ICD-10 CM Training. Cardiology

Transcription

1 ICD-10 CM Training Cardiology

2 ICD-10-CM Compliance Dates ICD-10-CM will be valid for dates of service on or after October 1, 2015 Outpatient dates of service of October 1, 2015 and beyond. Inpatient hospital service claims, is effective for dates of discharge after September 30, 2015

3 Covered and Non-Covered Entities Covered Entities Everyone covered by the Health Insurance Portability Accountability Act (HIPPA) Non-Covered Entities Worker s Compensation Auto Insurance Non covered HIPAA entities are exempt but are encouraged to adapt the new code set

4 ICD-10 Code Structure 21 Chapters Alpha-numeric codes; not case-sensitive Codes begin with Alpha letter, A-Z, excluding U Common errors I verses 1 O verses 0 X Placeholder 3 to 7 characters Decimal following 3 rd character

5 ICD-10 Code Structure Placeholder X Used for future expansion of a code Fills in empty characters when a 6 th and/or 7 th character apply The placeholder may be used in different scenarios but should never serve as the final character. Example: W19.XXXA Unspecified fall, Initial Encounter

6 ICD-10 Code Structure 7 th Character Provides specified information regarding the clinical visit Is required for certain categories and must be reported in the seventh position May be alpha or numeric Has different meanings depending on the coding category

7 ICD-10 Code Structure Laterality Some ICD-10-CM codes indicate laterality, specifying whether the condition occurs on the left, right or is bilateral. If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side. If the side is not identified in the medical record, assign the code for the unspecified side. OGCR section 1.B.13

8 ICD-10 Code Structure Other Codes Codes titled other or other specified are for use when the information in the medical record provides detail for which a specific code does not exist. Unspecified Codes Codes titled unspecified are for use when the information in the medical record is insufficient to assign a more specific code. OGCR section 1.A.9.a.b

9 ICD-10 Structure Excludes Notes Excludes1 A type 1 Excludes note is a pure excludes note It means NOT CODED HERE The code excluded should never be used at the same time When two conditions cannot occur together Excludes2 Represents Not included here The condition excluded is not part of the condition represented by the code It is acceptable to use both the code and the excluded code together, when appropriate OGCR section 1.A.12.a.b

10 ICD-10 Code Structure Code First and Use Additional Code ICD-10 has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. These instructional notes indicate the proper sequencing order of the codes. OGCR section 1.A.13 The - indicates there are additional reporting options

11 Most Common Diagnosis Codes

12 Chest pain ICD-9 Code ICD-10 Code Description Excludes1 Excludes R07.9 Chest pain, unspecified epidemic myalgia (B33.0) jaw pain R68.84 pain in breast (N64.4) There are more specific code choice selections: R07.2 Precordial pain R07.1 Chest pain on breathing R07.81 Pleurodynia R07.82 Intercostal pain R07.89 Other chest pain

13 Type Chest pain due to myocardial ischemia Chest pain on breathing Intercostal pain Pleurodynia Precordial chest pain Documentation Tips Use of a symptom code with a definitive diagnosis code Codes for signs and symptoms may be reported in addition to a related definitive diagnosis when the sign or symptom is not routinely associated with that diagnosis, such as the various signs and symptoms associated with complex syndromes. The definitive diagnosis code should be sequenced before the symptom code. Signs or symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification. OGCR Section I.C.18.b

14 Atherosclerotic heart disease of native coronary artery without angina pectoris ICD-9 Code ICD-10 Code Description Excludes1 Excludes I25.10 Atherosclerotic heart disease of native I25.10 coronary artery without angina pectoris N/A atheroembolism (I75.-) atherosclerosis of coronary artery bypass graft(s) and transplanted heart (I25.7-) Applicable To: Atherosclerotic heart disease NOS No ICD-10 code exists for unspecified vessel; native or bypass graft must be indicated Use additional code, if applicable, to identify: coronary atherosclerosis due to calcified coronary lesion (I25.84) coronary atherosclerosis due to lipid rich plaque (I25.83) chronic total occlusion of coronary artery (I25.82) exposure to environmental tobacco smoke (Z77.22) history of tobacco use (Z87.891) occupational exposure to environmental tobacco smoke (Z57.31) tobacco dependence (F17.-) tobacco use (Z72.0)

