1. ICD-10 Ahhhhhh I see…… … Ann Rees, RHIA, CCS

2. Why……. ICD-10 ? Enhanced ability to measure the quality, safety and efficiency of care. Efficiency of payment system and processing of claims for reimbursement. Improvement of clinical, financial and administrative performance. Prevention and detection of healthcare fraud and abuse. Enhanced ability of tracking public health and risks.

3. How many more codes?

4. Time is Ticking !!!! All claims received for encounters or dates of service occurring on or following this date of service must be coded utilizing ICD-10. ICD-10- CM ( diagnosis codes) are required for all claims regardless of services types: inpatient and outpatient). ICD-10 PCS (procedure code set) must be coded on all services that currently utilize ICD-9 CM volume III (Inpatient Coding).

5. The same…but different…. ICD-9 CM Format: XXX.XX Consists of three to five characters Category of code 3 digits to the left of the decimal point. Etiology, anatomic site, manifestation 4 th and 5 th place on the right side of the decimal point. First digit is numeric or alpha (E or V) Second, third, fourth, and fifth digits are numeric Always at least three digits Decimal placed after the first three characters ICD-10 CM Format: XXX.XXX X( extension code) Consists of three to seven characters First digit is alpha All letters used except U Second and third digits are numeric Fourth, fifth, sixth, and seventh digits can be alpha or numeric Decimal placed after the first three characters Category of code 3 digits to the left of decimal point. Etiology, anatomic site, severity are in the 4 th,5 th and 6 th places. The 7 th place is for the extension category.

6. ICD-10-CM Structure ICD-10-CM has an index and tabular list similar to those of ICD- 9-CM. However, the ICD-10-CM index is much longer. Categories, subcategories, and codes are contained in the tabular list. As with ICD-9-CM, proper coding relies on use of the guidelines, which house all information about the coding conventions for ICD-10-CM, general use guidelines, and chapter-specific guidelines for the tabular list. The two parts of the ICD-10-CM index are the index to diseases and injury and index to external causes of injury. The table of drugs and chemicals and the neoplasm table are housed in the index to diseases and injury. The former V codes are now Z codes contained in chapter 21, “Factors Influencing Health Status and Contact with Health Services.”

7. Organizational Changes ICD-10-CM consists of 21 chapters. Some chapters include the addition of a sixth character. ICD-10-CM includes full code titles for all codes (no references back to common fourth and fifth digits). V and E codes are no longer supplemental classifications. Sense organs have been separated from nervous system disorders. Injuries are grouped by anatomical site rather than injury category. Postoperative complications have been moved to procedure-specific body system chapter.

8. New Features of ICD-10-CM Combination codes for conditions and common symptoms or manifestations Combination codes for poisonings and external causes Added laterality Added extensions for episode of care Code extensions (seventh character) have been added for injuries and external causes to identify the encounter: initial, subsequent, or sequelae. The extensions are: A Initial encounter D Subsequent encounter S Sequelae Expanded codes (injury, diabetes, alcohol/substance abuse, postoperative complications) (50 different codes available for “complications of foreign body left in body following a procedure in comparison to 1 in ICD-9-CM) Inclusion of trimester in obstetrics codes and elimination of fifth digits for episode of care Expanded detail relevant to ambulatory and managed care encounters Changes in timeframes specified in certain codes External cause codes no longer a supplementary classification

9. ICD-10-CM Code Format-Exclude Notes Excludes 1 notes : designate codes that can never be used together because the two conditions represented by the codes would never occur together. Example: B06 Rubella (German Measles) Excludes 1 note for: Congenital rubella P35.0

10. ICD-10 CM Code Format-Excludes Notes Excludes 2 notes: indicate that the excluded condition is a separate condition that is not a part of, or included in the condition represented by the code; but a patient may have both conditions at the same time. Example: Acute laryngitis (J04.0) has an Excludes2 of chronic laryngitis (J37.0)

11. ICD-10-CM….Code Format Extension The first significant code format issue is the use of a seventh character extension. Some conditions require an extension to provide further specificity about the condition being coded. The extension may be a number or letter and must always be the seventh character. Examples: O65.0xx1 Obstructed labor due to deformed pelvis,fetus 1 T17.220D Food in pharynx causing asphyxiation, subsequent encounter

12. ICD-10-CM….Code Format Placeholder The placeholder is always the letter "x” and it has two uses: As the fifth character for certain 6 character codes. The “x” provides for future expansion without disturbing the sixth character structure. When a code has less than 6 characters and a 7th character extension is required. The “x” is assigned for all characters less than six in order to code to meet the requirement of coding to the highest level of specificity. Examples: T37.0x1A Poisoning by sulfonamides, accidental (unintentional), initial encounter T56.0x2S Toxic effect of lead and its compounds, intentional self-harm, sequela

13. New Guidelines for I-10 CM ICD-10 CM Chapter 3 Urosepsis has no default..physician must be queried. An acute organ dysfunction must be associated with the sepsis in order to assign severe sepsis code, If the documentation is not clear query the provider.

