Nancy Troutt, RHIA, CPC, CPC-I – Provider Coding Consultant – Blue Cross and Blue Shield of Alabama.

Consulting With The Coder- ICD-10

Nancy Troutt, RHIA, CPC, CPC-I – Provider Coding Consultant –

Blue Cross and Blue Shield of Alabama

Purpose

• To have a better understanding of documentation and coding guidelines.

• To have a better understanding of International Classification of Diseases, Tenth Edition (ICD-10).

2

What We Will Learn Today

• Importance of:-Good Documentation-Accurate Coding

• Blue Cross and Blue Shield of Alabama’s Role forSmooth Transition

• ICD-10: Differences and 7th Characters

• ICD-10: 21 Classifications

• ICD-10: New Chapter-Specific Features

3

Accurate and Complete Documentation is Important

ICD-9* and ICD-10

Use codes describing symptoms, conditions,problems, complaints, or other reasons for visits

*International Classification of Diseases, Ninth Edition (ICD-9)

4

Accurate and Complete Documentation is Important

• Accurate documentation and coding

• Difference in Clinical and Coding guidelines

• The coder/biller cannot assume

• Information on claim and documentation should match

5

Accurate and Complete Documentation is Important!

Payors Compare Documentation with Claims!

6

Documentation Errors Found

• Diagnosis on claim and documentation do not match

• Codes not “linked” in documentation or claims

• Manifestations not coded

7

Documentation Tips

Documentation should show:• Reason for visit

• Updated problem lists

• Detailed chief complaint, should “stand alone”

• Signature/Credentials

8

EMR Reminders

Providers should:

• Include relevant documentation

• HPI, MDM, exam documented by provider

9

Accurate ICD-9 Coding Will Not Change with ICD-10

• Reason

• Highest level specificity

• Chronic conditions

• Coexisting conditions

10

Accurate Coding Will Not Change With ICD-10

Reasons for correct coding/documentation:

• Required

• Future payments based on severity

• Medical necessity

11


Codes are invalid if:

• Not coded to full number of digits

This applies to both ICD-9 and ICD-10

12

NEC and NOS

Same Meaning in ICD-9 and ICD-10

• NEC – “not elsewhere classifiable”

• NOS – “not otherwise specified”

13


• List first the chief complaint (reason for visit)

• Diagnoses may be a symptom until diagnosis is confirmed by the physician

14

Accurate Coding Will Not Change with ICD-10

• Do not – code “rule outs”, probable, suspect

• Code highest degree of certainty

• Code signs and symptoms if diagnosis is not yet established

15

Accurate ICD-9 Coding Will Not Change With ICD-10

• Additional signs and symptoms should be coded that may not be associated with a disease process

• Chronic diseases should be coded as many times as patient receives treatment.

16

Accurate ICD-9 Coding Will Not Change With ICD-10

• Code all documented co-existing conditions

• Do not code conditions that no longer exist

• Exception is “history of” codes

17

Blue Cross Claims

• All HIPAA-covered entities will adopt ICD-10 by October 1, 2015

• Blue Cross will not process claims with ICD-10 codes before that date

• ICD-9 will no longer be accepted for dos after Sept. 30, 2015

18

ICD-9 to ICD-10 Mapping

GEMS (General Equivalency Mappings)

• Blue Cross will use GEMS

• GEMS not to be used exclusively

19

ICD-10 Diagnosis Mapping Tool

To access the mapping tool on Blue Cross website,Alabamablue.com/providers.

• Log into ProviderAccess.• Select “Provider Functions.”• Look for “ICD-10 Diagnosis Code Mapping Tool” under Claim Information.

20

Blue Cross “Front-End Testing”

Submission of claims to verify diagnosis code information:

Contact Your EDI Services Representative205-220-6899

[email protected]

21

ICD-10

October 1, 2015

ICD-9 vs. ICD-10

ICD-9• Has 3-5 characters, always at least 3• First is numeric, except E and V codes

ICD-10• Has 3-7 characters, always at least 3• First character always alpha, all letters used except U

In both, the decimal is after 3rd character, and alpha characters are not case sensitive

23

X X X X

Category

.Etiology, anatomic

site, severity

Added 7th character for obstetrics, injuries, and external causes of injury

Coding and Seventh Characters

X X X

24

AMS 0 2 6. 5 x A

Additional Characters

Alpha (Except U)

2 Numeric3-7 Numeric or Alpha

3–7 Characters


Seventh Characters:• Injury, external cause and obstetrics

• Alpha or numeric, at end in the 7th position

• Has different meanings

• Codes requiring 7th digit, leaving off makes invalid

25

Added seventh-characters for episode of care

Examples:

• M80.051A• S06.0X1A• S52.132B

26


Coding and Use of Seventh CharactersIn Injury and External Cause, the 7th character identifies:

• Initial- for patient receiving active treatment

• Subsequent - for after the patient has received active treatment

• Sequela - for complications arise as a result of a condition

27

New features in ICD-10-CM

28

Chapters of the ICD-10-CM Classification System

A – GA00 – B99 Certain Infectious and Parasitic Diseases

C00 – D49 Neoplasms

D50 – D89 Diseases of Blood and Blood forming organs and certain disorders involving the immune mechanism

