ICD-10 Here it comes – like it or not… © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. Brian D. Loftus, MD Bellaire Neurology iHeadache Southern Headache Society, Vice President

Disclosures: Nothing relevant regarding ICD-10 except … I am really fed up with meaningless use and have stopped participating I am really fed up with PQRS and have stopped participating Planning to drop medicare completely I am very computer literate (former programmer, iHeadache developer) © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc.

Objectives Identify ICD10 coding Understand the Structure of the International Classification of Headache Diseases Version 2 Recognize accurate disease coding of headache and facial pain in ICD10 © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc.

ICD10 Why Bother ICD-10 allows for more codes for more specific diagnosis, better ability to determine comorbid conditions, severity of illness, etc We are the only major country not using ICD-10 External injury codes are particularly more detailed and may improve injury surveillance © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. AHIMA (American HIM Assoc)

ICD10 Why Bother Improve monitoring Fewer rejected and improper reimbursed claims? Reduced coding errors? Reduced labor costs and increased productivity? © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. AHIMA (American HIM Assoc)

ICD10 Cons Track record has been so good with this sort of thing… Meaningful use has been debacle PQRS – very little quality being measured in my practice MOC – I see no value to practice for all the extra expense Multiple Boards – increasingly common – increasing cost © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. One more thing to deal with

ICD10 Cons ICD11 is just 2 years away © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. One more thing to deal with

ICD10 Here it Comes From the physician viewpoint – at least in my practice – it has been actually painless. © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. The Best Thing I can Say!!

ICD 10 in My Practice There exists a government approved ICD10 to ICD9 conversion (General Equivalence Mapping) More than 1 ICD10 code for each ICD9 code but only 1 ICD9 code for each ICD10 Code © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. Your experience may vary…

ICD 10 in My Practice I can search for words in either the ICD9 code names or ICD10 code names or both I have not encountered any initial or subsequent subcodes in my practice to date © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. Your experience may vary…

ICD 10 in My Practice I can search for words in either the ICD9 code names or ICD10 code names or both I have not encountered any patient in my practice where I had to worry about an initial encounter, subsequent, or sequelae code © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. Your experience may vary…

ICD 10 in My Practice 7 characters 1 st 3 – category 2 nd 3 – etiology, anatomic site, severity 7 th digit extension A (Initial) D (Subsequent), or S (Sequalae) © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. Structure

ICD 10 in My Practice 1 st character is an alpha. O and I will only be in the 1 st character, otherwise they are 0 (zero) or 1 (one). 7th character for injuries and external causes © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. Structure

Headaches © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. ICHD-2 is your friend

IHS Classification ICHD-2 Part One – Primary Headaches Part Two – Secondary Headaches Part Three – Cranial Neuralgias, Facial pain and other Appendix © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. Structure

Headaches – Part I ICHD-2 Periodic Headache Syndromes in Adult/child Opthalmoplegic migraine Abdominal migraine All of the above can be intractable or not intractable © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. Migraine – ICD10 additions

Headaches – Part 2 ICHD-2 No changes (tension unspecified, episodic, chronic) except All of the above can be intractable or not intractable © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. Tension – ICD10 additions

Headaches – Part 3 ICHD-2 No changes – Cluster (unspecified, episodic, intractable) and paroxysmal hemicrania (episodic, chronic), SUNCT, and Other Trigeminal Autonomic Cephalgias are unchanged All of the above can be intractable or not intractable © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. Cluster and TACs – ICD10 additions

Headaches – Part 4 ICHD-2 No additions – Reminder – Primary Stabbing Headache, Primary Cough Headache, Primary Exertional Headache, Primary headache associated with sexual activity, Hypnic Headache, Primary Thunderclap Headache, Hemicrania Continua, New Daily Persistant Headache © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. Other Primary HA – ICD10 additions

Headaches – Part 5 ICHD-2 No changes - Post traumatic headache (unspecified, acute, chronic) All of the above can be intractable or not intractable © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. Head Trauma– ICD10 additions

Concussion – S06.0X Digit 6 of Code is based upon length or loss of consciousness, (none, 24 hr with full recovery of consciousness, non recovery, death due to brain injury, death but not due to brain injury) Digit 7 of Code is initial encounter (end with A), subsequent encounter(end in D), or sequelae (end in S) © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. Head Trauma– ICD10 additions

Concussion Initial eval for concussion lasting a few minutes All concussions are S06.0X Next digit - – time <30 minutes – 1 Initial encounter A S06.0X1A © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. Head Trauma– ICD10 additions

Concussion The coding of the extension – is from the patient’s perspective. It is not – your first visit to see the patient. In our example, the ED physician, consulting neurologist/neurosurgeon, radiologist would all use the same code during the initial evaluation time frame. Other acute care would use subsequent extension D © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. Head Trauma– ICD10 additions

Concussion If you saw the patient post-discharge from the hospital for evaluation of seizures that you felt that were related to the concussion – you would code the extension as sequelae even though is was your initial visit with the patient © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. Head Trauma– ICD10 additions

Stroke and TIAs Cerebral infarction is now broken down by – 1) Basilar, Carotid, Vertebral, Cerebellar, Precerebral, ACA, PCA, MCA, PCA 2) Thrombosis, Embolism, or Unspecified 3) Left, Right, or Unspecified © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. ICD10 Additions

Stroke and TIAs Common stroke syndromes added MCA Syndrome, ACA Syndrome, PCA syndrome Pure Sensory Lacunar Syndrome Pure Motor Lacunar Syndrome © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. ICD10 Additions

Multiple Sclerosis Optic Neuritis gets unspecified, left, right, bilateral No changes to MS, NMO, Transverse Myelitis © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. ICD10 Additions

Dementia Alzheimer’s disease gets early onset, late onset other, and unspecified No changes in other dementia diagnosis or MCI © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. ICD10 Additions

Parkinsonism Vascular Neuroleptic induced Other drug induced Other external agents Postencephalitis Other secondary Unspecified © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. ICD10 Additions

Partial Seizures Simple Partial, Complex Partial, or unspecified Idiopathic or Symptomatic Intractable or not intractable With or without status epilepticus © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. ICD10 Additions

Generalized Seizures Idiopathic, JME, Absence, Lennox-Gastaut or Other Intractable or not Intractable With or Without Status epilepticus © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. ICD10 Additions

Radiculopathies 15 ICD10 codes that map to cervical stenosis (724.00) 3 by location (occipito-allanto-axial region, cervical, cervicothoracic) Cause of stenosis – subluxation, osseous, connective tissue, intervertebral disk Head vs cervical © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. ICD10 Additions

Radiculopathies 7 ICD10 codes for brachial neuritis (723.4) 9 ICD10 codes for lumbar stenosis (724.02) 8 ICD10 codes for thoracic stenosis (724.01) 8 ICD10 codes for thoracic or lumbar radiculopathy (724.4) 6 ICD10 codes for Sciatica © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. ICD10 Additions

Radiculopathies 25 ICD10 codes for other unspecified back disorders (724.9) 7 ICD10 codes for disorders of sacrum (724.6) © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. ICD10 Additions

Brian D. Loftus, MD © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. Thank you for your attention