AMBA 2013 National Convention Las Vegas, Nevada. Terri D. Wyman, CPC, CMRS

Transcription

1 AMBA 2013 National Convention Las Vegas, Nevada Terri D. Wyman, CPC, CMRS 1

2 To make this workshop an hour in length, I had to make some assumptions Participants have at least some basic knowledge of diagnosis coding with ICD-9 Have used the ICD-9 manual (at least sometime in the past) Participants have received some basic information regarding ICD-10 ICD-10 manual follows the same basic usage guidelines as ICD-9 2

3 What type of practices or specialties are represented here? We are going to try and cover as many specialties as possible If I/we start moving too quickly, please let me know We probably will not get through all slides, but I will be available throughout the rest of the convention 3

4 It s coming! We have been talking about it FOREVER! Learn by doing always calms me down How about you? Yes?.let s get going 4

5 Clostridium difficile causing Enteritis ICD-9 Main Term: Enteritis Subterm: Clostridium Sub-Sub: difficile Code: How about ICD-10; are there any differences in locating the code? ICD-10 Code: A04.7 (Enterocolitis due to Clostridium difficile) 5

6 Because infections are so common, let s try one more; this one uses a causative agent. Urinary tract infection caused by E coli ICD-9 Code(s):599.0 (UTI); (Unspec. E coli) What code(s) will be used for ICD-10? N39.0 (UTI site not specified) B96.20 (Unspec. E coli as cause of diseases classified elsewhere) Did you note the (1) notation next to N39.0? 6

7 Neoplasm table is located at end of Alpha Index; just before the Drug Table Laterality has been added, increasing documentation requirements Let s compare a neoplasm diagnosis using ICD-9 and ICD-10 codes Description ICD-9 ICD-10 Malignant Melanoma of Hip C43.70 (unspec.) C43.71 (RLE) C43.72 (LLE) 7

8 Breast Cancer, right side; lump found at lower inner quadrant For ICD-9, documentation of which breast was not needed ICD-9 Code: For ICD-10, documentation of laterality is crucial ICD-10 Code: C50.311(Malignant neoplasm of lower inner quadrant of right female breast) In ICD-9, there are only 2 codes for breast cancer in males (175.0 & 175.9) In ICD-10 for each female code, there is a comparable male code (27 codes) 2 codes to 27 codes...just an example of how we went from 14,200 codes to 68,000+ 8

9 As always, diabetes mellitus is the star of this chapter. Codes in ICD-10 list any condition related to underlying diabetes with many combination codes 2 codes still may be needed, but the underlying condition code must be the correct one IDDM with nephropathy (kidney disease) ICD-9: (IDDM);337.1(Nephropathy) V58.67 (long term insulin use) ICD-10 Code(s): E10.21 (Type 1 diabetes mellitus with diabetic nephropathy); Z79.4 (Long term use of insulin) 9

10 NIDDM with mild nonproliferative diabetic retinopathy ICD-9 did not require retinopathy type ICD-9 Code(s): (NIDDM); (Retinopathy) ICD-10 Code(s)??????? ICD-10 Code: E (Type 2 diabetes mellitus w/ mild nonproliferative diabetic retinopathy without macular edema) Because there is no mention of insulin, or other complication, one combination code does it all! 10

11 This is a specialty chapter we can only brush the surface Read the guidelines carefully Consider attending a specialty coding seminar if this is your specialty New code concept for pain that is exclusively psychological: F45.41 This code will be followed by code for category G89 Pain, not elsewhere classified There must be documentation of a psychological component to the patient s pain to use this code 11

12 Chronic (continuous) Alcoholism w/gastritis ICD-9 Codes: (Alcoholism); (Alcoholic gastritis w/o mention of hemorrhage) ICD-10 Codes: F (Alcohol dependence w/ other alcohol induced disorder) K29.20 (Alcoholic gastritis w/o bleeding) #2. Major depressive disorder recurrent, severe, w/o psychotic features ICD-9 Code: ICD-10 Code: F33.2 (Major depressive disorder, recurrent, severe w/o psychotic features) 12

