ICD-10 Update and Top Ten Professional Diagnoses* 2014 Blue Cross Blue Shield of Michigan

Transcription

1 ICD-10 Update and Top Ten Professional Diagnoses* 2014 Blue Cross Blue Shield of Michigan *NOTE: The information in this document is not intended to impart legal advice. This overview is intended as an educational tool only and should not be relied upon as legal or compliance advice.

2 ICD-10 overview The mandate The differences Agenda Top 10 Diagnoses for All Providers Top diagnostic codes ICD-10-CM chapter overviews of interest Combination and Laterality primary care examples Great information but so what? Next steps BCBSM readiness Provider testing It s all about the coding Appendix A chapter by chapter look at the ICD-10- CM code set 2

3 ICD-10 overview

4 The ICD-10 Mandate The ICD-10 implementation is scheduled for Oct. 1, On claims with that date of service, all HIPAAcovered health care entities must begin using ICD-10 codes in place of the ICD-9 codes Claims with non-compliant codes will be rejected Delivered in two parts ICD-10-CM (for all providers in all health care settings) and ICD-10-PCS (for hospital claims and inpatient hospital procedures Does not affect CPT or HCPCS codes and usage 4

5 The differences between ICD-9 and 10 Differences between the code sets make ICD-10 look like an entirely different coding language Main differences include: Volume Structure New features 5

6 Volume differences About 150,000 ICD-10 codes will replace 17,000 ICD-9 codes The greater level of detail in ICD-10 causes the increased volume 6

7 Structural differences ICD-9-CM 7

8 Structural differences ICD-10-CM 8

9 ICD-10-CM New Features Combination codes for some conditions and associated symptoms Laterality Expansion of some codes Injuries Diabetes Alcohol and substance abuse Post-op complications Injuries grouped by anatomical site instead of by category 9

10 There are other differences Code titles are more complete Specificity and detail significantly expanded Certain diseases reclassified to reflect current medical knowledge The letter O should be stated as O and not 0 (zero) 10

11 A quick ICD-10-PCS informational overview PCS - Procedure Coding System Completely different from ICD-9-CM procedure codes Codes are built one digit at a time, each digit represents a different piece of information Codes are each 7 characters long (no decimal points) Each character can be alpha or numeric except I and O so as not to be confused with 1 and 0. Each code is built specifically for the procedure performed so that the coding system is flexible and allows for new procedures to be easily incorporated into the coding system. 11

12 What s different for the Top Ten Diagnoses for All Professional Providers? Focus on Key ICD-10-CM Codes and Chapters

13 Top Ten Most Frequently Reported ICD-9-CM Diagnosis Codes for all Professional Claims Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled Lumbago 3. V76.12 Other screening mammogram Closed dislocation, lumbar vertebra 5. V20.2 Routine infant or child health check Nonallopathic lesions, lumbar region Nonallopathic lesions, cervical region Unspecified essential hypertension chest pain, unspecified 10. V70.0 Routine general medical examination at a health care facility The following slides will display the corresponding ICD-10-CM codes, key updates to the chapters for these codes and examples of combination codes and codes with laterality 13

14 Top Ten Most Frequently Reported Diagnosis Codes for all Professional Claims ICD-9-CM Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled ICD-10-CM E11.9 Type 2 diabetes mellitus without complications E13.9 Other specified diabetes mellitus without complications Lumbago M54.5 Low back pain V76.12 Other screening mammogram Z12.31 Encounter for screening mammogram for malignant neoplasm of breast 14

15 ICD-10-CM Overview Key Coding Updates for these codes Chapter 4: Endocrine, Nutritional and Metabolic Diseases (E00-E89) ICD-10-CM Diabetes Mellitus codes are combination codes that include the type of diabetes (1 or 2), the body system affected and complications affecting the body system (Retinopathy, Neuropathy, Arthropathy, Peripheral angiopathy with gangrene, etc.). In ICD-10-CM there are now 5 categories of codes for Diabetes Mellitus. Chapter 21: Factors Influencing Health Status and Contact with Health Services (Z00-Z99) These codes can be used in any health care setting. Z codes may be used as either a first-listed or principal diagnosis code in the inpatient setting, or secondary code, depending on the circumstances of the encounter. Certain Z codes may only be used as first-listed or principal diagnosis in certain situations. Refer to Official Coding Guidelines for details. 15

