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Organizational changes
Codes have been moved around
New chapters added
Use of full titles in ICD-10-CM (does not reference back to common 4th or 5th digits like ICD-9-CM)
About the speaker
DeLinda R. Doss, PMP, CPC, CPC-H
AHIMA Approved ICD-10-CM Trainer
Agenda
Background
ICD-10-CM
Background
ICD-10 BACKGROUND
ICD-10-CM
References
ICD-10-CM Coder Training Manual 2013, AHIMA
ICD-10-CM 2013 The Complete Official Draft Code Set, Optum
Principles of ICD-10-CM Coding, Second Edition, AMA
ICD-10-CM Workshops, Prepare and code for ICD-10-CM, Edition No. 2, AMA
ICD-10-CM
By October 1, 2014, covered entities are required to use ICD-10 for HIPAA covered transactions that contain any diagnoses or hospital procedure codes.
Includes 2 code sets:
ICD-10-CM
ICD-10-PCS
ICD-10-CM
ICD-10-CM is the diagnosis code set that replaces ICD-9-CM Volumes 1 and 2
Used to report diagnoses in ALL clinical settings
ICD-10-PCS is the procedure code set that replaces ICD-9-CM Volume 3.
Used to report hospital inpatient procedures
Financial
Educational
Technology
Operational
Health Care Delivery
PURPOSE
ICD-10-CM
ICD-10-CM; International Classification of Diseases, Tenth Revision, Clinical Modification
ICD-10 Official website
http://www.cms.gov/Medicare/Coding/ICD10/
Purpose
Reference: Principles of ICD-10-CM Coding, Second Edition, AMA
Website
Benefits
ICD-10-CM
Benefits of ICD-10
ICD-10-CM
CODE BLOCKS
ICD-10-CM
Ex. - Chapter 3 Diseases of Blood and Blood-forming Organs and Certain Disorders Involving the Immune Mechanism (D50-D89)
This chapter contains the following blocks:
D50-D53 Nutritional anemias
D55-D59 Hemolytic anemias
D60-D64 Aplastic and other anemias and other bone marrow failure syndromes
D65-D69 Coagulation defects, purpura and other hemorrhagic conditions
D70-D77 Other disorders of blood and blood-forming organs
D78 Intraoperative and postprocedural complications of the spleen
D80-D89 Certain disorders involving the immune mechanism
CODE BOOK
ICD-10-CM
General Equivalence Mappings
GENERAL GUIDELINES
Additional guideline related to “LATERALITY”
GENERAL GUIDELINES
Documentation of Complications of Care -
Guideline extends to any complication; cause and effect relationship must be documented
Review
GENERAL GUIDELINES
Section 1. B.
ICD-10-CM
Guidelines for outpatient coding and reporting
ICD-10-CM Official Guidelines for Coding and Reporting
GEMs
Guidelines for reporting additional diagnoses in non-outpatient settings
Guidelines for selection of principal diagnosis for non-outpatient settings
ICD-10-CM
Found on CDC and CMS websites
http://www.cdc.gov/nchs/icd/icd10cm.htm
http://www.cms.hhs.gov/ICD10
GUIDELINES
Structure and conventions of the classification and general guidelines that apply to the entire classification and chapter-specific guidelines
Presented by: DeLinda Doss, PMP, CPC, CPC-H AHIMA Approved ICD-10-CM Trainer
External Causes of morbidity, V00-V99
Ex. – W21.03xA, Struck by baseball, initial encounter
3-5
ICD-10-CM
Mental and Behavioral Disorders, F01-F99
Ex.1 - F10.251, Alcohol dependence with alcohol induced psychotic disorder with hallucinations
Ex.2 – F17.231, Nicotine dependence, cigarettes, with withdrawal
ICD-10-CM
Injury, poisoning and certain other consequences of external causes, S00-S99
Ex. – T22.151D, Burn of first degree of right shoulder, subsequent encounter
ICD-10-CM
Code Structure
Updated terminology
alpha characters not case sensitive
always at least 3 digits
Updated Terminology
decimal placed after first 3 digits
ICD-9-CM
character 2 always numeric; 3-7 can be alpha or numeric
2-5 are numeric
all letters used except "u"
1st digit can be alpha or numeric
Organizational Changes
1st character always alpha
3-5 characters
3-7 characters
Additional Characters
ICD-10-CM
S 0 2 . 6 5 x A
ICD-10-CM
Category
Etiology, anatomic site,
severity
ICD-10-CM
Placeholder X
Used as 5th character for six character codes
Provides for future expansion
7th Characters
May be a number or letter and must always be 7th character
New Features
ICD-10-CM
Classification changes
New Features
ICD-10-CM
Ex. T75.4 Electrocution
Shock from electric current
Shock from electroshock gun (taser)
Requires 7th character to identify encounter
A – initial encounter
D – subsequent encounter
S - sequela
Placeholder X must be used to fill missing characters in order for code to be valid
Q: What is code for Initial encounter?
A: T75.4xxA
ICD-10-CM
Instructional notes
Code first and Use additional code
Ex.1 - G30 Alzheimer’s disease
Use additional code to identify:
Dementia with behavioral disturbance (F02.81)
Ex.2 - F02 Dementia in other diseases classified elsewhere
Code first the underlying physioligical condition, such as Alzheimer’s (G30.-)
Combination Codes
ICD-10-CM
Expanded codes
Punctuation
- Dash
Ex.1 - M94.47-
Ex.2 – J43 Emphysema
Exclude 1: emphysematous (obstructive)
Bronchitis (J44.-)
ICD-10-CM
Combination codes
Include conditions and common symptoms or manifestations
Ex. - T36.0x1D, Poisoning by penicillins, accidental (unintentional), subsequent encounter
ICD-10-CM
Expanded codes
Ex.1 – E11.341 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema
Ex.2 – F14.221 Cocaine dependence with intoxication delirium
Instructional notes
Cross reference notes
Advises coder to look elsewhere before assigning code
“see”, “see also” and “see condition”
Relational Terms
“and” in code title in tabular means and/or
“with” means “associated with” or “due to” in code title in tabular
Abbreviations
NEC – Not Elsewhere Classified
Other specified code
Ex. - I25.89 Other forms of chronic ischemic heart disease
NOS – Not Otherwise Specified
Unspecified code
Ex. - J12.9 Viral pneumonia, unspecified
Laterality
ICD-10-CM
Trimester in OB codes
Punctuation
[ ] Brackets
Ex. - B06, Rubella [German measles]
Ex. - Nephrosis, in amyloidosis E85.4 [N08]
: Colon - Used after an incomplete term in tabular
ICD-10-CM
Punctuation
( ) Parentheses
Ex. - Hemophilia (classical) (familial) (hereditary)
Laterality
Left - Ex. H60.332, Swimmer’s Ear, left ear)
Right – Ex. M94.211, Chondromalacia, right shoulder
Unspecified – Ex. S40.259A, Superficial foreign body of unspecified shoulder, initial encounter
ICD-10-CM
Instructional notes
Includes
Clarifies conditions included in chapter, section, category, subcategory or code
Ex. – K25 Gastric Ulcer
Excludes1 and Excludes2
Excludes1 means “not coded here”; Ex. – K51.4
Excludes2 means “not included here”; Ex – J37.1
Inclusion of TRIMESTER in OB codes (elimination of 5th digits for episode of care)
Ex. 1 – O10.012, Pre-existing essential hypertension complication pregnancy, second trimester
Ex.2 – O99.013, Anemia complicating pregnancy, third trimester
ICD-10-CM
Timeframes
Timeframe changes
Just for Fun!