1. Clinical Documentation Improvement – Telling The Patient Story Thru ICD-10 Clinical Documentation Improvement – Telling The Patient Story Thru ICD-10 Presented by: Karen Kvarfordt, RHIA, CCS-P, CCDS President, DiagnosisPlus, Inc. 1

2. It will change the way in which we document patient care in our medical records both in the hospital and in our practices. Patient’s story will be better told through better documentation! 2 ICD-10 Changes Everything! ICD-10 Changes Everything!

3. WHO (World Health Organization) owns & publishes ‘ICD’ (International Classification of Diseases). WHO (World Health Organization) owns & publishes ‘ICD’ (International Classification of Diseases). WHO endorsed ICD-10 in 1990; members began using ICD-10 or modifications in 1994. WHO endorsed ICD-10 in 1990; members began using ICD-10 or modifications in 1994. United States is the only industrialized country not using ICD-10 for our coding & reporting of diseases, illnesses, and injuries. Why? United States is the only industrialized country not using ICD-10 for our coding & reporting of diseases, illnesses, and injuries. Why? What makes us so different? 3 ICD-10

4. United Kingdom (1995) United Kingdom (1995) Denmark, Finland, Iceland, Norway, Sweden (1994 – 1997) Denmark, Finland, Iceland, Norway, Sweden (1994 – 1997) France (1997) France (1997) Australia (1998) Australia (1998) Belgium (1999) Belgium (1999) Germany (2000) Germany (2000) Canada (2001) Canada (2001) United States (2015) United States (2015) (Reimbursement + Case Mix) (Reimbursement + Case Mix) Countries Using ICD-10 For Case Mix 4

5. Currently the U.S. health care industry uses ICD-9-CM codes for identifying and reporting diagnoses and procedures. Currently the U.S. health care industry uses ICD-9-CM codes for identifying and reporting diagnoses and procedures. ICD-10 will replace the existing ICD-9 code sets (diagnosis & procedure) effective October 1, 2015. ICD-10 will replace the existing ICD-9 code sets (diagnosis & procedure) effective October 1, 2015. ICD-10-CM = Diagnosis codes ICD-10-CM = Diagnosis codes ICD-10-PCS = Inpatient hospital procedure codes only ICD-10-PCS = Inpatient hospital procedure codes only No impact on CPT and/or HCPCS codes! No impact on CPT and/or HCPCS codes! CPT and HCPCS codes will continue to be used for physician and outpatient services including physician hospital visits (Observation & Inpatient) = E&M CPT and HCPCS codes will continue to be used for physician and outpatient services including physician hospital visits (Observation & Inpatient) = E&M 5 What is ICD-10? What is ICD-10?

6. Why Should We Do ICD-10? What is the benefit to the provider? What is the benefit to the provider? Dramatic improvement in the assignment of costs to procedures performed. Dramatic improvement in the assignment of costs to procedures performed. ICD-10 will allow us to develop meaningful estimates about what a disease state or a procedure costs us, while ICD-9 is limited in what it can do in this regard. ICD-10 will allow us to develop meaningful estimates about what a disease state or a procedure costs us, while ICD-9 is limited in what it can do in this regard. Identify opportunities to avoid cost & improve lives. Identify opportunities to avoid cost & improve lives. Additional information in an ICD-10 diagnosis code includes severity and specific comorbidity, but it can also include information about demographics and some of the underlying reasons for the diagnosis. Additional information in an ICD-10 diagnosis code includes severity and specific comorbidity, but it can also include information about demographics and some of the underlying reasons for the diagnosis. 6

7. Additional Benefits… Share higher-quality data with other health care providers. Share higher-quality data with other health care providers. ICD-10 increases the amount of “specific” information in every diagnosis code and makes this more valuable to other providers. ICD-10 increases the amount of “specific” information in every diagnosis code and makes this more valuable to other providers. For example, ICD-9 has a code for laceration of an artery. For example, ICD-9 has a code for laceration of an artery. ICD-10 lets you know if that artery was in someone’s finger or in their heart. ICD-10 lets you know if that artery was in someone’s finger or in their heart. 7

8. Reimbursements will better align with activity & cost. Reimbursements will better align with activity & cost. Payers will reimburse severe & complex cases better and simple cases at lower rates. Payers will reimburse severe & complex cases better and simple cases at lower rates. How? By the diagnosis codes! How? By the diagnosis codes! 8