16 ICD-10-CM Overview Key Coding Updates for these codes Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00-M99) ICD-10 identifies 3 different causes for pathologic fractures: Neoplastic disease Osteoporosis Other specified disease Most of the codes within this chapter have site and laterality designations. Some codes in this chapter require: The 7 th character extension that describes type of encounter, or the stage of the fracture s healing process, and any residual effects or sequela from the fracture. Some codes in this chapter will have the 7 th character applied. Example: A=Initial encounter D=Subsequent encounter S=Sequela 16

17 Examples of Combination ICD-10-CM Codes Chapter 4: Endocrine, Nutritional and Metabolic Diseases (E00-E89) E10.51 Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene E11.41 Type 2 diabetes mellitus with diabetic mononeuropathy Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00-M99) M32.11 Endocarditis in systemic lupus erythematosus Chapter 21: Factors Influencing Health Status and Contact with Health Services (Z00-Z99) Z48.21 Encounter for aftercare following heart transplant 4 17

18 Examples of Laterality in ICD-10-CM Codes Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00-M99) M Rheumatoid myopathy with rheumatoid arthritis of right shoulder M Rheumatoid myopathy with rheumatoid arthritis of left shoulder Chapter 21: Factors Influencing Health Status and Contact with Health Services (Z00-Z99) Z Encounter for fitting and adjustment of complete right artificial arm Z Encounter for fitting and adjustment of complete left artificial arm Note: When laterality is not documented, a corresponding code for unspecified is available: For example, code Z Encounter for fitting an adjustment of complete artificial arm, unspecified arm 18

19 Top Ten Most Frequently Reported Diagnoses Codes for all Professional Claims Cont d ICD-9-CM ICD-10-CM Closed dislocation, lumbar vertebra M Subluxation complex (vertebral) of lumbar region S33.0xxA - Traumatic rupture of lumbar intervertebral disc, initial encounter S33.100A - Subluxation of unspecified lumbar vertebra, initial encounter S33.101A - Dislocation of unspecified lumbar vertebra, initial encounter S33.110A - Subluxation of L1/L2 lumbar vertebra, initial encounter S33.111A - Dislocation of L1/L2 lumbar vertebra, initial encounter S33.120A - Subluxation of L2/L3 lumbar vertebra, initial encounter S33.121A - Dislocation of L2/L3 lumbar vertebra, initial encounter S33.130A - Subluxation of L3/L4 lumbar vertebra, initial encounter S33.131A - Dislocation of L3/L4 lumbar vertebra, initial encounter S33.140A - Subluxation of L4/L5 lumbar vertebra, initial encounter S33.141A - Dislocation of L4/L5 lumbar vertebra, initial encounter 19

20 ICD-10-CM Overview Key Updates for these codes Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) Injuries are grouped by body part rather than category of injury as they were in ICD-9-CM Laterality is specified in this chapter ICD-10-CM introduces the use of a seventh character to specify the encounter type. Most of the codes in this chapter use the seventh character. Most of the codes use at least the following seventh characters: A Initial encounter D Subsequent encounter S Sequela Complications such as malunion and nonunion of a fracture are reported with the applicable seventh character for subsequent care with nonunion (K, M, N) or subsequent care with malunion (P,Q,R). There are additional seventh characters that apply specifically to certain open fracture types (B,C,E,F,G,H,J). 20

