ICD-10 Getting There….. Radiology

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.

ICD-10-CM Enhancements Location and Laterality ICD-9-CM Code ChoicesICD-10 Code Choices Cellulitis of upper arm and forearm. Cellulitis of right axilla Cellulitis of left axilla Cellulitis of right upper limb Cellulitis of left upper limb Cellulitis of unspecified part of limb

Type I Diabetes with Neurological Manifestations Diabetic Polyneuropathy E10.42 Type I Diabetes Mellitus with Diabetic Polyneuropathy ICD-10-CM Enhancements Combination Codes

ICD-10-CM Enhancements Acuity, Type and Circumstances AcuityTypeCircumstances Acute Chronic Acute on Chronic Left Ventricular Systolic Diastolic Combined Following Surgery Due to Hypertension Due to Chronic Kidney Disease For example, a patient with dyspnea referred for a chest x-ray to rule out congestive heart failure.

Information NeededRequired ICD-10 Documentation How did the injury occur? What type of injury was sustained? What activity was taking place? When did the injury occur in relation to this encounter? Where was the patient when the injury occurred? Why was the activity happening? 32-year-old female S/P external fixation right displaced pilon fracture due to jumping from her second story bedroom window in a suicide attempt. Fracture shows nonunion four weeks post op. Here for additional surgical intervention. ICD-10-CM Enhancements Circumstances Surrounding Injuries For example, fracture resulting from suicide attempt.

AnemiaCardiomyopathyHeadache Nutritional Hemolytic Aplastic Blood Loss Dilated/Congestive Obstructive Non-obstructive Endomyocardial fibrosis Cluster Tension Post-traumatic Drug-induced ICD-10-CM Enhancements Type The specific type of a patient’s disease may impact treatment and medical necessity for services rendered.

DIABETESCOPDCANCERARTHRITIS Skin Ulcers Gout Kidney Disease PVD Eye Problems Malnutrition Pneumonia Musculoskeletal Changes CHF Anemia Depression Malnutrition Thrombosis Lung Disease Heart Disease Skin Problems Sickle Cell Disease Hypothyroidism ICD-10-CM Enhancements Underlying and Associated Conditions Accurate and complete documentation includes underlying or associated conditions and their impact on diagnostic findings.

Major Changes in ICD-10-CM Acuity Circumstances Surrounding Injuries Combination Codes Identification Affected Fetus Laterality Site Trimester Type Underlying and associated Conditions ICD-10-CM Enhancements Specificity and Granularity

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 – Jan 2015Department Meetings Introduction/Overview Jan 2015 – Mar 2015Web-basedOverview Service Specific Documentation Future Order Entry Diagnosis Assistant Mar 2015 – Jun 2015ClassroomDocumenting for ICD10 using the Electronic Health Record Jun 2015 – Sep 2015Web-basedOverview Documenting Operative and Procedure Notes for ICD-10-PCS

Future Orders & Diagnosis Assistant Demonstration