Barbara Parker, CMA (AAMA), CPC, CCS-P
ICD-10 Implementation Format Differences between ICD-9 and ICD-10 Resources
October 1, 2013 –NOT flexible All HIPAA covered entities must transition NO grace period ICD-9-CM not accepted after this date January 1, 2012 – electronic transmission changes to Version 5010 which accomodates ICD-10 format Proposed freeze on ICD-9-CM on October 1, 20ll CPT and HCPCS continue
January 1, 2010 Payers and providers should begin internal testing of Version 5010 standards for electronic claims December 31, 2010 Internal testing of Version 5010 must be complete to achieve Level I Version 5010 compliance January 1, 2011 Payers and providers should begin external testing of Version 5010 for electronic claims CMS begins accepting Version 5010 claims Version 4010 claims continue to be accepted December 31, 2011 External testing of Version 5010 for electronic claims must be complete to achieve Level II Version 5010 compliance January 1, 2012 All electronic claims must use Version 5010 Version 4010 claims are no longer accepted October 1, 2013 Claims for services provided on or after this date must use ICD-10 codes for medical diagnosis and inpatient procedures CPT codes will continue to be used for outpatient services
General Equivalence Mapping files ICD-9 to ICD-10 ICD-10 to ICD-9 Not set in stone – just the general idea
ICD-10-CM From 14,315 to 69,099 codes Added right, left, bilateral ICD-10-PCS From 3,838 to 71,957
Longer... Uses more alpha characters 3 to 7 characters 1 st character is a letter (except U) 2 nd character is a number 3 rd – 7 th can be a letter or number Decimal after third character
A78Q fever A69.21 Meningitis due to Lyme disease O9A311Physical abuse complicating pregnancy, first trimester S52.131ADisplace fracture of neck of right radius, initial encounter for closed fracture Reference: MLN Matters, SE 109
Laterality is added (left, right, bilateral) C50.511Malignant neoplasm of the lower-outer quadrant of right female breast H16.013Central corneal ulcer, bilateral L89.022Pressure ulcer of left elbow, stage II
Combination codes for conditions and commonly associated symptoms and manifestations K57.21Diverticulitis of large intestine with perforation and abscess with bleeding E11.341Type 2 diabetes mellitus with severe nonproliferating diabetic retinopathy with macular edema I25.110Atherosclerotic heart disease of native coronary artery with unstable angina pectoris
Combination codes for poisoning and associated external cause T42.3x2S Poisoning by barbiturates, intentional self-harm, sequela
Obstetric codes to identify trimester instead of episode of care O26.02Excessive weight gain in pregnancy, second trimester
Character “x” used as 5 th or 6 th character placeholder to fill in empty space when a code is less than 6 characters and requires a 7 th character T15.02xDForeign body in cornea, left eye, subsequent encounter T46.1x5AAdverse effect of calcium- channel blockers, initial encounter
Excludes1: Code excluded should NEVER be reported with the code where the note is located Q03Congenital hydrocephalus Excludes1: Acquired hydrocephalus (G91.0-)
Excludes2: Condition excluded is NOT part of the condition represented by the code but a patient may have both conditions at the same time in which case both codes are assigned L27.2 Dermatitis due to ingested food Excludes2: Dermatitis due to food in contact with skin (L23.6, L24.6, L25.4)
Underdosing T45.526D Underdosing of antithrombotic drugs, subsequent encounter Blood type Z67.40Type O blood, Rh positive Blood alcohol level Y90.6 Blood alcohol level of mg/100 ml
Injury S75.121A Major laceration of femoral vein at hip and thigh level, right leg, initial encounter Diabetes E Type 1 diabetes mellitus with diabetic neuropathic arthropathy
Substance abuse F10.182Alcohol abuse with alcohol- induced sleep disorder Postoperative complications T82.02xADisplacement of heart valve prosthesis, initial encounter
The appropriate 7 th character must be added to each code from category S01 A initial encounter D subsequent encounter S sequela (from prior disease or injury)
M84.6 Pathological fracture in other disease The appropriate 7 th character is to be added to each code from subcategory M84.6 A initial encounter for fracture D subsequent encounter for fracture with routine healing G subsequent encounter for fracture with delayed healing K subsequent encounter for fracture with nonunion P subsequent encounter for fracture with malunion S sequela
Distinction made between intraoperative complications and post operative disorders D78.01 Intraoperative hemorrhage and hematoma of spleen complicating a procedure of the spleen D78.21 Postprocedural hemorrhage and hematoma of spleen complicating a procedure of the spleen
Injuries grouped by anatomical site rather than injury type Example: S25.411A Minor laceration of right pulmonary blood vessel, initial encounter New code definitions Example: Acute myocardial infarction is defined as 4 weeks rather than 8 weeks V and E codes incorporated into main classification rather than separate classifications
(Choose Medicare, then coding, then ICD10) Medicare has many, many resources New ICD10 draft guidelines available here American Academy of Professional Coders has webinars, online courses, and a wealth of other resources