15 Artherosclerotic Heart Disease Coronary Artery Documentation Tips Associated Artery/Lesion Type Native artery Bypass graft Bypass graft, autologous artery Bypass graft, autologous vein Bypass graft, nonautologous biological Bypass graft, other Due to calcified coronary lesion Due to lipid rich plaque Native vs Transplanted Heart Associated angina Without angina With unstable angina With angina and spasm

16 Atrial fibrillation ICD-9 Code ICD-10 Code Description Excludes1 Excludes I48.91 Unspecified atrial fibrillation N/A There are more specific code choice selections available below: N/A I48.0 Paroxysmal atrial fibrillation I48.1 Persistent atrial fibrillation I48.2 Chronic atrial fibrillation Permanent atrial fibrillation

17 Atrial Fibrillation Documentation Tips Type Chronic (I48.2) Paroxysmal (I48.0) Persistent (I48.1)

18 Cardiac Arrhythmias ICD-9 Code ICD-10 Code Description Excludes1 Excludes I49.8 Other specified cardiac arrhythmias Applicable To: Coronary sinus rhythm disorder Ectopic rhythm disorder Nodal rhythm disorder R00.1 Bradycardia, unspecified Applicable To: Sinoatrial bradycardia Sinus bradycardia Slow heart beat Vagal bradycardia bradycardia NOS (R00.1) neonatal dysrhythmia (P29.1-) sinoatrial bradycardia (R00.1) sinus bradycardia (R00.1) vagal bradycardia (R00.1) abnormalities originating in the perinatal period (P29.1-) specified arrhythmias (I47- I49) neonatal bradycardia (P29.12) N/A N/A There are more code choice selections below: I49.9 Cardiac arrhythmia, unspecified

19 Cardiac Arrhythmias Documentation Tips Type Atrial fibrillation Atrial flutter Premature depolarization Re-entry ventricular arrhythmia Sick sinus syndrome Supraventricular tachycardia Ventricular fibrillation Ventricular flutter Ventricular tachycardia Paroxysmal tachycardia Cardiac arrhythmia

20 Cardiac Arrhythmias Documentation Tips Fibrillation Type Chronic Paroxysmal Persistent Flutter Type Typical Atypical Premature Depolarization Type Atrial Junctional Ventricular

21 Cardiac Arrhythmias Documentation Tips R Use Additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5) I49 - Code first cardiac arrhythmia complicating: Abortion or ectopic or molar pregnancy (O00-O07, O08.8) Obstetric surgery and procedures (O75.4)

22 Abnormal electrocardiogram [ECG] [EKG] ICD-9 Code ICD-10 Code Description Excludes1 Excludes R94.31 Abnormal electrocardiogram [ECG] [EKG] long QT syndrome (I45.81) abnormal findings on antenatal screening of mother (O28. -) abnormal findings on antenatal screening of mother (O28.-) certain conditions originating in the perinatal period (P04- P96) signs and symptoms classified in the body system chapters signs and symptoms of breast (N63, N64.5)

23 Documentation Tips Symptom Codes Codes that describe symptoms and signs are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider. Use of a symptom code with a definitive diagnosis code Codes for signs and symptoms may be reported in addition to a related definitive diagnosis when the sign or symptom is not routinely associated with that diagnosis code. Signs or symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.

24 Aortic Valve Disorders Nonrheumatic ICD-9 Code ICD-10 Code Description Excludes1 Excludes I35.0 Nonrheumatic aortic (valve) stenosis There are more specific code choice selections below: Aortic valve disorder of unspecified cause but with diseases of mitral and/or tricuspid valve(s) (I08.-) Aortic valve disorder specified as congential (Q23.0, Q23.1) Aortic valve disorder specified as rheumatic (I06.-) Hypertrophic subaortic stenosis (I42.1) N/A I35.1 Nonrheumatic aortic (valve) insufficiency I35.2 Nonrheumatic aortic (valve) stenosis with insufficiency I35.8 Other nonrheumatic aortic valve disorders I35.9 Nonrheumatic aortic valve disorder, unspecified

25 Documentation Tips Type Stenosis Insufficiency Stenosis with insufficiency List other

26 Shortness of breath ICD-9 Code ICD-10 Code Description Excludes1 Excludes R06.02 Shortness of breath abnormalities originating in the perinatal period (P29.1-) specified arrhythmias (I47-I49) acute respiratory distress syndrome (J80) respiratory arrest (R09.2) respiratory arrest of newborn (P28.81) respiratory distress syndrome of newborn (P22.-) respiratory failure (J96.-) respiratory failure of newborn (P28.5) tachypnea NOS (R06.82) transient tachypnea of newborn (P22.1) There are more specific code choice selections below: N/A R06.00 Dyspnea, unspecified R06.01 Orthopnea R06.09 Other forms of dyspnea

