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ICD-10 Orientation In Post Acute Care (Part IV)
Rhonda Anderson, RHIA Anderson Health Information Systems, Inc. ICD-10 Orientation in Post Acute Care 4Hrs PART IV
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Location, Date, Time Northern California Southern California
Fairfield Post Acute Rehab March 20, 2014 9:00am – 3:00pm Southern California Garden View Post Acute Rehab April 9, 2014
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Presenters Staci LePage, RHIT
Mobile: Khaleelah Wagner, RHIA Mobile: ICD-10 Orientation in Post Acute Care 4Hrs PART IV
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Chapter 17 – Congenital Malformations, Deformations & Chromosomal Abnormalities Q00-Q99
Nothing significantly changed Some reorganization of the section Organized by system
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Chapter 18 – Symptoms, Signs & Abnormal Clinical & Lab Findings (R00-R99)
Expanded abdominal pain by quadrants Abnormality of gait now has 6 types Sepsis now in this chapter Abnormal lab findings now specify “without diagnosis” rather than “nonspecific abnormal finding”
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Signs/Symptoms Coding
R65 Symptoms and signs specifically asso with systemic inflammation and infection R65.1- Systemic inflammatory response syndrome/SIRS of non-infectious origin Need to know with/without organ dysfunction R65.2- Severe sepsis Need to know with/without septic shock, also code 1st underlying infection Non-fectious SIRS could be caused by heat stroke or injury and trauma – code this first ICD-10 Orientation in Post Acute Care 4Hrs PART IV
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Signs/Symptoms Codes -2
Use of symptom codes are acceptable for use when a related diagnosis has NOT been established by the provider A symptom code with a diagnosis code may be reported when the sign or symptom is NOT routinely associated with that diagnosis Signs or symptoms that are associated routinely with a disease process should NOT be assigned as additional codes
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General Signs and Symptoms R50-R69
R50 Fever of unknown origin R51 Headache R52 Pain, unspecified Excludes acute and chronic pain, NEC (G89.-) R53 Malaise and fatigue R55 Syncope and collapse R56 Convulsions, not elsewhere classified Excludes seizure disorder G40. Be aware when coding in this section – should ONLY be using these codes if no further information as to condition causing these symptoms. A single seizure (usually someone who is NOT on med to control seizures) is coded to R56, but someone with seizure disorder (is usually on med) is coded to Epilepsy G40.- Epilepsy is a brain disorder in which a person has repeated seizures (convulsions) over time ICD-10 Orientation in Post Acute Care 4Hrs PART IV
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Dysphagia R13.10 Dysphagia, unspecified R13.11 Dysphagia, oral phase
R13.12 Dysphagia, oropharyngeal phase R13.13 Dysphagia, pharyngeal phase R13.14 Dysphagia, pharyngoesophageal phase R13.19 Other dysphagia ST knows phase of dysphagia after they do ST eval. Obtain info from them. Should not have to use unspecified code very often. ICD-10 Orientation in Post Acute Care 4Hrs PART IV
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Dysphagia -2 Code first, if applicable, dysphagia following CVD (I69.-) Need to know phase of dysphagia (therapist) ST knows phase of dysphagia after they do ST eval. Obtain info from them. Should not have to use unspecified code very often. ICD-10 Orientation in Post Acute Care 4Hrs PART IV
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Other Symptoms and Signs Involving Cognitive Functions
Expanded category: R41.81 Age-related cognitive decline R41.82 Altered mental status Excludes altered mental status d/t known condition – code to condition R41.83 Borderline intellectual functioning R Other specified cognitive deficit R Cognitive communication deficit R41.89 Other S/S involving cognitive function R41.9 Unspecified S/S involving cog function SNF’s should not typically be coding altered mental status, as the condition causing the altered mental status should have been diagnosed already. R some other codes too - ICD-10 Orientation in Post Acute Care 4Hrs PART IV
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Other Symptoms and Signs Involving Cognitive Functions -2
R29.6 Repeated falls is used when a patient has recently fallen and reason for the fall is being investigated. Z91.81 Hx falls is used when a pt has fallen in the past and is at risk for future falls Need to know which are appropriate, as both of the above codes may be assigned together, as needed
