2010 UBO/UBU Conference Health Budgets & Financial Policy 1 Briefing: ICD-10-CM (International Classification of Diseases – 10 th Revision – Clinical Modifications) A Piece of Cake Date: 23 March 2010 Time: 1400–1450

2010 UBO/UBU Conference Turning Knowledge Into Action Pre-Quiz 4. The ICD-9-CM codes are being “frozen” (will not change, no additions/deletions) in 2012 because – a. There is so much automation and all those programs need to have all the code numbers for the various conditions changed, tested, fixed, tested… – b. To give coders an entire year to goof off claiming they were studying VERY hard to understand the ICD-10-CM. – c. Because the cost of gasoline had gone up to $5/gallon and those of us driving up from Washington to Baltimore for the Coordination and Maintenance Meetings wanted a break for an entire year. – d. Because we knew Washington DC was going to get 30+ inches of snow in one week and we wanted all the coders to know how to spell “frozen” before December 2009 and February

2010 UBO/UBU Conference Turning Knowledge Into Action Outdated ICD-9-CM is Outdated 30 years old –technology has changed Many categories full Not descriptive enough Why Do We Need a New Coding System? Reimbursement–would enhance accurate payment for services rendered Quality–would facilitate evaluation of medical processes and outcomes 3

2010 UBO/UBU Conference Turning Knowledge Into Action What Characteristics Are Needed in a Coding System? Flexible enough to quickly incorporate emerging diagnoses and procedures Exact enough to identify diagnoses and procedures precisely ICD-9-CM is neither of these 4

2010 UBO/UBU Conference Turning Knowledge Into Action Reimbursement and Quality Problems With ICD-9-CM Example –fracture of wrist Patient fractures left wrist A month later, fractures right wrist ICD-9-CM does not identify left versus right –requires additional documentation ICD-10-CM describes Left versus right Initial encounter, subsequent encounter Routine healing, delayed healing, nonunion, or malunion 5

2010 UBO/UBU Conference Turning Knowledge Into Action Quality Problems Reimbursement and Quality Problems With ICD-9-CM – Example –combination defibrillator pacemaker device Codes for this device are not in the cardiovascular chapterof ICD-9-CM with other defibrillator and pacemaker devices – Coders and researchers have trouble findingthese codes with this type of erratic code assignment – ICD-10-PCS provides distinct codes for all these types of devices, in an orderly manner that is easy to find 6

2010 UBO/UBU Conference Turning Knowledge Into Action Benefits Benefits of Adopting the New Coding System – Incorporates much greater specificity and clinical information, which results in Improved ability to measure health care services – Increased sensitivity when refining grouping and reimbursement methodologies – Enhanced ability to conduct public health surveillance – Decreased need to include supporting documentation with claims 7

2010 UBO/UBU Conference Turning Knowledge Into Action Objectives Know that ICD-10-CM transition will be easy for coders Understand the General Equivalency Mappings Know the coding guidelines for ICD-10-CM 8

2010 UBO/UBU Conference Turning Knowledge Into Action Difference Between ICD-10-CM, ICD-10-PCS and ICD-9-CM International Classification of Diseases – 9 th Revision – Clinical Modifications (ICD-9-CM) – Developed in USA in 1970s based on the World Health Organization’s ICD-9 Based on ICD-8, and ICD-8a – Clinical Modifications (CM) is the United States’ version Added to WHO ICD-9: – External Causes of Injury – Factors Influencing Health – Volume 3, Institutional Procedure Coding 9

2010 UBO/UBU Conference Turning Knowledge Into Action Users of ICD-9-CM ICD-9-CM Users ICD-9-CM Diagnoses –used by all types of providers ICD-9-CM Procedures –used only by inpatient hospitals Current Procedural Terminology (CPT) –used for all ambulatory and physician procedure reporting 10

2010 UBO/UBU Conference Turning Knowledge Into Action ICD-10-CM ICD-10-Clinical Modifications is for use in the United States – Other countries use modifications specific to their country, such as ICD-10-CA for Canada and ICD-10- AM for Australia ONLY: – Diagnoses, – Factors Influencing Health, and – External Causes of Injury Does not include procedures as did ICD-9-CM – No third volume – See ICD-10-Procedure Classification System Currently used for cause of death reporting in the United States 11