27 Documentation Tips Dyspnea Type Shortness of breath Orthopnea Other forms

28 Ventricular premature depolarization ICD-9 Code ICD-10 Code Description Excludes1 Excludes I49.3 Ventricular premature depolarization bradycardia NOS (R00.1) neonatal dyrhythmia (P29.1-) sinoatrial bradycaria (R00.1) sinus bradycaria (R00.1) vagal bradycaria (R00.1) N/A There are more specific code choice selections below: I49.49 Other premature depolarization Code first cardiac arrhythmia complicating: Abortion or ectopic or molar pregnancy (O00.-O07, O08.8) Obstetric surgery and procedures (O75.4)

29 Documentation Tips Type Atrial premature depolarization (I49.1) Junctional premature depolarization (I49.2) Ventricular premature depolarization (I49.3) Other specified cardiac arrhythmias (I49.8)

30 Ventricular tachycardia ICD-9 Code ICD-10 Code Description Excludes1 Excludes I47.2 Ventricular tachycardia tachycardia NOS (R00.0) Sinoatrial tachycaria (R00.0) sinus tachycardia (R00.0) Code first cardiac arrhythmia complicating: Abortion or ectopic or molar pregnancy (O00.-O07, O08.8) Obstetric surgery and procedures (O75.4)

31 Other cardiomyopathies ICD-9 Code ICD-10 Code Description Excludes1 Excludes I42.8 Primary cardiomyopathies, NEC Ischemic cardiomyopathy (I25.5) Peripartum cardiomyopathy (O90.3) Ventricular hypertrophy (I51.7) There are more specific code choice selections below: I42.2 Other hypertrophic cardiomyopathy I42.5 Other restrictive cardiomyopathy I42.9 Cardiomyopathy, unspecified (familial)(idiopathic) Code first pre-existing cardiomyopathy complicating pregnancy and puerperium (O99.4)

32 Syncope and collapse ICD-9 Code ICD-10 Code Description Excludes1 Excludes R55 Syncope and collapse Applicable To: Blackout Fainting Vasovagal attack cardiogenic shock (R57.0) carotid sinus syncope (G90.01) heat syncope (T67.1) neurocirculatory asthenia (F45.8) neurogenic orthostatic hypotension (G90.3) orthostatic hypotension (I95.1) postprocedural shock (T81.1-) psychogenic syncope (F48.8) shock NOS (R57.9) shock complicating or following abortion or ectopic or molar pregnancy (O00-O07, O08.3) shock complicating or following labor and delivery (O75.1) Stokes-Adams attack (I45.9) unconsciousness NOS (R40.2-) abnormal findings on antenatal screening of mother (O28.-) certain conditions originating in the perinatal period (P04- P96) signs and symptoms classified in the body system chapters signs and symptoms of breast (N63, N64.5)

33 Documentation Tips Type Carotid sinus syncope (G90.01) Heat syncope Initial encounter (T67.1XXA) Subsequent encounter (T67.1XXD) Sequela (T67.1XXS) Psychogenic syncope (F48.8) Stokes-Adams syncope (I45.9) Vasovagal syncope (R55)

34 Cardiomegaly ICD-9 Code ICD-10 Code Description Excludes1 Excludes I51.7 Cardiomegaly Applicable To: Cardiac dilatation Cardiac hypertrophy Ventricular dilatation N/A certain conditions originating in the perinatal period (P04-P96) certain infectious and parasitic diseases (A00-B99) complications of pregnancy, childbirth and the puerperium (O00-O9A) congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99) endocrine, nutritional and metabolic diseases (E00-E88) injury, poisoning and certain other consequences of external causes (S00-T88) neoplasms (C00-D49) symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94) systemic connective tissue disorders (M30-M36) transient cerebral ischemic attacks and related syndromes (G45.-)

