICD-10 information es.htm ICD-10-CM files, information and general equivalence mappings between ICD-10-CM and ICD- 9-CM 0cm.htm WHO List of ICD-10 Updates es/en/ 40
41 Practical Application
42 1. Acute, Recurrent, Maxillary Sinusitis 2. Type 1 Diabetes Mellitus with diabetic cataract 3. Routine medical of a 3 month old child
43 1. Acute, Recurrent, Maxillary Sinusitis J Type 1 Diabetes Mellitus with diabetic cataract E Routine medical examination of a 3 month old child Z00.129
44 Contact Information: Shelley Garrett
45 Questions?pplica tion
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