PART 2 Countdown to ICD-10... Tips for a Smooth & Effective Transition

PART 2 Countdown to ICD-10... Tips for a Smooth & Effective Transition Cindy Cain, BSHA, CPC, CPC-H, CCS-P, CHC Senior Manager, Consulting June 23,2015

Objectives Identifying complex ICD-10 transitional codes Highlighting transitions from ICD-9 to ICD-10 and the necessary changes Developing steps necessary to improve clinical documentation 2 7/15/2015 McKesson Corporation Confidential and Proprietary

Recap from Part 1 3 7/15/2015 McKesson Corporation Confidential and Proprietary

Recap from Part 1 A Quick Overview ICD-10-CM replaces ICD-9CM for diagnosis coding (Captures more specific data from clinical documentation than ICD-9) : ICD-9-CM diagnosis codes = 3 to 5 digits ICD-10-CM codes = 3 to 7 digits Overall format of ICD-10 diagnosis codes similar to ICD-9 What we uncovered The majority of attendees were less than 25% ready for the transition 73% of attendees felt that inadequate documentation of medical records would have the most significant impact on their practice 4 7/15/2015 McKesson Corporation Confidential and Proprietary

Polling Question #1 How far along are you in your transition to ICD-10? (Select one) 1. 0-25% 2. 50% 3. 75% 4. Greater than 75% 5 7/15/2015 McKesson Corporation Confidential and Proprietary

Is Your Organization Ready? 6 7/15/2015 McKesson Corporation Confidential and Proprietary

Several different combinations Mapping Categories ICD-10 to ICD-9 ICD-9 to ICD-10 No Match 1.2% 3.0% 1-to-1 Exact Match 5.0% 24.2% 1-to-1 Approximate Match with 1 Choice 82.6% 49.1% 1-to-1 Approximate Match with Multiple Choices 4.3% 18.7% 1-to-Many Match with 1 Scenario 6.6% 2.1% 1-to-Many Match with Multiple Scenarios 0.2% 2.9% 7 Source: www.ama-assn.org/go/icd-10

Several different combinations - EXAMPLES 8 Source: www.ama-assn.org/go/icd-10

ICD-9-CM to ICD-10-CM Mapping Specialty ICD-9-CM Code Descriptor ICD-10-CM Code Descriptor Family Medicine/Podiatry 250.60 Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled E11.40 Type 2 diabetes mellitus with diabetic neuropathy, unspecified E11.41 Type 2 diabetes mellitus with diabetic mononeuropathy E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy E11.43 Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy E11.44 Type 2 diabetes mellitus with diabetic amyotrophy E11.49 Type 2 diabetes mellitus with other diabetic neurological complication E11.610 Type 2 diabetes mellitus with diabetic neuropathic arthropathy E13.40 Other specified diabetes mellitus with diabetic neuropathy, unspecified E13.41 Other specified diabetes mellitus with diabetic mononeuropathy E13.42 Other specified diabetes mellitus with diabetic polyneuropathy E13.43 Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy E13.44 Other specified diabetes mellitus with diabetic amyotrophy E13.49 Other specified diabetes mellitus with other diabetic neurological complication E13.610 Other specified diabetes mellitus with diabetic neuropathic arthropathy 12

ICD-9-CM to ICD-10-CM Mapping Specialty ICD-9-CM Code Descriptor ICD-10-CM Code Descriptor Podiatry 713.5 Arthropathy associated with neurological disorders A52.16 Charcot's arthropathy (tabetic) E08.610 Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy E09.610 Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy E10.610 Type 1 diabetes mellitus with diabetic neuropathic arthropathy E11.610 Type 2 diabetes mellitus with diabetic neuropathic arthropathy E13.610 Other specified diabetes mellitus with diabetic neuropathic arthropathy M14.60 Charcot's joint, unspecified site M14.611 Charcot's joint, right shoulder M14.612 Charcot's joint, left shoulder M14.619 Charcot's joint, unspecified shoulder M14.621 Charcot's joint, right elbow M14.622 Charcot's joint, left elbow M14.629 Charcot's joint, unspecified elbow M14.631 Charcot's joint, right wrist M14.632 Charcot's joint, left wrist M14.639 Charcot's joint, unspecified wrist M14.641 Charcot's joint, right hand M14.642 Charcot's joint, left hand M14.649 Charcot's joint, unspecified hand M14.651 Charcot's joint, right hip M14.652 Charcot's joint, left hip M14.659 Charcot's joint, unspecified hip M14.661 Charcot's joint, right knee M14.662 Charcot's joint, left knee M14.669 Charcot's joint, unspecified knee M14.671 Charcot's joint, right ankle and foot M14.672 Charcot's joint, left ankle and foot M14.679 Charcot's joint, unspecified ankle and foot M14.68 Charcot's joint, vertebrae M14.69 Charcot's joint, multiple sites 13

