ICD-10-CM For Orthopedics. Lynn M. Anderanin, CPC, CPC-I, COSC, AHIMA ICD-10-CM Certified Trainer

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1 ICD-10-CM For Orthopedics Lynn M. Anderanin, CPC, CPC-I, COSC, AHIMA ICD-10-CM Certified Trainer

2 Healthcare Information Services (HIS) HIS is a physician management company based in Chicago, IL specializing in Revenue Cycle Management and Information Technology. HIS provides services for over 450 providers and has a dedicated Division for Orthopaedics. HIS is dedicated to helping physicians maximize their reimbursement revenue, lower overhead and enhance your bottom line. HIS is an expert partner for increased profitability for your Orthopaedic practice.

3 Presenter - Lynn Anderanin Lynn Anderanin, CPC,CPC-I,COSC is the Sr. Director Coding Compliance and Education for Healthcare Information Services (HIS). She has over 28 years experience in all areas of the physician practice including Practice Administrator, Billing Manager, and Director of Operations. Lynn s experience is primarily in the specialties of Orthopedics, Rheumatology, and Hematology/Oncology. She has been a speaker for many conferences, including the AAPC National Conferences and Workshops, Community Colleges, audio conferences, and Local Chapters. Lynn became a CPC in 1993, and a Certified Instructor in 2002, and a Certified Orthopedic Surgery Coder in Lynn is the founder of the first local Chapter of the AAPC in Chicago, which is now 15 years old, and a former member of the AAPC National Advisory Board as well as other Boards for the AAPC.

4 ICD-10 is Coming HHS hints at Delay? No date set or confirmation of a certain delay 5010 Meaningful Use Certain Healthcare Entities Plan for the October 2013 timetable Do not relax and rely on a lengthy delay

5 General Facts ICD 9 CM diagnosis codes ICD 10 CM diagnosis codes 3 5 characters in length 3 7 characters in length. Approximately 14,000 codes Approximately 69,000 available codes. First digit may be alpha (E or V) or numeric; Digits Digit 1 is alpha; Digits 2 and 3 are numeric; Digits 2 5 are numeric 4 7 are alpha or numeric Limited space for adding new codes Flexible for adding new codes. Lacks detail Very specific. Lacks laterality Has laterality. Difficult to analyze data due to non- specific codes Specificity improves coding accuracy and richness of data for analysis. Codes are non- specific and do not adequately define diagnoses needed for medical research Does not support interoperability because it is not used by other countries. Detail improves the accuracy of data used for medical research. Supports interoperability and the exchange of health data between other countries and the U.S.

6 Quick References Annual updates of each system are posted on the ICD-10 website at Maintenance and updates of ICD-9-CM and ICD-10 are discussed at the ICD-9-CM Coordination and Maintenance (C&M) Committee meeting 03_meetings.asp

7 Draft ICD-10-CM Official Guidelines for Coding and Reporting

8 GEMS General Equivalence Mappings (GEMs) assist in converting data from ICD-9-CM to ICD-10 Forward and backward mappings Information on GEMs and their use (click on ICD-10-CM or ICD-10-PCS to find most recent GEMs) GEMs are not a substitute for learning how to code with ICD-10

9 Implementation Schedule Last regular, annual updates to both ICD-9-CM and ICD-10 will be made on October 1, 2011 On October 1, 2012 there will be only limited code updates to both ICD-9-CM & ICD-10 code sets to capture new technology and new diseases On October 1, 2013 there will be only limited code updates to ICD-10 code sets to capture new technology and new diseases On October 1, 2014 regular updates to ICD-10 will begin

10 Orthopedic Character Changes Right, Left, and Unspecified Initial Encounter, Subsequent Encounter, or Sequela Active Treatment or Aftercare

11 Other Notes The letter U is not used in ICD-10-CM 7th placeholder is always alpha The word with means includes, the word and means either or.

