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2. Today’s Panelists: Sandy Giangreco, Sandy Giangreco, RHIT, CCS, RCC, CPC, CPC-H, CPC-I, PCS, AHIMA Approved ICD-10 CM/PCS Trainer CHIMA ICD-10 Task Force Robin Linker, Robin Linker, CHCA, CHCAS, CPC-I, CCS-P, CPC-H, CPC-P, MCS-P, CHC Approved ICD-10-CM / PCS Trainer (AHCAE, AMA, AAPC) Robin Linker & Associates, Inc. and Executive Director, Association of Health Care Auditors and Educators 2

3. ICD-10-CM Basics ICD-10-CM is very similar to ICD-9-CM as far as look up and basic guideline information Total number of codes expands from about 14,000 ICD-9-CM codes to well over 68,000 in ICD-10-CM ICD-10 Uses full code titles, ICD-9 does not Plenty of room for expansion in ICD-10 3

4. ICD-9-CM Diagnosis Codes Are 3–5 digits; The first digit is alpha (E or V) or numeric (alpha characters are not case sensitive); Digits 2–5 are numeric; and A decimal is used after the third character. Examples: 496 – Chronic airway obstruction, not elsewhere classified (NEC); 511.9 – Unspecified pleural effusion; and V02.61 – Hepatitis B carrier 4

5. ICD-10-CM Diagnosis Codes Are 3–7 digits; Digit 1 is alpha; Digit 2 is numeric; Digits 3–7 are alpha or numeric (alpha characters are not case sensitive); and A decimal is used after the third character. Examples: A78 – Q fever; A69.21 – Meningitis due to Lyme disease; and S52.131A – Displaced fracture of neck of right radius, initial encounter for closed fracture. 5

6. ICD-10-CM Code Structure 6 Category first three characters Etiology, anatomic site, severity, fourth, fifth, sixth characters (if applicable) Extension seventh character (if applicable) M84 Disorder of continuity of bone M84.311- Stress fracture, right shoulder M84.311A Stress fracture, right shoulder; initial encounter

7. New Features in ICD-10-CM Laterality (Left, Right, Bilateral) Combination codes for certain conditions and common associated symptoms and manifestations Combination codes for poisonings and their associated external cause Obstetric codes identify trimester instead of episode of care 7

8. New Features in ICD-10-CM Placeholder “X” Character 8 4. Placeholder character The ICD-10-CM utilizes a placeholder character “X”. The “X” is used as a placeholder at certain codes to allow for future expansion. An example of this is at the poisoning, adverse effect and underdosing codes, categories T36-T50. Where a placeholder exists, the X must be used in order for the code to be considered a valid code. Example: H40.11X1 Mild stage primary open-angle glaucoma

9. 5. 7th Characters Certain ICD-10-CM categories have applicable 7th characters. The applicable 7th character is required for all codes within the category, or as the notes in the Tabular List instruct. The 7th character must always be the 7th character in the data field. If a code that requires a 7th character is not 6 characters, a placeholder X must be used to fill in the empty characters. Example 1: Some codes have even more! Example 2: 9 T79.0XXA Initial encounter for a traumatic air embolism W06.XXXD Subsequent encounter for a fall from a bed

10. 2014 ICD-10-CM Guideline Change 10

11. New Features in ICD-10-CM cont. The 7th character in ICD-10-CM is used in several chapters (for example, the Obstetrics, Injury, Musculoskeletal, and External Cause chapters). It has a different meaning depending on the section where it is being used (for example, in the Injury and External Cause sections, the 7th character often classifies an initial encounter, subsequent encounter, or sequelae (late effect) but may include others. Primarily, changes in ICD-10-CM are in its organization and structure, code composition and level of detail. 11

12. Examples of the Numbers by Specialty Specialty# ICD-9 Codes# ICD-10 Codes Gastroenterologists596706 Pulmonologists255336 Urologists389591 Endocrinologists335675 Neurologists459591 Pediatricians702591 Infectious Disease1,2701,056 12

13. Where are most of the new codes? The majority are in musculoskeletal and injury/poisoning: -Increased specificity of type of fracture, laterality, specific bone and encounter information.* -Increased doesn’t mean increased complexity, if you take away the 7 th character for encounter, the number of codes drop significantly. *Tip – documenting these additional elements will simplify the ICD-10 transition. 13

14. Questions? Z00.121 – Routine infant/child exam with abnormal findings – Does this include a separate and identifiable problem like an ear infection or is this limited to a problem within normal growth and development such as failing a hearing screen? 14 Section IV. Diagnostic Coding and Reporting Guidelines for Outpatient Services P. Encounters for general medical examinations with abnormal findings The subcategories for encounters for general medical examinations, Z00.0-, provide codes for with and without abnormal findings. Should a general medical examination result in an abnormal finding, the code for general medical examination with abnormal finding should be assigned as the first-listed diagnosis. A secondary code for the abnormal finding should also be coded.

15. Questions? We frequently use 079.99 – Viral syndrome And have identified a couple of options: B34.9 Viral infection, unspecified, or B97.89 Other viral agents as the cause of disease classified elsewhere (Use of this code requires we have diagnosed a disease.) – When we see these kids, the disease is a basket of symptoms that point to a viral illness. Which one should we use? – Let’s look at GEMS………………These can be found on the CMS website or the CDC website 15

16. GEMS (General Equivalency Mapping System) ICD-9-CM ICD-10-CM FlagMeaning 07999 B9789 10000Approximate Match 080 A750 00000Exact Match 16 CAUTION! You cannot rely simply on the GEMS system to cross-match everything. If the flag is other than “00000” there are other potential possibilities. It’s best to start in the alphabetic index and then complete the look up process in the tabular.

17. Questions? Let’s look up Viral syndrome in ICD-10-CM 1.Alphabetic Index2. Tabular Index Syndrome B34.9 Viral Infection, Unspecified 17 - virus B34.9

18. Useful Website Resources to Assist! AHIMA: https://www.ahima.org/icd10/ AMA: https://www.ama-assn.org/go/icd-10 CMS: https://www.cms.gov/icd10/ CDC: http://www.cdc.gov/nchs/icd/icd10cm.htm 18

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22. Questions? 22

23. Next Steps September 17 th – panel discussion with private payers October 15 th – panel discussion with government payers Email questions to marilyn_rissmiller@cms.orgmarilyn_rissmiller@cms.org 23

24. www.cms.org/icd-10 24