9. Here’s an Example Imagine you had a patient who was noncompliant with their medical therapy. Imagine you had a patient who was noncompliant with their medical therapy. In ICD-9, the only code we have available is V15.81 (personal history of noncompliance with medical treatment). In ICD-9, the only code we have available is V15.81 (personal history of noncompliance with medical treatment). Is the patient noncompliant because of their own personal reason? Or something else? Is the patient noncompliant because of their own personal reason? Or something else? 9

10. How Will it Look in ICD-10? Z9111 (Patient’s noncompliance with dietary regimen) Z9111 (Patient’s noncompliance with dietary regimen) Z91120 (Patient's intentional underdosing of medication Z91120 (Patient's intentional underdosing of medication regimen due to financial hardship) regimen due to financial hardship) Z91128 (Patient’s intentional underdosing of medication Z91128 (Patient’s intentional underdosing of medication regimen for other reason) regimen for other reason) Z91130 (Patient’s unintentional underdosing of medication Z91130 (Patient’s unintentional underdosing of medication regimen due to age-related debility) regimen due to age-related debility) Z91138 (Patient’s unintentional underdosing of medication Z91138 (Patient’s unintentional underdosing of medication regimen for other reason) regimen for other reason) Shows whether or not the patient’s noncompliance was intentional, but also identifies if the patient needs some form of assistance from social services, etc. 10

11. Diagnosis Coding (ICD-10-CM) 11

12. Allows for greater “specificity & detail” which is currently lacking in ICD-9-CM. Allows for greater “specificity & detail” which is currently lacking in ICD-9-CM. Moving from 14,000 ► 69,000 diagnosis codes! Moving from 14,000 ► 69,000 diagnosis codes! 25,000 (36%) of all ICD-10-CM diagnosis codes will now distinguish ‘right’ vs. ‘left’. 25,000 (36%) of all ICD-10-CM diagnosis codes will now distinguish ‘right’ vs. ‘left’. Must be documented in the medical record Must be documented in the medical record for code capture. for code capture. Expanded # of characters of the ICD-10-CM diagnosis codes will provide greater specificity to identify: etiology, anatomical site, & severity Expanded # of characters of the ICD-10-CM diagnosis codes will provide greater specificity to identify: etiology, anatomical site, & severity 12 ICD-10-CM

13. Why Are There So Many New Codes? Why Are There So Many New Codes? Main difference between ICD-9-CM and ICD- 10-CM codes, outside of structural changes, is the “SPECIFICITY” of the code. Main difference between ICD-9-CM and ICD- 10-CM codes, outside of structural changes, is the “SPECIFICITY” of the code. ICD-10-CM diagnosis codes will range anywhere from 3 to 7 characters which will allow us to capture this greater detail. ICD-10-CM diagnosis codes will range anywhere from 3 to 7 characters which will allow us to capture this greater detail. But it must be documented in the record! But it must be documented in the record! 13

14. ICD-9-CM ◦ 3 - 5 digits or characters ◦ 1st character is numeric or alpha (E or V codes) ◦ 2 nd – 5 th characters are numeric ◦ Decimal placed after the first 3 characters ◦ 17 Chapters and “V” & “E” codes are ‘supplemental’ ◦ 14,000 diagnosis codes ICD-10-CM ◦ 3 - 7 ◦ 3 - 7 digits or characters alpha ◦ 1 st character is alpha (all letters used except “U”) ◦ 2 nd – 7 th alpha and/or numeric ◦ 2 nd – 7 th characters can be alpha and/or numeric ◦ Decimal placed after the first 3 characters (the same!) ◦ 21 not’ ◦ 21 Chapters and “V” & “E” codes are ‘not’ supplemental ◦ 69,000+ ◦ 69,000+ diagnosis codes 14 ICD-9-CM vs. ICD-10-CM ICD-9-CM vs. ICD-10-CM

