Medtronic Cardiac Rhythm and Heart Failure ICD-10 Coding for Hospitals

Transcription

1 Medtronic Cardiac Rhythm and Heart Failure ICD-10 Coding for Hospitals May 19, 2015

2 Disclaimer This presentation is intended for educational use. Any duplication is prohibited without written consent of Medtronic s Economics and Health Policy department. This information does not replace seeking coding advice from the payer and/or your coding staff. The ultimate responsibility for correct coding lies with the provider of services. Please contact your local payer for their interpretation of the appropriate codes to use for specific procedures. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other third party payers as to the correct form of billing or the amount that will be paid to providers of service. 2

3 Topics Background and Framework ICD-10-CM Diagnosis Codes ICD-10-PCS Procedure Codes DRG Impact Appendix : Key Resources Questions Attachment : Diagnosis Code Crosswalks 3

4 Background and Framework 4

5 Effective Date ICD-10 goes into effect October 1, Use of ICD-10 in the United States was formally proposed in August 2008 and finalized in January Implementation of ICD-10 was initially scheduled for October 2013 and has been postponed twice since then. ICD-10 is effective by date of discharge, not by date of admission. ICD-10-CM for diagnosis codes and ICD-10-PCS for procedure codes go into effect together on the same date. 5

6 Who Uses What Hospitals, physicians and all other providers must use ICD-10 diagnosis codes. Hospitals must also use ICD-10-PCS procedure codes for inpatient cases. Implementation of ICD-10 does not affect use of CPT. Provider Setting Diagnoses Procedures Hospitals Inpatient ICD-10-CM ICD-10-PCS Hospitals Outpatient ICD-10-CM CPT Physicians Facility/Office ICD-10-CM CPT ASCs Outpatient ICD-10-CM CPT 6

7 ICD-10 Coding Guidelines Guidelines for use of ICD-10 are available from multiple credible sources. Instructions within the ICD-10 codebook itself The ICD-10 Official Guidelines for Coding and Reporting Coding Clinic and AHA Coding Clinic Advisor AHA ICD-10-CM and ICD-10-PCS Coding Handbook Minutes from meetings of the ICD-10 Coordination and Maintenance Committee ICD-10-PCS Reference Manual AHIMA ICD-10-PCS: An Applied Approach 7

8 General Equivalence Mappings General Equivalence Mappings (GEMs) are a useful tool for going back-and-forth between ICD-9 and ICD-10 codes, for both diagnoses and procedures. Forward GEMs go from ICD-9 to ICD-10; Backward GEMs go from ICD-10 to ICD-9. The GEMs can be found at: ICD-10-CM-and-GEMs.html The GEMs can be a good starting place. But NCHS and CMS strongly recommend coding directly from the ICD-10 codebooks, as studies have consistently indicated that this is most accurate. 8

9 ICD-10-CM Diagnosis Codes 9

10 Diagnosis Code Structure Codes are organized by chapter, mostly by body system. The chapters are virtually identical to those in ICD-9-CM. Codes are alpha-numeric and can be 3 to 7 digits long. Category Decimal Details Extension T 8 2 alpha number R A alpha or number T82.120A Displacement of cardiac electrode, initial encounter R55 Syncope I I50.23 Acute on chronic systolic heart failure 10

11 Volume of Diagnosis Codes ICD-10-CM has far more diagnosis codes than ICD-9-CM and provides a greater level of specificity. Example: Atrial fibrillation and atrial flutter ICD-9-CM 14,567 codes ICD-10-CM 69,823 codes Atrial fibrillation Atrial flutter ICD-9-CM ICD-10-CM I48.0 Paroxysmal atrial fibrillation I48.1 Persistent atrial fibrillation I48.2 Chronic atrial fibrillation I48.91 Unspecified atrial fibrillation I48.3 Typical atrial flutter (type I) I48.4 Atypical atrial flutter (type II) I48.92 Unspecified atrial flutter But some unnecessary distinctions have been removed. Example: Second degree atrioventricular block ICD-9-CM AV block, Mobitz II AV block, other second degree ICD-10-CM I44.1 Atrioventricular block, second degree 11