12 Initial, Subsequent, and Sequela for Injuries 7th character utilized on most injuries with the exception of fractures A- Initial Encounter- patient receiving active treatment for an injury D-Subsequent encounter- patient is receiving routine care during healing or recovery phase S-Sequela-patient is being seen for complications or conditions as a direct result of an injury

13 Placeholder x Used in the 4th, 5th, or 6th character position Utilized when a 6th or 7th character position is necessary Examples: M86.8x1-Other osteomyelitis, shoulder SØ6.5xØA-Initial encounter for traumatic subdural hemorrhage without loss of consciousness X75.xxxS-Intentional self-harm by explosive material, sequela

14 NEC and NOS NEC Not elsewhere classified Not elsewhere classifiable NEC leads you to certain specified forms are classified elsewhere NOS Not otherwise specified

15 Excludes Two kinds of excludes notes Note 1- NOT CODED HERE (ICD-9)- Two codes cannot be coded together Congenital vs. acquired Note 2- Not included here- Indicates that codes listed could be billed together only if appropriate, but they may be needed to reported for clarification

16 Chapter 12 Diseases of the Skin and Subcutaneous Tissue L00-L08- Infections of the skin and subcutaneous tissue L60-L75- Disorders of skin appendages L76- Intraoperative and postprocedural complications of skin and subcutaneous tissue L80-L89- Other disorders of the skin an subcutaneous tissue L89-Pressure ulcer

17 Chapter 13 Diseases of Musculoskeletal and connective tissue (M00-M99) Site and laterality Bone Versus Joint Acute Traumatic vs. chronic recurrent Pathological Fractures Osteoporosis

18 Site and Laterality Most codes in Chapter 13 have site and laterality designations. Site represents Bone Joint Muscle Multiple sites code If there is no multiple site code, multiple codes should be used

19 Bone Vs. Joint Bone maybe affected at upper or lower end If joint is affected as well as bone, the designation will be the bone, not the joint

20 Acute Vs. Chronic or Recurrent Many musculoskeletal conditions result of previous injury or trauma to a site, or are recurrent conditions. Chapter 13 has Chronic or recurrent bone, joint, or muscle conditions Conditions that are the result of healed injury If it is difficult to determine acute or chronic, query the provider Acute injury coding is in Chapter 19

21 Swelling of a Limb No longer a code for swelling of a limb Now classified to other soft tissue disorder NEC See Disorder, soft tissue, specified type, NEC ICD-9-CM Swelling of limb ICD-10-CM- M79.8 Other specified soft tissue disorder

22 Pathological Fractures 7th character treatment status Osteoporosis M80-with current pathological fracture M81-without pathological fracture

23 Osteoarthritis M15-19 Codes to 5th and 6th character Listed by body part Unilateral and bilateral Right and left Primary and secondary

24 Other Joint Disorders M20-25 M20-Acquired deformities of fingers M21-Other acquired deformities of limbs M22-Disorder of patella M23-Internal derangement of knee M24-Other specific joint derangements M25-Other joint disorder, not elsewhere classified

25 Deforming Dorsopathies M40-49 M40-Kyphosis and lordosis M41-Scoliosis M42-Spinal osteochondrosis M43-Other deforming dorsopathies M45-Ankylosing spondylitis M46-Other inflammatory Spondylopathies M47-Spondylosis M48-Other spondylopathies M49-Spondylopathies in diseases classified elsewhere

26 Other Dorsopathies M50-M54 M50-Cervical disc disorders M51-Thoracic, thoracolumbar, and lumbosacralintervertebral disc disorders M53-Other and unspecified dorsopathies, not elsewhere classified M54-Dorsalgia

27 Soft Tissue Disorders M60-M63-Disorders of muscles M65-M67-Disorders of synovium and tendon M70-M79-Other soft tissue disorders M80-M85-Disorders of bone density and structure M86-Osteomyelitits M96-Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classified

28 Chapter 17 Now titled Congenitial Malformations, Deformations, and Chromosomal, Abnormalities Q00-Q07- Nervous system Q65-Q79- Musculoskeletal system Q Other congenital malformations Q90-Q99- Chromosomal abnormalities, not elsewhere classified

29 Chapter 19 Injury, Poisoning, and other certain consequences of external causes (S00-T88) Traumatic Injury- SØØ-T14.9 Code the most serious injury first Complications of care Pain due to medical devices- T code section Aftercare Z codes should not be used for aftercare for injuries

