Understanding & Utilization of ICD 10 Coding System in Outpatient

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1 HPA The Catalyst is the Section on Health Policy & Administration of APTA Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 1 Understanding & Utilization of ICD 10 Coding System in Outpatient and Home Care Settings Jean Jurek Associates, Inc. Education Session April 29, 2014 Webinar 1:00 3:00 EST Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 2 4/29/2014 1

2 Agenda ICD 10 Background and Code Structure How to Code in ICD 10 Outpatient and Home Care Reporting Guidelines, Documentation and Billing Overview Identifying ICD 10 Codes and Usage of Resources (case studies) Implementation Strategies for Transition Staff Training/Utilization Resources Questions Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 3 Objectives Understand the reason behind the move from ICD 9 to ICD 10. Formulate an action plan to help prepare therapists to implement ICD 10 for billing outpatient and home care services Apply basic ICD 10 coding concepts to diagnosis and conditions. Report and bill ICD 10 diagnosis codes appropriately Understand the impact of ICD 10 coding to Rehabilitation Services. Identify ICD 10 resources for ICD 10 coding and implementation. Recognize key ICD 10 documentation requirements for rehabilitation therapists Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 4 4/29/2014 2

3 How will ICD 10 Impact you? Who Me? Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 5 ICD 10 Background Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 6 4/29/2014 3

4 ICD 10 Background Like ICD 9, ICD 10 was developed by the World Health Organization (WHO) Some countries that have already adopted ICD 10 made modifications to the WHO version Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 7 The ICD 10 Delay The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD 10 code sets as the standard for code sets under section 1173(c) of the 13 Social Security Act (42 U.S.C. 1320d 2(c)) and section of title 45, Code of Federal Regulations., Code of Federal Regulations. Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 8 4/29/2014 4

5 HIPAA The 2009 Final Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Administrative Simplification with Modifications to the medical data code sets Established standard that ICD 10 CM would be used for diagnosis coding September 2012 Final Rule extending deadline from October 1, 2013 to Implementation Date: October 1, 2015 CPT and HCPCS code sets DO NOT CHANGE and will continue to be used Hospital Outpatient Services Therapy Services Latest News: US Department of HHS Secretary Kathleen Selibus steps down and President Obama has nominated Sylvia Mathews Burwell. The Department If HHS will make an announcement shortly and messaging will come through CMS > Issues include code freeze, testing and readiness. Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 9 ICD 10 Basic Rules All Claims for Covered Entities, as defined by HIPAA, must use ICD 10 CM diagnoses codes Effective no sooner than October 1, 2015 (split claim and use from date for those that have a date span) Claims with ICD 9 CM codes will NOT be accepted after October 1, 2015 (single implementation date) New Guidelines will impact code assignment and sequencing CPT/HPCS codes are not impacted Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/2014 5

6 Basic Uses for ICD 10 CM diagnostic codes Provides medical necessity for services rendered Provides severity of patient illness Required for reimbursement Identifies diagnoses therapist is treating which justifies patient plan of care Must be updated to show progress and changes in patient status Support continuity of care throughout an episode of treatment May be used for outcome analysis Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 11 ICD 10 Code Structure Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/2014 6

7 Comparison of ICD 10 CM and ICD 9 CM ICD-9-CM 3 5 characters 1 st Character is numeric OR alpha 2 5 th character is always numeric Decimal after 3 rd character ICD-10-CM 3 7 characters 1 st Character is always alpha (all letters EXCEPT u) 2nd character is always numeric 3 7 th character are alpha or numeric Decimal after 3 rd character Use of dummy placeholder x Not Case Sensitive Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 13 New Code Structure Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/2014 7