21 ICD-10-CM Overview Key Updates for these codes Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) Other 7 th characters applied in this chapter to certain code categories depending upon site of fracture: A = initial encounter for closed fracture B = Initial encounter for open fracture (type I or II or NOS) C = initial encounter for open fracture (type IIIA IIIB,IIIC) D = subsequent encounter for fracture w /routine healing E = subsequent encounter for open fracture (type I or II w/routine healing) F = subsequent encounter for open fracture (type IIA,IIB,IIC w/routine healing) G = subsequent encounter for fracture w/delayed healing H = subsequent encounter for open fracture (type I or II w/delayed healing) J = subsequent encounter for open fracture (type IIA,IIB,IIC w/delayed healing) K = subsequent encounter for fracture w/nonunion M = subsequent encounter for open fracture (type I, II w/nonunion) N = subsequent encounter for open fracture(type IIIA,IIIB,IIIC w/nonunion) P = subsequent encounter for fracture w/malunion Q = subsequent encounter for open fracture(type I,II w/malunion) R = subsequent encounter for open fracture(type IIIA,IIIB,IIIC w/malunion)

22 Examples of ICD-10-CM Combination Codes Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) S06.1X0A Traumatic cerebral edema without loss of consciousness, initial encounter T36.0X1D Poisoning by penicillin, accidental (unintentional), subsequent encounter T36.0X5A Adverse effect of penicillin, initial encounter 22

23 Top 10 Most Frequently Diagnoses Codes for all Professional Claims Cont d ICD-9-CM V20.2 Routine infant or child health check Nonallopathic lesions, lumbar region ICD-10-CM Z Encounter for routine child health examination with abnormal findings Z Encounter for routine child health examination without abnormal findings M99.03 Segmental and somatic dysfunction of lumbar region Nonallopathic lesions, cervical region M99.01 Segmental and somatic dysfunction of cervical region 23

24 Top 10 Most Frequently Diagnoses Codes for all Professional Claims Cont d ICD-9-CM Unspecified essential hypertension ICD-10-CM I10 Essential (primary) hypertension chest pain, unspecified V70.0 Routine general medical examination at a health care facility R07.9 chest pain, unspecified Z00.00 Encounter for general adult medical examination without abnormal findings Z00.01 Encounter for general adult medical examination with abnormal findings 24

25 ICD-10-CM Overview Key Updates for these codes Chapter 9: Diseases of the Circulatory System (I00-I99) In ICD-10-CM there is only one code for Hypertension; I10 defined as essential (primary) hypertension. There were 3 codes in ICD-9-CM. The time limit for assigning the acute MI code is 28 days. Terminology used to describe several cardiovascular conditions has been updated to reflect more current medical practice. Chapter 18: Symptoms, Signs and Abnormal clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99) Repeated falls is coded to a symptom code in ICD-10-CM instead of a V code in ICD-9-CM There are codes to identify a patient s coma scale Systemic Inflammatory Response Syndrome (SIRS) due to noninfectious process is moved from the Injury and Poisoning chapter in ICD-9-CM to this chapter in ICD-10-CM 25

26 Examples of ICD-10-CM Combination Codes Chapter 9: Diseases of the Circulatory System (I00-I99) I Atherosclerotic heart disease of native coronary artery with unstable angina pectoris I26.01 Septic pulmonary embolism with acute cor pulmonale Chapter 18: Symptoms, Signs and Abnormal clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99) R50.2 Drug induced fever R65.21 Severe sepsis with septic shock 26

27 Examples of Laterality in ICD-10-CM Codes Chapter 9: Diseases of the Circulatory System (I00-I99) I60.21 Nontraumatic subarachnoid hemorrhage from right anterior communicating artery I60.22 Nontraumatic subarachnoid hemorrhage from left anterior communicating artery Chapter 18: Symptoms, Signs and Abnormal clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99) R19.31 Right upper quadrant abdominal rigidity R19.32 Left upper quadrant abdominal rigidity R19.33 Right lower quadrant abdominal rigidity R19.34 Left lower quadrant abdominal rigidity 27

