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Organizational changes

Codes have been moved around

  • V and E Codes are included in the Main classification

New chapters added

  • Eyes and Ears have been moved from Nervous system into their own chapters

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

ICD-10-CM

Agenda

  • Overview
  • What's changed?
  • Conventions and Guidelines
  • Code Book
  • Benefits
  • Impacts
  • GEMs
  • Just for Fun!

Background

Overview

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

Impacts

Technology

Operational

Health Care Delivery

At A Glance

What is ICD-10-CM?

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

  • Establish Medical Necessity
  • Translate written terminology into a universal common language
  • Provide data for statistical analysis

Reference: Principles of ICD-10-CM Coding, Second Edition, AMA

Website

Benefits

ICD-10-CM

Benefits of ICD-10

  • Provides greater clinical detail and specificity
  • Promotes quality documentation, coding and reimbursement
  • Terminology is more up to date with current practice
  • Provides better data for research, quality measurements and setting health policy

ICD-10-CM

CODE BLOCKS

  • Each chapter begins with a summary of blocks
  • Code blocks provide an overview of the categories within the chapter
  • Most categories are further subdivided into 4 or 5 character subcategories
  • If the category is not further subdivided it is considered to be a valid code
  • Ex. P90, Convulsions of newborn
  • ICD-10-CM contains 21 chapters vs. 17 chapters in ICD-9-CM
  • Organized by body or organ system or by etiology or nature of the disease process (e.g. Chapter 1)
  • Each chapter is divided into subchapters (blocks) that contain 3 character categories which form the foundation of the code

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

  • Assist in transition from one code set to another
  • Bidirectional (2 files)
  • I9 to I10
  • I10 to I9
  • Used to convert databases from I9 to I10
  • Not a crosswalk

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

Section 4

Guidelines for outpatient coding and reporting

Section 3

ICD-10-CM Official Guidelines for Coding and Reporting

GEMs

Guidelines for reporting additional diagnoses in non-outpatient settings

Section 2

Guidelines for selection of principal diagnosis for non-outpatient settings

ICD-10-CM

Section 1

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

  • E Codes located in chapter 19 or 20
  • External causes code include:
  • Cause of injury
  • Intent
  • Place of occurrence
  • Activity of patient at time of event
  • Status (civilian, military)

Ex. – W21.03xA, Struck by baseball, initial encounter

3-5

OTHER CHANGES...

ICD-10-CM

What has changed?

Mental and Behavioral Disorders, F01-F99

  • More subchapters, categories and subcategories
  • Some disorders reclassified
  • Greater clinical detail

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

  • Grouped by body region beginning with head down to ankle and foot (not by injury type like ICD9-CM)
  • Effects of foreign body, burns and frostbite are not classified by body region
  • Includes codes for poisoning, adverse effects and other consequences of external causes

Ex. – T22.151D, Burn of first degree of right shoulder, subsequent encounter

ICD-10-CM

Code Structure

Updated terminology

  • Term “Sepsis” has replaced “Septicemia”
  • Tobacco use disorder or dependence has been updated to include Nicotine dependence with subcategories to identify the specific tobacco product and nicotine induced disorders
  • Term “Age related cataract” has replaced “Senile cataract”
  • Asthma has been updated with classifications for mild intermittent, mild persistent, moderate persistent and severe persistent

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

  • Placeholder “x”
  • 7th Character
  • Expanded codes
  • Combination codes
  • Laterality
  • Inclusion of trimesters in OB codes
  • Timeframe changes

ICD-10-CM

Classification changes

  • Goit reclassified from endocrine chapter to musculoskeletal
  • Injuries reclassified by specific site and then by type of injury (e.g. fracture, open wound)
  • Post-op complications have been moved to procedure-specific body system chapters

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

New Features continued...

Conventions

Instructional notes

Code first and Use additional code

  • For conditions that have both underlying etiology and multiple body system manifestations due to the underlying etiology

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

  • Used in index and tabular to indicate an incomplete code

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

  • Used in tabular to enclose synonyms, alternative wordings or explanatory phrases
  • Used in index to identify manifestation codes

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

  • Used in both index and tabular list
  • Enclose supplementary words

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

  • Acute MI – time period from 8 weeks to 4 weeks

  • Abortion fetal death time frame from 22 weeks to 20 weeks

Just for Fun!

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