13 New category G89 Pain, Not Elsewhere classified Provides additional information regarding acute or chronic pain at specific sites Read guidelines for this new category carefully Guillain-Barre Syndrome (inflammatory polyneuropathy) ICD-9: ICD-10 Code: G61.0 (Guillain-Barre syndrome) 13

14 New chapter for ICD-10 ICD-9 included Eye and Ear as a subset of the Nervous System chapter Although this is a new chapter, there are no new guidelines for ICD-10 vs ICD-9 Do continue to be aware of laterality documentation Moderate open-angle low tension glaucoma; bilateral ICD-9: (low tension glaucoma); (moderate stage) ICD-10 Code(s): H (Low tension glaucoma, bilateral, moderate) Note that the mandatory 7 th digit in ICD-10 gives the staging so that only one code is needed. 14

15 ICD-10 uses an x placeholder to keep room for code expansion. If 5 th, 6 th or 7 th digit is mandatory for code completion; the x is used as a placeholder Example: Primary open-angle glaucoma; mild ICD-10 Rubric: x7 th H40.11 Note ( x7 th ) next to code There are 5 characters to the rubric, but you are to add a 7 th character to denote the stage Complete ICD-10 code: H40.11x1 (Primary open angle glaucoma, mild) The x holds the 6 th place and the 1 completes the code 15

16 Also new chapter for ICD-10 In ICD-9 Ear & Mastoid was also included in Neurologic chapter. Code Ear & Mastoid in the same way as coding in ICD-9 Acute allergic (serous) otitis media left ear ICD-9: (laterality is not required) ICD-10 Code(s): H (Acute & subacute allergic OM, left ear) Not only is laterality included, but separate codes are also included if diagnosis is recurrent H (L), H (R), H (bilateral) 16

17 Keep in mind hypertensive causal relationship hypertensive due to, caused by Use code from category I11- Hypertensive heart disease If no causal relationship is stated, code conditions separately if both heart disease and HTN exist Read Circulatory Guidelines lots of rules Hypertensive heart disease w/o CHF ICD-9: (hypertensive heart disease (unspec.) w/o heart failure) ICD-10 Code(s): I11.9 (Hypertensive heart disease w/o heart failure) 17

18 Respiratory Diseases continue to be coded in the same manner as in ICD-9 Follow sequencing guidelines carefully COPD w/ parainfluenza virus pneumonia ICD-9: 496 (COPD); (pneumonia) ICD-10 Code(s): J44.0 (COPD w/ acute lower respiratory infection) J12.2 (Parainfluenza virus pneumonia) 18

19 No new Guidelines for the GI System Crohn s Disease ICD-9: (Enteritis small intestine: Crohn s NOS) ICD-10 Code(s): K50.90 (Crohn s disease, unspec w/o complications Important note for ICD-10 specific codes are available K50.0 Small intestine w/o complications 6 th K50.01 Small intestine w/ complications K50.10 Large intestine w/o complications 6 th K50.11 Large intestine w/ complications K50.80 Both Small and Large intestines w/o complications 6 th K50.81 Both Small and Large intestines w/ complications K50.90 Unspecified w/o complications 6 th K50.91 Unspecified w/ complications 19

20 Crohn s codes illustrate perfectly the documentation differences between I9 & I10 ICD-9 - A simple diagnosis of Crohn s is all that was needed ICD-10 includes an unspecified code, but much more specific codes are available Payers may or may not pay for unspecified codes Expectation is that the physician knows location That knowledge must be documented to code to the level required 20

21 Pressure (decubitus) ulcers are staged 1-4 Codes also available for Unstageable ulcers (L89.xx) Unspecified stage (L89.9x) query physician about documentation before using this stage Unspecified codes to be used if healing is not documented Stage 2 Healing pressure ulcer of buttock ICD-9 Codes: (buttock) (Stage 2) ICD-10 Code(s): L (Pressure ulcer unspec buttock, stage 2) Note also ICD-10 utilizes laterality for buttocks 6 th L89.31x for right side and 6 th L89.32x for left side 21