8 Comparison of ICD 10 CM and ICD 9 CM ICD 10 CM is more specific and contains significantly more codes than ICD 9 CM (~69,099 v 14,315) ICD 10 CM Diagnosis codes start with a letter (except U) and are alphanumeric (watch for 0 and O, I and 1) ICD 10 CM Diagnosis codes can be 3, 4, 5, 6, or 7 characters long with a decimal after the third character Examples: I10 Hypertension M54.9 Back Pain G81.11 Spastic Hemiplegia affecting right dominant side G Complex regional pain syndrome 1 of right upper limb S72.041A Displaced fracture of base of neck, right femur, initial encounter for closed fracture 7th character extension (i.e. A= initial encounter, D = subsequent encounter, S = sequelae) o No change in CPT/HPCPS codes or use Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 15 Identifying ICD 10 Codes and Usage of Resources Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/2014 8

9 ICD 10 CM Book Example Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 17 Contents: Tabular Index of Diseases Alphabetical Index Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/2014 9

10 Alphabetic Index Example Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 19 Tabular List Example Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

11 Examples of Greater Specificity and Laterality More Combination Codes ICD 9 CM Diagnosis Codes ICD 10 CM Diagnosis Codes Decubitus Ulcer Stage of Decubitus Ulcer See Wall Street Journal article for additional examples of specificity 125 codes for Decubitus ulcers L Pressure Ulcer of right lower back, stage I L Pressure ulcer of right lower back, stage II L Pressure ulcer of right lower back, stage III L Pressure ulcer of right lower back, stage IV L Pressure ulcer of right lower back, unspecified stage L Pressure ulcer of left lower back, stage I L Pressure ulcer of left lower back, stage II L Pressure ulcer of left lower back, stage III L Pressure ulcer of left lower back, stage IV L Pressure ulcer of left lower back, unspecified stage L Pressure ulcer of sacral region, stage I L Pressure ulcer of sacral region, stage II Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 21 Summary of Changes ICD 9 CM Diagnoses Three to five characters Multiple Codes for each diagnosis/ symptom No Laterality Conventions Tabular List is non inclusive Result ICD 10 CM Diagnoses Three to seven characters 1 code assigned to combine 2 ICD 9 codes (e.g. Diagnosis with a complication Laterality New Conventions: Excludes II, Place Holders, and Extension and Generic Codes Available Each Code has full definition 14,567 Diagnosis Codes 69,832 Diagnosis Codes Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

12 Code Category M00 M02 M05 M14 M15 M19 M20 M25 M26 M27 M30 M36 M40 M43 M45 M49 M50 M54 M60 M63 M65 M67 M70 M79 M80 M85 M86 M90 M91 M94 M95 M96 Musculoskeletal conditions that are healed, chronic, or recurrent: Chapter 13, "Diseases of the Musculoskeletal System and Connective Most codes in Chapter 13 require site and laterality designations Infectious Arthropathies Inflammatory Polyarthropathies Osteoarthritis Other Joint Disorders Dentofacial Anomalies [Including Malocclusion] and Other Disorders of Jaw Systemic Connective Tissue Disorders Deforming Dorsopathies Spondylopathies Other Dorsopathies Disorders of Muscles Disorders of Synovium and Tendon Other Soft Tissue Disorders Disorders of Bone Density and Structure Other Osteopathies Chondropathies Other Disorders of the Musculoskeletal System and Connective Tissue Intraoperative and Postprocedural Complications and Disorders of Musculoskeletal System, Not Elsewhere Classified Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 23 Code Category S02 S12 S22 S32 S42 S52 S59 S62 S69 Traumatic Fractures Ch 19"Injury, Poisoning, and Certain Other Consequences of External Causes Most require type of fx, 7th character extension (A,D,G,K,P,S for closed Fx and Gustillo classification for open fx) Fracture of Skull and Facial Bones Fracture of Cervical Vertebra and Other Parts of Neck Fracture of Rib(s), Sternum, and Thoracic Spine Fracture of Lumbar Spine and Pelvis Fracture of Shoulder and Upper Arm Fracture of Forearm Other and Unspecified Injuries of Elbow and Forearm Fracture at Wrist and Hand Level Other and Unspecified Injuries of Wrist, Hand, and Finger(s) S72 S79 S82 S89 S92 Fracture of Femur Other and Unspecified Injuries of Hip and Thigh Fracture of Lower Leg, Including Ankle Other and Unspecified Injuries of Lower Leg Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 24 Fracture of Foot and Toe, Except Ankle 4/29/