15. ICD-9-CM (Irregular Astigmatism) (367.22) ICD-9-CM (Irregular Astigmatism) (367.22) Only 1 code in ICD-9-CM Only 1 code in ICD-9-CM ICD-10-CM (Irregular Astigmatism) ICD-10-CM (Irregular Astigmatism) Will have four choices: Will have four choices: H52.211 (irregular astigmatism, right eye) H52.211 (irregular astigmatism, right eye) H52.212 (irregular astigmatism, left eye) H52.212 (irregular astigmatism, left eye) H52.213 (irregular astigmatism, bilateral) H52.213 (irregular astigmatism, bilateral) H52.219 (irregular astigmatism, unspecified eye) H52.219 (irregular astigmatism, unspecified eye) Physicians are likely documenting “laterality” now, but coders aren’t looking for it. Physicians are likely documenting “laterality” now, but coders aren’t looking for it. One easy place to look for documentation improvement! One easy place to look for documentation improvement! Level of Detail Example Level of Detail Example 15

16. LATERALITY LATERALITY For bilateral sites, the final character of the codes in ICD-10-CM indicate laterality. For bilateral sites, the final character of the codes in ICD-10-CM indicate laterality. Right side is always character 1 (RT) Right side is always character 1 (RT) Left side is always character 2 (LT) Left side is always character 2 (LT) Bilateral code is always character 3 (RT & LT) Bilateral code is always character 3 (RT & LT) But be careful! Not all codes will have a ‘bilateral’ distinction, i.e., carpal tunnel, etc. But be careful! Not all codes will have a ‘bilateral’ distinction, i.e., carpal tunnel, etc. “Unspecified” side code is also provided should the side not be documented in the medical record. “Unspecified” side code is also provided should the side not be documented in the medical record. Did we just lose our specificity? Did we just lose our specificity? Biggest Change in ICD-10-CM Biggest Change in ICD-10-CM 16

17. Joint pain Joint pain Joint effusion Joint effusion Injuries Injuries Fractures Fractures Dislocations Dislocations Arthritis Arthritis Cerebral infarction Cerebral infarction Extremity atherosclerosis Extremity atherosclerosis Pressure ulcers Pressure ulcers Cancers, neoplasms (breast, lung, bones, etc.) Cancers, neoplasms (breast, lung, bones, etc.) Diagnoses That Will Require Laterality Diagnoses That Will Require Laterality 17

18. Injuries Seventh (7 th ) character identifies the patient encounter type, with “A” for the initial encounter, “D” for the subsequent encounter and “S” for sequela encounter. Seventh (7 th ) character identifies the patient encounter type, with “A” for the initial encounter, “D” for the subsequent encounter and “S” for sequela encounter. Initial = Patient is receiving ‘active’ treatment Initial = Patient is receiving ‘active’ treatment First time being seen for the injury, i.e., ER visit, surgery, evaluation by new physician First time being seen for the injury, i.e., ER visit, surgery, evaluation by new physician Subsequent = Follow-up care Subsequent = Follow-up care Sequela = Complication of a previous injury Sequela = Complication of a previous injury 18

19. I10 Essential (primary) hypertension I10 Essential (primary) hypertension S01.02xA Laceration with foreign body of scalp, initial encounter S01.02xA Laceration with foreign body of scalp, initial encounter S01.02xD Laceration with foreign body of scalp, subsequent encounter S01.02xD Laceration with foreign body of scalp, subsequent encounter S02.2xxA Fracture of nasal bones, initial encounter for closed fracture S02.2xxA Fracture of nasal bones, initial encounter for closed fracture H65.01 Acute serous otitis media, right ear H65.01 Acute serous otitis media, right ear H65.02 Acute serous otitis media, left ear H65.02 Acute serous otitis media, left ear H65.03 Acute serous otitis media, bilateral H65.03 Acute serous otitis media, bilateral 19 Examples of ICD-10-CM Emergency Room Examples of ICD-10-CM Emergency Room

20. Procedure Coding (ICD-10-PCS) 20

21. ICD-10-PCS Characters (Medical and Surgical Section) ICD-10-PCS Characters (Medical and Surgical Section) Root Root Section Operation Approach Qualifier Section Operation Approach Qualifier Body Body Device Body Body Device System Part System Part 1 2 3 4 5 6 7 21

22. Dissect ICD-10-PCS Code Dissect ICD-10-PCS Code Endoscopic Esophageal Excision via Natural or Artificial Opening ICD-9-CM: 45.16 Esophagogastroduodenoscopy (EGD) with Closed Biopsy 22 0DB58ZX Section (Medical/Surgical) Body System (Gastro- intestinal) Root Operation (Excision) Body Part (Esophagus) Approach (Via natural or artificial opening endoscopic) Device (No Device) Qualifier (Diagnostic)