12 12 Heart Failure Heart failure works the same way in ICD-10-CM as it does in ICD-9-CM. ICD-9-CM ICD-10-CM Congestive heart failure, unspecified I50.9 Heart failure, unspecified Left heart failure I50.1 Left ventricular failure Systolic heart failure, unspecified I50.20 Unspecified systolic (congestive) heart failure Acute systolic heart failure I50.21 Acute systolic (congestive) heart failure Chronic systolic heart failure I50.22 Chronic systolic (congestive) heart failure Acute on chronic systolic heart failure I50.23 Acute on chronic systolic (congestive) heart failure Unspecified diastolic heart failure I50.30 Unspecified diastolic (congestive) heart failure Acute diastolic heart failure I50.31 Acute diastolic (congestive) heart failure Chronic diastolic heart failure I50.32 Chronic diastolic (congestive) heart failure Acute on chronic diastolic heart failure I50.33 Acute on chronic diastolic (congestive) heart failure Unspecified combined systolic and diastolic Unspecified combined systolic (congestive) and diastolic I50.40 heart failure (congestive) heart failure Acute combined systolic and diastolic heart Acute combined systolic (congestive) and diastolic I50.41 failure (congestive) heart failure Chronic combined systolic and diastolic heart Chronic combined systolic (congestive) and diastolic I50.42 failure (congestive) heart failure Acute on chronic combined systolic and I50.43 Acute on chronic combined systolic (congestive) and diastolic heart failure diastolic (congestive) heart failure Unspecified heart failure I50.9 Heart failure, unspecified Congestive heart failure does not have its own code. A code from I50 is assigned separately to identify the type of heart failure with hypertensive heart disease with heart failure.

13 Acute Myocardial Infarction ICD-10-CM handles acute myocardial infarction differently from ICD-9-CM. AMI: ICD-9-CM ICD-9-CM 410.0x Acute myocardial infarction, of anterolateral wall 410.1x Acute myocardial infarction, of other anterior wall 410.2x Acute myocardial infarction, of inferolateral wall 410.3x Acute myocardial infarction, of inferoposterior wall 410.4x Acute myocardial infarction, of other inferior wall 410.5x Acute myocardial infarction, of other lateral wall 410.6x Acute myocardial infarction, true posterior wall 410.7x Acute myocardial infarction, subendocardial (NSTEMI) 410.8x Acute myocardial infarction, of other specified sites 410.9x Acute myocardial infarction, unspecified site 5 th digit 0 unspecified episode of care 1 initial episode of care 2 subsequent episode of care AMI: ICD-10-CM Episode of care is not identified per se. AMI is differentiated between initial AMI (I21) and subsequent AMI (I22) The AMI site identifies the specific coronary artery involved ( culprit lesion ). 13

14 Acute Myocardial Infarction Initial AMI (I21) ICD-10-CM I21.01 ST elevation (STEMI) myocardial infarction involving left main coronary artery I21.02 ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery I21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall I21.11 ST elevation (STEMI) myocardial infarction involving right coronary artery I21.19 ST elevation (STEMI) myocardial infarction involving other coronary artery I21.21 ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery I21.29 ST elevation (STEMI) myocardial infarction involving other sites I21.3 ST elevation (STEMI) myocardial infarction of unspecified site I21.4 Non-ST elevation (NSTEMI) myocardial infarction Initial AMI codes I21 continue to be assigned to encounters for continued care, including transfer to another hospital or post-acute setting, while the AMI is within 28 days of onset. 1 If the AMI is documented as NSTEMI (subendocardial, non-transmural) and a site is provided, it is still coded as NSTEMI ICD-10-PCS Official Guidelines for Coding and Reporting (Diagnosis), FY 2015, Section I, C9.e(1 ) 2. ICD-10-PCS Official Guidelines for Coding and Reporting (Diagnosis), FY 2015, Section I, C9.e(3 ) 14

15 Crosswalk: Acute Myocardial Infarction Subsequent AMI (I22) ICD-10-CM I22.0 Subsequent ST elevation (STEMI) myocardial infarction of anterior wall I22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wall I22.2 Subsequent non-st elevation (NSTEMI) myocardial infarction I22.8 Subsequent ST elevation (STEMI) myocardial infarction of other sites I22.9 Subsequent ST elevation (STEMI) myocardial infarction of unspecified site Old MI A subsequent AMI is a new AMI that occurs within 28 days of a previous AMI, regardless of site. 3 Codes from I22 cannot be assigned alone. They must always be assigned with a code from I21. Sequencing of the codes depends on the circumstances of the encounter. 3 ICD-9-CM ICD-10-CM 412 Old myocardial infarction I25.2 Old myocardial infarction ICD-10-PCS Official Guidelines for Coding and Reporting (Diagnosis), FY 2015, Section I, C9.e(4 )