ICD-9-CM to ICD-10-CM Mapping Specialty ICD-9-CM Code Descriptor ICD-10-CM Code Descriptor OMM 782.0 Disturbance of skin sensation R20.0 Anesthesia of skin R20.1 Hypoesthesia of skin R20.2 Paresthesia of skin R20.3 Hyperesthesia R20.8 Other disturbances of skin sensation R20.9 Unspecified disturbances of skin sensation 14

15 ICD-9-CM to ICD-10-CM Mapping Specialty ICD-9-CM Code Descriptor ICD-10-CM Code Descriptor Fam Med/OMM/PT/Podiatry 729.5 Pain in limb M79.601 Pain in right arm M79.602 Pain in left arm M79.603 Pain in arm, unspecified M79.604 Pain in right leg M79.605 Pain in left leg M79.606 Pain in leg, unspecified M79.609 Pain in unspecified limb M79.621 Pain in right upper arm M79.622 Pain in left upper arm M79.629 Pain in unspecified upper arm M79.631 Pain in right forearm M79.632 Pain in left forearm M79.639 Pain in unspecified forearm M79.641 Pain in right hand M79.642 Pain in left hand M79.643 Pain in unspecified hand M79.644 Pain in right finger(s) M79.645 Pain in left finger(s) M79.646 Pain in unspecified finger(s) M79.651 Pain in right thigh M79.652 Pain in left thigh M79.659 Pain in unspecified thigh M79.661 Pain in right lower leg M79.662 Pain in left lower leg M79.669 Pain in unspecified lower leg M79.671 Pain in right foot M79.672 Pain in left foot M79.673 Pain in unspecified foot M79.674 Pain in right toe(s) M79.675 Pain in left toe(s) M79.676 Pain in unspecified toe(s)

16 ICD-9-CM to ICD-10-CM Mapping Specialty ICD-9-CM Code Descriptor ICD-10-CM Code Descriptor OPhysical Therapy 362.01 Background diabetic retinopathy E08.311 Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema E08.319 Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema E08.331 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema E08.339 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema E08.341 Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema E08.349 Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema E09.311 Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy with macular edema E09.319 Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy without macular edema E09.331 Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema E09.339 Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema E09.341 Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema E09.349 Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema E10.311 Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema E10.319 Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema E11.311 Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema E11.319 Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema E13.311 Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema E13.319 Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edema

ICD-9-CM to ICD-10-CM Mapping Specialty ICD-9-CM Code Descriptor ICD-10-CM Code Descriptor OPhysical Therapy OPhysical Therapy 362.11 Hypertensive retinopathy 365.11 Primary open angle glaucoma H35.031 Hypertensive retinopathy, right eye H35.032 Hypertensive retinopathy, left eye H35.033 Hypertensive retinopathy, bilateral H35.039 Hypertensive retinopathy, unspecified eye H40.11X0 Primary open-angle glaucoma, stage unspecified H40.11X1 Primary open-angle glaucoma, mild stage H40.11X2 Primary open-angle glaucoma, moderate stage H40.11X3 Primary open-angle glaucoma, severe stage H40.11X4 Primary open-angle glaucoma, indeterminate stage 17

ICD-9-CM to ICD-10-CM Mapping Specialty ICD-9-CM Code Descriptor ICD-10-CM Code Descriptor OPhysical Therapy 250.50 Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled E11.311 Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema E11.319 Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema E11.321 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema E11.329 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema E11.331 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema E11.339 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema E11.341 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema E11.349 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema E11.351 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema E11.359 Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema E11.36 Type 2 diabetes mellitus with diabetic cataract E11.39 Type 2 diabetes mellitus with other diabetic ophthalmic complication E13.311 Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema E13.319 Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edema E13.321 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema E13.329 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema E13.331 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema E13.339 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema E13.341 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema E13.349 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema E13.351 Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema E13.359 Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema E13.36 Other specified diabetes mellitus with diabetic cataract E13.39 Other specified diabetes mellitus with other diabetic ophthalmic complication 18