23. What’s New In ICD-10? 23

24. Under ICD-10-CM diagnosis codes will be based on the stage of pregnancy Under ICD-10-CM diagnosis codes will be based on the stage of pregnancy First trimester First trimester Second trimester Second trimester Third trimester Third trimester Trimesters are counted from the first day of the last menstrual period, and defined as: Trimesters are counted from the first day of the last menstrual period, and defined as: First trimester: Fewer than 14 weeks First trimester: Fewer than 14 weeks Second trimester: Fourteen weeks Second trimester: Fourteen weeks Third trimester: Twenty-eight weeks Third trimester: Twenty-eight weeks Obstetrics Obstetrics 24

25. ICD-10-CM contains a separate category for nicotine dependence with subcategories to identify the specific tobacco product and nicotine-induced disorder(s). For example: ICD-10-CM contains a separate category for nicotine dependence with subcategories to identify the specific tobacco product and nicotine-induced disorder(s). For example: Cigarettes Cigarettes Chewing tobacco Chewing tobacco Cigar, etc. Cigar, etc. ICD-9 has only one diagnosis code (305.1) for tobacco use disorder or tobacco dependence. ICD-9 has only one diagnosis code (305.1) for tobacco use disorder or tobacco dependence. Nicotine Dependence 25

26. New diagnosis code in the ICD-10 world! New diagnosis code in the ICD-10 world! Identifies situations in which a patient has taken less of a medication than prescribed by the physician and captures those reason(s). Identifies situations in which a patient has taken less of a medication than prescribed by the physician and captures those reason(s). Must be documented in the record! Must be documented in the record! Financial Financial Non-compliance* Non-compliance* Underdosing 26

27. Burn codes identify: Burn codes identify: Thermal burns, except for sunburns, that come from a heat source Thermal burns, except for sunburns, that come from a heat source Burns resulting from electricity and/or radiation Burns resulting from electricity and/or radiation Addition of the term “corrosion” is new in Addition of the term “corrosion” is new in ICD-10-CM: ICD-10-CM: Corrosions are burns due to chemicals Corrosions are burns due to chemicals Burns and Corrosions 27

28. Physician Documentation 28

29. 1. Laterality (left vs. right) 2. Stage of Care (initial or follow-up) 3. Specific Diagnosis (acute vs. chronic) 4. Specific Anatomy (specific bone in the hand) 5. Associated and/or Related Conditions 6. Cause of Injury (hit by baseball, fall) 7. Documentation of Additional Symptoms or Conditions 8. Dominant vs. Non-Dominant Side 9. Tobacco Exposure or Use 10. Gustilo-Anderson Scale 29 Top 10 Documentation ‘Pearls’

30. Documentation Tips For Specific Diagnoses 30

31. GERD Documentation GERD Documentation ICD-10-CM will include 2 codes but does not include the abbreviation “GERD” ICD-10-CM will include 2 codes but does not include the abbreviation “GERD” K21.0 (Gastro-esophageal reflux disease with esophagitis) K21.0 (Gastro-esophageal reflux disease with esophagitis) K21.9 (Gastro-esophageal reflux disease without K21.9 (Gastro-esophageal reflux disease without esophagitis) esophagitis) Barrett’s now broken down: Barrett’s now broken down: With or without ulcer With or without ulcer With or without dysplasia With or without dysplasia Staging of dysplasia Staging of dysplasia Low grade Low grade High grade High grade 31

32. Digestive Ulcer Documentation needs to include the specific location: Documentation needs to include the specific location: Gastric Gastric Duodenal Duodenal Peptic Peptic Gastrojejunal Gastrojejunal Further specificity needs to identify: Further specificity needs to identify: Acute or chronic Acute or chronic With hemorrhage With hemorrhage With perforation With perforation With hemorrhage and perforation With hemorrhage and perforation Without mention of hemorrhage or perforation Without mention of hemorrhage or perforation 32

33. Document the Severity (3 levels): Document the Severity (3 levels): 1. Mild (more than two times per week) 2. Moderate (daily and may restrict physical activity) 3. Severe (throughout the day with frequent severe attacks limiting the ability to breathe) Clarify whether acute, chronic, intrinsic or extrinsic Clarify whether acute, chronic, intrinsic or extrinsic Specify exercise-induced or other forms Specify exercise-induced or other forms Specify when chronic state asthmatic bronchitis exists and when acute exacerbation occurs Specify when chronic state asthmatic bronchitis exists and when acute exacerbation occurs Document tobacco exposure or history of Document tobacco exposure or history of Asthma Documentation 33