16 Bradycardia and Tachycardia Tachycardia ICD-9-CM ICD-10-CM Paroxysmal supraventricular tachycardia I47.1 Supraventricular tachycardia (includes AVNRT) I49.2 Junctional premature depolarization Paroxysmal ventricular tachycardia I47.0 Re-entry ventricular arrhythmia I47.2 Ventricular tachycardia Paroxysmal tachycardia, unspecified I47.9 Paroxysmal tachycardia, unspecified Tachycardia, unspecified R00.0 Tachycardia, unspecified Paroxysmal does not need to be documented for SVT and VT. But tachycardia that s unspecified is assigned to symptom code R00.0. Bradycardia ICD-9-CM ICD-10-CM Sinoatrial node dysfunction (SSS) I49.5 Sick sinus syndrome (tachy-brady syndrome) R00.1 Bradycardia, unspecified Bradycardia that s unspecified or documented only as sinoatrial or sinus bradycardia is assigned to symptom code R

17 Device Complications Mechanical complication is defined the same way in ICD-10-CM as it is in ICD-9-CM. For mechanical complication, ICD-10-CM differentiates the type of complication and the component but not the device ICD-9-CM Mechanical complication due to cardiac pacemaker Mechanical complication due to implantable defibrillator T82.110A T82.111A T82.118A T82.120A T82.121A T82.128A T82.190A T82.191A T82.198A ICD-10-CM Breakdown (mechanical) of cardiac electrode, initial encounter Breakdown (mechanical) of cardiac pulse generator, initial encounter Breakdown (mechanical) of other cardiac electronic device, initial encounter Displacement of cardiac electrode, initial encounter Displacement of cardiac pulse generator, initial encounter Displacement of other cardiac electronic device, initial encounter Other mechanical complication of cardiac electrode, initial encounter Other mechanical complication of cardiac pulse generator, initial encounter Other mechanical complication of other cardiac electronic device, initial encounter For other (non-mechanical) complications, ICD-10-CM also differentiates the type of complication but not the type of device. Proposals have already been made to ICD-10 C&M Committee to create new codes to provide more detail on the specific device. 17

18 ICD-10-PCS Procedure Codes 18

19 ICD-10-PCS Format and Structure Codes are alpha-numeric and are always 7 digits long. There is no decimal point. There are virtually no unspecified or default codes. Each position in an ICD-10-PCS procedure code represents a distinct element section root operation approach qualifier body system body part device In ICD-10-PCS, codes are not assigned per se. They are constructed, character by character, from code tables. ICD-10-PCS contains no instructional notes. Standardized terms and definitions are used throughout. 19

20 Volume of Procedure Codes ICD-10-PCS has far more procedure codes than ICD-9-CM and provides much greater specificity. Full system CRT-D ICD-9-CM ICD-10-PCS 1 code 4 codes ICD-9-CM 3,882 codes ICD-10-PCS 71,962 codes Use of ICD-10-PCS requires in-depth clinical and technical coding knowledge: Relevant clinical anatomy Procedural components Exact nature of devices used Standard terms, particularly Root Operation Procedure coding guidelines and precedents 20

21 21 Root Operations for Devices Six root operations always involve implanted devices where the sole objective is do something with the device. Three of the six root operations are relevant for cardiac rhythm and heart failure devices. Root Operation Objective 4 Example H-Insertion Putting in a non-biological device Implanting a pulse generator P-Removal Taking out a device Removing a lead W-Revision Correcting a malfunctioning or displaced device Repositioning a lead R-Replacement Putting in a device that replaces a body part Replacing a hip or heart valve U-Supplement Putting in a device that reinforces or augments a Laying mesh in a hernia repair body part 2-Change Exchanging a device without cutting or puncture Exchanging a tracheostomy tube There are two scenarios for replacing a device: 5 H-Insertion of the new device and P-Removal of the old device R-Replacement of the body part with a new device and P-Removal of the old device 4. ICD-10-PCS Reference Manual 2015, p ICD-10-PCS Reference Manual 2015, p.69; see also AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p.416, 418, 302