ICD-9-CM to ICD-10-CM Mapping Specialty ICD-9-CM Code Descriptor ICD-10-CM Code Descriptor OPhysical Therapy 365.71 Mild stage glaucoma H40.10X1 Unspecified open-angle glaucoma, mild stage H40.11X1 Primary open-angle glaucoma, mild stage H40.1211 Low-tension glaucoma, right eye, mild stage H40.1221 Low-tension glaucoma, left eye, mild stage H40.1231 Low-tension glaucoma, bilateral, mild stage H40.1291 Low-tension glaucoma, unspecified eye, mild stage H40.1311 Pigmentary glaucoma, right eye, mild stage H40.1321 Pigmentary glaucoma, left eye, mild stage H40.1331 Pigmentary glaucoma, bilateral, mild stage H40.1391 Pigmentary glaucoma, unspecified eye, mild stage H40.1411 Capsular glaucoma with pseudoexfoliation of lens, right eye, mild stage H40.1421 Capsular glaucoma with pseudoexfoliation of lens, left eye, mild stage H40.1431 Capsular glaucoma with pseudoexfoliation of lens, bilateral, mild stage H40.1491 Capsular glaucoma with pseudoexfoliation of lens, unspecified eye, mild stage H40.20X1 Unspecified primary angle-closure glaucoma, mild stage H40.2211 Chronic angle-closure glaucoma, right eye, mild stage H40.2221 Chronic angle-closure glaucoma, left eye, mild stage H40.2231 Chronic angle-closure glaucoma, bilateral, mild stage H40.2291 Chronic angle-closure glaucoma, unspecified eye, mild stage H40.30X1 Glaucoma secondary to eye trauma, unspecified eye, mild stage H40.31X1 Glaucoma secondary to eye trauma, right eye, mild stage H40.32X1 Glaucoma secondary to eye trauma, left eye, mild stage H40.33X1 Glaucoma secondary to eye trauma, bilateral, mild stage H40.40X1 Glaucoma secondary to eye inflammation, unspecified eye, mild stage H40.41X1 Glaucoma secondary to eye inflammation, right eye, mild stage H40.42X1 Glaucoma secondary to eye inflammation, left eye, mild stage H40.43X1 Glaucoma secondary to eye inflammation, bilateral, mild stage H40.50X1 Glaucoma secondary to other eye disorders, unspecified eye, mild stage H40.51X1 Glaucoma secondary to other eye disorders, right eye, mild stage H40.52X1 Glaucoma secondary to other eye disorders, left eye, mild stage H40.53X1 Glaucoma secondary to other eye disorders, bilateral, mild stage H40.60X1 Glaucoma secondary to drugs, unspecified eye, mild stage H40.61X1 Glaucoma secondary to drugs, right eye, mild stage H40.62X1 Glaucoma secondary to drugs, left eye, mild stage H40.63X1 Glaucoma secondary to drugs, bilateral, mild stage 19

20 Specialty Podiatry Podiatry ICD-9-CM to ICD-10-CM Mapping ICD-9-CM Code Descriptor 454.0 Varicose veins of lower extremities with ulcer 681.10 Cellulitis and abscess, unspecified ICD-10-CM Code Descriptor I83.001 Varicose veins of unspecified lower extremity with ulcer of thigh I83.002 Varicose veins of unspecified lower extremity with ulcer of calf I83.003 Varicose veins of unspecified lower extremity with ulcer of ankle I83.004 Varicose veins of unspecified lower extremity with ulcer of heel and midfoot I83.005 Varicose veins of unspecified lower extremity with ulcer other part of foot I83.008 Varicose veins of unspecified lower extremity with ulcer other part of lower leg I83.009 Varicose veins of unspecified lower extremity with ulcer of unspecified site I83.011 Varicose veins of right lower extremity with ulcer of thigh I83.012 Varicose veins of right lower extremity with ulcer of calf I83.013 Varicose veins of right lower extremity with ulcer of ankle I83.014 Varicose veins of right lower extremity with ulcer of heel and midfoot I83.015 Varicose veins of right lower extremity with ulcer other part of foot I83.018 Varicose veins of right lower extremity with ulcer other part of lower leg I83.019 Varicose veins of right lower extremity with ulcer of unspecified site I83.021 Varicose veins of left lower extremity with ulcer of thigh I83.022 Varicose veins of left lower extremity with ulcer of calf I83.023 Varicose veins of left lower extremity with ulcer of ankle I83.024 Varicose veins of left lower extremity with ulcer of heel and midfoot I83.025 Varicose veins of left lower extremity with ulcer other part of foot I83.028 Varicose veins of left lower extremity with ulcer other part of lower leg I83.029 Varicose veins of left lower extremity with ulcer of unspecified site L02.611 Cutaneous abscess of right foot L02.612 Cutaneous abscess of left foot L02.619 Cutaneous abscess of unspecified foot L03.031 Cellulitis of right toe L03.032 Cellulitis of left toe L03.039 Cellulitis of unspecified toe L03.041 Acute lymphangitis of right toe L03.042 Acute lymphangitis of left toe L03.049 Acute lymphangitis of unspecified toe