22 The most site & laterality codes are here Chronic & recurrent conditions codes here Acute injuries are coded in Chapter 18 (Injuries, Poisonings & Consequences of External Causes) Pathological Fx T7 due to post-menopausal osteoporosis, initial encounter ICD-9: (osteoporosis) (fracture) ICD-10 Code(s): M80.08xA (Age-related osteoporosis w/ current pathological fracture, vertebra(e) Note the x space holder is required because of the x7 th notation for the encounter type character 22

23 Chronic Kidney Disease (CKD) is staged I-V ESRD has own code N18.6 If both CKD & ESRD are documented code ESRD only If patient is s/p transplant, code both the transplant status and CKD stage IDDM (uncontrolled) w/ Stage III CKD ICD-9: (IDDM); (CKD) ICD-10 Code(s): E10.22 (IDDM); N18.3 (CKD) Note that except for code differences, the process remains identical between the coding systems 23

24 If this is your specialty get ye to a specialty seminar Trimester rules do NOT match the ACOG 1 st - <14 weeks 0 days 2 nd - 14 weeks 0 days to < 28 weeks 0 days 3 rd 28 weeks 0 days until delivery Never report unspecified trimester unless documentation makes trimester determination impossible Codes from this chapter have sequencing priority over other chapters Exception: Z31.1 Pregnant state incidental Used only if documented that encounter does not affect pregnancy 24

25 NIDDM (uncontrolled glucose levels) affecting pregnancy at 26 weeks ICD-9: (NIDDM affecting current pregnancy); (NIDDM) ICD-10 Code(s): O (Preexisting diabetes mellitus, type 2 in pregnancy, second semester E11.8 Type 2 diabetes mellitus with unspecified complications 25

26 For use on Newborn Record Only Principal diagnosis for newborn is always from category Z38; Liveborn Infants Perinatal conditions only coded if found to be present after screening 30 weeks, suspected withdrawal due to mother s cocaine abuse ICD-9: (preterm); (29-30 completed weeks); (drug W/D syndrome, newborn) ICD-10 Code(s): P07.33 (gestational age 30 weeks); P04.41(newborn affected by maternal use of cocaine) 26

27 Use only when diagnosis is documented to be of a congenital/chromosomal nature May be used as primary or secondary diagnosis dependent on reason for encounter May be used throughout life of patient If deformity is corrected a history of code will be used 27

28 Used when definitive diagnosis is not available OR in addition to diagnosis when symptom is not usually associated with that diagnosis Definitive diagnosis is sequenced first Nausea and vomiting ICD-9: (Nausea with vomiting) ICD-10 Code(s): R11.2 (Nausea & Vomiting, unspecified) 28

29 Replaces the E codes of ICD-9 If the injury/condition prompts the question, What happened, you probably need a code from this chapter Fractures, burns, poisonings and adverse effects These codes are NEVER primary diagnosis codes Most codes have 7 th character encounter code extensions A Initial ; D Subsequent; S Sequela Enormous chapter not all payers take these codes Read guidelines carefully 29

30 Created for standardization of morbidity reporting Third party payers may not take these codes Provide data for injury research and evaluation of injury prevention strategies Use as many external cause codes as needed to describe, cause, intent and place of occurrence as well as activity of patient In ICD-9, these codes were included with the Ecodes. 30

31 Known as V codes in ICD-9 Reasons for encounters Remember chemo, radiation treatments Personal history of disease or condition Family history of disease or condition Inoculations/Vaccinations Well child & yearly physical exams Screenings, follow up, and aftercare Another big chapter, read the guidelines at the beginning of the manual Medicare does not like Z codes as primary diagnosis 31

32 AMBA has an Intro to ICD-10 course available AAPC and AHIMA, as well as Contexo also have courses on line If your A&P knowledge is weak, consider taking an A&P course for coders prior to ICD-10 class Questions???????? Contact me any time: Remember Knowledge is Power! 32