2010 UBO/UBU Conference Turning Knowledge Into Action ICD-10-CM Available for download from: – At the bottom of the page A bit easier and less expensive than going to Ingenix and buying it on disc for $ Would recommend buying one book every other year until 2013 as they are much easier to work with The downloads are nice for a quick word search 12

2010 UBO/UBU Conference Turning Knowledge Into Action ICD-10-CM Is Better Due To Addition of information relevant to ambulatory and managed care encounters – Expanded injury codes Creation of combination diagnosis/symptom codes to reduce the number of codes needed to fully describe a condition Addition of a sixth character for some codes Incorporation of common 4th and 5th digit subclassifications Laterality; and Greater specificity in code assignment for many codes. The new structure will allow further expansion than was possible with ICD-9-CM. 13

2010 UBO/UBU Conference Turning Knowledge Into Action ICD-10-CM “Piece of Cake” for anyone who can code using ICD-9-CM – Same basic guidelines – Same basic layout/organization – Same basic index – Same basic tabular – Some codes are more detailed – Some codes indicate initial or subsequent encounter – Format – alpha + 2 numerics + decimal point + numeric+3 alphanumerics H66.9 Otitis media, unspecified – Otitis media NOS – Acute otitis media NOS – Chronic otitis media NOS H66.90 Otitis media, unspecified, unspecified ear H66.91 Otitis media, unspecified. right ear H66.92 Otitis media, unspecified, left ear H66.93 Otitis media, unspecified, bilateral 14

2010 UBO/UBU Conference Turning Knowledge Into Action Review of Existing Code Formats ICD-9-CM diagnoses (look for the decimal point) – 3-5 numeric characters with decimal point after the 3 rd – External cause of injury Exxx.x – Factors influencing health Vxx.xx ICD-9-CM procedure (look for the decimal point) – Numeric xx.xx CPT – 5 numeric, or 4 numeric with terminal F or T (no decimal point) HCPCS – alpha with 4 numeric (no decimal point) – does not currently use F or T 15

2010 UBO/UBU Conference Turning Knowledge Into Action ICD-9-CM Comparison to ICD-10-CM 16

2010 UBO/UBU Conference Turning Knowledge Into Action ICD-9-CM Comparison to ICD-10-CM 17

2010 UBO/UBU Conference Turning Knowledge Into Action Sample of Downloaded Index 18

2010 UBO/UBU Conference Turning Knowledge Into Action The Tabulars ICD-9-CM 001 Cholera – Due to Vibrio cholerae – Due to Vibrio cholerae el tor – Cholera, unspecified 002 Typhoid and paratyphoid fevers ICD-10-CM A00 Cholera – A00.0 Cholera due to Vibrio cholerae 01, biovar cholerae (classical cholera) – A00.1 Cholera due to Vibrio cholerae 01, biovar eltor (cholera eltor) – A00.9 Cholera, unspecified A01 Typhoid and paratyphoid fevers 19

2010 UBO/UBU Conference Turning Knowledge Into Action The Tabular – Example J00 (Currently 460) Excludes1 = NOT CODED HERE (both conditions cannot occur at same time Excludes2 = Not included in this diagnosis, if it is there, code them both 20

2010 UBO/UBU Conference Turning Knowledge Into Action ICD-9-CM vs ICD-10-CM Tabular ICD-9-CM 8. Diseases of the Respiratory System ( ) Acute Respiratory Infections ( ) 460 Acute nasopharyngitis [common cold] ICD-10-CM Chapter X – Diseases of the Respiratory System (J00-J99) Acute Upper Respiratory Infections (J00-J06) J00 Acute nasopharyngitis [common cold] 21

2010 UBO/UBU Conference Turning Knowledge Into Action ICD-10-CM Morbidity classification – Includes potentially fatal conditions – Treatable For use in – Hospitals; acute short-term, long-term – Provider office – Other outpatient settings 22

2010 UBO/UBU Conference Turning Knowledge Into Action Benefit to the MHS Ability to – Collect more detailed information – Compare morbidity data to mortality data – Compare to international data – Collect some laboratory results (e.g., blood alcohol levels and ABO blood types) 23

