Transcript ICD-10 - ONCOCHART

Covered by pages 2.23-2.39
Section 2
ICD-9-CM
ICD-10-CM
Susan Vannoni
10:45-11:30
040314
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Historical Background
ICD-9-CM is an acronym for International
Classification of Diseases-9th Revision-Clinical
Modification.
ICD is a statistical classification system that has been published since
1900. It arranges diseases and injuries into groups according to
established criteria.
Most ICD-9-CM codes are numeric and consist of three numbers followed by
one or two decimals and a description.
HISTORY OF ICD
REVISION
1st
2nd
3rd
4th
5th
6th
7th
8th
9th (ICD-9)
10th (ICD-10)
11th (ICD-11)
YEARS
1900-1909
1910-1920
1921-1929
1930-1938
1939-1948
1949-1957
1958-1967
1968-1978
1979-1998
1999-2014
2015
NIB
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The final rule mandated that as of
Oct.1, 2013 CMS would require
ICD-10 to be used, but this date is
now moved to Oct 1, 2015 the
same year ICD-10 expires and
ICD-11 becomes active!!!!.
To allow an Orderly Transition from
ICD-9 to ICD-10
• October 1, 2011, CMS Set a 1 year freeze on any
further updates to ICD-9 and ICD-10.
• October 2012 a limited number of updates were
allowed to both, but only for new technologies and
diseases.
• October 2013 only limited updates to ICD-10, but
allow continued use of ICD-9 until October 2014.
• October 2014 Regular updates will resume to ICD10
• This schedule is STILL valid.
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ICD-10
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• Will/may be required for your practice in 18 months.
• Will require massive changes in software, and staff training to
use ICD-10
• ICD-10 has 120,000 codes in contrast to ICD-9 which has 12,000
codes
• ICD-10 will happen some day , and your
practice needs to be ready for it
• You have a great deal of preparation necessary
for this conversion.
Preparations for ICD-10
NIB
• Identify commonly used ICD-9 codes and build a
crosswalk to ICD-10 codes. We have this for you!
• Identify and update all paper and electronic forms to
accommodate the ICD -10 code structure.
• Schedule ICD-10 training for clinicians, office staff, billers,
coders, and any other key individuals.
• Participate in all testing opportunities to identify
weaknesses/risks in documentation.
• Avail yourself of all opportunities to participate in
provider based training programs in ICD-10.
• You should start coding both in ICD-9 and ICD10 to gain familiarity.
Courtesy of Iridium
Suite
Cost Estimates of ICD-10
NIB
• The conversion cost is estimated to range from
$20,000 for a small practice to over $2,000,000 for
a large multi specialty group practice.
• The Feds will not cover the cost of
conversion!! No Bonus money here.
• Will your software handle ICD-10?
• How much will the upgrade cost?
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FORMAT OF ICD-10
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Divided into 22 chapters
Neoplasms, Chapter 2
Blocks or Sections C00 to D48
Malignant Neoplasms C00-C97
Benign Neoplasms D10-D36
Almost all have a decimal (C09.1 tonsillar
pillar)
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LOCATION AND LATERALITY
• C50.11- Malignant neoplasm female
breast, central portion
• C50.111 Malignant neoplasm female
breast, central portion, right breast.
• C50.112 Malignant neoplasm female
breast, central portion, left breast.
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ICD-9 has 6 codes, ICD-10 has 18 codes
Additional ICD 10 codes
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Exposure to environmental smoke..............Z77.22
History of tobacco use....................................Z87.891
Occupational exposure to smoke.................Z57.31
Tobacco dependence.......................................F17.- Tobacco use......................................................Z72.0
Alcohol use/dependence................................F10.- Right side........................................................XXX.XX1
Left side...........................................................XXX.XX2
Bilateral...........................................................XXX.XX3
ICD 10 September 30
October 1 NIB
For dates of service on or after the October 1, 2015,
deadline, you must use ICD10. You will not be
able to use ICD-9 and ICD-10 codes on the same
claim based on your payers' instructions.