28 BCBSM s lessons learned about the ICD-10-CM code set Some chapters of codes included significant changes to the axis of classification (or other factors) which increased our review time. These include: OB chapter: Change from episode of care to trimester Injury/Poisoning and Other Consequences of External Causes: Addition of 7 th character to identify type of fracture (open, closed, etc.) and episode of care (initial, subsequent or for sequela) See the appendix for more information about each chapter and the changes 28

29 Great information but so what?

30 Everyone has different views of ICD-10 Clinician Perspective: ICD-10 is understanding the increased level of detail needed in the medical record documentation. Coder Perspective: Training is required to understand the additional detail in the codes. Payer Perspective: Make sure that our systems can take the submitted codes and pay claims/apply benefits appropriately. The best way to understand the impact of the ICD-10 code set is to see it in action 30

31 Important points from an industry perspective ICD-10 most likely will increase the need for certified coders This is due to the increased detail in the code set, especially during the initial months of the transition Entities must take into consideration external factors (such as impacts of Health Care Reform and requirements of Medicare and Medicaid) when planning for ICD-10 A maintenance process must be in place as part of a long-term solution to enable processing of codes How do you update the codes today? With increased volume, that process will likely have to change 31

32 Medical records A call for detail Because of ICD-10 specificity, provider documentation must change to meet the new level of detail. For example Diagnosis: Obesity must be specified in ICD-10 if due to excess calories or if drug induced. Angina Pectoris is further classified as unstable angina, angina pectoris with documented spasm or other forms of angina pectoris. Asthma is specified as mild intermittent, mild persistent, moderate persistent and severe persistent. Tobacco dependence in ICD-9 becomes Nicotine dependence in ICD-10. The type of nicotine dependence must be documented for coding purposes. Procedures: Transfusion of Packed Red Blood Cells need to specify if red blood cells are fresh or frozen. Hernia repairs require the device (graft/implant) to be coded to autologous tissue substitute, synthetic substitute or nonautologous tissue substitute. Radiological procedures (aortogram, arteriography performed under fluoroscopy) need to specify contrast material used (High Osmolar, Low Osmolar or other contrast) 32

33 Why you should care about the ICD-10 transition If we receive non-compliant codes (problem in the provider space) OR incorrectly associate ICD-10 diagnosis codes in our systems (problem in the payer space). then there is major disruption and if there s disruption Provider has to call the payer Payer answers questions, requests other information Claims are delayed Disruption in cash flows No one is happy It is in everyone s best interest to work toward a seamless transition 33

34 Next steps

35 Next steps to prepare for ICD-10* Learn about the ICD-10 code set Determine Impact Identify training needs Reach out to others Identify all places within your organization that use ICD-9 codes and understand the impact of the transition Determine strengths and weaknesses in medical record documentation Staff review and refresh medical terminology Plan for coder training (6-9 months prior to implementation) Talk to business partners about ICD-10 readiness (payers, vendors, billing services, etc.) Be sure to discuss testing capabilities *Information from CMS MLN Matters, SE1019 and Basics for Medical Practices (source cms.gov\icd-10 website) 35

36 More ICD-10 readiness tactics Start recoding the superbill and determine the documentation required to code accurately Diabetes: Type 1 or 2, due to underlying condition, drug/chemical induced Manifestations now included in chapter, but some will need an additional code Do you need to expand the superbill based on physician activities? Start with the CMS GEMs They will get you in the ball park The GEMs list all possible code combinations Budget for time and costs related to ICD-10 implementation Expenses include system changes, resource materials, and training, costs for potential software updates, and reprinting of superbills. 36

37 ICD-10 Implementation Resources CMS.gov provider resources link: CMS.gov provider implementation timelines and checklists link: CMS.gov ICD-10 basics for medical practices link: American Hospital Association - AHA.org website link: Specialized training resources (extra cost): American Health Information Association AHIMA.org and American Association Professional Coders AAPC.com links: Coding Tipsheets - AHIMA.org and Californiahia.org links: American Medical Association AMA.org website links: BCBSM website BCBSM.com and provider readiness mailbox links: icd-10providerreadiness@bcbsm.com Check with your professional and medical associations about ICD-10 readiness. 37

