ICD-10-CM Made Simple Prepared Geanetta Agbona CPC, CPC-I, CBCS AHIMA Approved ICD-10-CM Trainer/AAPC Physician Educator 1

Objectives 2  Learn why ICD-10-CM is needed  Learn some differences & similarities between ICD-9 & ICD-10  How does ICD-10-CM affect coding compliance

Do We Really Need New Codes? 3  ICD-10 provides more categories for diseases and other health-related conditions  ICD-10 provides clinical language  ICD-10 will permit us to have more valuable data to help us improve patient care

What are the major differences? 4 ICD-9-CMICD-10-CM 17 chapters of ICD-9-CM guidelines21 chapters of ICD-10-CM guidelines Classifies injuries by typeGroups injuries by specific site, then by type of injury 3 to 5 characters in length.Alphanumeric and can be up to 7 characters in length No placeholdersAddition of placeholder X Can’t code lateralityWe can code laterality

Guidelines for Diabetes 5 Diabetes in ICD-9Diabetes in ICD-10 If the type of diabetes mellitus is not documented in the medical record the default is type II: If the type of diabetes mellitus is not documented in the medical record the default is: E11 type II diabetes mellitus For type II patients who routinely use insulin and the type of diabetes is not documented use: , V58.67 For type II patients who routinely use insulin and the type of diabetes is not documented use: E11, Z79.4 Whether diabetes is controlled or uncontrolled is a factor Whether diabetes is controlled or uncontrolled is not a factor.

Guidelines for HIV 6 HIV in ICD-9-CMHIV in ICD-10-CM If a patient is admitted for an HIV related condition, the principal diagnosis should be 042 If a patient is admitted for an HIV related condition, the principal diagnosis should be B20 Asymptomatic HIV is: V08Asymptomatic HIV is: Z21 Patients previously diagnosed with any HIV illness 042 should never be assigned with or V08. Patients previously diagnosed with HIV illness B20 should never be assigned with R75 or Z21 If a patient is being seen to determine his/her HIV status use V73.89 If a patient is being seen to determine his/her HIV status use Z11.4

Personal History 7 Personal History in ICD-9-CMPersonal History in ICD-10-CM When a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site and there is no evidence of any existing primary malignancy, a code from category V10 personal history of Neoplasm should be used When a primary malignancy has been previously excised or eradicated from it site, there is no further treatment of the malignancy, a code from category Z85, Personal history of primary malignancy & secondary malignant neoplasm should be used to indicate the former site of its malignancy. * ICD-10-CM has pregnancy with neoplasm codes in chapter 15. O 9A.1 * New

Guidelines for Hypertension 8 Hypertension in ICD-9-CMHypertension in ICD-10-CM The terms malignant and benign are important in ICD-9-CM * The terms malignant and benign are not important in ICD-10-CM. Unspecified HTN is HTN I 10 Hypertensive Heart and CKD code from categories 404, 428 & 585 Hypertensive Heart and CKD code from categories I 13, I 50, N18 *New

ICD-10-CM & Compliance 9 There are many things to consider. Here are a few items of utmost importance:  How will ICD-10-CM affect the electronic health records?  Documents need to be revised. Assist staff by reviewing the most used ICD-9-CM & ICD-10-CM codes.  Train the coders well and be sure that they can assist the physicians when necessary. This will prevent a decrease in cash flow.  Be fully compliant by 10/1/2014.

Review 10  Why do we need ICD-10-CM?  What are some differences?  What are some similarities?  To be compliant what things do we need to do?

Coding for Fun 11  Example from AHIMA ICD-10-CM Coding Manual: Ex. 1.6 This 42 year old HIV positive male has a fever and shortness of breath. The diagnostic workup, including chest x-ray and sputum culture, resulted in a diagnosis of Pneumocystis pneumonia. This was documented as Pneumocystis pneumonia due to AIDS. What diagnosis codes are assigned?

Answers to Coding for Fun 12  B20  B59

Questions? 13

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