13 7 th Character A D Definition Initial encounter for fracture Subsequent encounter for fracture with routine healing Examples Used while the patient is receiving active treatment for the condition. Used for subsequent encounters after the patient has received active treatment of the condition. At this time, the patient is receiving routine care for the condition during the healing or recovery phase (such as cast change or removal, ortho aftercare rehab during the healing phase). G K P Subsequent encounter for fracture with delayed healing Subsequent encounter for fracture with nonunion Subsequent encounter for fracture with malunion Assigned for delayed healing. Delayed healing occurs when the initial injury heals slower than expected, taking into account age, bone involved, and the extent and type of the fracture. Assigned for a nonunion. A nonunion occurs when bone ends do not meet and heal. Assigned for a malunion of a fracture. Malunions are bones that are healing in an abnormal position. Malunion may result in a bone being shorter than normal, poor alignment, or bent. S Sequela Used for Fractures/Injuries Identifies the injury responsible for the sequela. The term sequela indicates the after effects or late effects that occur after the healing and recovery phase of the fracture. For example, if a previous femur fracture resulted in a leg deformity, the 7th character S is used with the femur Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 25 fracture code. The specific leg deformity is coded first. Reporting Guidelines and Documentation Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

14 Rehab Coding Guidelines In Outpatient and Home Care Setting the first listed condition (the diagnosis sequenced first) should be the primary reason for the visit Codes for other diagnoses may be sequenced as additional dx Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 27 Rehab Coding Guidelines Uncertain Diagnoses not coded for outpatient visits signs/symptoms are then acceptable Code AND document ALL chronic diseases that exist (per ICD 10 Official Coding Guidelines) **Super Coders Factors Influencing health status and contact with health services Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

15 Documentation of Rehab Diagnoses Similar to ICD 9 guidelines Use physician referral and clinical assessment documentation Must be specific and as relevant to the problem being treated i.e. physician referral states stress urinary incontinence and assessment reveals detrusor instability Report both conditions Stress urinary incontinence, Detrusor instability Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 29 Reimbursement of Rehab Services Note reimbursement may be impacted by ICD 10 diagnoses Use Split Billing for services with cross over on October 1, 2015 Review Payer Guidelines and Coverage Medicare: Review National and Local Coverage Determinations which will provide ICD 9 to ICD 10 crosswalks by April 1, 2014 (check with your Medicare Administrative Contractor MAC) Workman s Compensation (Non covered Entity) may still require ICD 9 CM Codes Test use of ICD 10 codes with clearinghouse and payers (billing and remittance advice). Remember CPT codes stay the same Sign up for CMS ICD 10 Industry updates 10_Industry_ _Updates.html Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

16 Billing of Rehab Services Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 31 Patient Case Fracture 85 year old fell while ambulating and sustained a displaced right greater trochanteric fracture which required a THA. Patient also has hypertension. He was referred to PT, OT for therapy for the following functional limitations: difficulty walking and dressing. Appropriate Diagnoses for Rehab: Gait Abnormality Hypertension Status post hip replacement (health status) Cause of Gait Abnormality (fracture) healing Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

17 ICD 10 CM Coding Examples Gait Abnormality Step I Alphabetic Index Gait abnormality R26.9 ataxic R26.0 falling R29.6 hysterical(ataxic) (staggering) F44.4 paralytic R26.1 spastic R26.1 specified type NEC R26.89 staggering R26.0 unsteadiness R26.81 walking difficulty NEC R26.2 Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 33 ICD 10 CM Coding Examples Gait Abnormality Step II Tabular List (verify) Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

