Getting Ready for ICD-10 Part 2: ICD-10 Coding
Introduction In the United States, on October 1, 2015 the ICD 9 code set used to report medical diagnoses and inpatient procedures will be replaced by International Classification of Disease, Tenth Edition (ICD 10). The purpose of this module is to provide a more in depth look at ICD 10Codingandtolearntonavigate theicd 10Manual.
Directions: Review the content of this module and complete the attached posttest. Successful completion of the post test is worth 0.5 PRMC educational credit and will be documented on your NetLearning transcript. Objectives: After completion of this module the learner will be able to: 1. Discuss the difference in the organization of the ICD 10 Coding Manual. 2. Describe what a combination code is and its purpose. 3. Discuss the level of specificity possible with ICD 10 Codes. 4. Identify common terminology and symbols used in ICD 10.
A Review: What is ICD 10? ICD 10 is the updated version of medical codes used for coding patients medical treatments and care. It will replace the ICD 9 codes (International Classification of Diseases, 9 th edition). ICD 10 contains 2 classification code sets: 1. Diagnoses for all providers (ICD 10 CM) CM stands for Clinical Modifications 2. Inpatient hospital procedures (ICD 10 PCS) PCS stands for Procedure Coding System
A Review: ICD 10 Structure ICD 10 CM replaces ICD 9 CM for diagnosis coding: ICD 10 CM diagnosis codes will be 3 to 7 digits ICD 10 PCS replaces ICD 9 CM for inpatient procedure coding: ICD 10 PCS codes must be 7 alphanumeric digits Each position has a specific meaning. ICD 10 expands details for many conditions. Please Note: The change to ICD 10 does not affect Current Procedure Terminology (CPT) for outpatient procedures.
ICD 10 CM replaces ICD 9 CM for Diagnosis Coding: The new structure of ICD 10 CM will be: X X X X X X X category etiology extension anatomic site severity
ICD 10 PCS replaces ICD 9 CM (Volume 3, Procedural Codes) for Inpatient Procedure Coding The new structure of ICD 10 PCS will be: 1 2 3 4 5 6 7 Section Root Approach Qualifier Operation Body Body Device System Part
Comparison of ICD 9 CM to ICD 10 ICD-9 18,000 codes 14,000 diagnosis codes 4,000 procedure codes 1,592 MCCs (major comorbid conditions) 3,427 CCs (comorbid conditions) Little detail Difficult to analyze data ICD-10 155,000 codes 68,000 diagnosis codes 87,000 procedure codes 3,152 MCCs (major comorbid conditions) 13,594 CCs (comorbid conditions) High definition Laterality, bilaterally dominance Supports data analysis Greater specificity Full description and consistency within the code set Uses modern terminology for descriptions
Organization of the ICD 10 Coding Manual The organization of the ICD 10 Coding Manual differs from the ICD 9 manual in the following ways: Sense organs have been separated from nervous system disorders Injuries are grouped by anatomical site rather than injury category Postoperative complications have been moved to procedure specific body system chapters As an example: In ICD 10, injuries of the head and neck will be grouped together, but in ICD 9 they are grouped by fractures or open wounds. 9
In ICD 10 Laterality It makes a difference whether the right or left limb is the subject of the problem. Some codes contain descriptions to include right or left designation. The right is usually character 1 and left is character 2. In the case of a bilateral code the character is usually 3 and if the laterality is not specified, the character 9 is used. M25.551 Pain in right hip M25.552 Pain in left hip M25.553 Pain in both hips M25.559 Pain in unspecified hip 10
In ICD 10 Use Unspecified Code Sparingly There is a selection for unspecified found in every category. It should be used sparingly because it could result in denial of payment. Example The following ICD 10 code: 86.909 translates as: Unspecified injury of unspecified muscle(s) and tendon(s) at lower leg level, unspecified leg. This code does not provide enough detail regarding the injury to correctly identify the problem, which could lead to inaccurate reimbursement. 11
Combination Codes Combination codes are used to represent an illness and/or disease with an associated: sign or symptom manifestation and/or complication Individual codes should not be used when there is a combination code provided. Combination codes allow fewer codes to be submitted. Examples of combination codes H90.41 Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side H90.42 Sensorineural hearing loss, unilateral left ear with unrestricted hearing on the contralateral side 12
Additional Examples of Combination Codes I63.331 Cerebral infarction due to thrombosis of right posterior cerebral artery I63.332 Cerebral infarction due to thrombosis of left posterior cerebral artery I11.0 Heart failure due to hypertension 13
Dummy Placeholder In ICD 10 All codes in ICD 10 PCS, and some in ICD 10 CM, require 7 characters, however when coding a procedure or condition there may not be 7 characters used to identify that condition. When this occurs, an X is used as a dummy placeholder For example, the code T19.0xxD represents Foreign body in urethra, subsequent encounter. The two x in the code are place holders because a 7 th digit extension is needed for this code. 14
Another Example of Dummy Placeholders The ICD 10 code 035.2 translates as maternal care (suspected) hereditary disease in fetus. This code requires a seventh character to indicate the number of fetuses there are. The choices are: 0 = Not applicable or unspecified 1 = fetus one 2 = fetus two 3 = fetus three 4 = fetus four 5 = fetus 5 9 = other fetus If there is one fetus, the code will be 035.2xx1. If there are two fetuses the code will be 035.2xx2. In order to indicate the number of fetuses there are 2 placeholders (x x) needed to make the 7 th positon. 15