This may mean splitting services that would
typically be captured on one claim into two claims:
one claim with ICD-9 diagnosis codes for services
provided before October 1, 2015, and another claim
with ICD10 diagnosis codes for services provided
on or after October 1, 2015.
WHY DO WE NEED ICD-10?
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• Will eventually increase the number of
available codes for diagnostic, medical, and
treatment procedures by a factor of 10
• There just are not enough code numbers left
in ICD-9 to cover the multitude of new
procedures
• Added codes are needed for the many new
procedures, and the new ones to come in the
future.
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RADIATION ONCOLOGY PROCEDURE
CODING SYSTEM
• Will this replace CPT?, probably not in
the immediate future, but later??
• ICD-10, and later ICD-11 will have
characters for the basic modes of
radiation therapy used (external beam,
Brachytherapy, stereotactic, other)
• Further identify the type of radiation
used ( photons, electrons, heavy
particles, contact radiation, others)
Radiation Oncology Series D Codes
D-1 Use of radiation oncology.
D-2 Body system involved.
D-3 Root type.
0 External beam
1 Brachytherapy.
2 SRS,SBRT
4 Other types of radiation therapy.
D-3 Specific Body part being treated.
D-5 Modality, blocking, beam modifiers, etc..
D-6 Use of radioisotopes, all or part of treatment.
D-7 Qualifiers, none for radiation oncology.
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NIB
Prediction
• ICD-9 has been a requirement since 1989, conversion
to ICD-10 will/may happen October 1 , 2015.
• CPT has been in use for 48 years, much longer than
most predicted it would last
• After ICD-10 or ICD-11 has been in effect for a
few years, procedure reporting using CPT will
disappear, one specialty at a time, and be
replaced with the enhanced features of
diagnosis and treatment based reporting.
70/90
Applicability of ICD-9 and ICD-10 to
Radiation Oncology
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See Table, Section 2
Over 1700 ICD-9 and ICD-10 codes that
are most applicable to Radiation
Oncology are covered in these tables.
The tables are arranged by subject,
followed by specific areas indicating the
proper code to use
TABLES AT END OF SECTION 2
Primary Bone Tumors
Female Breast
Carcinoma the Lung
Central Nervous System
Ovary-Prostate
Prostate is still discriminated against
Cancer of the Cervix
Head and Neck
Hodgkin's goes on Forever
Many types of Skin Cancer
More Skin Cancer
Lymph Node Metastasis
ICD-9 versus ICD-10
There are approximately 220 ICD-9 codes in the malignancy
section of ICD-9 that we commonly utilize for radiation
therapy.
Some of these are broken down into subsets with the final
number of approximate 396 individual ICD-9 code/narration
that we commonly utilize.
This conversion table has 1788 ICD-10 codes,
almost 5 times as many codes to deal with.
DRG
HCFA contracted for the development of the first
concepts of DRG (Diagnostic Related Groups) in the
early 1980’s.
This was a means of utilizing the coding
system for procedures based on ICD-9
codes to ration payments to hospitals.
This shifted the emphasis from the previously
utilized CPT procedure based system to the
ICD-9 diagnostic based system.
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Cancer of the prostate (185)
cannot link to a female patient
Watch for obvious mistakes
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Medicare requires the use of the
appropriate ICD-9 code on all
Medicare claims submitted for
reimbursement.
Absence of an ICD-9 diagnosis code
will result in rejection of the claim and
a delay in payment.
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It is extremely important that the proper ICD-9
code for the course of therapy being delivered is
used as the code for that course of therapy.
The patient's primary cancer, which was
previously treated, becomes the secondary code
for this particular claim form.
This is important not only from the aspect of
Medicare coding, but also for statistical record
keeping in your department, based upon
diagnostic coding of treated patients.
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Case examples with multiple diagnoses
• Metastatic disease, known previous
primary cancer
• Metastatic disease with active
primary cancer
• Multiple primary cancers
Brain metastasis from primary carcinoma of the lung
Primary Lung,
initially treated
with SBRT
9 months later developed
brain metastasis, treated
with whole brain radiation.