38 ICD-10 Implementation Resources Professional Resources New CMS website built with the help of small practice physicians, Road to 10 is a no-cost tool that will help you: Get an overview of ICD-10 by accessing the links on the left Explore Specialty References by selecting a specialty below Click the BUILD YOUR ACTION PLAN box to create your personal action plan If you re having trouble getting started with your ICD-10 implementation, the American Association of Professional Coders (AAPC) has a great, free way to start you on your way. By accessing the AAPC ICD-10 coding crosswalk, you can start your practice off on the right foot to having the information you need. A free.pdf copy is available from AAPC by going to this website link: and providing some basic contact information. Once you submit your information, a list of specialties will be displayed and you will be able to download the free.pdf for any of the specialties you choose. The Crosswalk contains the top 50 ICD-9 codes and the corresponding ICD-10 codes and is especially useful for the most commonly defined diagnosis codes. 38

39 BCBSM readiness

40 Upcoming major activities External testing and Implementation 2009 to 10 Strategy, planning and mapping methodology 2011 Technical changes, mapping the codes and financial neutrality Technical coding, neutrality, testing provider readiness, business readiness 40

41 Steps we are taking to minimize the risk of disruption Choose a solution that allows us to transition and positions us for possible contingencies Extension of ICD-10 deadline Request to accept both ICD-9 and ICD-10 codes for a time period (especially for claims run out) Outreach and communications Internal training of staff Extensive testing plan 41

42 Introduction: ICD-10 conference calls Purpose of the calls: To inform and educate about the ICD-10 transition Upcoming calls always on Mondays, from 1-2 p.m. EST, the fourth Monday of every month. Sign-up for webinar notifications and materials in advance by sending an to: 42

43 It s all about the coding

44 ICD-10 coding and documentation When you think about it ICD-10 is another example of appropriate coding This is not up-coding Rather it s about following national coding guidelines and making sure to accurately describe a patient s condition Here are some important notes about appropriate coding and documentation Valid signatures are needed in medical records Specificity in medical record notes, especially for ICD-10- CM, is essential It s important to code claims with accurate level of specificity 44

45 Documentation Tips For all documented diagnoses, consider the acronym: M.E.A.T. Include details on how you either: Manage/Monitor the condition Evaluate the condition Assess the condition Treat the condition

46 Why appropriate coding is important Ensuring appropriate benefit application and/or payment (if applicable) Helps to reduce the possibility of requests for medical records Could help reduce the instances of medical record reviews Proper coding now will help your practice or facility deal with the increased detail needed for: quality measures government programs (such as risk adjustment) incentive programs and ACOs 46

47 For example Accurate documentation and coding impacts several programs: Stars HEDIS PQRI (CMS Physician Quality Reporting Initiative) PCMH 47

48 ICD-10 Provider Testing Options with BCBSM (updated for 2014)

49 ICD-10 Testing Options Testing option What it tests What it will tell you Time line How to join Transactional testing of claims with ICD-10 codes Medical scenario testing professional DRG shift testing facility The ability to accept fully compliant 837 transactions with ICD- 10 codes A medical scenario is presented (by specialty) and the submitter is asked to assign appropriate ICD-10 codes The impact of ICD-10 coding on DRG shifts Whether or not a claim with an ICD-10 code was received and passed EDI compliance checks What codes were submitted What other health care providers of the same specialty submitted for that scenario ICD-10 codes submitted (based on a historical ICD-9 claim) Impact of the ICD-10 codes on the DRG assignment Testing available through 10/1/2015 Testing available through 10/1/2015 Testing available through 10/1/2015 Send an to: Icd-10claimstesting@bcbsm.com If you re interested in external claims testing. Use this link (copy and paste to your internet browser) to register for medical scenario testing for professionals: ghpoint-solutions.com Once registered, we will provide detailed instructions on how to use the tool will be provided via . Send an to: icd-10providertesting@bcbsm.com if you would like to register for facilities testing. For the medical scenario testing and the DRG shift testing, we will provide you with background documentation and detail