35 Hypertension ICD-9 Code ICD-10 Code Description Excludes1 Excludes I10 Essential (Primary) Hypertension Includes: high blood pressure, Hypertension (arterial) (benign) (essential) (malignant) (systemic) Hypertensive disease complicating pregnancy, childbirth and the puerperium (O10-O11, O13-O16) Neonatal hypertension (P29.2) Primary pulmonary hypertension (I127.0) Essential (primary) hypertension involving vessels of brain (I60-I69) Essential (primary) hypertension involving vessels of eye (H35.0-) Hypertensive Diseases Categories (I10-I15) The use additional codes and Excludes1 codes apply for all categories. (I10-I15) Use additional code to identify: Exposure to environmental tobacco smoke (Z77.22) History of tobacco use (Z87.891) Occupational exposure to environmental tobacco smoke (Z57.31) Tobacco dependence (F17.-) Tobacco use (Z72.0) Hypertensive disease complicating pregnancy, childbirth and the puerperium (O10-O11. O13-O16) Neonatal hypertension (P29.2) Primary Pulmonary hypertension (I27.0)

36 Hypertension cont. ICD-9 Code ICD-10 Code Description Excludes1 Excludes I11.0 Hypertensive Heart Disease with heart failure Use additional code to identify type of heart failure (I50.-) N/A N/A I11.9 Hypertensive Heart Disease without heart failure N/A N/A I12.0 Hypertensive Chronic Kidney Disease with stage 5 Chronic Kidney Disease or end stage renal disease. Use additional code to identify the stage of chronic kidney disease (N185.5, N18.6) Hypertension due to Kidney Disease (I15.0, I15.1) Renovascular Hypertension (I15.0) Secondary Hypertension (I115.-) Acute Kidney Failure (N17.-) I12.9 Hypertensive Chronic Kidney Disease with stage 1-4 Chronic Kidney Disease, or unspecified Chronic Kidney Disease. Use additional code to identify the stage of chronic kidney disease (N18.1-N18.9) Hypertension due to Kidney Disease (I15.0, I15.1) Renovascular Hypertension (I15.0) Secondary Hypertension (I115.-) Acute Kidney Failure (N17.-)

37 Hypertension cont. ICD-9 Code ICD-10 Code Description Excludes1 Excludes I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1-4 chronic kidney disease, or unspecified chronic kidney disease Use additional code to identify type of heart failure (I50.-) Use additional code to identify stage of chronic kidney disease (N18.1-NN18.4, N18.9) N/A N/A I13.10 Hypertensive Heart and Chronic Kidney Disease without heart failure, with stage 1-4 chronic kidney disease, or unspecified chronic kidney disease. Use additional code to identify the stage of chronic kidney disease (N18.1-N18.4, N18.9) N/A N/A I13.11 Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease or end stage renal disease. Use additional code to identify the stage of chronic kidney disease (N18.5, N18.6) N/A N/A I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease. Use additional code to identify type of heart failure (I50.-) Use additional code to identify the stage of chronic kidney disease (N18.5. N18.6) N/A N/A

38 Hypertension cont. ICD-9 Code ICD-10 Code Description Excludes1 Excludes I15.0 Renovascular Hypertension Code also underlying condition I15.1 Hypertension secondary to other renal disorders Code also underlying condition I15.2 Hypertension secondary to endocrine disorders Code also underlying condition I15.8 Other secondary hypertension Code also underlying condition I15.9 Secondary hypertension, unspecified Code also underlying condition Postprocedural hypertension (I97.3) Postprocedural hypertension (I97.3) Postprocedural hypertension (I97.3) Postprocedural hypertension (I97.3) Postprocedural hypertension (I97.3) Secondary hypertension involving vessels of brain (I60-I69) Secondary hypertension involving vessels of eye (H35.0-) Secondary hypertension involving vessels of brain (I60-I69) Secondary hypertension involving vessels of eye (H35.0-) Secondary hypertension involving vessels of brain (I60-I69) Secondary hypertension involving vessels of eye (H35.0-) Secondary hypertension involving vessels of brain (I60-I69) Secondary hypertension involving vessels of eye (H35.0-) Secondary hypertension involving vessels of brain (I60-I69) Secondary hypertension involving vessels of eye (H35.0-)

39 Hypertension Documentation Tips Hypertension is no longer classified as benign, malignant or unspecified. ICD-10 Codes have been grouped according to disease progression: I10 Essential Hypertension I11.- Hypertensive Heart Disease I12.- Hypertensive CKD» Further subdivided by stage of kidney disease I13.- Hypertensive Heart and CKD» Further subdivided by stage of kidney disease I15.- Secondary Hypertension Transient Hypertension A code for hypertension is NOT assigned unless the patient has a documented, established diagnosis of hypertension. R03.0 Elevated blood pressure reading without diagnosis of hypertension Document requirements Type Current Status Associated relationships