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Correct coding/billing for this case
Present Brain Metastasis
Previous Lung Primary
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Skin cancer metastatic to lymph nodes in
the Head and Neck area.
Primary Squamous
cell skin cancer
resected with
positive margins,
will treat this area
with electrons.
Parotid and Neck
nodes to be treated
with IMRT at the
same time
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In order to be paid as IMRT, this case must be
coded as metastatic cancer to lymph nodes (196.0)
as the first code, and list the Squamous cell skin
primary as the secondary code (173.32).
Treatment delivery is 77418.
ICD-10 Versus Carrier LCD
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• The majority of the Medicare carriers now realize that the
conversion to ICD-10 will increase the number of diagnosis
codes utilized as restrictive payment policy in their LCD
documents from hundreds of codes to thousands of codes.
• These carriers will probably discontinue the LCD policy, which
will remove code restrictions from the procedure payment
policies.
• This may eliminate the restrictions on the use of IMRT in
certain anatomic areas.
• However, this will certainly increase the close
scrutiny and medical necessity of the use of IMRT
and result in a higher rate of case denial for
payment of IMRT.
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Two Distinct Primary Cancer Diagnoses
Primary Carcinoma of the
Larynx, started on
treatment as the initial
course of therapy
Then found an unsuspected
Adenocarcinoma of the lung,
treat as a second primary site
Proper Coding for this Case
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First course, Larynx is
primary diagnosis,
Lung is a secondary
code.
Second course,
Lung is the
primary
diagnosis,
Larynx is now
secondary.
ICD-10 AND STAGING
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• The 2010 AJC staging book uses ICD-9 and
ICD-10 for all the diagnostic areas.
• Many of new codes are used for histology
modified staging not found in earlier
versions
• Numerous areas have been completely re
done to take into account many of the new
features of ICD-10
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T-N-M Staging
• The AJCC has been developing staging
methodology since 1950
• The AJCC 7th edition is far more comprehensive
than previous editions.
• T -Tumor size
• N- Nodal status
• M- Presence or absence of Metastatic disease
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“V” Codes
Two supplementary classifications included in
the tabular list of ICD-9 are the V codes and the
E codes.
These are the so called encounter codes,
one of which may be required by your
carrier.
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V58.0 Encounter for Radiation Therapy: This V code may still
be required to be listed first on all Medicare claims for patients who
receive radiation therapy treatment as part of the encounter. Use this
code in addition to the ICD-9-CM diagnosis code.
V67.1 Follow-up Examination: This is a follow-up code for use
after a course of radiation therapy has been delivered. You may be
required to use this code in addition to the ICD-9-CM diagnosis code.
V-10 Personal History of Malignant Neoplasm: There is an
entire section devoted to specific malignant neoplasms based upon the
V-10 Codes. These are the codes to be utilized if the patient does not
have an encounter for radiation therapy.
CHECK YOUR LCD
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Added IMRT “V” Code
• Some GYN, Lymphoma, Metastatic lymph
nodes, and Sarcomas will require a
supplemental V code.
• 179, 180.0-180.9, 182.0-182.9, 183.0-183.9,
184.0-184.9, 196.0, and 200.00-200.88
• Require V49.89, Other specified conditions
influencing health status
• IMRT will not be paid without this code.
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Prophylactic Whole Brain Radiation
• What code to use?
• 198.3 brain metastasis not proven
• 162.3 lung primary previously treated cancer,
wrong anatomic area to treat (use as secondary)
• V 10.2 history of respiratory tract cancer, or
• V 07.8 other specified prophylactic measure, or
• V10.11 history of lung cancer; are the possible
codes to properly describe the problem
END
THANK YOU FOR
YOUR ATTENDANCE
PLEASE FILL OUT
THE CRITIQUE
SHEETS
PRINCIPLES OF
BILLING, CODING
AND COMPLIANCE IN
RADIATION
ONCOLOGY
BMSi 2014
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