1. ICD-10
Getting There…..
Dermatology

2. What Physicians Need To Know
Claims for ambulatory and physician services provided on or after 10/1/2015 must use ICD-10-CM diagnosis codes.
Hospital inpatient claims for discharges occurring on or after 10/1/2015 must use ICD-10-CM diagnosis codes.
CPT Codes will continue to be used for physician inpatient and outpatient services and for hospital outpatient procedures.
ICD-10-PCS – a NEW procedure coding classification system, must be used to code all inpatient procedures on Facility Claims for discharges on or after 10/1/15.
ICD-9-CM codes must continue to be used for all dates of services on or before 9/30/2015.
Further delays are not likely.
What Physicians Need To Know

3. ICD-9 vs ICD-10 Diagnosis Codes
ICD-9-CM Diagnosis Codes
ICD-10-CM Diagnosis Codes
3 to 5 digits
7 digits
Alpha “E” & “V” – 1st Character
Alpha or numeric for any character
No place holder characters
Include place holder characters (“x”)
Terminology
Similar
Index and Tabular Structure
Coding Guidelines
Somewhat similar
Approximately 14,000 codes
Approximately 69,000 codes
Severity parameters limited
Extensive severity parameters
Does not include laterality
Common definition of laterality
Combination codes limited
Combination codes common
ICD-9 vs ICD-10 Diagnosis Codes

4. Number of Codes by Clinical Area
ICD-9 Codes
ICD-10 Codes
Fractures
747
17,099
Poisoning and Toxic Effects
244
4,662
Pregnancy Related Conditions
1,104
2,155
Brain Injury
292
574
Diabetes 69
239
Migraine 40 44
Bleeding Disorders 26 29
Mood Related Disorders 78 71
Hypertensive Disease 33 14
End Stage Renal Disease 11 5
Chronic Respiratory Failure 7 4
Right vs. left accounts for nearly ½ the increase in the # of codes.
Number of Codes by Clinical Area

5. The Importance of Good Documentation
The role of the provider is to accurately and specifically document the nature of the patient’s condition and treatment.
The role of the Clinical Documentation Specialist is to query the provider for clarification, ensuring the documentation accurately reflects the severity of illness and risk of mortality.
The role of the coder is to ensure that coding is consistent with the documentation.
Good documentation….
Supports proper payment and reduces denials
Assures accurate measures of quality and efficiency
Captures the level of risk and severity
Supports clinical research
Enhances communication with hospital and other providers
It’s just good care!
The Importance of Good Documentation

6. Severity, cause, specific ingested substance, and encounter type.
Inadequate Documentation
Required ICD-10 Documentation
Here for rash eval. On day 4 of antibiotic course for strep throat.
Woke up with maculopapular rash. Reports taking antibiotics this morning. Rash secondary to drug allergy.
Here for rash eval. On day 4 of Amoxicillin course for strep throat.
Woke up with generalized maculopapular rash. Reports taking antibiotics as prescribed. Rash secondary to PCN allergy.
Needed improvements:
Severity, cause, specific ingested substance, and encounter type.
Inadequate vs. Adequate Documentation Example 1: Dermatitis Related to Ingested Substances

7. Inadequate vs. Adequate Documentation Example 2: Skin Cancer
Inadequate Documentation
Required ICD-10 Documentation
Biopsy proven skin cancer of arm and vitiligo.
Biopsy proven malignant melanoma of left upper arm. Right lower eyelid and periocular vitiligo.
Needed improvements:
Site, laterality, type, stage and underlying condition(s).
Inadequate vs. Adequate Documentation Example 2: Skin Cancer

8. Inadequate vs. Adequate Documentation Example 3: Burns
Inadequate Documentation
Required ICD-10 Documentation
Consulted to assist with management of patient with multiple burns due to an incident occurring 2 weeks ago.
Approximately 13.5% of BSA with burns.
Consulted to assist with management of patient with third degree burn of left anterior arm, second degree burns bilateral thighs. Third degree burn covers 4.5% of BSA. Second degree burns cover 9% of BSA.
Patient was using pressure cooker at home and accidently spilled scalding water on herself 2 weeks ago.
Needed improvements:
Site, laterality, body surface area (BSA) by degree of burn, and injury specifics.
Inadequate vs. Adequate Documentation Example 3: Burns

9. Inadequate vs. Adequate Documentation Example 4: Pressure Ulcers
Inadequate Documentation
Required ICD-10 Documentation
Terminally ill nursing home resident with diabetes, S/P above knee amputation presents for G-tube placement. He has multiple pressure ulcers of varying stages & measurements. Ulcer noted on back, hip, & buttock. There is also some injury noted on the coccyx.
Terminally ill nursing home resident with type II NIDDM, S/P (L) above knee amputation presents for G-tube placement. Stage 1 decubitus (L) upper back, stage 2 decubitus extending from (R) hip to (R) lower back including (R) buttock. Coccyx with deep tissue injury.
Needed improvements:
Location, laterality, contiguous ulcers, stages(s), underlying condition(s), and complication(s).
Inadequate vs. Adequate Documentation Example 4: Pressure Ulcers

10. Key Requirements for Documentation
Identify dermatological disorders with and etiology of physiological origin.
Identify the exact site, laterality, and the morphology type as either primary or secondary.
Identify conditions that are known to be the cause of any disorder
Clarify the specific disease type, if known, rather than using umbrella terms such as “dermatitis”.
List any associated conditions (e.g., Type I Diabetes, Allergies)
With ICD-10, the need for specific and accurate documentation is increased significantly.

11. Using Sign/Symptom and Unspecified Codes
Sign/symptom and “unspecified” codes have acceptable, even necessary, uses.
If a definitive diagnosis has not been established by the end of the encounter, it is appropriate to report codes for signs and/or symptoms in lieu of a definitive diagnosis.
When sufficient clinical information is not known or available about a particular health condition, it is acceptable to report the appropriate “unspecified” code.
It is inappropriate to select a SPECIFIC code that is not supported by the medical record documentation.
Using Sign/Symptom and Unspecified Codes

12. Training for Physicians
Dates
Method
Content
Nov 2014 – Jan 2015
Department Meetings
Introduction/Overview
Jan 2015 – Mar 2015
Web-based
Overview
Service Specific Documentation
Future Order Entry
Diagnosis Assistant
Mar 2015 – Jun 2015
Classroom
Documenting for ICD10 using the Electronic Health Record
Jun 2015 – Sep 2015
Documenting Operative and Procedure Notes for ICD-10-PCS
Training for Physicians

13. Future Orders & Diagnosis Assistant
Demonstration
Future Orders & Diagnosis Assistant