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Lack of Coordination Expanded codes in ICD-10-CM
Now with subcategories: R27.0 Ataxia, unspecified R27.8 Other lack of coordination R27.9 Unspecified lack of coordination Need to know type of lack of coordination (therapist determines)
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Signs/Symptoms Involving Speech and Voice R47-R49
R47.0 Dysphasia and aphasia R47.1 Dysarthria and anarthria R47.8 Other speech disturbances R47.9 Unspecified speech disturbances Excludes these conditions when following Cerebrovascular disease I69 Therapist needs to know type of speech disturbance
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Dyslexia and Other Symbolic Dysfunctions R48
Expanded category: R48.0 Dyslexia and alexia R48.1 Agnosia R48.2 Apraxia R48.3 Visual agnosia R48.8 Other symbolic dysfunctions R48.9 Unspecified symbolic dysfunctions Therapist needs to know type of symbolic dysfunction R48.8 includes acalculia and agraphia ICD-10 Orientation in Post Acute Care 4Hrs PART IV
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Weakness R53.1 Weakness vs. M62.81 Generalized muscle weakness
Need to know if just “weakness” or “muscle weakness” R53.1 codes to just signs/symptoms code vs M62.81 codes to musculoskeletal system *preferred code ICD-10 Orientation in Post Acute Care 4Hrs PART IV
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Abnormality of Gait Difficulty in walking category has changed from unspecified joint disorders to abnormalities of gait and mobility R26.0 Ataxic gait R26.1 Paralytic gait R26.2 Difficulty in walking R26.8- Other abnormalities of gait/mobility R26.9 Unspecified abnormalities gait/mobility Need to know type of gait abnormality (therapist) Code was in ICD-9 ICD-10 Orientation in Post Acute Care 4Hrs PART IV
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Quadriplegia R53.2 Functional quadriplegia vs. G82.5- Quadriplegia
Complete immobility d/t severe physical disability or frailty vs. G82.5- Quadriplegia I69.- Paresis d/t sequelae of CVD It should only be assigned if functional quadriplegia is specifically documented in the medical record by MD. Functional quadriplegia is the lack of ability to use one’s limbs or to ambulate d/t extreme debility Since it is NOT associated with neurologic deficit or injury, code R53.2 should NOT be used for cases of neurologic quadriplegia (G82.5-) Quadriplegia, NOS (G82.50) ICD-10 Orientation in Post Acute Care 4Hrs PART IV
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Malaise and Fatigue R53 Expanded category:
R53.0 Neoplastic related fatigue R53.1 Weakness R53.2 Functional quadriplegia R53.8- Other malaise and fatigue R53.81 Other malaise (debility) R53.82 Chronic fatigue, unspecified R53.83 Other fatigue (lethargy) Only code if malaise/fatigue is NOT d/t another condition
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Chapter 19 – Injury, Poisoning & Certain Other Consequences of External Causes S00-T88
Fractures in sub-categories by: Displaced and non-displaced, then Site on the specific bone or type/name of fracture (torus, green stick, transverse, oblique spiral, comminuted, segmental), then Right or left Hip fracture has 69 possible codes ICD-10 Orientation in Post Acute Care 4Hrs PART IV
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Traumatic Fractures A fracture not indicated as open or closed should be coded to closed A fracture not indicated whether displaced or not should be coded to displaced Example: S42.321D Displaced transverse fracture of shaft of humerus, right arm, subsequent encounter for fracture with routine healing
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Traumatic Fractures -2 Need to carefully look at the pink text boxes (in the tabular) for assigning the correct 7th digit Need to know if displaced or not, type of fracture/bone, laterality Pink text box to assign this 7th character is located at the beginning of the category for S42., not on the same pg as the code. ICD-10 Orientation in Post Acute Care 4Hrs PART IV
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Types of Fractures Displaced fracture - fracture in which the two ends of the broken bone are separated from one another Non-displaced fracture - the bone cracks either part or all of the way through, but does move and maintains its proper alignment. Closed fracture - the bone breaks but there is no puncture or open wound in the skin
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Types of Fractures Open fracture - the bone breaks through the skin
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Poisoning by, Adverse Effects of and Underdosing of Drugs
