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ICD-10-CM At A Glance

ICD-10 Overview
by

delinda doss

on 4 September 2013

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Transcript of ICD-10-CM At A Glance

At A Glance
ICD-10-CM
Overview
What is ICD-10-CM?
What has changed?
Conventions
New Features continued...
OTHER CHANGES...
Impacts
PURPOSE
Code Structure
Expanded codes
GUIDELINES
Operational
Agenda
Overview
What's changed?
Conventions and Guidelines
Code Book
Benefits
Impacts
GEMs
Just for Fun!
About the speaker
DeLinda R. Doss, PMP, CPC, CPC-H
AHIMA Approved ICD-10-CM Trainer
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
Background
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
ICD-10 BACKGROUND
ICD-10-CM
Background
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
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/
Organizational Changes
Updated Terminology
New Features
ICD-9-CM
ICD-10-CM
ICD-10-CM
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)
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
ICD-10-CM
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
ICD-10-CM
New Features
Placeholder “x”
7th Character
Expanded codes
Combination codes
Laterality
Inclusion of trimesters in OB codes
Timeframe changes
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
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
3-5
3-5 characters
3-7 characters
1st character always alpha
all letters used except "u"
character 2 always numeric; 3-7 can be alpha or numeric
always at least 3 digits
1st digit can be alpha or numeric
2-5 are numeric
decimal placed after first 3 digits
alpha characters not case sensitive
S 0 2 . 6 5 x A
Category
Etiology, anatomic site,
severity
Additional Characters
Q: What is code for Initial encounter?
A: T75.4xxA
Combination Codes
Laterality
Timeframes
Trimester in OB codes
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
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
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
Timeframe changes

Acute MI – time period from 8 weeks to 4 weeks

Abortion fetal death time frame from 22 weeks to 20 weeks
ICD-10-CM
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
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
Website
ICD-10-CM
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
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
Punctuation

( ) Parentheses
Used in both index and tabular list
Enclose supplementary words
Ex. - Hemophilia (classical) (familial) (hereditary)
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
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
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.-)
ICD-10-CM
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
CODE BOOK
ICD-10-CM
ICD-10-CM Official Guidelines for Coding and Reporting
Guidelines for outpatient coding and reporting
Guidelines for reporting additional diagnoses in non-outpatient settings
Section 4
Section 3
Guidelines for selection of principal diagnosis for non-outpatient settings
Structure and conventions of the classification and general guidelines that apply to the entire classification and chapter-specific guidelines
Section 2
Section 1
Review
GENERAL GUIDELINES
Section 1. B.
GENERAL GUIDELINES
Documentation of Complications of Care -
Guideline extends to any complication; cause and effect relationship must be documented
GENERAL GUIDELINES
Additional guideline related to “LATERALITY”
ICD-10-CM
ICD-10-CM
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
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
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
ICD-10-CM
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
CODE BLOCKS
ICD-10-CM
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
GEMs
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
Presented by: DeLinda Doss, PMP, CPC, CPC-H AHIMA Approved ICD-10-CM Trainer
Found on CDC and CMS websites
http://www.cdc.gov/nchs/icd/icd10cm.htm
http://www.cms.hhs.gov/ICD10
Financial
Technology
Educational
Health Care Delivery
Just for Fun!
Full transcript