22 Cardiac Rhythm and HF Procedures PPM, ICD, CRT-P, CRT-D Antibacterial Envelope Implanted Loop Recorder (Cardiac Event Monitor) Ablation for Arrhythmia Diagnostic Electrophysiologic Studies (EPS) Electrophysiologic (EP) Mapping Device Evaluation Cardioversion 22

23 PPM, ICD, CRT-P, CRT-D Typical Indications Conventional pacemakers are placed for bradycardia and heart block. Conventional defibrillators are placed for ventricular tachycardia or ventricular fibrillation, or for primary prevention indications such as cardiomyopathy. CRT-P (biventricular pacemakers) are placed for heart failure, with or without bradycardia or heart block. CRT-D (biventricular defibrillators) are placed for heart failure with either ventricular tachycardia or primary prevention indications. 23

24 PPM, ICD, CRT-P, CRT-D Device Values and Models The model name may be insufficient to assign the device value. 4-Pacemaker, Single Chamber 5-Pacemaker, Single Chamber RR 6-Pacemaker, Dual Chamber 7-Cardiac Resynchronization Pacemaker Pulse Generator Adapta Sensia Advisa Versa Viva Consulta Syncra 8-Defibrillator Generator Evera Secura Protecta DR/VR 9-Cardiac Resynchronization Defibrillator Pulse Generator Viva Quad, XT, S Protecta The model numbers differentiate and can be found at: documents/documents/medicare-c-code-list-color.pdf (see p. 6-7) 24

25 Generator Placement Root Operation H Insertion Coding Guidelines Creation of the pocket is not coded separately 6 Examples of Generator Insertion Body System J Subcutaneous Tissue and Fascia 25 0JH608Z Insertion of defibrillator generator into chest subcutaneous tissue and fascia, open approach 0JH609Z Insertion of cardiac resynchronization defibrillator pulse generator into chest subcutaneous tissue and fascia, open approach 6. AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p.419

26 Generator Removal Root Operation P Removal Device Value P Cardiac Rhythm Related Device Coding Guideline For P-Removal, the same device value and same code are used regardless of whether the generator is a PPM, ICD, CRT-P, or CRT-D. 7 Example of Generator Removal 0JPT0PZ Removal of cardiac rhythm related device from trunk subcutaneous tissue and fascia, open approach AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p.418

27 Generator Revision Root Operation W Revision Device Value Example of Generator Revision P Cardiac Rhythm Related Device Coding Guideline For W-Revision, the same device value and same code are used regardless of whether the generator is a PPM, ICD, CRT-P, or CRT-D. This can be used for revising or relocating the device pocket 8, or re-opening the pocket to correct a flipped generator. 0JWT0PZ Revision of cardiac rhythm related device from trunk subcutaneous tissue and fascia, open approach AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p.416, 417

28 Lead Placement Root Operation H Insertion Body System 2 Heart and Great Vessels Coding Guidelines Placement of each lead is coded separately. Body Parts 6 and 7 for Atrium, Right and Left and K and L for Ventricle, Right and Left are apparently assigned for transcatheter placement of a lead into the chamber. Transcatheter placement of a left ventricular lead via the coronary vein is apparently assigned to Body Part 4-Coronary Vein. Body Part N-Pericardium is apparently assigned for placement of an epicardial lead (patch). 28

29 Lead Placement Examples of Lead Insertion 29 Transvenous placement of CRT-D leads into right atrium and right ventricle with transvenous left ventricular lead via coronary sinus 02H63KZ Insertion of defibrillator lead into right atrium, percutaneous approach 02HK3KZ Insertion of defibrillator lead into right ventricle, perc approach 02H43KZ Insertion of defibrillator lead into coronary vein, perc approach Epicardial placement of CRT-D left ventricular lead by thoracotomy 02HN0KZ Insertion of defibrillator lead into pericardium, open approach

30 Lead Removal Root Operation P Removal Example of Lead Removal Device Value M Cardiac Lead Coding Guideline For P-Removal, the same device value and same code are used regardless of whether the lead is for a PPM, ICD, CRT-P, or CRT-D. 02PA3MZ Removal of cardiac lead from heart, percutaneous approach 30

