ICD-10 Ahhhhhh I see…… … Ann Rees, RHIA, CCS. Why……. ICD-10 ? Enhanced ability to measure the quality, safety and efficiency of care. Efficiency of payment.

ICD-10

Ahhhhhh I see………

Ann Rees, RHIA, CCS

Why……. ICD-10 ?• Enhanced ability to measure the quality, safety and

efficiency of care.• Efficiency of payment system and processing of

claims for reimbursement.• Improvement of clinical, financial and administrative

performance.• Prevention and detection of healthcare fraud and

abuse.• Enhanced ability of tracking public health and risks.

How many more codes?

Time is Ticking !!!!

All claims received for encounters or dates of service occurring on or following this date of service must be coded utilizing ICD-10.

ICD-10- CM ( diagnosis codes) are required for all claims regardless of services types: inpatient and outpatient).

ICD-10 PCS (procedure code set) must be coded on all services that currently utilize ICD-9 CM volume III (Inpatient Coding).

The same…but different….

ICD-9 CMFormat: XXX.XX Consists of three to five characters Category of code 3 digits to the left

of the decimal point. Etiology, anatomic site, manifestation 4th and 5th place on the right side of the decimal point.

First digit is numeric or alpha (E or V)

Second, third, fourth, and fifth digits are numeric

Always at least three digits Decimal placed after the first three

characters

ICD-10 CMFormat: XXX.XXX X(extension code)

Consists of three to seven characters

First digit is alpha All letters used except U Second and third digits are

numeric Fourth, fifth, sixth, and seventh

digits can be alpha or numeric Decimal placed after the first three

characters Category of code 3 digits to the left

of decimal point. Etiology, anatomic site, severity are in the 4th,5th and 6th places. The 7th place is for the extension category.

ICD-10-CM Structure ICD-10-CM has an index and tabular list similar to those of ICD-

9-CM. However, the ICD-10-CM index is much longer. Categories, subcategories, and codes are contained in the tabular list.

As with ICD-9-CM, proper coding relies on use of the guidelines, which house all information about the coding conventions for ICD-10-CM, general use guidelines, and chapter-specific guidelines for the tabular list.

The two parts of the ICD-10-CM index are the index to diseases and injury and index to external causes of injury. The table of drugs and chemicals and the neoplasm table are housed in the index to diseases and injury.

The former V codes are now Z codes contained in chapter 21, “Factors Influencing Health Status and Contact with Health Services.”

Organizational Changes

ICD-10-CM consists of 21 chapters. Some chapters include the addition of a sixth

character. ICD-10-CM includes full code titles for all codes (no

references back to common fourth and fifth digits). V and E codes are no longer supplemental

classifications. Sense organs have been separated from nervous

system disorders. Injuries are grouped by anatomical site rather than

injury category. Postoperative complications have been moved to

procedure-specific body system chapter.

New Features of ICD-10-CM Combination codes for conditions and common symptoms or

manifestations Combination codes for poisonings and external causes Added laterality Added extensions for episode of care Code extensions (seventh character) have been added for injuries and

external causes to identify the encounter: initial, subsequent, or sequelae. The extensions are:

A Initial encounter D Subsequent encounter S Sequelae Expanded codes (injury, diabetes, alcohol/substance abuse, postoperative

complications) (50 different codes available for “complications of foreign body left in body following a procedure in comparison to 1 in ICD-9-CM)

Inclusion of trimester in obstetrics codes and elimination of fifth digits for episode of care

Expanded detail relevant to ambulatory and managed care encounters Changes in timeframes specified in certain codes External cause codes no longer a supplementary classification

ICD-10-CMCode Format-Exclude Notes

Excludes 1 notes: designate codes that can never be used together because the two conditions represented by the codes would never occur together.

Example: B06 Rubella (German Measles)Excludes 1 note for:

Congenital rubella P35.0

ICD-10 CMCode Format-Excludes Notes

Excludes 2 notes: indicate that the excluded condition is a separate condition that is not a part of, or included in the condition represented by the code; but a patient may have both conditions at the same time.

Example:

Acute laryngitis (J04.0) has an Excludes2 of chronic laryngitis (J37.0)

ICD-10-CM….Code FormatExtension

The first significant code format issue is the use of a seventh character extension. Some conditions require an extension to provide further specificity about the condition being coded. The extension may be a number or letter and must always be the seventh character.

Examples: O65.0xx1 Obstructed labor due to deformed pelvis,fetus 1 T17.220D  Food in pharynx causing asphyxiation,

subsequent encounter

ICD-10-CM….Code Format Placeholder The placeholder is always the letter "x” and it has two uses:

As the fifth character for certain 6 character codes. The “x” provides for future expansion without disturbing the sixth

character structure.

