1. ICD 10 Presented by: Rhonda Anderson, RHIA, President Anderson Health Information Systems, Inc.

2. OBJECTIVES Participants will identify: – Dates for New ICD-10 – Documentation support – New terms encounter principal diagnosis re- defined – Some general coding guidelines –. 2

3. FINAL REGULATION January 15, 2009 Final Regulation Released EXCHANGE the ICD-9 for the ICD-10 by October, 1, 2013 – 2014? ICD-10 for billing purposes as far as ability to accept the code known as “5010” is required by October 2011 3

4. HIPAA Assigning ICD-10 diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA) HIPAA has evolved from HIPAA – 1996, to (HIPAA-II) HITECH which relates to security and breaches And most recently HIPAA Transactions 5010 ICD-10 Code Set 4

5. WHO IS AFFECTED?? All inpatient and outpatient facility visits as well as freestanding providers and ancillary services “that means all of us really” who provide services and bill for them under Medicare, MediCal and private insurances. Current Procedural Terminology (CPT) is still used for the Physician and some services, but they must have a diagnosis that is ICD-10 Complaint 5

6. Benefits More specific coding system Reflects medical advancements Standardization, UK implemented in 1995 used worldwide

7. What do you think? The U.S. is the only industrialized nation that has not yet implemented ICD-10? True What is the date for implementation of ICD-10 10/1/2013 OR 2014? ICD-10-CM has more chapters than ICD-9-CM True ICD10 has 21 chapters while ICD-9-CM only had 17

8. ICD-9 vs ICD 10 What are the differences? ICD-9 …… 3-5 characters in length Approximately 14,000 codes First digit may be alpha (E or V) or numeric Digits 2-5 are numeric Always at least three digits Decimal placed after the first three characters Limited space for new codes 8

9. ICD-9-CM DIAGNOSIS CODES -2 Lacks detail Lacks laterality, difficult to analyze, dated, non-specific and does not adequately define diagnoses needed for medical research Does not support interoperability because it is not used in other countries. 9

10. ICD-10-CM DIAGNOSIS CODES – FORMAT & STRUCTURE 3-7 characters in length Over 69,000 codes Digit 1 is always alpha, digit 2 is always numeric, 3-7 are alpha or numeric Decimal placed after the first 3 characters All letters used except “U” Flexible for adding new codes Very specific Has laterality 10

11. ICD-10 STRUCTURE Index and Tabular list similar to ICD-9 ICD-10 index larger, Categories, subcategories and codes are contacted in the tabular list. More combined codes i.e. diabetic retinopathy More specificity i.e. Alzheimer’s disease with specific details of early or late onset 11

12. CONVENTIONS FOR THE ICD-10-CM General rules for use of the classification independent of the guidelines – Alphabetic Index and Tabular List Alphabetic Index – List of terms and their corresponding code Tabular List – chronological list of codes divided into chapters based on body system/condition 12

13. CONVENTIONS FOR THE ICD-10-CM -2 General rules for use of the classification independent of the guidelines – Format and Structure Three character category that has no further subdivision is equivalent to a code Subcategories are either 4 or 5 characters Codes may be 3, 4, 5, 6 or 7 characters 13

14. CODE FORMAT ICD-10 Code Format 14 ICD-9-CM Code FormatICD-10-CM Code Format

15. NO MORE V CODES Former V=codes are nowZ=codes 15

16. Some of the differences 274 –Gout ICD-10-CM = M10 250 – Diabetes ICD-10-CM= E10 Type 1 E12 Type 2 E13 Other

17. Aftercare Aftercare Z code is not to be used with injuries. The acute injury code with the appropriate seventh character (for subsequent encounter)

18. Let’s take a look Aftercare for fracture of right upper arm V54.11 Aftercare fracture – code to fracture with extension D Fracture arm (upper) see also fracture, humerus, shaft) S42.30 S42.301(right arm) S42.301D (subsequent encounter for fracture with routine healing)

19. Right Hip replacement: Now: V54.81 Aftercare following joint replacement V43.64 Joint replacement, hip Then: Z47.1 Aftercare following joint replacement surgery Z96.6 Presence of right artificial hip joint

20. DIABETIC RETINOPATHY Now: 250.50, 362.01 Then: E11.319 Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema

21. Deep vein thrombosis patient on Coumadin Now = 453.40, V58.61 Then= I82.409 Could be more specific with laterality Long Term use of Coumadin = Z79.01

22. Therapy ICD-10-CM does not provide a separate code for physical, occupational and speech therapy

23. You will no longer code admission for rehab services V57 With ICD-10-CM you will only code the pertinent diagnoses

24. What now????? Resident admitted for physical therapy following CABG. ICD-10-CM codes Z48.812 Aftercare following surgery (for) (on), circulatory system Z95.1 Status (post) aortocoronary bypass

25. Status post Lt BKA. Admitted for dressing changes following resolved infection of the amputation stump Z48.01 Aftercare, following surgery, attention to dressings, surgical Z89.52 Absence (of) (organ or part) (complete partial), extremity(acquired), lower, below knee

26. Stage 3 decubitus ulcer to Rt. Ankle with gangrene I96 Gangrene lower extremity L89.513 Decubitus ulcer of Rt. Ankle Stage 3

27. Late effects of CVA I69 = Sequelae of Cerebrovascular Disease Admission for OT and PT due to left hemiplegia of non-dominant side secondary to a recent CVA I69.354 Hemiplegia and hemiparesis following cerebral infarction affecting left nondominant side