31 Lead Revision Root Operation W Revision Example of Lead Revision Device Value M Cardiac Lead Coding Guideline For W-Revision, the same device value and same code are used regardless of whether the lead is for a PPM, ICD, CRT-P, or CRT-D. This can be used for repositioning a displaced lead. 9 02WA3MZ Revision of cardiac lead in heart, percutaneous approach 9. AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p.419, see also ICD-10-PCS Reference Manual 2015, p

32 Subcutaneous Defibrillator Lead The lead is tunneled subcutaneously and positioned in the left chest to achieve reliable defibrillation. The electrical impulse generated travels through the tissues to the heart. Body System J Subcutaneous Tissue and Fascia Device Value P Cardiac Rhythm Related Device 10 0JH60PZ Insertion of cardiac rhythm related device into chest subcutaneous tissue and fascia, open approach Coding Clinic, 4 th Q 2012

33 Antimicrobial Envelope Antimicrobial envelopes are coated with antibiotics. They hold PPM, ICD, CRT-P or CRT-P generators and are implanted with the generator. The intent is to reduce infection and also stabilize the devices. Device: AIGISRx envelope (also called TYRX) Example of Envelope Placement There s a separate code for placement of an antimicrobial envelope; it is assigned in addition to the generator insertion code. 33 3E0102A Introduction of anti-infective envelope into subcutaneous tissue, open approach

34 Implanted Loop Recorder ILRs (implanted cardiac event recorders, implanted cardiac monitors) are placed in subcutaneous tissue for long-term recording and monitoring of heart rhythms. Devices 2 Monitoring Device : Reveal XT, Reveal LINQ Approach 0 Open placement of Reveal XT 3 Percutaneous placement of Reveal LINQ 34

35 Loop Recorder Example of Loop Recorder Placement 0JH632Z Insertion of monitoring device into chest subcutaneous tissue and fascia, percutaneous approach Example of Loop Recorder Removal 35 0JPT32Z Removal of monitoring device from trunk subcutaneous tissue and fascia, percutaneous approach

36 Ablation for Arrhythmia Transvenous ablation is performed to disrupt aberrant electrical conduction pathways within the heart and restore normal rhythm. Root Operation Body Part 5 Destruction 8 Conduction Mechanism 11 Example of Ablation for Arrhythmia A single code is apparently used for all ablations of all arrhythmias because the target is always the aberrant conduction pathway ZZ Destruction of conduction mechanism, percutaneous approach Coding Clinic, 4 th Q 2014

37 Diagnostic Electrophysiologic Studies In a diagnostic EP study, catheters are threaded through the vena cava and into the heart, usually at the high right atrium, bundle of HIS, and right ventricle. For diagnosis, the catheters are used to perform pacing and recording as well as induction of arrhythmia. The patients may go on to receive an therapeutic ablation. Example of EP Study There s just one code for a diagnostic EP study 12 4A023FZ Measurement of cardiac rhythm, percutaneous approach AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p.415

38 Electrophysiologic Mapping Mapping is often performed together with diagnostic EP studies and also with therapeutic ablations. Special mapping catheters within the heart precisely identify the arrhythmia origin or path, and create 3D maps to guide the physician. Example of Cardiac EP Mapping This is a separate step and is coded separately from the EP study or ablation. 02K83ZZ Map conduction mechanism, percutaneous approach 38

39 Device Evaluation: Interrogation Pacemakers and defibrillators, both conventional and biventricular, need to be checked periodically. This can be done by interrogation or by non-invasive programmed stimulation (NIPS). Both evaluations are non-invasive. The difference is that for an interrogation, an arrhythmia is not induced but for NIPs, it is. Example of Interrogation 13 The approach is X-External by its nature. 4B02XSZ Measurement of cardiac pacemaker, external approach 4B02XTZ Measurement of cardiac defibrillator, external approach 13. AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p

40 Device Evaluation: NIPS NIPS tests the device to ensure it can deliver the appropriate shock as needed. This requires inducing a potentially lethal arrhythmia. Coding Guidelines Do not code NIPS for device testing at the time of defibrillator implantation. This is considered integral and is not coded at all. 14 Do not code a diagnosis of ventricular fibrillation when NIPS is performed. Inducing this arrhythmia is the point. 14 Example of NIPS The approach is X-External by its nature. 4A02X4Z Measurement of cardiac electrical activity, external approach 14. AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p