50 Professional Testing with BCBSM The testing tool is available for use now through the ICD-10 implementation date (Oct. 1, 2015). Use of this tool is free of charge. Testing is done through the web; no special software or lengthy test requirements are needed. It is content based and specialty specific, which means that you will be presented with several medical scenarios and be asked to code the scenarios in ICD-10. Scenarios are based on specialties (internal medicine, oncology, etc.) and providers must register for each specialty they are interested in testing.

51 Professional Testing with BCBSM Continued We recommend you have some familiarity with the ICD-10 codes and have a code book or other access to the code set to complete this test. BCBSM will provide a peer group report of the codes selected for the same scenarios which can be accessed multiple times as additional providers participate in the testing. To register and begin the ICD-10 professional testing process, access the following link: bcbsmicd10providerregistry.highpoint-solutions.com

52 Facility Testing with BCBSM The process will continue through the ICD-10 implementation of Oct. 1, Use of this tool is free of charge. This testing identifies the impact of ICD-10 code selection on DRG shifts. Facilities will register the historical claims which they would like to include in the test effort. BCBSM will validate/register those claims and provide a link to a web based tool.

53 Facility Testing with BCBSM Continued Facilities will recode the original medical record and submit the ICD-10 codes either directly into the tool or via uploading a spreadsheet with the responses into the tool. BCBSM will run the response thru the DRG grouper and provide a side by side comparison report of how each claim was grouped using the original ICD-9 codes along with the new ICD- 10 codes. Send an to icd-10providertesting@bcbsm.com if you would like to register for facilities testing.

54 Questions

55 Appendix - A chapter by chapter look at the ICD- 10-CM code set

56 Chapter 1 - Certain infectious and parasitic diseases Includes diseases generally recognized as communicable or transmissible. Updates to Chapter 1 of ICD-10-CM include: Terminology changes Sepsis (ICD-10-CM) has replaced Septicemia (ICD-9-CM) Urosepsis is a nonspecific term and is not coded in ICD-10-CM. Should a provider use this term, he/she must be queried for clarification. Late Effects of Infectious and Parasitic Diseases (ICD-9-CM) is now Sequela of infectious and Parasitic Diseases in ICD-10-CM Coding guideline changes Infections resistant to antibiotics requires the use of an additional code for any associated drug resistance only if the infection code does not identify drug resistance (Z16 category, resistance to antimicrobial drugs) Expansion of the codes to reflect manifestations of the disease Many of the codes are combined conditions and common symptoms 56

57 Chapter 2 - Neoplasms Key updates to the Neoplasm chapter include Classification improvements Code expansions - Significant expansion in the malignant neoplasm of male breast codes Revisions to identify laterality for some of the neoplasm sites 57

58 Chapter 3 - Diseases of the blood and bloodforming involving organs and certain disorders the immune mechanism Anemia is the most common condition included in this chapter. The use of specific terminology is important in applying codes for this condition. Updates include Classification improvements Code expansions Updates to medical terminology 58

59 Chapter 4 - Endocrine, nutritional and metabolic diseases Considerable changes were made to the organization, code expansions and updates to medical terminology in Chapter 4. The largest change noted is to the Diabetes Mellitus classification. ICD-10-CM Diabetes mellitus codes are now combination codes that include the type of diabetes (1 or 2), the body system affected and complications affecting the body system (Retinopathy, Neuropathy, Arthropathy, Peripheral angiopathy with gangrene, etc.) As many codes within a particular category as are necessary to describe all of the complications of the disease may be used. 59

60 Other diabetes changes Diabetes Mellitus (E08-E13) is no longer classified as controlled or uncontrolled in ICD-10-CM. Therefore this is no longer a factor in the ICD-10-CM code selection. ICD-10-CM classifies inadequately controlled, out of control, and poorly controlled diabetes mellitus to diabetes, by type with hyperglycemia. Secondary diabetes is always caused by another condition or event (e.g., cystic fibrosis, malignant neoplasm of pancreas, pancreatectomy, adverse effect of drug, or poisoning). 60

