1. Angela R Campbell, RHIA AHIMA Approved ICD-10-CM/PCS Trainer Eastern Illinois University

2. * Differences are in the organization of ICD-10-CM * ICD-10-CM has the same hierarchical structure as ICD-9-CM. * First three characters of the code and all codes within the same category have similar traits.

3. * ICD-10-CM offers the addition of information relative to ambulatory and managed care encounters. * Conditions that are new or that were not uniquely identified in ICD-9-CM have been assigned code numbers in ICD-10-CM. * In ICD-10-CM, some three-character categories are not used in order to allow for revisions and future expansion.

4. * ICD-10-CM codes are alphanumeric and include all letters except "U”. * ICD-9-CM’s V and E codes are incorporated into the main classification in ICD-10-CM. * The length of codes in ICD-10-CM can be a maximum of seven characters. * Injuries grouped by site of the injury, then type. * New treatment protocol, new discoveries, new etiologies listed in a more appropriate chapter.

5. * Grouping of codes * More complete descriptions * Fifth and sixth characters * Laterality * Many categories * Excludes notes * Use of extensions * Combination codes * Terminology used * Postprocedural conditions * Trimester specificity * New codes

6. Coding Examples Laterality Coding Examples Combination Codes K50.812 Crohn’s disease of both small and large intestine with intestinal obstruction K71.51 Toxic liver disease with chronic active hepatitis with ascites M05.271 Rheumatoid vasculitis with rheumatoid arthritis of right ankle and foot C50.512 Malignant neoplasm of lower-outer quadrant of left female breast

7. ICD-9-CMICD-10-CM Three to five charactersThree to seven characters First character may be alpha (E or V) or numeric; second thru fifth characters are numeric First character alpha, second and third are numeric, characters 4 – 7 can be alpha or numeric Limited space for adding new codesFlexible for adding new codes Lacks detailVery specific Lacks lateralityHas laterality Addition of a sixth character in some chapters Addition of code extensions (seventh character) for obstetrics, injuries and external causes of injuries Addition of dummy place holder (x) Includes full code titles for all codes (no reference back to common fourth and fifth digits)

8. X Category Etiology, manifestation, site Etiology, Severity, site Extension S52.13 1 a Displaced fracture of neck of right radius, initial encounter for closed fracture ICD-9-CM Format ICD-10-CM Format ICD-10-CM Example

9. CategoriesSection Titles 710 – 719Arthropathies and Related Disorders 720 – 724Dorsopathies 725 – 729Rheumatism, Excluding the Back 730 – 739 Osteopathies, Chondropathies, and Acquired Musculoskeletal Deformities CategoriesBlocks M00 - M02Infectious arthropathies M05 - M14Inflammatory polyarthropathies M15 - M19Osteoarthritis M20 - 25Other joint disorders M26 - M27 Dentofacial anomalies (including malocclusion) and other disorders of the jaw M30 - M36Systemic connective disorders M40 - M43Deforming dorsopathies M45 - M49Spondylopathies M50 - M54Other dorsopathies M60 - M63Disorders of the muscles M67 - M67Disorders of synovium and tendon M70 - M79Other soft tissue disorders M80 - M85Disorders of bone density and structure M86 - M89Other osteopathies M91 - M94Chondropathies M95 Other disorders of the musculoskeletal system and connective tissue M96 Intraoperative and postprocedural compilations and disorders of musculoskeletal system, not elsewhere classified M99Biomechanical lesions, not elsewhere classified

10. * Category 274, Gout in ICD-9-CM Chapter 3, Endocrine, Nutritional and Metabolic Diseases and Immunity Disorders * M10, Gout, ICD-10-CM Chapter 13. * Code 268.2, Osteomalacia, unspecified in ICD-9-CM Chapter 3 * M83, Adult osteomalacia in ICD-10-CM Chapter 13. * Code 524.4 Malocclusion, unspecified in ICD-9-CM Chapter 9, Diseases of the Digestive System * M26.4, Malocclusion, unspecified in ICD-10-CM Chapter 13. * Code 526 Diseases of the jaw in ICD-9-CM Chapter 9 * Moved to Chapter 13

11. Inflammatory Polyarthropathies (M05 – M14) This section includes subcategories for: * Rheumatoid lung disease with rheumatoid arthritis (M05.1) * Rheumatoid vasculitis with rheumatoid arthritis (M05.2) * Rheumatoid heart disease with rheumatoid arthritis (M05.3) * Rheumatoid myopathy with rheumatoid arthritis (M05.4) * Rheumatoid polyneuropathy with rheumatoid arthritis (M05.5) * Rheumatoid arthritis with involvement of other organs and systems (M05.6) * Rheumatoid arthritis with rheumatoid factor without organ or systems involvement (M05.7) * Other rheumatoid arthritis with rheumatoid factor (M05.8) * Rheumatoid arthritis with rheumatoid factor, unspecified (M05.9)

12. * A initial encounter for fracture * B subsequent encounter for fracture with routine healing * G subsequent encounter for fracture with delayed healing * K subsequent encounter for fracture with nonunion * P subsequent encounter for fracture with malunion * S sequelae

13. * The following must also be coded in addition to the type of fracture: * Place of occurrence code * Activity code * Displaced vs. non-displaced * Type of fracture * Site of fracture * Laterality

14. Other changes to this chapter include: * Postoperative complications have been moved to procedure-specific body system chapters. * Pyogenic arthritis is now classified by organism, specific site, and laterality. * Rheumatoid arthritis has 191 code options by type, manifestation, and laterality. * Osteomyelitis is now classified by type, acuity, specific site, and laterality. * Osteoarthritis is now classified by type, specific site, and laterality. * Systemic Lupus Erythematosus (SLE) is now classified by etiology or manifestation. * Scoliosis is classified by type and anatomical region of spine. * Pain in the limb, which had only one code option in ICD-9-CM, now has 31 code options based on specific site and laterality.

