ICD-9-CM to ICD-10-CM: What to Expect August 9, 2011 Emily Hill, PA Hill & Associates The Coding & Compliance Professionals
ACOG Committee on Coding and Nomenclature Coding for Consultation Services August 9, 2011 CONFLICT OF INTEREST DISCLOSURE: FACULTY NO DISCLOSURES TO DECLARE Emily Hill, PA Donna Tyler, CPC, COBGC
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Disclaimer ICD-10 codes included in this presentation are not valid prior to the implementation date of October 1, 2013 ICD-10 codes included in this presentation may be revised prior to implementation ICD-9 codes should continue to be used until transition date of October 1, 2013
Learning Objectives Participants will: Recognize the importance of ICD coding to a physician practice Comprehend the key distinctions between ICD-9-CM and ICD-10-CM Understand the principles of ICD coding and how to apply them to clinical practice Recognize the challenges and opportunities presented by the transition to ICD-10-CM
Why The Change ICD-9-CM: Out of date- Out of space! ICD-10: International standard for a number of years ICD: Important to Health Information Technology (HIT) Change needed to fully implement HIT
Understanding ICD ICD: World Health Organization s (WHO) system of classification ICD-CM (clinical modification) used to track morbidity Diseases or causes of illness ICD used to report mortality Causes of death
History of ICD-10 ICD-10 adopted by WHO in 1990 First modification in 1998 U.S. only industrialized nation that has not yet implemented ICD-10 or a modification U.S. first began exploring idea in 1994 Draft versions available 2002, 2007, 2009, 2010, 2011 Implementation Date: October 1, 2013
Key Differences: ICD-9-CM to ICD-10-CM ICD-10-CM : 21 chapters vs. ICD-9-CM: 17 chapters ICD-10 chapters divided into blocks of codes with additional subcategories V and E code supplemental classifications part of main classifications Sense organs separated from nervous system
Key Differences: ICD-9-CM to ICD-10-CM ICD-10: Reclassification of certain diseases to reflect current medical knowledge ICD-10:Injuries classified by specific site then type vs. ICD-9: Injuries classified by type ICD-10: Postoperative complications in procedure specific system chapters (complications of GU surgery in GU chapter)
Key Differences: ICD-9-CM to ICD-10-CM ICD-10-CM: Alphanumeric codes with up to 7 characters vs. ICD-9-CM: 3-5 characters in length (mostly numeric) ICD-10-CM: Full code titles vs. references to common 4 th -5 th digits Addition of 6 th characters for some Addition of code extensions (7 th digit) Addition of dummy placeholder X
New Features in ICD-10-CM Combination codes for conditions and common symptoms/manifestations Combination codes for poisoning and external causes Added laterality for some codes (right vs. left)
Key Changes for OB/Gyn Inclusion of trimesters in obstetric codes Elimination of episodes of care for obstetric codes Changes in timeframes: Abortion vs. Fetal death ( 20 weeks) Early vs. Late pregnancy (20 weeks) Extensions to denote specific fetus New GU codes and notes including category title changes
Structure and Format of ICD-10-CM First character is always alphabetic letter Chapter 14 Diseases of the GU system (N00- N99) Chapter 15 Pregnancy, Childbirth and Puerperium (O00-O9A) Second character is always a number Characters 3-7 alpha or numeric O9A.311: Physical abuse complicating pregnancy, first trimester
Structure and Format of ICD-10-CM Alphabetic Index: Alphabetic Listing of Terms and Codes Index to Diseases and Injury Index to External Causes of Injury Neoplasm Table Table of Drugs and Chemicals Tabular List: Chronological list divided into chapters based on body system or condition
Structure and Format of ICD-10-CM Code Format: XXX.XXX X XXX= Category XXX= Etiology, anatomic site, severity X= Extension Placeholder Character X Used with certain codes for potential future expansion When placeholder exists, must use X in that location for valid code
Structure and Format of ICD-10-CM Labor and delivery complicated by cord around neck, without compression: O69.81X2 O69:Labor and delivery complicated by umbilical cord complications 81:Cord around neck, without compression X: Placeholder 2: Fetus 2
Abbreviations NEC: Not elsewhere classifiable Represents other specified NOS: Detail provided for which a code does not exist Not otherwise specified Represents unspecified Information insufficient to assign code
Punctuation and Definitions [ ] Brackets Tabular List to enclose synonyms, alternative wording or explanatory phrases Alphabetic Index to identify manifestation codes ( ) Parenthesis (Alphabetic and Tabular) Non-essential modifiers May be present or absent without affecting the code number
Punctuation and Definition : Colon Tabular List after an incomplete term which needs one or more of the modifiers following the colon to make it assignable to a given category And : Means and or and/or With : Means associated with or due to