61 Overweight and obesity codes The classification for overweight and obesity has been expanded in ICD-10-CM to include: Obesity due to excess calories Morbid (severe) obesity due to excess calories Other obesity due to excess calories Drug induced obesity Morbid (severe) obesity due to alveolar hypoventilation Overweight Other obesity Obesity unspecified An additional code (Z68 category) is used to identify the body mass index (BMI), if known. 61

62 Chapter 5 - Mental, behavioral and neurodevelopmental disorders Updates to Chapter 5 include: Classification improvements (different categories) Code expansions Most notably, Other Isolated or Specific Phobias Updates to medical terminology Bipolar I disorder, single manic episode will change to Manic episode Undersocialized conduct disorders, aggressive will become Conduct disorder childhood-onset type Other significant changes Nicotine dependence updated to identify specific tobacco products (cigarettes, chewing tobacco, other tobacco) Alcohol abuse and dependence codes no longer identify continuous or episodic use 62

63 Chapter 6 - Diseases of the nervous system ICD-10-CM devotes Chapter 6 to Diseases of the Nervous System. The sense organs (eye/adnexa and ear/mastoid processes) have their own chapters in ICD- 10-CM. Updates to Chapter 6 include Classification improvements (significant changes to sleep disorders) Code expansions (e.g. Alzheimer s, headaches) Updates to medical terminology (epilepsy, seizures) 63

64 Chapter 7 - Diseases of the eye and adnexa Diseases of the Eye and Adnexa is a new chapter in ICD-10-CM. Key updates to this chapter include Terminology improvements (bringing terms up to date) Revisions to identify laterality ICD-10-CM contains codes for right side, left side and in some instances bilateral sides for diseases of the eye and adnexa. An unspecified site is also provided should the site not be identified in the medical record. If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side. 64

65 Chapter 8 - Diseases of the ear and mastoid process This is a new chapter in ICD-10, which has been separated from the chapter for Diseases of the Nervous System. Codes are grouped to make it easier to identify the types of conditions There is also a greater specificity and detail in the codes. Many codes have laterality designation. 65

66 Chapter 9 - Diseases of the circulatory system Similar structure to ICD-9-CM, but there are classification changes to be aware of Terminology used to describe several cardiovascular conditions has been revised to reflect more current medical practice A major change is the classification of hypertension, which in ICD-9-CM was classified by type: benign, malignant or unspecified. That classification is not required in ICD-10-CM. The code for hypertension has been updated to one code for essential (primary) hypertension. 66

67 Chapter 10 - Diseases of the respiratory system Modifications have been made to specific categories that bring the terminology up-to-date with current medical practice. Emphysema now contains codes with panlobular and centrilobular in their titles Asthma is now classified as mild intermittent, mild persistent, moderate persistent and severe persistent. Specificity increased for diseases like influenza, acute bronchitis Coding guidelines updates to require the coder to include information about tobacco use/dependence, where applicable. 67

68 Chapter 11 - Diseases of the digestive system A number of new subchapters have been added to this chapter (including liver diseases) Some terminology changes and revisions to the classification of specific digestive conditions The term hemorrhage is used when referring to ulcers The term bleeding is used when classifying gastritis, duodenitis, diverticulosis and diverticulitis There is new specificity to conditions like Crohn s disease, which have been expanded to specify site, if a complication is present, and what the complication is. 68

69 Chapter 12 - Diseases of the skin and subcutaneous tissue This chapter has been completely restructured to bring together groups of diseases that are related to one another in some way. Greater specificity has been added to many of the codes at the 4 th, 5 th or 6 th character level. It has 9 subchapters (compared to 3 in ICD-9-CM) There are many changes to the ulcer s section pressure ulcer codes are combination codes that identify site and stage of the ulcer. Procedural complications of the skin and subcutaneous tissue are included. 69