2010 UBO/UBU Conference Turning Knowledge Into Action Benefit to the MHS Ability to collect concepts such as – “Do Not Resuscitate” – Initial versus subsequent encounters – Right, left, bilateral – First, second, third trimester – Identification of fetus in multiple gestations – Classifications of fractures – Dominate versus non-dominate side – Burns separated based on heat or chemical – Cesarean delivery without medical indication 24

2010 UBO/UBU Conference Turning Knowledge Into Action Benefit to the MHS Better data on which to base decisions Easier to pull records with criteria needed for a specific study Expandable, more space for new conditions More detailed external causes of injury – e.g., Y93.5B Cellular telephone usage in work-related activity 25

2010 UBO/UBU Conference Turning Knowledge Into Action Example of Expanded Code Set F10.2 Alcohol dependence – Excludes1: alcohol abuse (F10.1-) – alcohol use, unspecified (F10.9-) – Excludes2: toxic effect of alcohol (T51.0-) – F10.20 Alcohol dependence, uncomplicated – F10.21 Alcohol dependence, in remission – F10.22 Alcohol dependence with intoxication – Acute drunkenness (in alcoholism) Excludes1: alcohol dependence with withdrawal (F10.23-) – F Alcohol dependence with intoxication, uncomplicated – F Alcohol dependence with intoxication delirium – F Alcohol dependence with intoxication, unspecified – F10.23 Alcohol dependence with withdrawal Excludes1: Alcohol dependence with intoxication (F10.22-) – F Alcohol dependence with withdrawal, uncomplicated – F Alcohol dependence with withdrawal delirium – F Alcohol dependence with withdrawal with perceptual disturbance – F Alcohol dependence with withdrawal, unspecified – F10.24 Alcohol dependence with alcohol-induced mood disorder – F10.25 Alcohol dependence with alcohol-induced psychotic disorder – F Alcohol dependence with alcohol-induced psychotic disorder with delusions – F Alcohol dependence with alcohol-induced psychotic disorder with hallucinations – F Alcohol dependence with alcohol-induced psychotic disorder, unspecified – F10.26 Alcohol dependence with alcohol-induced persisting amnestic disorder – F10.27 Alcohol dependence with alcohol-induced persisting dementia – F10.28 Alcohol dependence with other alcohol-induced disorders – F Alcohol dependence with alcohol-induced anxiety disorder – F Alcohol dependence with alcohol-induced sexual dysfunction – F Alcohol dependence with alcohol-induced sleep disorder – F Alcohol dependence with other alcohol-induced disorder – F10.29 Alcohol dependence with unspecified alcohol-induced disorder 26

2010 UBO/UBU Conference Turning Knowledge Into Action Example of New Code Set O35 Maternal care for known or suspected fetal abnormality and damage – Includes: the listed conditions in the fetus as a reason for hospitalization or other obstetric care to the mother, or for termination of pregnancy – Code also any associated maternal condition – Excludes1: encounter for suspected maternal and fetal conditions ruled out (Z03.7-) – One of the following 7th characters is to be assigned to each code under category O35. 7th character 0 is for single gestations and multiple gestations where the fetus is unspecified. 7th characters 1 through 9 are for cases of multiple gestations to identify the fetus for which the code applies. The appropriate code from category O30, Multiple gestation, must also be ICD-10-CM Tabular Page – assigned when assigning a code from category O35 that has a 7th character of 1 through 9. 0 not applicable or unspecified 1 fetus 1 2 fetus 2 3 fetus 3 4 fetus 4 5 fetus 5 9 other fetus – O35.0 Maternal care for (suspected) central nervous system malformation in fetus – O35.1 Maternal care for (suspected) chromosomal abnormality in fetus – O35.2 Maternal care for (suspected) hereditary disease in fetus – O35.3 Maternal care for (suspected) damage to fetus from viral disease in mother – O35.4 Maternal care for (suspected) damage to fetus from alcohol – O35.5 Maternal care for (suspected) damage to fetus by drugs – O35.6 Maternal care for (suspected) damage to fetus by radiation – O35.7 Maternal care for (suspected) damage to fetus by other medical procedures – O35.8 Maternal care for other (suspected) fetal abnormality and damage – O35.9 Maternal care for (suspected) fetal abnormality and damage, unspecified 27