40 Hyperlipidemia ICD-9 Code ICD-10 Code Description Excludes1 Excludes E78.4 Other Hyperlipidemia Familial combined hyperlipidemia E78.5 Hyperlipidemia, unspecified There are more specific code choice selections available below: Sphingolipidosis (E75.0-E75.3) N/A E78.0 Pure Hypercholesterolemia E78.1 Pure Hypercholesterolemia E78.2 Mixed Hyperlipidemia E78.3 Hyperchylomicronemia E78.6 Lipoprotein deficiency

41 Hyperlipidemia Documentation Tips Type Mixed Other Unspecified

42 Heart failure, unspecified ICD-9 Code ICD-10 Code Description Excludes1 Excludes I50.9 Heart failure, unspecified Applicable To: Biventricular (heart) failure NOS Cardiac, heart or myocardial failure NOS Congestive heart disease Congestive heart failure NOS Right ventricular failure (secondary to left heart failure) Cardia arrest (I46.-) Neonatal cardiac failure (P29.0) fluid overload (E87.70) Code first: Heart failure complicating abortion or ectopic or molar pregnancy (O00-O07, O08.8) Heart failure following surgery (I97.13-) Heart failure due to hypertension (I11.0) Heart failure due to hypertension with chronic kidney disease (I13.-) Obstetrics surgery and procedures (O75.4) Rheumatic heart failure (I09.81) N/A

43 Heart failure, unspecified Documentation Tips Type Systolic Diastolic Combined Chronicity Acute Chronic Acute on chronic

44 Heart failure, unspecified Documentation Tips 1) Hypertension with Heart Disease Heart conditions classified to I50.- or I51.4-I51.9, are assigned to a code from category I11, Hypertensive heart disease, when a causal relationship is stated (due to hypertension) or implied (hypertensive). Use an additional code from category I50, Heart failure, to identify the type of heart failure in those patients with heart failure.

45 Heart failure, unspecified Documentation Tips 2) Hypertensive Chronic Kidney Disease Assign codes from category I12, Hypertensive chronic kidney disease, when both hypertension and a condition classifiable to category N18, Chronic kidney disease (CKD), are present. Unlike hypertension with heart disease, ICD-10-CM presumes a cause-and-effect relationship and classifies chronic kidney disease with hypertension as hypertensive chronic kidney disease. The appropriate code from category N18 should be used as a secondary code with a code from category I12 to identify the stage of chronic kidney disease. See Section I.C.14. Chronic kidney disease. If a patient has hypertensive chronic kidney disease and acute renal failure, an additional code for the acute renal failure is required.

46 Monitor Claims On October 01, 2015 we will monitor claims for date of service rules Outpatient claims cannot have crossover dates Outpatient claims will be coded according to date of service Inpatient facility claims will be coded per date of discharge We will monitor claims to resolve any unanticipated problems with the submission process

47 Claim Denial and Management We will monitor for claim denials We will monitor editing trends for ICD-10 Coding guidelines We will provide feedback to the physicians regarding supporting documentation requirements We will monitor WC or Liability carriers for published rules on use of ICD-9 or ICD-10 code sets

48 Client Responsibilities Client will need to update Templates Order Sets Superbills Favorites Future Orders Remove ICD-9 code add ICD-10 code

49 Documentation Start Now All Conditions treated or assessed must be documented in the medical record. In addition to the documentation tips reviewed, below are more areas to document that will ensure proper ICD-10-CM code selection. Site specificity Document notation of qualifiers Exacerbation Manifestations Relapse Status Stages Indicate acute or chronic Indicate underlying or external cause factors Medication Smoke Accidents Mechanical failure Laterality Bilateral Right Left

50 Documentation Start Now Episode of Care for injuries, poisoning, external causes and other conditions Initial Encounter Use while the patient is receiving active treatment of the condition Active treatment includes surgical treatment, an emergency encounter, and evaluation and treatment by a new physician Subsequent Encounter Used on encounter after the patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase. Medication adjustments, aftercare, device adjustments, cast change Sequela Used for complications or conditions that arise as a direct result of a condition, late effect

51 Documentation Start Now Combination codes that capture Etiology and manifestation Related conditions Disease, injury or other medical condition and complications Disease or other medical conditions and common signs or symptoms Add ICD-10 Codes to patient Problem List

52 Questions Centers for Disease Control and Prevention (ICD-10-CM)