ICD-9-CM to ICD-10-CM Mapping Specialty ICD-9-CM Code Descriptor ICD-10-CM Code Descriptor OMM Family Medicine/OMM 723.0 Spinal stenosis in cervical region 780.79 Other malaise and fatigue M48.01 Spinal stenosis, occipito-atlanto-axial region M48.02 Spinal stenosis, cervical region M48.03 Spinal stenosis, cervicothoracic region M99.20 Subluxation stenosis of neural canal of head region M99.21 Subluxation stenosis of neural canal of cervical region M99.30 Osseous stenosis of neural canal of head region M99.31 Osseous stenosis of neural canal of cervical region M99.40 Connective tissue stenosis of neural canal of head region M99.41 Connective tissue stenosis of neural canal of cervical region M99.50 Intervertebral disc stenosis of neural canal of head region M99.51 Intervertebral disc stenosis of neural canal of cervical region M99.60 Osseous and subluxation stenosis of intervertebral foramina of head region M99.61 Osseous and subluxation stenosis of intervertebral foramina of cervical region M99.70 Connective tissue and disc stenosis of intervertebral foramina of head region M99.71 Connective tissue and disc stenosis of intervertebral foramina of cervical region G93.3 Postviral fatigue syndrome R53.0 Neoplastic (malignant) related fatigue R53.1 Weakness R53.81 Other malaise R53.83 Other fatigue 21

ICD-9-CM to ICD-10-CM Mapping Specialty ICD-9-CM Code Descriptor ICD-10-CM Code Descriptor OPhysical Therapy Family Medicine Family Medicine Family Medicine 918.1 Superficial injury of cornea V20.2 Routine infant or child health check V70.0 Routine general medical examination at a health care facility V70.5 Health examination of defined subpopulations S05.00XA Injury of conjunctiva and corneal abrasion without foreign body, unspecified eye, initial encounter S05.00XD Injury of conjunctiva and corneal abrasion without foreign body, unspecified eye, subsequent encounter S05.00XS Injury of conjunctiva and corneal abrasion without foreign body, unspecified eye, sequela S05.01XA Injury of conjunctiva and corneal abrasion without foreign body, right eye, initial encounter S05.01XD Injury of conjunctiva and corneal abrasion without foreign body, right eye, subsequent encounter S05.01XS Injury of conjunctiva and corneal abrasion without foreign body, right eye, sequela S05.02XA Injury of conjunctiva and corneal abrasion without foreign body, left eye, initial encounter S05.02XD Injury of conjunctiva and corneal abrasion without foreign body, left eye, subsequent encounter S05.02XS Injury of conjunctiva and corneal abrasion without foreign body, left eye, sequela Z00.121 Encounter for routine child health examination with abnormal findings Z00.129 Encounter for routine child health examination without abnormal findings Z00.00 Encounter for general adult medical examination without abnormal findings Z00.01 Encounter for general adult medical examination with abnormal findings Z02.0 Encounter for examination for admission to educational institution Z02.1 Encounter for pre-employment examination Z02.2 Encounter for examination for admission to residential institution Z02.3 Encounter for examination for recruitment to armed forces Z02.4 Encounter for examination for driving license Z02.89 Encounter for other administrative examinations 22 Family Medicine V77.91 Screening for lipoid disorders Z13.220 Encounter for screening for lipoid disorders

Polling Question #2 Do you think your practice has the necessary tools in place to excel during the transition? 1. Yes 2. No 23 7/15/2015 McKesson Corporation Confidential and Proprietary

Submitted by You I work for an ASC in NJ. This is the one we use that will be more complex with the ICD-10 transition 365.70 Glaucoma Stage Unspecified. 24

Resources Centers for Medicare & Medicaid Services: www.cms.gov American Medical Association: http://www.nationalfamilyplanning.org/document.doc?id=780 25 7/15/2015 McKesson Corporation Confidential and Proprietary

Questions Contact Us at 877-217-9199 www.mckesson.com/bps performanceinfo@mckesson.com 26 7/15/2015 McKesson Corporation Confidential and Proprietary

Thank you 27 7/15/2015 McKesson Corporation Confidential and Proprietary