18 Abnormality of Gait ICD 9 CM Diagnoses Codes ICD 10 CM Diagnoses Codes Abnormality of gait R26.0 Ataxic gait R26.1 Paralytic gait R26.81 Unsteadiness on feet R26.89 Other abnormalities of gait and mobility R26.9 Unspecified abnormalities of gait and mobility Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 35 Hypertension Chronic co morbid condition ICD 9 CM Diagnoses Codes ICD 10 CM Diagnoses Codes Essential Hypertension, unspecified benign or malignant I10 Essential (primary) hypertension Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

19 Status post hip replacement (status code) ICD 9 CM Diagnoses Codes ICD 10 CM Diagnoses Codes V43.64 Hip Joint Replacement Status Z Presence of right artificial hip joint Z Presence of left artificial hip joint Z Presence of artificial hip joint, bilateral Z Presence of unspecified artificial hip joint Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 37 Underlying Cause of Gait Abnormality Healing displaced, right, greater trochanter fracture ICD 9 CM Diagnoses Codes ICD 10 CM Diagnoses Codes V54.13 Aftercare for healing traumatic fracture of the hip S72.111D Displaced fracture of greater trochanter of right femur, subsequent encounter for closed fracture with routine healing. Note: over 100 crosswalk choices for ICD 9 CM code V54.13 Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

20 7 th Character Extension for Injuries A Initial Encounter: while patient is receiving active treatment for condition Surgical treatment ED encounter Evaluation by New Physician Treatment by New Physician Reference: ICD 10 CM Official Guidelines Section I.C.19.A Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ th Character Extension for Injuries D Subsequent Encounter : After patient received active treatment of the condition and is receiving routine care during healing or recovery phase Cast Change Medication Adjustment Other Aftercare F/U visits for Treatment of Injury Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

21 7 th Character Extension Case Scenario The patient presented for therapy following an acute care hospitalization for surgical treatment of a displaced fracture of the right intertrochanteric femur. What are the appropriate rehab diagnosis codes? Answer: S72.141D, Displaced intertrochanteric fracture of right femur, subsequent encounter Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ th Character Extension for Injuries S Sequelae Encounter: complications or conditions that arise as a direct result of an acute condition that is no longer being treated such as: Hemiplegia from a previous traumatic subdural hematoma Post traumatic arthritis following previous ankle fracture Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

22 Summary of Reporting Late Effects / Sequelae Is condition a Sequelae? YES Is Cause of Late Effect/Sequelae Traumatic? YES NO Code The Causative Injury with 7 th Character S Code the sequelae based on medical condition i.e. hemiplegia s/p cerebral infarction affecting dominant Right dominant side I Add Code for Residual Condition i.e. hemiplegia s/p traumatic sub dural hematoma w/o LOC S06.5x0S Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 43 Placeholder Convention ICD 10 CM uses a placeholder character, which is always the letter X and it has two uses o The X provides for future expansion without disturbing the overall code structure o When a code has less than 6 characters and 7 th character extension is required. The X is assigned for all characters less than six in order to meet the requirements of coding to the highest level of specificity. Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

23 Patient Case Orthopedics 17 yo referred to PT s/p R PTP ACL reconstruction and Medical Meniscus Repair. Pt sustained a tear of her right ACL and a bucket handle tear of her right medical meniscus while playing HS basketball in a school gym. PMH includes Exercise Induced Asthma. Pt presents with knee pain, swelling, limited ROM, decreased strength, and difficulty walking What codes do you assign? Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 45 Patient Case Orthopedics What codes do you assign? ICD 9 CM ICD 10 CM R PTP ACL reconstruction not coded S83.511D Medical Meniscus Repair not coded S83.211D Exercise Induced Asthma J Pain (knee) M Swelling (joint effusion) M Limited ROM/Joint Stiffness M Decreased strength M62.81 Difficulty walking R26.2 Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