Punctuation and Definitions N90.0 Mild vulvar dysplasia Vulvar intraepitheal neoplasia [VIN], grade 1 N 95 Menopausal and other perimenopausal disorders due to naturally occurring (age related) menopause and perimenopause N61 Inflammatory disorders of the breast Abcess (acute) (chronic) (nonpuerperal) of breast
General Terminology Inclusion terms: Conditions for which that code is to be used May be synonyms Other specified: list of conditions assigned to code List is not exhaustive Additional terms found in Alphabetic Index may be assigned to code
General Terminology N92.0 Excessive and frequent menstruation with regular cycle Heavy periods NOS Menorrhagia NOS Polymenorrhea NOS
General Terminology N92.1 Excessive and frequent menstruation with irregular cycle Irregular intermenstrual bleeding Irregular, shortened intervals between menstrual bleeding Menometrorrhagia Metrorrhagia
General Terminology Exclude Notes: 2 Types Excludes 1: Means NOT CODED HERE! Cannot report excludes code with code above Used when two conditions cannot occur together Excludes 2: Means Not included here Acceptable to use both the code and the excluded code together Indicates condition excluded is not part of the condition represented by the code, patient may have both conditions
Etiology/ Manifestation Convention Conditions may have underlying etiology and multiple related manifestations Underlying condition coded FIRST followed by manifestation codes Etiology code note: use additional code Manifestation code note: code first other condition Diseases classified elsewhere can never be first-listed or principle diagnosis
General Guidelines Locate code in Alphabetic Index and confirm in Tabular list Report the highest number of characters available Signs and symptoms are acceptable if diagnosis has not been confirmed by provider (Chapter 18 contains many but not all)
General Guidelines Signs and symptoms routinely associated with a disease process should not be assigned as additional codes Signs and symptoms NOT routinely associated should be assigned Multiple codes for single condition follow guidelines for etiology/manifestations
General Guidelines Combination codes should be reported when code fully describes condition Combination code is single code that describes: Two diagnoses Diagnosis with an associated secondary process (manifestation) Diagnosis with an associated complication
Chapter 14: Diseases of the Genitourinary System (N00-N99) Important Blocks (new concept) : N30-N39: Other diseases of urinary system N60-N65: Disorders of breast N70-N77: Inflammatory diseases of pelvic organs N80-N98: Noninflammatory disorders of female genital track N99: Intraoperative and postprocedural complications and disorders of gu system, not classified elsewhere
Chapter 14: Diseases of the Genitourinary System (N00-N99) Acute cystitis-icd-10 N30.00 Acute cystitis without hematuria OR N30.01 Acute cystitis with hematuria Plus appropriate B code to describe infectious agent (B96.2-E.coli as cause of disease classified elsewhere) Acute cystitis-icd-9: 595.0 (acute cystitis) plus 041.4 (E. coli)
Chapter 14: Diseases of the Genitourinary System (N00-N99) Overactive Bladder ICD-10 N32.81 Cystocele (N81.1) is listed as Type2 exclusion code so may also be reported if applicable N81.10 Unspecified N81.11 Midline N81.12 Lateral Overactive Bladder ICD-9: 596.51 (hypertonicity of bladder)
Chapter 14: Diseases of the Genitourinary System (N00-N99) ICD-10: N39.4 Other specified urinary incontinence Multiple 5 character codes for specific conditions ( urge, mixed, continuous leakage, etc.) ICD-9: 788.3 Urinary incontinence Multiple 5 digit codes for specific conditions Category in signs/symptoms chapter
Chapter 14: Diseases of the Genitourinary System (N00-N99) ICD-10: 3 subcategories related to bleeding disorders (other than menopausal) N91: Absent, scanty and rare menstruation N92: Excessive, frequent and irregular menstruation N93: Other abnormal uterine and vaginal bleeding ICD-9: 1 category 626 Disorders of menstruation and other abnormal bleeding from female genital tract
Chapter 14: Diseases of the Genitourinary System (N00-N99) ICD-10: N99.820 Postprocedural hemorrhage and hematoma of a genitourinary system organ or structure following a genitourinary system procedure ICD-9: 998.11 Hemorrhage complicating a procedure 998.12 Hematoma complicating a procedure Located in Injury and Poisoning Chapters
Chapter 15: Pregnancy, Childbirth and 9 Blocks the Puerperium(O00-O9A) Pregnancy with abortive outcomes Supervision of high risk pregnancy Edema, proteinuria and hypertensive disorders in pregnancy, childbirth and puerperium Other maternal disorders primarily related to pregnancy
Chapter 15: Pregnancy, Childbirth and the Puerperium(O00-O9A) Maternal care related to the fetus and amniotic cavity and possible delivery problems Complications of labor and delivery Encounter for delivery Complications predominately related to the puerperium Other obstetric conditions, not elsewhere classified
Chapter 15: Pregnancy, Childbirth and the Puerperium(O00-O9A) Codes have been moved from other chapters to Chapter 15 Supervision of high risk pregnancy from Supplementary Classification to Chapter 15 Several code titles have been revised ICD 9: Abnormality of organs and soft tissue of pelvis ICD-10: Maternal care for abnormality of pelvic organs