70 Chapter 13 - Diseases of the musculoskeletal system and connective tissue Most of the codes within this chapter have site and laterality designations. ICD-10-CM identifies three different causes for pathological fractures: neoplastic disease, osteoporosis, and other specified disease. ICD-10-CM introduces the 7 th character that describes type of encounter or the state of a fracture s healing and any sequela. Some of the codes in this chapter have a 7 th character applied. BCBSM Proprietary Document 70

71 Chapter 14 - Diseases of the genitourinary system Procedural complications affecting the genitourinary system are included in chapter 14. Laterality is used to identify conditions under N60 category, benign mammary dysplasia. In some of the categories specificity is based on the gender of the patient. 71

72 Chapter 15 - Pregnancy, childbirth and the puerperium Trimester is now the axis of classification instead of the current episode of care as in ICD-9-CM. The majority of codes in this chapter have a final character for trimester of pregnancy (see chart). Trimesters 1 st Less than 14 weeks 0 days 2 nd 14 weeks 0 days to less than 28 weeks 0 days 3 rd 28 weeks 0 days until delivery 72

73 Chapter 16 - Certain conditions originating in the perinatal period Codes from this chapter are for use on newborn records only, never on maternal records and include conditions that have their origin in the fetal or perinatal period (before birth through the first 28 days after birth) even if morbidity occurs later. Different codes are used for light for gestational age and small for gestational age. Codes for assigning birth trauma have been expanded to include more specificity. 73

74 Chapter 17 - Congenital malformations, deformations and chromosomal abnormalities Modifications have been made to specific categories that bring the terminology up-to-date with current medical practice. Other enhancements to Chapter 17 include classification changes that provide greater specificity than found in ICD-9-CM. 74

75 Chapter 18 - Symptoms, signs and abnormal clinical and laboratory findings Chapter 18 includes symptoms, signs, abnormal results of clinical or other investigative procedures, and ill-defined conditions regarding which no diagnosis classifiable elsewhere is recorded. Practically all categories in Chapter 18 could be designated as: Not otherwise specified Unknown etiology or Transient There are codes to identify a patient s coma scale. ICD-10-CM contains a number of combination codes that identify both the definitive diagnosis and common symptoms of that diagnosis. 75

76 Chapter 19 - Injury, poisoning, and certain other consequences of external causes Injuries are grouped by body part rather than category of injury as in ICD-9 ICD-10-CM introduces a 7 th character requirement that describes the type of encounter. Most categories in this chapter use the 7 th character requirement. Many categories in this chapter have three 7 th character values of: A - Initial encounter D Subsequent encounter S Sequela For traumatic fractures, there are additional 7 th character requirements depending upon the type of fracture and complication. Some of these character descriptions are based on the Gustilo open fracture classification. Codes for underdosing are new in ICD-10-CM. Underdosing refers to taking less of a medication than is prescribed by a provider or less than the manufacturer s instructions. 76

77 Chapter 20 - External causes of morbidity External cause codes are intended to provide data for injury research and evaluation of injury prevention strategies. These codes capture how the injury or health condition was caused, the intent, the place where the event occurred, the activity of the patient at the time of the event, and the person s status. These codes are secondary codes for use in any health care setting and can never be a principal (first listed) diagnosis. 77

78 Chapter 21 - Factors influencing health status and contact with health services These codes are used in any healthcare setting. Z codes may be used as either a first listed (principal diagnosis code in the inpatient setting), or secondary code, depending on the circumstances of the encounter. Certain Z codes may only be used as first-listed or principal diagnosis in certain conditions refer to Official coding Guidelines for details. Some of the category sections include, contact/exposure, vaccinations, status code, screening, aftercare Aftercare note - In ICD-10-CM Aftercare Z codes should not be used for aftercare of fractures. For aftercare of a fracture, assign the acute fracture code with the 7th character extension of D for subsequent encounter. 78