24 Patient Case Traumatic 65 year old was in an MVA where he immediately lost consciousness for <20 minutes. He sustained a TBI due to a subdural hematoma causing left spastic hemiplegia and aphasia. He was referred to PT, OT and ST for therapy for the following functional limitations: difficulty walking, aphasia, concentration and attention deficits, and difficulty feeding. What codes do you assign? Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 47 Patient Case Traumatic What codes do you assign? 65 year old was in an MVA where he immediately lost consciousness for <20 minutes. He sustained a TBI due to a subdural hematoma causing left spastic hemiplegia and aphasia. ICD 9 CM ICD 10 CM TBI (hematoma) S06.5X1S Spastic hemiplegia (right dominant side) G81.11 difficulty walking R26.2 aphasia R47.01 concentration and attention deficits R difficulty feeding R63.3 Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

25 Patient Case Non Traumatic What codes do you assign? 65 year old has non traumatic intracerebral hemorrhage causing left spastic hemiplegia and aphasia. ICD 9 CM ICD 10 CM Intracerebral Hemorrhage I Spastic hemiplegia (right dominant side) I difficulty walking R26.2 aphasia None None concentration and attention deficits R difficulty feeding R63.3 Other late effect of CVA I Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 49 Trauma versus non traumatic conditions Sequelae Clarification When coding late effects in ICD 10 (sequelae) Traumatic Cause Non Traumatic Cause Code original trauma with 7 th character representing sequelae (S); Code associated deficits The underlying cause is may be incorporated into the deficit (i.e. Sequelae of hemorrhagic CVA) Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

26 Implementation Strategy Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 51 Develop Implementation Strategy Identify the Impact on Organization Clinical Documentation Superbills and Code Assignment Software EMR Reporting Systems Create a Detailed Timeline to Transition Budget for Transition Productivity Software Upgrades Staff Education Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

27 Develop Implementation Strategy Contact Billing Services, Practice Management vendors See ICD 10 Assessing Your Vendors Handout questions for system vendors 2/ Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 53 Staff Training/Utilization Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

28 ICD 10 Exercises Conduct Documentation Audits Determine where Diagnosis Codes will be recorded: Documentation Flow and Design Update Charge Sheets Ensure CPT codes correspond to an appropriate diagnosis code (laterality etc) Assess your Readiness (test, test, test) Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 55 ICD 10 Exercises Build your TEAM! Develop Educational Resources for Staff Engage Clinicians, Coders, Front End staff Early Identify your top ICD 9 Codes and build crosswalks for your staff Start Testing/Training by April Continue to Educate Yourself Complete Vendor Assessments Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

29 How to Build Your Crosswalks Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 57 Tools: General Equivalency Mappings (GEMs) A. Medicare tool designed to test the conversion from ICD 9 to ICD 10 ICD 10 CM and GEMs.html > click on 2014 Reimbursement Mappings B. The GEM files can be used by anyone who wants to convert diagnoses and procedure data including but not limited to: i. Health Plans ii. Providers iii. Medical Researchers iv. Medical Software Vendors Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

30 General Equivalence Mappings (GEMS) Mappings All codes included ICD 9 CM to ICD 10 CM ICD 10 CM to ICD 9 CM (backward mapping) Warning: The GEMS tool is not a substitute for learning and coding from documentation Used to Produce the ICD 10 Reimbursement Mappings Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ ICD 10 CM and GEMs.html Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

31 Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 61 ICD 9 CM to ICD 10 CM Shoulder Pain ( in ICD-9 to M in ICD-10). The third column is the GEM flag representing how good the map is. Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

32 Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 63 ICD 10 CM to ICD 9 CM shoulder pain maps back to three different ICD-10 codes because there is not a perfect match Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

33 Other ICD 10 Translators Available Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 65 Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