Chapter 15: Pregnancy, Childbirth and the Puerperium(O00-O9A) Codes identify trimester in which condition occurred in 5 th or 6 th character as appropriate Trimester counted from first day of LMP Trimester based on the trimester for current encounter Applies to pre-existing conditions and those that develop during or are due to pregnancy Assign in childbirth code for complication when delivery occurs (represents delivery phase)
Chapter 15: Pregnancy, Childbirth and the Puerperium(O00-O9A) ICD-10: O10.012 Pre-existing essential hypertension complicating pregnancy, second trimester ICD-9: 642.03 Antepartum benign essential hypertension
Chapter 15: Pregnancy, Childbirth and the Puerperium(O00-O9A) ICD-10: O10.02 Pre-existing essential hypertension complicating childbirth ICD-9: 642.01 Benign essential hypertension with delivery
Chapter 15: Pregnancy, Childbirth and the Puerperium(O00-O9A) Certain codes require 7 th character to identify multiple gestation affected by condition 0: Not applicable (single gestations) or unspecified 1-5: Fetus number 9: Other fetus Must assign code from O30 (Multiple Gestation)
Chapter 15: Pregnancy, Childbirth and the Puerperium(O00-O9A) ICD-10: O40.3xx1 Polyhydramnios, third trimester, fetus 1 xx placeholders ICD-10: O30.043 Twin pregnancy dichorionic/diamniotic
Chapter 15: Pregnancy, Childbirth and the Puerperium(O00-O9A) ICD-9: 657.03 Polyhydramnios antepartum condition or complication ICD-9: 651.03 Twin pregnancy, antepartum condition or complication ICD-9: V91.03 Twin gestation, dichorionic/diamniotic
Chapter 15: Pregnancy, Childbirth and the Puerperium(O00-O9A) Combination codes for obstructed labor that incorporates reason for the obstruction ICD-10: O64.1xx0 Obstructed labor due to breech presentation, single gestation ICD-9: 660.01 Obstruction caused by malposition of fetus at onset of labor with delivery ICD-9: 652.21 Breech presentation without version delivered
Chapter 18: Symptoms, Signs and Abnormal Clinical Findings, Not Elsewhere Classified (R00-R99) Organizational changes as compared to corresponding chapter in ICD-9 General symptoms follow those related to a system or other grouping Some codes moved from or to disease chapters Titles changed for some codes
Chapter 18: Symptoms, Signs and Abnormal Clinical Findings, Not Elsewhere Classified (R00-R99) ICD-10: R87 Abnormal findings in specimens from female genital organs R87.613 High grade squamous intraepithelial lesion on cytologic smear of cervix (HGSIL) ICD-9: 795 Other and nonspecific abnormal cytological, histological, immunological and DNA test findings 795.04 Papanicolaou smear of cervix with high grade squamous intraepithelial lesion (HGSIL)
Chapter 21: Factors Influencing Health Status and Contact with Health Services (Z00-Z99) Certain codes moved from other chapters to Chapter 21 Codes for elective abortion without complication Personal and family history codes expanded Codes for circumstances related to reproduction (Z32-Z39)
Chapter 21: Factors Influencing Health ICD-10: Status and Contact with Health Services (Z00-Z99) Z01.411 Encounter for gynecological examination (general) (routine) with abnormal findings Z01.419 Encounter for gynecological examination (general) (routine) without abnormal finding ICD-9: V72.31 Routine gynecological examination
Summary Codes/changes are not valid until Oct.1, 2013 Changes and additions are being worked through the ICD code process ACOG seeking some additional changes such as gestational age by weeks/day
Summary System changes necessary to accommodate increased digits and character changes May require changes in medical record documentation to support increased specificity Education will be necessary for staff and providers
Planning for the Transition Verify with software vendors plans for testing and implementation Assign internal implementation team Include physicians and other providers Clinical staff (nursing, lab, etc) Administrative staff Coding/ Billing staff Contact payers/read notices/bulletins re: payer implementation
Planning for the Transition Assess current uses and users of ICD-9 in practice Assess skills and understanding of ICD Determine who needs ICD-10 training Evaluate training options Evaluate current documentation practices Plan for changes to charge capture documents
ICD-10 Resources CMS http://www.cms.gov/icd10 NCHS (CDC) http://www.cdc.gov/nchs/icd/icd10.htm AHIMA http://www.ahima.org/icd10/ AAPC http://www.aapc.com/icd-10/
Questions
ACOG Resources Use ACOG s coding reference materials to: Enhance coding knowledge in Ob/Gyn Appeal denied claims Develop internal coding policies Dispute insurance company policies Ob/Gyn CPT Coding Manual with CD Rom ICD-9-CM Abridged Diagnostic Coding in Ob/Gyn Frequently Asked Questions in Ob/Gyn Coding Essential Guide to Coding in Ob/Gyn Order from: http://www.acog.org/bookstore/coding_resources_c56.cfm
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