Prepared by: Sherry A. Milton, RHIA Milton & Associates P.O. Box 683 Erin, Tennessee October 13, 2011

 Quality Measures  Public Health  Research  Organized Monitoring and Performance  Information System Advances  Reimbursement

 Medical ◦ Constant ◦ W/O CC/MCC ◦ W/CC ◦ W/CC/MCC ◦ W/MCC  Surgical ◦ Constant ◦ W/O CC/MCC ◦ W CC ◦ W/CC/MCC ◦ W/MCC

 Congestive Heart Failure ◦ CHF without CC/MCC – Wt $3, ◦ CHF with CC – Wt $5, ◦ CHF with MCC – Wt $8, DIASTOLIC/SYSTOLIC ACUTE/CHRONIC

 Pneumonia – as principal – Wt $3, ◦ CHF – Unspecified (W/O CC/MCC)  Pneumonia as principal – Wt $$ ◦ CHF – Chronic, diastolic/systolic/both (W CC)  Pneumonia – as principal – Wt $8, ◦ CHF – Acute, diastolic/systolic/both (W MCC)

 No longer meet the demands of healthcare’s data needs  Cannot accurately describe the diagnoses and inpatient procedures for care delivered  Coded data is well beyond the purposes of ICD-9-CM  Greater need for coding accuracy and specificity  ICD-9-CM initially was not used for reimbursement purposes  ICD-9-CM procedures are outdated and inadequate  ICD-9-CM cannot support many of the IT and data exchange initiatives.

 Quality measures and medical error reduction (Patient safety)  Outcomes measurement  Clinical, financial and administrative performance improvement  Health Policy planning  Payment systems design and claims processing  Provider profiling  Refinements to current reimbursement systems, such as severity-adjusted DRG systems  Pay-for Performance programs  Educating consumers on costs and outcomes of treatment options

 More accurate payment for new procedures  Fewer rejected claims  Fewer fraudulent claims  Better understanding of new procedures  Improved disease management

Combination Codes for conditions and common symptoms or manifestations E Type I diabetes mellitus with diabetic nephropathy I Arteriosclerotic heart disease of native coronary artery with unstable angina pectoris K Crohn’s disease of large intestine with intestinal obstruction

Combination codes for poisonings and external causes  T36.0x1D – Poisoning by penicillin, accidental (unintentional), subsequent encounter  T42.4x5A – Adverse effect of benzodiazepines, initial encounter

Added Laterality  H – Swimmer’s ear, left ear  M – Chondromalacia, right shoulder  S40.259A – Superficial foreign body of unspecified shoulder, initial encounter

Added seventh-character extensions for episode of care  M80.051A – Age related osteoporosis with current pathological fracture, right femur, initial encounter for fracture  S06.0x1A – Concussion with loss of consciousness of 30 minutes or less, initial encounter  S52-132B – Displaced fracture of neck of left radius, initial encounter for open fracture, Type I or II or initial encounter for open fracture NOS

Expanded codes (injuries, diabetes, alcohol and substance abuse, postoperative complications  E – Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema  F – Cocaine dependence with intoxication delirium  K91.71 – Accidental puncture and laceration of a digestive system organ or structure during a digestive system procedure.

Inclusion of trimesters in obstetrical codes (and elimination of fifth digits for episode of care)  – Pre-existing essential hypertension complicating pregnancy, second trimester  O – Anemia, complicating pregnancy, third trimester

Changes in timeframes specified in certain codes  Acute myocardial infarction – time period changed from 8 weeks to 4 weeks  Time frame for abortion versus fetal death changed from 22 weeks to 20 weeks.

DOCUMENTATION

 Anatomy and Physiology  Microbiology  Pharmacology  Coding rules understanding  DRG Payment Methodology