Table of drugs shows following categories: Poisoning, accidental (unintentional) Poisoning, intentional (self-harm) Poisoning, assault Poisoning, undetermined Adverse effect * Underdosing * Categories have changed – be aware *was therapeutic use ICD-9 drug table with categories of: poisoning, accident, therapeutic use, suicide attempt, assault, undetermined In ICD-10, the 6th character will be: 1- for accidental, 2 – for intentional, 3 – for assault, 4 – for undetermined, 5 – for adverse effect, 6- for underdosing ICD-10 Orientation in Post Acute Care 4Hrs PART IV
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Underdosing Underdosing refers to taking less of a medication than is prescribed by a provider or a manufacturer’s instruction Assign T36-T50 with 6th character of “6” Codes for underdosing should never be assigned as principal dx Noncompliance (Z91.12-) codes are to be used with an underdosing code, if known Z pt intentional underdosing of med regimen d/t financial hardship Z pt intentional underdosing of med regimen for other reason ICD-10 Orientation in Post Acute Care 4Hrs PART IV
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Chapter 20 External Causes
Not used in long term care, not required to use
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Chapter 21 – Factors Influencing Health Status and Contact with Health Services (Z00-Z99)
For use in any healthcare setting May be used as either a principal diagnosis or secondary code Certain Z-codes may only be used as principal diagnosis *but these codes are not applicable to long term care setting These are the equivalent to ICD-9 V codes with mult changes See coding guidelines for lists of allowable first listed Z codes, etc In long term care, none of the Z codes that may only be principal/first listed are applicable to us. ICD-10 Orientation in Post Acute Care 4Hrs PART IV
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Z Codes -2 Provided for occasions when circumstances other than a dx, injury or external cause are recorded Several codes have been expanded, i.e. personal and family hx Now have a code for patients blood type, i.e. Z67 Z code should not be used if treatment is directed at a current acute disease Chapter 20 – former E codes are now V00-Y99 codes *long term care still does not code these ICD-10 Orientation in Post Acute Care 4Hrs PART IV
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Z Codes -3 No longer have V57 codes
Code the underlying condition, i.e. injury, etc. with the appropriate 7th character for subsequent encounter Z68 BMI is divided into adult and pediatric codes (Adults = age 21 or older) RD in facility can assist with documenting the BMI
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Z Codes -4 Code Z92.82 when tsf facility has admin tPA within 24 hrs prior to admit (usually with new dx of MI or CVD) Aftercare Z codes should NOT be used for aftercare of fractures For aftercare of fractures, assign fracture code with 7th character D for subsequent encounter
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Z47 Orthopedic Aftercare
Excludes aftercare for healing fracture – code to fracture with 7th character D Z47.1 Aftercare following joint replacement surg Use add’l code to id the joint (Z96.6-) Z47.3 Aftercare following explantation of joint prosthesis Need to know joint (shoulder, knee, hip) Z47 excludes aftercare for fx – only for OA, etc. not injury -Z47.2 Encounter for removal of internal fixation device *would NOT use this code in LTC setting -explantation = to remove -Z47.81 encounter for orthopedic aftercare following surgical amputation *new code ICD-10 Orientation in Post Acute Care 4Hrs PART IV
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Z47 Orthopedic Aftercare -2
Z47.8 Encounter for other orthopedic aftercare Z47.81 following surgical amputation Use add’l code to identify the limb amputated (Z89.-) Z47 excludes aftercare for fx – only for OA, etc. not injury -Z47.2 Encounter for removal of internal fixation device *would NOT use this code in LTC setting -explantation = to remove -Z47.81 encounter for orthopedic aftercare following surgical amputation *new code ICD-10 Orientation in Post Acute Care 4Hrs PART IV
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Joint Replacement ICD-9-CM: ICD-10-CM:
V54.81 Aftercare following joint replacement V43.64 Joint replacement, hip ICD-10-CM: Z47.1 Aftercare following joint replacement surgery Excludes aftercare for healing fracture Z Presence of right artificial hip joint Need to know right or left and which joint Z47 is only used for musculoskeletal conditions, ie OA, etc. ICD-10 Orientation in Post Acute Care 4Hrs PART IV