41 Cardioversion Cardioversion applies electrical shock to convert an arrhythmia to normal rhythm. Coding Guidelines 15 This code is used only for external cardioversion. The code is still assigned regardless of whether cardioversion was successful in converting the rhythm. Example of Cardioversion There s just one code for external cardioversion. 5A2204Z Restoration of cardiac rhythm, single AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p.112

42 42 DRG Impact

43 ICD-10 DRG Conversion The conversion of the DRG Grouper is about coding, not about grouping. CMS has repeatedly stated its goal in the DRG conversion: The same DRG will be assigned regardless of whether the case is coded in ICD-9 or ICD-10. The conversion process has involved only replacing the ICD-9-CM codes with the equivalent ICD-10 codes. DRG titles and underlying DRG logic has not changed, but some minor DRG variations are unavoidable. In a study of 10 million FY 2013 MedPAR records, CMS found a DRG shift of 1.07%, with reimbursement change of -0.04% 15 If the same DRG is not assigned, recheck the codes 15. Estimating the Impact of the Transition to ICD-10 on Medicare Inpatient Hospital Payments 43

44 Sample CCs Code Description E44.0-E46 other malnutrition E87.0 hypernatremia E87.1 hyponatremia I31.4 cardiac tamponade cardiomyopathy (non-ischemic) I42.0, I42.5, (dilated, congestive, constrictive, I42.8-I42.9 restrictive) I44.2 AV block, complete I45.2 bifascicular block I45.3 trifascicular block I45.89 other conduction disorder I47.2 ventricular tachycardia I50.1 left ventricular failure I50.20 systolic heart failure, unspecified I50.22 systolic heart failure, chronic I50.30 diastolic heart failure, unspecified I50.32 diastolic heart failure, chronic I50.40 combined diastolic/systolic heart failure, unspecified I50.42 combined diastolic/systolic heart failure, chronic Code Description I I venous thrombosis and embolism J44.1 acute exacerbation of COPD J80 acute respiratory distress syndrome (adult, child) J90, J94.2, J94.8 pleural effusion, hemothorax, hydrothorax (non-traumatic) J J iatrogenic pneumothorax, air leak J96.10-J96.12 respiratory failure, chronic J98.11-J98.19 atelectasis, pulmonary collapse K56.0, K56.60-K56.7 bowel obstruction, ileus N17.8-N17.9 acute renal failure, other and unspecified N18.4 CKD, stage IV N18.5 CKD, stage V N39.0 urinary tract infection R65.10 SIRS R78.81 bacteremia Z68.1 BMI less than 19, adult Z68.41-Z68.45 BMI 40 and over, adult 44

45 Sample MCCs Code Description A40.0-A40.9, A41.01-A41.9 septicemia, sepsis E41-E43 severe malnutrition I21.01-I21.4, I22.0-I22.9 acute myocardial infarction I26.01-I26.99 pulmonary embolism I50.21 systolic heart failure, acute I50.23 systolic heart failure, acute on chronic I50.31 diastolic heart failure, acute I50.33 diastolic heart failure, acute on chronic I50.41 combined diastolic/systolic heart failure, acute I50.43 combined diastolic/systolic heart failure, acute on chronic J12.0-J18.9 pneumonia J69.0 aspiration pneumonia J81.0 acute pulmonary edema J96.00-J96.02 respiratory failure, acute J96.20-J96.22 respiratory failure, acute on chronic N17.0-N17.2 acute renal failure, specified lesion N18.6 ESRD R65.20-R65.21 severe sepsis 45

46 Appendix: Key Resources 46

47 Key Websites NCHS and CMS have a wealth of ICD-10 resources and educational materials available on-line. NCHS ICD-10-CM Tabular and Index Diagnosis code GEMS Official ICD-10-CM guidelines (diagnoses) CMS ICD-10-PCS Code Tables and Index Procedure code GEMs Official ICD-10-CM guidelines (procedures) ICD-10 Coordination and Maintenance Committee Diagnoses: Procedures: ICD-9-CM-C-and-M-Meeting-Materials.html 47 Code proposals, presentation slides, videos, summaries

48 Medtronic Contacts Medtronic is available to assist with your ICD-10 questions and issues. Hotline: us: Visit the CRHF reimbursement website at: We re here to help make this transition smoother for you 48

49 Questions