ICD-10 CM Training Gastroenterology

ICD-10-CM Compliance Dates ICD-10-CM will be valid for dates of service on or after October 1, 2015 Outpatient dates of service of October 1, 2015 and beyond. Inpatient hospital service claims, is effective for dates of discharge after September 30, 2015

Covered and Non-Covered Entities Everyone covered by the Health Insurance Portability Accountability Act (HIPPA) Non-Covered Entities Worker’s Compensation Auto Insurance Non covered HIPAA entities are exempt but are encouraged to adapt the new code set

ICD-10 Code Structure 21 Chapters Alpha-numeric codes; not case-sensitive Codes begin with Alpha letter, A-Z, excluding U Common errors I verses 1 O verses 0 “X” Placeholder 3 to 7 characters Decimal following 3rd character

ICD-10 Code Structure Placeholder “X” Used for future expansion of a code Fills in empty characters when a 6th and/or 7th character apply The placeholder may be used in different scenarios but should never serve as the final character. Example: W19.XXXA Unspecified fall, Initial Encounter

ICD-10 Code Structure 7th Character Provides specified information regarding the clinical visit Is required for certain categories and must be reported in the seventh position May be alpha or numeric Has different meanings depending on the coding category

ICD-10 Code Structure Laterality Some ICD-10-CM codes indicate laterality, specifying whether the condition occurs on the left, right or is bilateral. If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side. If the side is not identified in the medical record, assign the code for the unspecified side. OGCR section 1.B.13

ICD-10 Code Structure “Other” Codes “Unspecified” Codes Codes titled “other” or “other specified” are for use when the information in the medical record provides detail for which a specific code does not exist. “Unspecified” Codes Codes titled “unspecified” are for use when the information in the medical record is insufficient to assign a more specific code. OGCR section 1.A.9.a.b

ICD-10 Structure Excludes Notes Excludes1 Excludes2 A type 1 Excludes note is a pure excludes note It means “NOT CODED HERE” The code excluded should never be used at the same time When two conditions cannot occur together Excludes2 Represents “Not included here” The condition excluded is not part of the condition represented by the code It is acceptable to use both the code and the excluded code together, when appropriate OGCR section 1.A.12.a.b

ICD-10 Code Structure “Code First” and “Use Additional Code” ICD-10 has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. These instructional notes indicate the proper sequencing order of the codes. OGCR section 1.A.13 The “-” indicates there are additional reporting options

Most Common Diagnosis Codes

Encounter for screening for malignant neoplasm of colon ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 V76.51 Z12.11 examinations related to pregnancy and reproduction (Z30-Z36, Z39.-) encounter for diagnostic examination-code to sign or symptom N/A There are more specific code choice selections below: Z12.10 Z12.12 Z12.13 Use additional code to identify any family history of malignant neoplasm (Z80.-)

Documentation Tips Nonspecific abnormal findings disclosed at the time of these examinations are classified to categories R70-R94. Screening is the testing for disease or disease precursors in asymptomatic individuals so that early detection and treatment can be provided for those who test positive for the disease.

Colon & Appendix Benign Neoplasm ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 211.3 D12.0 Benign neoplasm of cecum benign carcinoid tumors of the large intestine, and rectum (D3A.02-) There are more specific code choices: D12.1 Benign neoplasm of appendix benign carcinoid tumor of the appendix (D3A.020) D12.6 Benign neoplasm of colon, unspecified inflammatory polyp of colon (K51.4-) polyp of colon NOS (K63.5) K63.5 Polyp of colon adenomatous polyp of colon (D12.6) polyposis of colon (D12.6)

Abdominal pain 789.00 R10.9 Unspecified abdominal pain ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 789.00 R10.9 Unspecified abdominal pain renal colic (N23) dorsalgia (M54.-) flatulence and related conditions (R14.-) There are more specific code choice selections below: R10.0 Acute abdomen 789.09 R10.10 Upper abdominal pain, unspecified 789.01 R10.11 Right upper quadrant pain 789.02 R10.12 Left upper quadrant pain 789.06 R10.13 Epigastric pain R10.2 Pelvic and perineal pain R10.30 Lower abdominal pain, unspecified 789.03 R10.31 Right lower quadrant pain 789.04 R10.32 Left lower quadrant pain 789.05 R10.33 Periumbilical pain 789.61 R10.81- Other abdominal pain R10.82- Rebound abdominal tenderness

Abdominal Pain Documentation Tips Document specific location: LLQ, LUQ, RUQ, RLQ Periumbilical Epigastric Generalized (R10.84) Colic (R10.83) Acute abdominal pain (R10.0) Abdominal tenderness (R10.811-R10.819) Rebound abdominal pain (R10.821-R10.829)

Personal history of colonic polyps ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 V12.72 Z86.010 N/A personal history of malignant neoplasms (Z85.-) Code first any follow-up examination after treatment (Z09)

Documentation Tips There are two types of history Z codes, personal and family. Personal history codes explain a patient’s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring. Personal history codes may be used in conjunction with follow-up codes and family history codes may be used in conjunction with screening codes to explain the need for a test or procedure. History codes are also acceptable on any medical record regardless of the reason for visit. A history of an illness, even if no longer present, is important information that may alter the type of treatment ordered.