34. Congestive Heart Failure Congestive Heart Failure Documentation in ICD-10-CM needs to identify whether the CHF is acute or chronic and the specific ‘type’ of heart failure: Documentation in ICD-10-CM needs to identify whether the CHF is acute or chronic and the specific ‘type’ of heart failure: Combined systolic & diastolic Combined systolic & diastolic Diastolic Diastolic Systolic Systolic Left ventricular Left ventricular 34

35. Bronchitis Bronchitis Need to include specificity such as: Need to include specificity such as: Acute or subacute Acute or subacute Further specify with bronchiectasis, COPD, etc. Further specify with bronchiectasis, COPD, etc. Allergic Allergic Asthmatic Asthmatic Chronic Chronic Obstructive Obstructive Viral Viral 35

36. ICD-9 features 59 codes for diabetes, while ICD-10 offers more than 200 and adds a provision of “poorly controlled” to categories of controlled or not controlled. ICD-9 features 59 codes for diabetes, while ICD-10 offers more than 200 and adds a provision of “poorly controlled” to categories of controlled or not controlled. Diabetes mellitus codes expanded to include the classification of the diabetes AND the manifestation. Diabetes mellitus codes expanded to include the classification of the diabetes AND the manifestation. Needs to be clearly documented in the record! Needs to be clearly documented in the record! Diabetes Mellitus 36

37. More on Diabetes Identify Type 1, Type 2, due to other secondary cause, i.e., gestational, etc. Identify Type 1, Type 2, due to other secondary cause, i.e., gestational, etc. In Type 2 or secondary cause, identify when using insulin long-term In Type 2 or secondary cause, identify when using insulin long-term Identify all body systems affected by the diabetes (neuropathy and its manifestation, retinopathy and proliferative or nonproliferative, nephropathy and stage of CKD, vasculopathy, etc.) Identify all body systems affected by the diabetes (neuropathy and its manifestation, retinopathy and proliferative or nonproliferative, nephropathy and stage of CKD, vasculopathy, etc.) Identify all manifestations (ulcer, coma, gangrene, osteomyelitis, etc.) Identify all manifestations (ulcer, coma, gangrene, osteomyelitis, etc.) 37

38. Hypertension & CKD When a patient has both a diagnosis of hypertension and CKD, there is an assumed ‘cause and effect’ relationship and will be reported as “hypertensive chronic kidney disease, stage I through stage IV, or unspecified, unspecified benign or malignant”. When a patient has both a diagnosis of hypertension and CKD, there is an assumed ‘cause and effect’ relationship and will be reported as “hypertensive chronic kidney disease, stage I through stage IV, or unspecified, unspecified benign or malignant”. If not related, provider documentation must be stated as not due to hypertension. If not related, provider documentation must be stated as not due to hypertension. 38

39. Additional documentation needs to include: Additional documentation needs to include: Stage I Stage I Stage II (mild) Stage II (mild) Stage III (moderate) Stage III (moderate) Stage IV (severe) Stage IV (severe) Stage V Stage V Requiring chronic dialysis Requiring chronic dialysis End-stage renal disease End-stage renal disease 39

40. Chest Pain Chest Pain Medical record documentation must include the specific location of the chest pain: Medical record documentation must include the specific location of the chest pain: Anterior wall Anterior wall Atypical Atypical Intercostal Intercostal Musculoskeletal Musculoskeletal Non-cardiac Non-cardiac Precordial Precordial 40

41. Documentation will need to include the following Documentation will need to include the following to accurately code a fracture in ICD-10-CM: to accurately code a fracture in ICD-10-CM: Displaced or non-displaced Displaced or non-displaced Open or closed Open or closed Laterality (left vs. right vs. bilateral) Laterality (left vs. right vs. bilateral) Specific bone and location of the bone Specific bone and location of the bone Distal, proximal, mid-shaft, etc. Distal, proximal, mid-shaft, etc. Encounter Encounter Initial, subsequent, sequela Initial, subsequent, sequela Fracture Documentation Fracture Documentation 41