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Therapy Admission Resident admitted for physical therapy following CABG Z Encounter for surgical aftercare following surgery on the circulatory system Z95.1 Presence of aortocoronary bypass graft Plus, therapy treatment codes (muscle weakness, gait disturbance, etc), per therapists
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Amputee Status Status post L BKA admitted for dressing changes following resolved infection of the amputation stump Z48.01 Encounter for change or removal of surgical wound dressing Z Acquired absence of leg below left knee Need to know which knee and above or below the joint ICD-10 Orientation in Post Acute Care 4Hrs PART IV
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ICD-10-CM Readiness Identify if education is needed
Knowledge is a key step in successful implementation Separate roles into two groups Group that primarily assigns codes Group that primarily does NOT assign codes
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Different Knowledge Levels Defined As
A general knowledge of the code system and important differences between ICD-9 and ICD-10 Use/professional knowledge level which would be for an individual who uses coded data but is typically not assigning codes daily Application of the code set would be for those individuals who are routinely applying codes
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Education Time An employee with experience in coding (who was trained on the job) is estimated to need 18 hours of cumulative education for ICD-10 Education varies based upon the needs of each individuals skill level Intense coding education should NOT be initiated until three months before implementation
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Steps To Take Now Educational Tasks/Phase I
Learn about the structure, organization, and unique features of ICD-10 Network with peers, access resources, and read literature to identify transition issues and best practices Provide opportunity for coders to review code structure and coding conventions for ICD-10
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General Implementation Task / Phase I
Develop an implementation plan Identify steps to prepare for implementation Identify who should be involved in preparation Develop time frames for implementation phases Identify current systems that input, store and utilize ICD data Identify who is currently performing coding; in addition to other individuals who may be cross-trained for code assignment
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General Implementation -2
Review current workflow to identify areas of impact and analyze opportunities for improvement (data in MDS, health record, and claim form) Common workflow examples are diagnostic tests (laboratory, radiology, therapy diagnoses and billing) Document improvement processes
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Improvement Processes
Analyze current documentation practices, physician, nursing and therapy to identify areas in need of improvement Identify current processes that may lead to poor data quality due to inadequate or outdated documentation practices Conduct detailed assessment of staff educational needs r/t documentation
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Improvement Processes -2
Review current workflow to identify the areas of impact and analyze areas for improvement
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General Implementation Tasks / Phase 2
Determine the date of installation of facilities ICD-10 database software (must be utilized in a parallel manner with current ICD-9 code library) *by April Do NOT uninstall ICD-9 database Address timeline to begin coding current residents’ dx
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Educational Tasks / Phase 3
Continue educational plan, including intensive education for roles who primarily assign codes Practice ICD-10 coding of current records Implement process for parallel coding of current residents with ICD-10 to facilitate future data entry
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Educational Tasks / Phase 3
Provide more intensive educational and consultative support to coders and users of coded data Continue documentation improvements in areas identified for Improvement Install ICD-10 vendor software into the system to prepare for transition Perform software system testing
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General Implementation Tasks/Phase 3
ICD-9 legacy data must be maintained and available Closely monitor productivity and quality measures for issues that might be r/t implementation of new code sets ICD-10 Orientation in Post Acute Care 4Hrs PART IV
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Thanks for attending!!
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