A big benefit of ICD 10 coding is that it allows for much more specific information regarding a disease or condition. For example: ICD 10 CM Specificity In ICD 9 CM, Diabetes Mellitus was identified by one code 250. In ICD 10 CM, Diabetes Mellitus is broken down and split into specific category codes: E08 E09 E10 E11 E13 Diabetes mellitus due to underlying condition Drug or chemical induced diabetes mellitus Type 1 diabetes mellitus Type 2 diabetes mellitus Other specified diabetes mellitus 16
Examples of ICD 10 CM Specificity Staying with the example of diabetes, in ICD10 CM, diabetes can again be further broken down into codes which represent specific classifications of diabetes and/or manifestations. E08.22 Diabetes mellitus due to underlying condition with diabetic chronic kidney disease E09.52 Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene E10.11 Type 1 diabetes mellitus with ketoacidosis with coma E11.41 Type 2 diabetes mellitus with diabetic mononeuropathy 17
Another Example of ICD 10 CM Specificity In ICD 9 CM this is the code for hematuria 599.7 Hematuria (blood in urine) In ICD 10 CM these codes are used for hematuria: R31.0 Gross hematuria R31.1 Benign essential microscopic hematuria R31.2 Other microscopic hematuria R31.9 Hematuria, unspecified 18
A Further Example of ICD 10 CM Specificity Looking at a Sports Injury: In ICD 9 CM the injury of striking against or struck accidentally in sports without subsequent fall would be coded E917.0 In ICD 10 CM, sports injuries are now coded with sport and reasons for injury. There are 24 ICD 10 CM detailed sports injury codes! Examples include: W21.00 Struck by hit or thrown ball, unspecified type W21.01 Struck by football W21.02 Struck by soccer ball W21.03 Struck by baseball W21.04 Struck by golf ball W21.05 struck by basketball 19
One Last Example of ICD 10 CM Specificity Tonsillitis In ICD 10 CM, acute tonsillitis is expanded at the fourth character (to indicate organism) and fifth character (to indicate acute and recurrent) levels. J03 Acute Tonsillitis J03.0 Streptococcal tonsillitis J03.00 Acute streptococcal tonsillitis unspecified J03.01 Acute recurrent streptococcal tonsillitis 20
ICD 10 PCS Coding The benefits of the ICD 10 PCS coding procedure includes: It allows for unique coding of procedures (easy to distinguish procedures). There is room for code expansion as it is needed. It uses standardized terminology. There is consistency in coding from chapter to chapter. 21
An Example of ICD 10 PCS Coding In ICD 9 CM, the code for laparoscopic appendectomy is 47.01. In ICD 10 PCS, laparoscopic appendectomy will be coded as 0DTJ4ZZ, in which: 0 = Medical and Surgical Section D = Gastrointestinal system T = Resection (root operation) J = Appendix (body part) 4 = Percutaneous endoscopic (approach) Z = No device X = No qualifier 22
ICD 10 PCS Coding Example In ICD 9 CM, there is one code for artery suture. In ICD 10 PCS, there are 195 codes for artery suture, which includes: 4 different approaches 67 possible arteries 23
Locating a Code in ICD 10 CM To locate a code in ICD 10 CM: Locate the term in the Index which is an alphabetical list of terms and their corresponding code. It contains Diseases and Injuries, Neoplasm Table, and Table of Drugs and Chemicals and Index of External Causes of Injuries. Verify the code in the Tabular List a sequential alphanumeric list of codes divided into chapters based on body systems and condition. Consists of categories, subcategories and valid codes. Read and be guided by instructional notations that appear in both the Index and Tabular List. The Index does not always provide the full code. Selection of the full code can only be done in the Tabular List. A dash ( ) at the end of an Index indicates additional characters are required. 24
ICD 10 Coding Manual Terminology NEC and NOS NEC stands for Not Elsewhere Classified An alphabetical Index entry that states NEC directs the coder to Other Specified Code in the Tabular List. Other or Other Specified Code are used when the documentation in the Medical Record provides detail for which a code does not exist. Example NEC: Diabetic, type 2 E11.9 with circulatory complication NEC E11.59 NOS stands for Not Otherwise Specified This is the equivalent of unspecified 25
ICD 10 Coding Manual Punctuation [ ] Brackets are used in the Tabular List to enclose synonyms, alternative wording, or explanatory wording. They are used in the alphabetical listing to identify manifestation codes. ( ) Parentheses are used in both the Alphabetical Index and Tabular List to enclose supplemental words that do not affect the code number. : A colon is used after an incomplete term that needs one or more of the modifiers following the colon to make it assignable to a given category. } The brace encloses a series of terms of which is modified by the statement appearing at the right of the brace., a comma words following a comma are essential modifiers. A Code Also note indicates that two codes may be required. 26
In Summary You need to know how ICD 10 affects you: The ICD 10 code set differs significantly from ICD 9. The ICD 10 code set conveys significantly more information and detail than ICD 9. The change in code sets has significant impact on healthcare providers, patients and payers. It is important for you to understand and be aware of the coding structure of ICD 10 in order to support Patient Financial Services functions. Coding experience is not required you are not expected to be a coder. 27
Resources www.cms.gov/icd10. Sign up for e mail updates Follow @CMS.gov on Twitter for the latest news and resources www.wedi.rog WEDO ICD 10 Implementation www.cdc.gov/nchs/about/otheract/icd9/abticd10.htm NCHS Basic ICD 10 CM Information www.ahima.org/icd10/index.asp AHIMA ICD 10 Education www.cms.gov/medicare/coding/icd10/downloads/gemscrosswalksbasicfaq.pdf General Equivalence Mappings Frequently Asked Questions
Congratulations! You have now completed the Getting Ready for ICD 10, Part 2: ICD 10 Coding and are now ready to take the accompanying post test. Click on the Take Test button located on the upper right side of this screen to take the posttest.