15. * ICD-10-CM groups injuries * first by specific site (e.g., head, arm, leg), * then by type of injury (e.g., fracture, open wound).

16. * Greater level of specificity in code selection * Coders need detailed progress notes * Detailed notes equal less inquires * Reduction in A/R and claims turnaround Pressure Ulcers ICD-9-CMICD-10-CM 707.00 – 709.09 – broad locationL89.131 – Pressure ulcer of right lower back, Stage I L89.132 – Pressure ulcer or right lower back, Stage II L89.133 – Pressure ulcer or right lower back, Stage III L89.141 – Pressure ulcer of left lower back, Stage I L89.149 – Pressure ulcer of left lower back, unspecified stage

17. Asthma ICD-9-CMICD-10-CM 493.00 – 493.92 – code rangeJ45.20 – J45.998 note large expansion of codes - extrinsic vs. intrinsic - chronic obstructive asthma - with status asthmaticus - with exacerbation - exercise induced bronchospasm - cough variant asthma - mild intermittent - mild persistent - moderate persistent - severe persistent - with status asthmaticus - with exacerbation - exercise induced bronchospasm - cough variant asthma - excludes chronic obstructive asthma

18. * E codes now Y or V categories * V codes were replaced by Z codes * Represent reasons for encounters other than disease * BMI located in this section Z68 * Pediatric and adult codes

19. * ICD-10-CM and ICD-10-PCS * October 1, 2014 * Date of discharge for inpatient claims * Date of service for outpatient claims * HHS had stated the date will not be extended.

20. * Coding errors * Backlog of claims * Change in documentation requirements * Superbills – expansion to accommodate increased codes, may require alternative * Confusion and possible slow claims transactions with claims administrators

21. * Coding professionals * Physicians * Other healthcare professional * Nonphysician clinicians/ancillary department personnel * Utilization management personnel * Software vendors * Information systems personnel * Billing/accounting personnel * Compliance officers * Fraud investigators * Government agency personnel

22. * Staff * Professional Organizations * World Health Organization * Software Vendors * EMR, Encoders/Coding solutions * Industry specific organizations * Journals/Magazines * Universities/Community Colleges * Consultants

23. * World Health Organization (WHO) * http://www.who.int/classifications/icd/en/ http://www.who.int/classifications/icd/en/ * Centers for Medicare and Medicaid Services (CMS) (2 free modules, CME credit) * http://www.cms.gov/Medicare/Coding/ICD10/in dex.html?redirect=/icd10 http://www.cms.gov/Medicare/Coding/ICD10/in dex.html?redirect=/icd10 * Centers for Disease Control and Prevention (CDC) * http://www.cdc.gov/nchs/icd/icd10.htm http://www.cdc.gov/nchs/icd/icd10.htm * U.S. Department of Health and Human Services * http://www.hrsa.gov/healthit/toolbox/webinars /pdfs/icd10.pdf http://www.hrsa.gov/healthit/toolbox/webinars /pdfs/icd10.pdf

24. * American Health Information Management Association (AHIMA) * http://www.ahima.org/icd10/ http://www.ahima.org/icd10/ * AAPC * http://www.aapc.com/icd-10/ http://www.aapc.com/icd-10/ * For the Record Magazine * http://www.fortherecordmag.com http://www.fortherecordmag.com * Health Data Management * http://www.healthdatamanagement.com/ http://www.healthdatamanagement.com/ * Healthcare IT News * http://www.healthcareitnews.com/ http://www.healthcareitnews.com/

25. * HIMSS * http://www.himss.org/library/icd-10/playbook http://www.himss.org/library/icd-10/playbook * ICD10Monitor * http://ICD10Monitor.com http://ICD10Monitor.com * ICD-10 Education (Free webinars, readiness assessments) * http://www.icd10-education.com/ http://www.icd10-education.com/ * ICD 10 Watch * http://www.icd10watch.com/ http://www.icd10watch.com/

26. * Step 1 – Impact Analysis: 3 – 6 months * Step 2 – Contact your Vendors: 2 – 3 months * Step 3 – Contact your Payers, Billing Service and Clearinghouse: 2 – 3 months * Step 4 – Installation of Vendor Upgrades: 3 – 6 months * Step 5 – Internal Testing: 2 – 3 months

27. * Step 6 – Update Internal Processes: 2 – 3 months * Step 7 – Conduct Staff Training: 2 – 3 months * Step 8 – External Testing with Clearinghouses, Billing Service, and Payers: 6 – 9 months * Step 9 – Make the Switch to ICD-10: October 1, 2014 * After October 1, 2014

28. * General Equivalence Mappings * Developed for specific, limited short-term need * Reference mappings * Not a substitute for using/learning ICD-9-CM and ICD-10-CM/PCS * Links concepts without consideration of context or encounter information * Two GEM files available allowing for bidirectional mappings. * ICD-9-CM to ICD-10-CM * ICD-10-CM to ICD-9-CM

29. * Basic conventions are the same * All letters used in alphabet with exception of U * Be careful in writing a zero vs. and “o”, or an “I” vs. one. * Read, read, read, notes at the beginning of each chapter – the only way to become familiar with guideline changes * ICD-10-CM will allow comparison of mortality and morbidity data * Incorporates much greater specificity and clinical information