Dysphagia, unspecified ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 787.20 R13.0 Aphagia Psychogenic aphagia (F50.9) Psychogenic dysphagia (F45.8) N/A R13.10** **Code first, if applicable, dysphagia following cerebrovascular disease (I69. with final characters -91) There are more specific code choice selections below: 787.21 R13.11 Dysphagia, oral phase 787.22 R13.12 Dysphagia, oropharyngeal phase 787.23 R13.13 Dysphagia, pharyngeal phase 787.24 R13.14 Dysphagia, pharyngoesophageal phase 787.29 R13.19 Other dysphagia Cervical dysphagia Neurogenic dysphagia

Dysphagia Documentation Tips Document phase: Oral Oropharyngeal Pharyngeal Pharyngo-esophageal Document if sequelae of nontraumatic hemorrhage: specify type: Subarachnoid Intracerebral Intracranial Document if sequelae of: Cerebral infarction Cerebrovascular disease

Family history of malignant neoplasm of digestive organs ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 V16.0 Z80.0 N/A Code also any follow-up examination (Z08-Z09)

Documentation Tips Z80.3 is considered unacceptable as a principal diagnosis as it describes a circumstance which influences an individual's health status but not a current illness or injury, or the diagnosis may not be a specific manifestation but may be due to an underlying cause. Family history codes are for use when a patient has a family member(s) who has had a particular disease that causes the patient to be at higher risk of also contracting the disease. Personal history codes may be used in conjunction with follow-up codes and family history codes may be used in conjunction with screening codes to explain the need for a test or procedure. History codes are also acceptable on any medical record regardless of the reason for visit. A history of an illness, even if no longer present, is important information that may alter the type of treatment ordered.

Diverticular disease of intestine ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 562 K57.9- Diverticular disease of intestine, part unspecified, congenital diverticulum of intestine (Q43.8) Meckel's diverticulum (Q43.0) diverticulum of appendix (K38.2) There are more specific code choice selections below: K57.0- Diverticulitis of small intestine with perforation and abscess K57.1- Diverticular disease of small intestine without perforation or abscess K57.2- Diverticulitis of large intestine with perforation and abscess K57.3- Diverticular disease of large intestine without perforation or abscess K57.4- Diverticulitis of both small and large intestine with perforation and abscess K57.5- Diverticular disease of both small and large intestine without perforation or abscess K57.8- Diverticulitis of intestine, part unspecified, with perforation and abscess

Documentation Tips Identify: With or without bleeding Small and/or large intestine Perforation and/or Abscess

Gastro-Esophageal Reflux Disease ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 530.81 K21.9 Gastro-esophageal reflux disease without esophagitis Esophageal reflux NOS Newborn esophageal reflux (P78.83) N/A There are more specific code choice selections below: 530.11 K21.0 Gastro-esophageal reflux disease with esophagitis

GERD Documentation Tips Identify with or without esophagitis

Gastroenteritis ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 787.91 K52.2 Allergic and dietetic gastroenteritis and colitis Use additional code to identify type of food allergy (Z91.01-, Z91.02-) N/A K52.89 Other specified noninfective gastroenteritis and colitis R19.7 Diarrhea, unspecified acute abdomen (R10.0) functional diarrhea (K59.1) neonatal diarrhea (P78.3) psychogenic diarrhea (F45.8) There are more specific code choice selections below: 558.1 K52.0 Gastroenteritis and colitis due to radiation 535.70 535.71 535.41 K52.81 Eosinophilic gastritis or gastroenteritis Eosinophilic enteritis

Barrett's esophagus ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 530.85 K22.70 Barrett's esophagus without dysplasia Applicable to: Barrett's esophagus NOS Barrett's ulcer (K22.1) malignant neoplasm of esophagus (C15.-) N/A There are more specific code choice selections below: K22.710 Barrett's esophagus with low grade dysplasia K22.711 Barrett's esophagus with high grade dysplasia K22.719 Barrett's esophagus with dysplasia, unspecified

Documentation Tips Identify: With or without dysplasia Type of dysplasia

Benign neoplasm of rectum and anal canal ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 211.4 D12.7 Benign neoplasm of rectosigmoid junction N/A D12.8 Benign neoplasm of rectum benign carcinoid tumor of the rectum (D3A.026) D12.9 Benign neoplasm of anus and anal canal Applicable to: Benign neoplasm of anus NOS benign neoplasm of anal margin (D22.5, D23.5) benign neoplasm of anal skin (D22.5, D23.5) benign neoplasm of perianal skin (D22.5, D23.5)

Calculus of bile duct without cholangitis or cholecystitis ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 574.50 K80.50 Calculus of bile duct without cholangitis or cholecystitis without obstruction retained cholelithiasis following cholecystectomy (K91.86) N/A 574.51 K80.51 Calculus of bile duct without cholangitis or cholecystitis with obstruction

