0 Presentation to: 5 August 2015 Presented by: Heather Bond, Medicaid Assistant Chief, Regulatory Compliance Exciting ICD-10 Presentation

1 Mission The mission of the Department of Community Health is to provide access to affordable, quality health care to Georgians through effective planning, purchasing, and oversight. We are dedicated to A Healthy Georgia.

2 Title or Chapter Slide (use as needed; feel free to delete) 1.History of ICD 2.Benefits of updating from ICD-9 to ICD-10 3.Code Format Structure 4.ICD-10 Coding Conventions: Same, Changed, New 5.Note on Causation and Specificity 6.Advice 7.Questions

3 ICD: International Statistical Classification of Diseases and Related Health Problems –Maintained by the World Health Organization (WHO) ICD-6: Published in Morbidity reporting. –Injuries, External Causes of Injuries, Mental Disorders ICD-7: Published in 1955 –Amendments of errors and inconsistencies ICD-8a: Published in 1965 –ICD used for indexing hospital medical records – American Hospital Association’s “Advisory Committee to the Central Office on ICDA” developed the needed adaptation proposals History of ICD

4 ICD-9: Published in 1978 –Dagger and asterisk system: Information about both an underlying general disease and a manifestation in a particular organ or site ICD-9-CM –Updated annually on 1 October –Volumes 1 (tabular) and 2 (index): Diagnosis –Volume 3: Procedure Codes ICD-10: Published in 1990 –ICD-10-CM: Diagnosis Codes (replaces volumes 1 and 2) –ICD-10-PCS: Procedure Codes ICD-11: Estimated publication date of 2017

5 Benefits of updating from ICD-9 to ICD-10 Per the AHA, many sections are so full additions are placed in other sections Lack of detail on ICD-9 Cannot capture new technologies EHR and PHR need codes that are expandable Epidemiology Cannot identify emerging disease Improved disease management

6 Code Format Structure

7 ICD-10 Coding Conventions: Same, Changed, New What’s the Same? –NEC: Other specified –NOS: Unspecified Georgia Medicaid will not cover NOS! –With or without Default is without –And “And” may be interpreted as either “and” or “or”

8 ICD-10 Coding Conventions: Same, Changed, New –Brackets: Identifies manifestation codes, synonyms –Code First: Sequencing Directive –Use Additional Codes: Use additional code to completely identify the condition –Code Also: Sequencing is discretionary

9 ICD-10 Coding Conventions: Same, Changed, New What’s changed? –Excludes1: Never use both codes! E.g., F84.0 Austistic Disorder. Excludes1: Asperger’s syndrome –Excludes2: Code separately. The additional code can be assigned, too, but is not included or excluded from the original code.

10 ICD-10 Coding Conventions: Same, Changed, New What’s new? –Placeholders: x or X Needs more characters, but not enough are given Capitalization does not matter Used for 4, 5, 6 characters, only Note that X is also a series!

11 ICD-10 Coding Conventions: Same, Changed, New 7 th Character Used in Injury, Poisoning, External Causes Usually a choice of three –Initial encounter (A): Condition is actively treated during the initial encounter –Subsequent encounter (D): Used for encounters after the initial treatment, but while continuing to receive care during recovery –Sequela (S): Complications or conditions resulting from the condition

12 ICD-10 Coding Conventions: Same, Changed, New Not limited to one provider! These designations are about the condition Does not end at midnight like an E/M code Same provider group is treated as if it is the same provider –Laterality Right, left, bilateral –If no bilateral, code right and left separately –Dash Identifies if additional characters are needed, but not used exclusively throughout

13 Causation and specificity Providers, build your record! Create causation with the words: –Due to –Because of Auditors do not allow coders to assume. No matter how closely related two diagnosis seem in your clinical knowledge, correlate the two for your coder. Specify laterality! NOS are not reimbursable!

14 Advice Code 2-3 claims a day in both ICD-9 and ICD-10 Test with Georgia Medicaid! This identifies our errors and yours prior to go-live ICD-10 certification will become a part of CPC coding, get this early to prepare Dental claims do not require ICD-10 diagnosis codes Use care in coding a diagnosis- you are creating a medical record

15 Questions Questions?