34 General Equivalence Mappings (GEMS) When should I NOT use GEMS When small numbers of codes are being converted to ICD 10 When ICD 10 is implemented in October 1, 2014 Warning: GEMS are limited and not reliable as a coding tool Only 5% of the mappings will create a one to one match Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 67 Physical Therapy Crosswalk Examples Hemiplegia non dominant side (L) w/ Abnormality of Gait left or right non dominant side and underlying cause G81.93 (right dominant side) Difficulty Walking s/p (Right) THA (V43.64) R26.2 (NEC) and Z Lumbago M54.5 ***Note** M54.4 denotes lumbago with sciatica must link the two conditions and also specify laterality V54.19 Traumatic, closed, displaced left ankle fracture aftercare during routine healing S82.892D Lower limb weakness R (other symptoms involving musculoskeletal system) Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

35 Occupational Therapy Crosswalk Examples Spastic hemiplegia affecting right dominant side due to previous hemorrhagic bleed in cerebellum) I Cerebral palsy with spastic congenital hemiplegia G80.2 Spastic hemiplegic cerebral palsy Parkinson s G , Obstructive Hydrocephalus with dementia G91.1 (obstructive hydrocephalus), F02.80 (dementia is diseases classified elsewhere without behavioral disturbance) Muscle weakness (generalized) M62.81 Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 69 Women s Health Crosswalk Examples Chronic interstitial cystitis with hematuria N Myofascial pain syndrome M79.1 (myalgia) Chronic pelvic pain R10.2 (pelvic and perineal pain) Stress incontinence, female N39.3 (stress incontinence (male or female) , Pelvic muscle wasting (non obstetric) with incontinence N81.84, N (other incontinence) , , Pelvic muscle wasting during second trimester (obstetric) with incontinence O34.82, N81.84, R (other incontinence) Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

36 Speech and Language Crosswalk Examples Aphasia due to right middle cerebral artery occlusion with infarction versus late effect R47.01 (aphasia) AND I (right middle cerebral artery occlusion) I (aphasia following other cerebrovascular disease) Voice Disturbance NEC R49.9 (unspecified voice and resonance disorder) Speech Disturbance Slurred Speech NEC R47.81 (Slurred speech) Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 71 Speech and Language Crosswalk Examples Dysphagia pharyngoesophageal phase due to insidious onset with chronic coughing R13.14 (dysphagia, pharyngoesophageal phase) R05 (cough) dysphagia s/p CVA (cerebral infarction), I (dysphagia following cerebral infarction) R13.10 (dysphagia unspecified) Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

37 Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 73 TOOLS & RESOURCES Get in Shape for ICD 10 Challenge Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

38 Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 75 Resources AHIMA ICD 10 CM/PCS Implementation Toolkit ICD 10 CM Guidelines..\..\ICD 10 Materials 2014\icd10cm_guidelines_2014.pdf 2014 ICD 10 PCS Guidelines..\..\ICD 10 Materials 2014\PCS 2014 guidelines.pdf 2014 ICD 10 CM and GEMs ICD 10 CM and GEMs.html 2014 ICD 10 PCS and GEMs ICD 10 PCS.html September 13, 2011 Wall Street Journal Walked into a Lamppost? Hurt While Crocheting? Help is on the Way. CMS Timelines and Tools 10ImplementationTimelines.html Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

39 Resources Sign up for CMS ICD 10 Industry updates 10_Industry_ _Updates.html ICD 10 Mapping Web Site (ASHA) Code Book Vendor National Uniform Claim Committee (revised 1500 claim form version 02/12) Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/14 77 Resources Jean Jurek, MS, RHIA, CPC Jean Jurek Associates, Inc Karen Hughes, PT, MS Jean Jurek Associates, Inc Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

40 Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ HPA The Catalyst is the Section on Health Policy & Administration of APTA Presented by: Jean Jurek, MS, RHIA, CPC & Karen Hughes, PT, MS, ATC 4/29/ /29/

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