E00 – E89 Endocrine, nutritional and metabolic disorders

F01 – F99 Mental, Behavioral and Neurodevelopment Disorders

G00 – G99 Disease of Nervous System

29


H – L H00 – H59 Diseases of the Eye and Adnexa

H60 – H95 Diseases of the Ear and Mastoid Process

I00 – I99 Diseases of the Circulatory System

J00 – J99 Diseases of the Respiratory System

K00 – K95 Diseases of the Digestive System

L00 – L99 Diseases of the Skin and Subcutaneous Tissue

30


M – R M00 – M99 Diseases of the Musculoskeletal System and

Connective Tissue

N00 – N99 Diseases of the Genitourinary System

O00 – O9A Pregnancy, Childbirth and the Puerperium Period

P00 – P96 Certain Conditions Originating in the Perinatal Period

Q00 – Q99 Congenital Malformations, Deformations and Chromosomal Abnormalities

R00 – R99 Symptoms, Signs and Abnormal Clinical and Laboratory Findings, NEC

31


S – Z

S00 – T88 Injury, Poisoning and Certain other consequences of External Causes

V00 – Y99 External Causes of Morbidity

Z00 – Z99 Factors Influencing Health Status and Contact with Health Services

New Features in ICD-10-CM

Greater level of specificity and clinical detail:

Combination Codes of Common Symptoms• Diabetes with manifestations will only require

one code instead of two.

• Atherosclerotic heart disease with unstable angina only one code instead of two.

32


Combination codes for poisoning and external causes:

• Accidental poisoning

• Adverse effects

33


LateralityCoding guidelines are basically the same in ICD-10 as in ICD-9, except with one additional guideline: laterality

• Right• Left• Bilateral

34


Expanded codesExamples:

E11.341 DM type II with retinopathy and macular edema

F14.221 Cocaine dependence with intoxication delirium

35


Changes in time frames specific to certain codes

Acute MI – “acute” time period change from 8 weeks to 4 weeks in iCD-10

36

Chapter 4 – Endocrine, Nutritional and Metabolic Disease

Diabetes Mellitus

• Combination codes in ICD-10

• No longer “controlled or uncontrolled”

• Poorly controlled coded by type with hyperglycemia

37


38

Diabetes Mellitus: 5 Categories

E08 Diabetes due to underlying condition

E09 Drug or chemical-induced Diabetes

E10 Type I Diabetes

E11 Type II Diabetes

E13 Other specified Diabetes


39

Long-term (Current) Use of Insulin

ICD-9 V58.67

ICD-10 Z79.4


Patient presents with type II diabetes with diabetic chronic kidney disease, stage IV. She is on insulin and her glucose is documented as uncontrolled.

40

ICD-9 ICD-10• 250.42: Diabetes mellitus with

renal manifestations, type II, uncontrolled

• 585.4: CKD, Stage IV

• E10.65: Diabetes type II with hyperglycemia

• E10.22: Diabetes type II with chronic kidney disease

• N18.4: Chronic kidney disease, stage IV

Chapter 9 – Circulatory System

• Acute MI has changed from 8 to 4 weeks acute status

• Hypertensive heart and Kidney disease; same guidelines:– Link hypertension and heart disease in documentation– Hypertension and chronic kidney disease: can assume

linkage

41

Hypertension

42

ICD-9401.1 – benign essential hypertension

ICD-10I10 – essential hypertension

Stage 3 CKD with CHF Due to HTN

ICD-9 ICD-10404.91 I13.0428.0 I50.9585.3 N18.3

43

Coding Stroke (CVA)

Acute Stroke (CVA)ICD-9: 493.91 acute cerebral artery occlusion

with cerebral infarctionICD-10: I63.9 Cerebral infarction, unspecified

“History of”Stroke (CVA)ICD-9: V12.54ICD-10: Z86.73

44

Chapter 20 – External Causes

External causes are:

• Health condition due to external cause

• Mostly used for injuries

• V, W, X and Y codes

• Used in 7th character

• Not required or mandated

45

Chapter 21 Factors Influencing Health Status

General (adult) medical examination code

ICD-9 V70.0

ICD-10 Z00.00 w/out abnormal findingsZ00.01 with abnormal findings

46

Chapter 21 Factors Influencing Health Status

Patient is in for his Annual Wellness Visit (AWV) and he also has hypertension and diabetes.

47

ICD-9 ICD-10V70.0 Routine physical exam Z00.01 General medical examination

with abnormal findings

401.9 Diabetes hypertension I10 Hypertension

250.00Diabetes type II, without complications, not stated

as uncontrolledE11.9 Type II diabetes,

without complications

New Non-compliance Codes for ICD-10

Z91.19 Medical Noncompliance

Z91.11 Dietary regimen

Z91.15 Renal Dialysis

Z91.14 Medication regiment, NEC

Z91.14 Underdosing (see also Table of Drugs and chemicals T36-50 with fifth or sixth character 6)

Z91.128 Intentional NEC

Z91.120 Due to financial hardship

Z91.138 Unintentional NEC

Z91.130 Due to patient’s age-related disability

48

Coding Email Box

[email protected]

49

QUESTIONS?

Nancy Troutt, RHIA, CPC, CPC-I – Provider Coding Consultant – Blue Cross and Blue Shield of Alabama.

Documents

edition icd

classifications icd

date icd

blue shield of alabama

v codes icd

th characters icd

smooth transition icd

code conditions