30 Injuries ICD-9-CM to ICD-10-CM ICD-9-CM Codes looked up by type and then site ICD-10-CM Codes looked up by body region and then type

31 Injuries SØØ-SØ9-head S1Ø-S19-neck S2Ø-S29-thorax S3Ø-S39-abdomen,lower back, lumbar spine, pelvis S4Ø-S49-shoulder and upper arm S5Ø-S59-elbow and forearm S6Ø-S69-wrist and hand S7Ø-S79-hip and thigh S8Ø-S89-knee and lower leg S9Ø-S99-ankle and foot

32 Fractures Displaced or non-displaced Fracture type (2,3,or 4 part) What kind (greenstick, communited, transverse) Routine healing, delayed healing, malunion,nonunion Open or closed Open breaks down further (Type I, II,IIIA,IIIB,IIIC)

33 Open Fractures Gustilo Open Fracture Classifications 3 main categories, I,II,III Type III further divided, IIIA,IIIB,IIIC Mechanism of injury Extent of soft tissue damage Degree of bone injury or involvement

34 Salter-Harris Fractures Occur along the epiphyseal (growth) plates Listed under fracture, then physeal Classified into 9 types Types I-IV- most common Specific codes for most site Types V-IX- less common Other physeal fracture If no type is specified, use unspecified code

35 Fracture 7th character extension for type of encounter A-Initial encounter for closed fracture B- Initial encounter for open fracture D- Subsequent encounter for fracture with routine healing G- Subsequent encounter for fracture with delayed healing K- Subsequent encounter for fracture with nonunion P- Subsequent encounter for fracture with malunion S- Sequela

36 Right, Left and Unspecified 6th character utilized to designate side Fracture of pisiform S Displaced fracture, right wrist S Displaced fracture, left wrist S Displaced fracture, unspecified wrist S Nondisplaced fracture, right wrist S Nondisplaced fracture, left wrist S Nondisplaced fracture, unspecified wrist

37 Chapter 20 External Causes of Morbidity Replaces E Codes VØØ-X58-Accidents VØØ-V99-Transport accidents WØØ-X58-Other external causes of accidental injury WØØ-W19-Slipping,tripping,stumbling,and falls X92-YØ8-Assault

38 Chapter 20 Notes Y Sequelae of External Causes of Morbidity and Morality All late effects for each intent brought together in a subchapter Alpha Extender for sequelae S is added to the code Y89-Sequelae of other external causes W55.01S-Bitten by cat, sequela

39 Chapter 21 Factors influencing health status and contact with health services Replaces V Codes Z68- Body mass index Z80-Z92- History of Z96- Presence of other functional implants

40 Aftercare Encounter for: Z45- Adjustment and management of implanted device Z47- Orthopedic aftercare Z48- Other postprocedural aftercare

41 References for this Presentation Ingenix ICD-10-CM-The Complete Official Draft Code SetDRAFT Implementing ICD-10 Contexo-Media Advanced Anatomy and Physiology for ICD-10-CM/PCS

42 Improve Profitability with HIS HIS is a full service Physician Management organization offering expert services in Revenue Cycle Management, EHR, Consulting and IT services. Expert Coding consultation, Coding Certification (including ICD-10), training, audits, assessments, etc. HIS typically can increase your reimbursements by 10% or more. Call HIS to see how we can improve your reimbursements, lower overhead and boost overall profitability RINGHIS

43 RCM plus EHR HIS is the only reseller in the nation of the award winning productivity-driven SRS-EHR by SRSsoft. More Orthopedics are using SRS than any other EHR in the country! Bundled service: SRS-EHR and HIS's Revenue Cycle Management Services together Mitigates the up-front costs associated with the software, hardware and implementation of an EHR purchase. HIS will amortize the hardware and software costs into HIS monthly service fee... allowing you to enjoy the benefits and costs savings with zero capital out-lay.

44 Andy Salmen Contact HIS Business Development Lynn Anderanin Senior Director of Coding Education and Compliance RING-HIS