14. New Guidelines for I-10 CM ICD-10 CM-Chapter 4 The Diabetes mellitus codes are combination codes that include: type of DM affected body system complications affecting the body system. Example : Type I Diabetes with Diabetic nephropathy E10.21 Type II Diabetes with Diabetic nephropathy E11.21

15. New Guidelines for I-10 CM ICD-10 CM-Chapter 6 Dominant/nondominant side-should this information not be available in record, the default should be Dominant. The default code for post-thoracotomy and other postoperative pain not specified as acute or chronic is the code for the acute form. Routine or expected post operative pain immediately after surgery should not be coded.

16. New Guidelines for I-10 CM ICD-10 Chapter 9 Circulatory System Combination codes for atherosclerotic heart disease with angina pectoris; it is not necessary to use an additional code for angina. Hypertension table has been eliminated. Hypertension is no longer classified as benign, malignant, unspecified,or uncontrolled code is I10.

17. New Guidelines for I-10 CM ICD-10 Chapter 9 Circulatory System CodeI21.3 (STEMI) ST elevation myocardial infarction of unspecified site is the default for the unspecified term acute myocardial infarction. Time frame decreased for Acute myocardial infarction to 4 weeks (28 days) from 8 weeks (Icd-9).

18. New Guidelines for I-10 CM ICD-10 Chapter 10 Respiratory System Many of the instructions related to chronic obstructive pulmonary disease have been eliminated in Icd-10. Codes in categories J44 and J45 distinguish between uncomplicated cases and those in acute exacerbation. Asthma must be documented as mild, moderate or severe. Mild asthma must be documented as intermittent or persistent.

19. New Guidelines for I-10 CM ICD-10 Chapter 12 Skin and Subcutaneous Tissues. In ICD-10 a single code reports both the site and the stage of the pressure ulcer. Laterality of the side of the body affected must be reported. Contact dermatitis must be documented as allergic or irritant and the substance causing the contact dermatitis must be identified. Burns are classified as due to heat(thermal) or corrosive(chemicals).

20. New Guidelines for I-10 CM ICD-10 Chapter 13 Musculoskeletal Instructions on coding site and laterality are included. Acute traumatic verses chronic or recurrent conditions are defined and coding instructions are provided. Clarifications are given for assigning a code for the joint affected verses the specific bone affected. Seventh digit character are required to identify episode of care, fracture open verses closed.

21. Comparison Table ICD-9 CodeICD-10 CodeDifference in ICD-10 174.2 Malignant neoplasm of breast rt upper-inner quadrant. C50.211, malignant neoplasm of upper inner quadrant of right female beast. Laterality 284.89 other specified aplastic anemia D61.1 Drug induced aplastic anemia Specificity in regarding cause. 250.51 Diabetes with ophthalmaic manifestations, type I, not stated as uncontrolled + 362.05 moderate non- proliferative diabetic retinopathy + Diabetic macular edema. 362.07 E10.331 Type I diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema. Combination code for diabetes and associated complications; no identification of controlled vs. uncontrolled.

22. Comparison Table ICD-9 CodeICD-10 CodeDifference in ICD-10 414.01 Coronary atherosclerosis of native coronary artery + 411.1 Intermediate coronary syndrome. I25.110 Arteriosclerotic heart disease of native artery with unstable angina pectoris. Combination code for underlying condition and associated manifestation. 466.0 Acute bronchitis + 041.5 Bacterial infection in conditions classified elsewhere, Hemophilus influenza (H. Influenza) J20.1 Acute bronchitis due to Hemophilus influenzae Combination code that include both the disease and the organism. 555.1 Regional enteritis of large intestine + 569.81 Fistula of intestine. K50.113, Crohn’s disease of large intestine with fistula. Combination code that includes both the underlying condition and associated manifestation; site specificity.