Gastrointestinal hemorrhage ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 578.9 K92.2 Gastrointestinal hemorrhage, unspecified Applicable to: Gastric hemorrhage NOS Intestinal hemorrhage NOS neonatal gastrointestinal hemorrhage (P54.0-P54.3) acute hemorrhagic gastritis (K29.01) hemorrhage of anus and rectum (K62.5) angiodysplasia of stomach with hemorrhage (K31.811) diverticular disease with hemorrhage (K57.-) gastritis and duodenitis with hemorrhage (K29.-) peptic ulcer with hemorrhage (K25-K28) N/A

Gastritis There are more specific code choice selections below: ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 535.00 K29.00 Acute gastritis without bleeding eosinophilic gastritis or gastroenteritis (K52.81) Zollinger-Ellison syndrome (E16.4) N/A There are more specific code choice selections below: 535.01 K29.01 Acute gastritis with bleeding 535.30 K29.20 Alcoholic gastritis without bleeding 535.31 K29.21 Alcoholic gastritis with bleeding 535.10 535.40 K29.30 Chronic superficial gastritis without bleeding 535.11 535.41 K29.31 Chronic superficial gastritis with bleeding K29.40 Chronic atrophic gastritis without bleeding K29.41 Chronic atrophic gastritis with bleeding K29.50 Unspecified chronic gastritis without bleeding K29.51 Unspecified chronic gastritis with bleeding 535.20 K29.60 Other gastritis without bleeding K29.61 Other gastritis with bleeding 535.50 K29.70 Gastritis, unspecified, without bleeding 535.51 K29.71 Gastritis, unspecified, with bleeding

Gastritis and duodenitis ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 535.60 K29.80 Duodenitis without bleeding 535.61 K29.81 Duodenitis with bleeding Gastritis and duodenitis ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 535.61 K29.81 Gastroduodenitis, unspecified, without bleeding Gastroduodenitis, unspecified, with bleeding

Gastritis Documentation Tips Document acuity: - Acute or Chronic Differentiate between: Gastritis Gastroduodenitis Duodenitis Document type: Alcoholic Superficial Atrophic Document any related hemorrhage Document any alcohol or drug use, abuse, dependence or past history Specify name of medication or drug with purpose of its use

Monitor Claims On October 01, 2015 we will monitor claims for date of service rules Outpatient claims cannot have crossover dates Outpatient claims will be coded according to date of service Inpatient facility claims will be coded per date of discharge We will monitor claims to resolve any unanticipated problems with the submission process

Claim Denial and Management We will monitor for claim denials We will monitor editing trends for ICD-10 Coding guidelines We will provide feedback to the physicians regarding supporting documentation requirements We will monitor WC or Liability carriers for published rules on use of ICD-9 or ICD-10 code sets

Client Responsibilities Client will need to update Templates Order Sets Superbills Favorites Future Orders Remove ICD-9 code add ICD-10 code

Documentation – Start Now All Conditions treated or assessed must be documented in the medical record. In addition to the documentation tips reviewed, below are more areas to document that will ensure proper ICD-10-CM code selection. Site specificity Document notation of qualifiers Exacerbation Manifestations Relapse Status Stages Indicate acute or chronic Indicate underlying or external cause factors Medication Smoke Accidents Mechanical failure Laterality Bilateral Right Left

Documentation – Start Now Episode of Care for injuries, poisoning, external causes and other conditions Initial Encounter Use while the patient is receiving active treatment of the condition Active treatment includes surgical treatment, an emergency encounter, and evaluation and treatment by a new physician Subsequent Encounter Used on encounter after the patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase. Medication adjustments, aftercare, device adjustments, cast change Sequela Used for complications or conditions that arise as a direct result of a condition, late effect

Documentation – Start Now Combination codes that capture Etiology and manifestation Related conditions Disease, injury or other medical condition and complications Disease or other medical conditions and common signs or symptoms Add ICD-10 Codes to patient Problem List

Official Guidelines for Coding and Reporting Underdosing Underdosing refers to taking less of a medication than is prescribed by a provider or a manufacturer’s instruction. For underdosing, assign the code from categories T36-T50 (fifth or sixth character “6”). Codes for underdosing should never be assigned as principal or first-listed codes. If a patient has a relapse or exacerbation of the medical condition for which the drug is prescribed because of the reduction in dose, then the medical condition itself should be coded. Noncompliance (Z91.12-, Z91.13-) or complication of care (Y63.6-Y63.9) codes are to be used with an underdosing code to indicate intent, if known. OGCR Section 1.C.19.e.5.c

Questions codingresource@g1hs.com Centers for Disease Control and Prevention (ICD-10-CM) http://www.cdc.gov/nchs/icd/icd10cm.htm Offical Guidelines, Alpha Index, Tabular Index, Neoplasm Table, Drug Table, External Cause of Injury Index