28. Examples Acute Hepatitis with Hepatic Coma ICD-9-CM = 070.41 ICD-10-CM =B17.11 Alzheimer’s Disease with Behavioral Disturbance ICD-9-CM = 331.0, 294.11 ICD-10-CM = F02.81

29. Examples Stage 4 pressure ulcer of the sacrum ICD-9-CM = 707.03 707.24 ICD-10-CM = L89.154

30. ICD 10 “HAS TWO PARTS” ICD-10 CM = Clinical Modification ICD-10 PCS = Procedural Code System (used for procedures, operations within the hospital inpatient setting i.e., acute hospital) 30

31. ICD-10 has 21 Chapters Chapter 1- Certain Infectious & Parasitic Diseases (A00-B99) Chapter 2-Neoplasms (C00-D49) Chapter 3- Diseases Blood & Blood Forming Organs & disorders Immune System (D50-D89) Chapter 4- Endocrine, Nutritional and Metabolic Diseases (E00-E89)

32. CHAPTERS 5 – 8 Chapter 5 – Mental (F00-F99) Chapter 6 – Diseases of Nervous System (G00- G99) Chapter 7 – Disease s of Eye and Adnexa (H00- H59) Chapter 8 – Disease of Ear and Mastoid (H60- H95) 32

33. Chapters 9-12 Chapter 9- Diseases of the Circulatory System (I00-I99) Chapter 10- Diseases of the Respiratory System (J00-J99) Chapter 11- Diseases of the Digestive System (K00-K94) Chapter 12-Diseases of the skin and Subcutaneous Tissue (L00-L99)

34. Chapters 13-16 Chapter 13- Diseases of the Musculoskeletal System and Connective Tissue (M00-M99) Chapter 14- Diseases of the Genitourinary System (N00-N99) Chapter 15- Conditions Related to Pregnancy and Childbirth (O00-O99) Chapter 16- Conditions Originating in the Perinatal Period (P00-P96)

35. Chapters 17-20 Chapter 17- Congenital Malformations, Deformations, & Chromosomal Abnormalities (Q00-Q99) Chapter 18- Symptoms, Signs & Abnormal Clinical & Laboratory Findings (R00-R99) Chapter 19- Injury, Poisoning & Certain Other Consequences of External Causes (S00-T88) Chapter 20- External Causes of Morbidity (V00-Y99)

36. Chapter 21 Chapter 21- Factors Influencing Health Status & Contact with Health Services (Z00-Z99)

37. CONVENTIONS FOR THE ICD-10-CM -3 General rules for use of the classification independent of the guidelines – 7 th Characters Certain ICD-10-Cm categories have applicable 7 th characters Required for all codes within the category or as instructed by the notes in the Tabular List Must always be the 7 th character in the data field If a code that requires a7th character is not 6 characters, a placeholder X must be used to fill in the empty characters 37

38. Example 7 th characters for a fracture -A = initial encounter for fracture -D = Subsequent encounter for fracture with routine healing -G = Subsequent encounter for fracture with delayed healing -K = Subsequent encounter for fracture with non-union -P = Subsequent encounter for fracture with malunion -S= Sequela

39. It’s in the details….. Coma scale -Eyes open -Best verbal response -Best motor response

40. CODE STRUCTURE OF ICD-10 ICD-10 Codes may consist of up to 7 digits, with the 7 th digit extensions representing visit encounter or sequel for injuries or external causes. In some cases the place holder “X” will be used to expand the code and accommodate the 7 th character Example: Pathological vertebral fracture due to age related osteoporosis (Subsequent encounter with delayed healing M80.80XG 40

41. ICD-10-CM DIAGNOSIS CODES-2 Specificity improves coding accuracy and depth of data for analysis Detail improves the accuracy of data used in medical research Supports interoperability and the exchange of health care data between other countries and the U.S. 41

42. ICD-10 NEW FEATURES -2 Added Laterality – C50.212 Malignant neoplasm of upper-inner quadrant of left female breast – L80.213, Pressure Ulcer of right hip, Stage III 42

43. LET’S SEE SOME CODES Hypertensive Retinopathy ◦ H35.03 Hypertensive Retinopathy ◦ 031-Right eye, 032, left eye, 033, bilateral, ◦ 039 unspecified (and this would be a ?? For billing most likely)!! ◦ I10, Essential Primary Hypertension 43

44. ABBREVIATIONS NEC – “Not elsewhere classifiable Punctuation – [ ] Brackets – ( ) Parentheses Use of “and” “Other” or “other specified” “Unspecified” “Includes Notes” “Inclusion Terms” 44

45. ABBREVIATIONS -2 “Excludes Notes” “Code first”, “Use additional code” and “elsewhere notes” “And”, “and” or “or” “With” “See”, “see also” “Code also note” “Default codes” “Syndromes” 45

46. PRINCIPAL DIAGNOSIS -6 Complications of surgery and other medical care – Is sequenced as the principal diagnosis Uncertain Diagnosis – “probable”, “suspected”, “likely”, “questionable”, “possible”, or “still to be ruled out”, or other similar terms indicating uncertainty, code the condition as if it existed/established – Applicable only to inpatient admissions to short-term, acute, long-term care & psychiatric hospitals 46

47. Focus DOCUMENTATION

48. TIMELINE 10/01/2011 – Last major update to ICD-9-CM and ICD10-CM/PCS 10/01/2012 – Limited changes to ICD-9-CM and ICD-10CM/PCS 10/01/2013 ICD-10-CM/PCS Implemented

49. References http://www.cdc.gov/nchs/icd/icd10cm.htm http://www.cdc.gov/nchs/icd/icd9cm.htm

50. Questions and Answers