ICD-10 Getting There….. Cancer Center

What Physicians Need To Know Claims for ambulatory and physician services provided on or after 10/1/2015 must use ICD-10-CM diagnosis codes. Hospital inpatient claims for discharges occurring on or after 10/1/2015 must use ICD-10-CM diagnosis codes. CPT Codes will continue to be used for physician inpatient and outpatient services and for hospital outpatient procedures. ICD-10-PCS – a NEW procedure coding classification system, must be used to code all inpatient procedures on Facility Claims for discharges on or after 10/1/15. ICD-9-CM codes must continue to be used for all dates of services on or before 9/30/2015. Further delays are not likely.

ICD-9 vs ICD-10 Diagnosis Codes ICD-9-CM Diagnosis CodesICD-10-CM Diagnosis Codes 3 to 5 digits7 digits Alpha “E” & “V” – 1 st CharacterAlpha or numeric for any character No place holder charactersInclude place holder characters (“x”) TerminologySimilar Index and Tabular StructureSimilar Coding GuidelinesSomewhat similar Approximately 14,000 codesApproximately 69,000 codes Severity parameters limitedExtensive severity parameters Does not include lateralityCommon definition of laterality Combination codes limitedCombination codes common

Number of Codes by Clinical Area Clinical AreaICD-9 CodesICD-10 Codes Fractures74717,099 Poisoning and Toxic Effects2444,662 Pregnancy Related Conditions1,1042,155 Brain Injury Diabetes69239 Migraine4044 Bleeding Disorders2629 Mood Related Disorders7871 Hypertensive Disease3314 End Stage Renal Disease115 Chronic Respiratory Failure74 Right vs. left accounts for nearly ½ the increase in the # of codes.

The Importance of Good Documentation The role of the provider is to accurately and specifically document the nature of the patient’s condition and treatment. The role of the Clinical Documentation Specialist is to query the provider for clarification, ensuring the documentation accurately reflects the severity of illness and risk of mortality. The role of the coder is to ensure that coding is consistent with the documentation. Good documentation…. Supports proper payment and reduces denials Assures accurate measures of quality and efficiency Captures the level of risk and severity Supports clinical research Enhances communication with hospital and other providers It’s just good care!

Inadequate vs. Adequate Documentation Example 1: Leukemia Inadequate DocumentationRequired ICD-10 Documentation ASSESSMENT: This gentleman has leukemia, anemia, and a cataract. ASSESSMENT: This gentleman has chronic lymphocytic leukemia currently in remission, autoimmune hemolytic anemia, and a right Prednisone induced cataract. Needed improvements: Acuity, type, remission status, cause, and laterality.

Inadequate vs. Adequate Documentation Example 2: Lymphoma Inadequate DocumentationRequired ICD-10 Documentation 10-year-old male with complaints of 10 pound weight loss, on and off fevers for 2 weeks and enlarged lymph nodes. Lymph node fine needle aspiration shows anaplastic large cell lymphoma. Will proceed with PET and CHOP. 10-year-old male with complaints of 10 pound weight loss, on and off fevers for 2 weeks and enlarged lymph nodes. Axillary lymph node fine needle aspiration shows anaplastic kinase positive large cell lymphoma. Will proceed with PET and CHOP. Needed improvements: Type and location

Inadequate DocumentationRequired ICD-10 Documentation 74-year-old female with anemia and dehydration. S/P surgical treatment for pancreatic cancer per Path report. Bone cancer rib cage & spine. Previous cancer treatment. 74-year-old female with anemia and dehydration secondary to Fluorouracil. S/P surgical treatment for stage IV primary cancer of pancreatic head per Path report. Bone metastasis left rib cage & spine. Previous radiation therapy. Inadequate vs. Adequate Documentation Example 3: Pancreatic Cancer Needed improvements: Location, stage, pathology, metastasis, reason for/focus of treatment, and complication(s) with linkage.

Inadequate DocumentationRequired ICD-10 Documentation 42-year-old with chronic kidney disease, HTN, & diabetes. Hbg & Hct decreased, transfuse 2 units PRBCs. 42-year-old on transplant list with ESRD on dialysis, HTN, IDDM type 2 with nephropathy & neuropathy. Chronic kidney disease related iron deficiency anemia, transfuse 2 units PRBCs. Inadequate vs. Adequate Documentation Example 4: Chronic Kidney Disease Needed improvements: Stage, transplant status, and related or contributing disease. E11.21 Type 2 diabetes mellitus with diabetic nephropathy I112.0 Hypertensive End Stage Renal Disease N18.6 Chronic Kidney Disease requiring chronic dialysis Z99.2 Dependence on Renal Dialysis E11.40 Type 2 diabetes mellitus with diabetic neuropathy, unspecified D63.1 Anemia in chronic kidney disease Z76.82 Awaiting Organ Transplant Status I12.9 Hypertensive Chronic Kidney Disease, NOS E11.9 Type 2 Diabetes Mellitus Without Complications N18.9 Chronic Kidney Disease, Unspecified (Stage)

Using Sign/Symptom and Unspecified Codes Sign/symptom and “unspecified” codes have acceptable, even necessary, uses. If a definitive diagnosis has not been established by the end of the encounter, it is appropriate to report codes for signs and/or symptoms in lieu of a definitive diagnosis. When sufficient clinical information is not known or available about a particular health condition, it is acceptable to report the appropriate “unspecified” code. It is inappropriate to select a SPECIFIC code that is not supported by the medical record documentation.

Training for Physicians DatesMethodContent Nov 2014 – Feb 2015Dept. MeetingsICD-10 Introduction/Overview Feb 2015 – Mar 2015On-line/ClassroomFuture Order Entry Diagnosis Assistant Feb 2015 – Jul 2015Web-basedICD-10-CM Overview & Service Specific Documentation Mar 2015 – Jun 2015ClassroomPhysician Playbooks/ Documenting for ICD10 using the Electronic Health Record Jul 2015 – Sep 2015Web-basedDocumenting Operative and Procedure Notes for ICD-10-PCS

Future Orders & Diagnosis Assistant Demonstration