42. Subsequent encounter for open and closed fractures: Subsequent encounter for open and closed fractures: Used for encounters after active fracture treatment has been completed and the patient is receiving routine care during the healing or recovery period. Used for encounters after active fracture treatment has been completed and the patient is receiving routine care during the healing or recovery period. Closed Fracture 7 th Character Extensions: Closed Fracture 7 th Character Extensions: D ► Routine healing or aftercare D ► Routine healing or aftercare G ► Delayed healing G ► Delayed healing K ► Nonunion K ► Nonunion P ► Malunion P ► Malunion Fracture “Subsequent” Encounter Fracture “Subsequent” Encounter 42

43. Gustilo-Anderson classification identifies the ‘severity of soft tissue damage’ in open fractures – may be new to coders and physicians: Gustilo-Anderson classification identifies the ‘severity of soft tissue damage’ in open fractures – may be new to coders and physicians: Type I: Wound is smaller than 1 cm, clean, and generally caused by a fracture fragment that pierces the skin (low energy injury) Type I: Wound is smaller than 1 cm, clean, and generally caused by a fracture fragment that pierces the skin (low energy injury) Type II: Wound is longer than 1 cm, not contaminated, and w/o major soft tissue damage or defect (low energy injury) Type II: Wound is longer than 1 cm, not contaminated, and w/o major soft tissue damage or defect (low energy injury) Type III: Wound is longer than 1 cm, with significant soft tissue disruption. The mechanism often involves high- energy trauma, resulting in a severely unstable fracture with varying degrees of fragmentation. Type III: Wound is longer than 1 cm, with significant soft tissue disruption. The mechanism often involves high- energy trauma, resulting in a severely unstable fracture with varying degrees of fragmentation. What is Gustilo-Anderson Scale? What is Gustilo-Anderson Scale? 43

44. Hernias Specify location (inguinal, femoral, umbilical, ventral, diaphragmatic; all other abdominal hernias default to “other”, etc.) Specify location (inguinal, femoral, umbilical, ventral, diaphragmatic; all other abdominal hernias default to “other”, etc.) Specify unilateral (which side) or bilateral Specify unilateral (which side) or bilateral Specify with obstruction when present Specify with obstruction when present Specify with gangrene when present Specify with gangrene when present Specify when recurrent hernia (defaults to primary) Specify when recurrent hernia (defaults to primary) 44

45. Malignancy Example Malignant Neoplasm Lung/Bronchus Malignant Neoplasm Lung/Bronchus 63 choices available in ICD-10-CM 63 choices available in ICD-10-CM Documentation must include: Documentation must include: Specific site/location: Specific site/location: Hilus, lingula, main bronchus, lower lobe, middle lobe, upper lobe, etc. Hilus, lingula, main bronchus, lower lobe, middle lobe, upper lobe, etc. Laterality Laterality Tobacco exposure or use (secondary diagnosis) Tobacco exposure or use (secondary diagnosis) Example: C34.2 (Malignant neoplasm of middle lobe, bronchus or lung) Example: C34.2 (Malignant neoplasm of middle lobe, bronchus or lung) 45

46. ICD-10-CM diagnosis codes will impact every physician practice large or small! ICD-10-CM diagnosis codes will impact every physician practice large or small! Look at all areas that will impact your practice and identify each one that will be affected: Look at all areas that will impact your practice and identify each one that will be affected: Practice Management System Practice Management System Electronic Medical Record (EMR) Electronic Medical Record (EMR) Paper record Paper record Superbill/encounter form – Does it have diagnosis codes on it? Superbill/encounter form – Does it have diagnosis codes on it? Lab requisitions Lab requisitions Physician Practices 46

47. Although the coding book is “huge”, many physician practices use only a small set or # of diagnosis codes. Although the coding book is “huge”, many physician practices use only a small set or # of diagnosis codes. Start developing crosswalks between Start developing crosswalks between ICD-9-CM & ICD-10-CM codes you use ICD-9-CM & ICD-10-CM codes you use most frequently in the office. most frequently in the office. Revise your superbill/encounter form if it currently contains ICD-9-CM codes. Revise your superbill/encounter form if it currently contains ICD-9-CM codes. Task Is Not As Huge As It Appears! 47

48. That’s ICD-10! 48

49. Contact Info: Karen Kvarfordt, RHIA, CCS-P, CCDS AHIMA Certified ICD-10 Trainer President, DiagnosisPlus, Inc. PO Box 486 Pocatello, ID 83204 (208) 221-5486 diagnosisplus1@live.com 49