2010 UBO/UBU Conference Turning Knowledge Into Action Example of New Data Collection R40.2 Coma – Coma NOS; Unconsciousness NOS – Codes first any associated: coma in fracture of skull (S02.-) coma in intracranial injury (S06.-) – The appropriate 7th character is to be added to each code from subcategory R40.21-, R40.22-, R40.23-: 0 unspecified time 1 in the field [EMT or ambulance] 2 at arrival to emergency department 3 at hospital admission 4 24 hours or more after hospital admission – A code from each subcategory is required to complete the coma scale – Note: These codes are intended primarily for trauma registry and research use but may be utilized by all users of the classification who wish to collect this information R40.20 Unspecified coma – R40.21 Coma scale, eyes open – R Coma scale, eyes open, never – R Coma scale, eyes open, to pain – R Coma scale, eyes open, to sound – R Coma scale, eyes open, spontaneous 28

2010 UBO/UBU Conference Turning Knowledge Into Action Coma R40.22 Coma scale, best verbal response – R Coma scale, best verbal response, none – R Coma scale, best verbal response, incomprehensible words – R Coma scale, best verbal response, inappropriate words – R Coma scale, best verbal response, confused conversation – R Coma scale, best verbal response, oriented R40.23 Coma scale, best motor response – R Coma scale, best motor response, none – R Coma scale, best motor response, extension – R Coma scale, best motor response, abnormal – R Coma scale, best motor response, flexion withdrawal – R Coma scale, best motor response, localizes pain – R Coma scale, best motor response, obeys commands 29

2010 UBO/UBU Conference Turning Knowledge Into Action Coding Guidelines Same – Look it up in the alphabetic, then check in the tabular Same – Abbreviations Same – Punctuation Same – use of “and,” “with,” “see,” “see also” Same – other and unspecified codes Same – includes notes and inclusion terms Same – etiology/manifestation (code first, use additional code, in disease classified elsewhere) Same – must use all available characters Same – conditions that are or are not an integral part of the disease process 30

2010 UBO/UBU Conference Turning Knowledge Into Action Coding Guidelines Same – Acute and Chronic conditions Same – Late Effects (sequela) Same – Human Immunodeficiency Virus (HIV) coding Same – Treatment directed at malignancy Same – Treatment of secondary site of maligancy Same – Primary malignancy previously excised Same – Admission/Encounter for chemo Same – Hypertension Same – Acute myocardial infarction Same – Coding Pathologic Fractures… 31

2010 UBO/UBU Conference Turning Knowledge Into Action Coding Guidelines New – placeholder “x” if the code only has 4 or 5 characters, but needs a 7 th character (e.g., initial/subsequent/sequela to injury), use an “x” in the blank spaces Different – Exclude1 (never code it here) and Exclude2 (not included, if he has that code it separately) New – Laterality New – Coding pregnancy trimesters New – Glasgow coma scale New – Functional quadriplegia 32

2010 UBO/UBU Conference Turning Knowledge Into Action Review ICD-10-CM Diagnoses, not procedures Very similar to ICD-9-CM diagnoses, volumes 1 and 2 (diagnosis index and tabular) Up to 7 alphanumeric characters BOTTOM LINE: If you can code with ICD-9-CM, you can easily transition to ICD-10-CM 33

2010 UBO/UBU Conference Turning Knowledge Into Action 34 Summary MHS is working on the transition The transition will be most difficult for the soft-ware programs ICD-10-CM is much better than ICD-9-CM Coders will not have a problem transitioning from ICD-9- CM to ICD-10-CM.

2010 UBO/UBU Conference Turning Knowledge Into Action 35 Quiz Take the quiz again =-)

2010 UBO/UBU Conference Turning Knowledge Into Action 36 Q&A Questions? Training – Who needs ICD-10-CM training? – When (e.g., 2 months prior)? – Intensity (e.g., 1 hour teleclass a day with 1 hour a day at work to do the assigned lessons)? – Format (e.g., train-the-trainer to come back to work to train you, teleclasses, one REALLY large class [400 students in an auditorium], good teacher sent to each site for a week)? – For more information please check: –