When a code has less than 6 characters and a 7th character extension is required.

The “x” is assigned for all characters less than six in order to code to meet the requirement of coding to the highest level of specificity.

Examples: T37.0x1A Poisoning by sulfonamides, accidental

(unintentional), initial encounter T56.0x2S Toxic effect of lead and its compounds, intentional

self-harm, sequela

New Guidelines for I-10 CMICD-10 CM Chapter 3

Urosepsis has no default..physician must be queried.

An acute organ dysfunction must be associated with the sepsis in order to assign severe sepsis code, If the documentation is not clear query the provider.

New Guidelines for I-10 CMICD-10 CM-Chapter 4The Diabetes mellitus codes are combination

codes that include:

type of DM

affected body system

complications affecting the body system.Example:Type I Diabetes with Diabetic nephropathy E10.21

Type II Diabetes with Diabetic nephropathy E11.21

New Guidelines for I-10 CMICD-10 CM-Chapter 6Dominant/nondominant side-should this

information not be available in record, the default should be Dominant.

The default code for post-thoracotomy and other postoperative pain not specified as acute or chronic is the code for the acute form. Routine or expected post operative pain immediately after surgery should not be coded.

New Guidelines for I-10 CMICD-10 Chapter 9 Circulatory SystemCombination codes for atherosclerotic heart

disease with angina pectoris; it is not necessary to use an additional code for angina.

Hypertension table has been eliminated.

Hypertension is no longer classified as benign, malignant, unspecified,or uncontrolled code is I10.

New Guidelines for I-10 CMICD-10 Chapter 9 Circulatory SystemCodeI21.3 (STEMI) ST elevation myocardial

infarction of unspecified site is the default for the unspecified term acute myocardial infarction.

Time frame decreased for Acute myocardial infarction to 4 weeks (28 days) from 8 weeks (Icd-9).

New Guidelines for I-10 CMICD-10 Chapter 10 Respiratory SystemMany of the instructions related to chronic

obstructive pulmonary disease have been eliminated in Icd-10.

Codes in categories J44 and J45 distinguish between uncomplicated cases and those in acute exacerbation.

Asthma must be documented as mild, moderate or severe. Mild asthma must be documented as intermittent or persistent.

New Guidelines for I-10 CMICD-10 Chapter 12 Skin and Subcutaneous

Tissues.In ICD-10 a single code reports both the site and

the stage of the pressure ulcer.Laterality of the side of the body affected must be

reported.Contact dermatitis must be documented as

allergic or irritant and the substance causing the contact dermatitis must be identified.

Burns are classified as due to heat(thermal) or corrosive(chemicals).

New Guidelines for I-10 CMICD-10 Chapter 13 MusculoskeletalInstructions on coding site and laterality are

included.Acute traumatic verses chronic or recurrent

conditions are defined and coding instructions are provided.

Clarifications are given for assigning a code for the joint affected verses the specific bone affected.

Seventh digit character are required to identify episode of care, fracture open verses closed.

Comparison TableICD-9 Code ICD-10 Code Difference in ICD-10

174.2 Malignant neoplasm of breast rt upper-inner quadrant.

C50.211, malignant neoplasm of upper inner quadrant of right female beast.

Laterality

284.89 other specified aplastic anemia

D61.1 Drug induced aplastic anemia

Specificity in regarding cause.

250.51 Diabetes with ophthalmaic manifestations, type I, not stated as uncontrolled + 362.05 moderate non-proliferative diabetic retinopathy + Diabetic macular edema. 362.07

E10.331 Type I diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema.

Combination code for diabetes and associated complications; no identification of controlled vs. uncontrolled.

Comparison TableICD-9 Code ICD-10 Code Difference in ICD-10

414.01 Coronary atherosclerosis of native coronary artery + 411.1 Intermediate coronary syndrome.

I25.110 Arteriosclerotic heart disease of native artery with unstable angina pectoris.

Combination code for underlying condition and associated manifestation.

466.0 Acute bronchitis + 041.5 Bacterial infection in conditions classified elsewhere, Hemophilus influenza (H. Influenza)

J20.1 Acute bronchitis due to Hemophilus influenzae

Combination code that include both the disease and the organism.

555.1 Regional enteritis of large intestine + 569.81 Fistula of intestine.

K50.113, Crohn’s disease of large intestine with fistula.

Combination code that includes both the underlying condition and associated manifestation; site specificity.