ICD-10 - Texas Ambulatory Surgery Center Society

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Transcript ICD-10 - Texas Ambulatory Surgery Center Society

ICD-10 Impact on Coding and Billing

Use of this handout is for informational purposes only

Refer to current updated version of ICD-10 manual at the time of implementation to confirm coding accuracy

Paul Cadorette CPC, CPC-H, CPC-P, CASCC, COSC AAPC ICD-10 Proficiency Certified Director of Education [email protected]

Why the Need for ICD-10?

ICD-10

• A98.4 Ebola virus disease

ICD-9

Other specified diseases due to viruses Arthropod-borne hemorrhagic fever • •

Codes lack specificity which is necessary for identifying Ebola patients Makes the process of monitoring and tracking the disease more difficult

21 Chapters with alphanumeric codes ICD-9 14,000 codes vs. ICD-10 68,000 Diseases of nervous system and sense organs ICD-10-CM Complete Official Draft Code Set

2014 Ingenix.

E codes V codes

ICD-10 Guidelines

For ambulatory surgery, code the diagnosis for which the surgery was performed. If the postoperative diagnosis is known to be different from the preoperative diagnosis at the time the diagnosis is confirmed, select the postoperative diagnosis for coding, since it is the most definitive

ICD-10 CONVENTIONS

General rules for the use of the classification system with instructional notes that are applicable regardless of the health care setting

ICD-10 Conventions

• “See” - another term should be referenced, it is

necessary

for the coder to go to the main term indicated by the “see” note

Arthritis, arthritic – spine

rheumatoid –

see

Spondylitis, ankylosing • “See Also” – another main term can be referenced that may have additional index entries that may be useful. When the main term provides an appropriate code, it is

not necessary

to follow the “see also” note

Stricture

(

see also

Stenosis) bladder N32.89 neck N32.0

nasolacrimal duct (

see also

congenital Q10.5

ICD-10-CM Complete Official Draft Code Set

2014 Ingenix.

Stenosis, lacrimal duct)

“Excludes” Notes

• •

EXCLUDES 1

The two conditions cannot be reported together

When present, the EXCLUCDED code/condition should be reported instead of the code listed above it

EXCLUDES 2

It may be appropriate to use both the code listed along with the

excluded

code when supported by the medical documentation • S92 Fracture of foot and toe, except ankle

EXCLUDES 1

traumatic amputation of ankle and foot (S98.-)

EXCLUDES 2

fracture of ankle (S82.-) fracture of malleolus (82.-)

Expansion of diagnosis code sets

Anatomy and Terminology

Spondylo

- (vertebra or spinal column) -

pathy

(disease process) Atlanto-occipital Atlanto-axial

- C7-T1 - T12-L1 - L5-S1

Anatomy and Terminology

Enthesopathy

• Enthesis – the point where a tendon or ligament inserts into a bone • Enthesopathy – disease process in the zones of attachment for ligaments or tendons to bone, a disorder of entheses (bone attachments) ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved.

Anatomy and Terminology

• Spondylopathies (M45-M49) •

spondylo (vertebra) pathy (disease process)

• Spondylosis - a term referring to degenerative osteoarthritis of the joints between the center of the spinal vertebra and/or neural foramina ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved.

S96.2 Injury of Intrinsic Muscle at Ankle and Foot Level

Dorsal Interossei

C A B A B A B B C

Plantar Interossei A – Flexor digitorum brevis B – Abductor digiti minimi C – Abductor hallucis A - Quadratus plantae B - Lumbricales A – Flexor hallucis brevis B – Adductor hallucis C – Flexor digiti minimi ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved.

Diagnosis Code Structure

S52.551A

Type of Encounter Laterality Other extra-articular fracture lower end of radius Fracture lower end of radius Base code Fracture of forearm Fracture of right distal radius, extra-articular ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix.

Diagnosis Code Structure

- Base Codes

Diagnosis Code Structure

Fractures of Femur

(23 Different Classifications plus 9 Other/Unspecified codes)

ICD-10 Laterality

• RT is usually indicated with 1 • LT is usually indicated with 2 • Bilateral is usually indicated with 3

(When no bilateral code exists, report both the RT and LT code) (Bilateral refers to paired organs)

• M20.4

0 • M20.4

1 • M20.4

2 Other hammertoe(s) (acquired), unspecified foot Other hammertoe(s) (acquired), right foot Other hammertoe(s) (acquired), left foot

Unspecified character is 0 if in the fifth position or 9 when it is in the sixth position

• M20.01

1 • M20.01

2 Mallet finger of right finger(s) Mallet finger of left finger(s) • M20.01

ICD-10 Laterality

NOTE: Although toes are identified by proximal, medial or distal phalanx the specific toe (second, third, fourth or fifth) is not mentioned

CPT Code Sections

•

Forearm, Wrist

•

Hand , Finger Select CPT code based on the anatomical site where at which the procedure was performed Hand or Wrist

Wrist and Hand Level

For categories where no multiple site code is provided and more than one bone, joint or muscle is involved, multiple codes should be used to indicate the different sites involved

Exceptions

ICD-10 Laterality

Other and Unspecified

ICD-10 Laterality

• .

Eyelid Characters

CPT Code Modifiers

Seventh Character Extensions

Seventh Character Extension 7

vs. X7

th • When a diagnosis code requires a 7 th character - that character

must

always be the 7 th character in the data field, which sometimes necessitates the use of placeholder “X” • Some codes may be only 4 characters long, but they require a 7 th character extension so placeholder “x” is used twice S46.011 Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder S46.011

A S43.50 Sprain of acromioclavicular joint The appropriate 7 th from category S00 S sequela character is to be added to each code A initial encounter D subsequent encounter S43.50

XA S33.0 Traumatic rupture of lumbar intervertebral disc S33.0

(7

Encounters Character Extensions)

• A - Initial encounter – Active treatment (

surgical treatment

, emergency department encounter or evaluation and treatment by new physician) • D - Subsequent encounter – Routine care during healing or recovery phase (cast change/removal,

removal of internal/external fixation device

, medication adjustment, follow-up visits) • S - Sequela - Late effect from initial injury • Condition that occurs after the acute phase of an injury • No time limit to identify a late effect ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved.

Defaults

Fracture Encounters

No open fx code

Implant Removal

Previous Injury

Fracture of 1 st metatarsal bone right foot S92.311D

(Subsequent encounter “D” – defaulted to displaced)

Previous Surgery

Austin bunionectomy for hallux valgus Z47.2

(Acquired deformity)

ICD-10-CM Complete Official Draft Code Set

2014 Ingenix

Acute vs. Chronic

Chapter 13. Diseases of the Musculoskeletal System and Connective Tissue Chapter 19. Injury , Poisoning and Certain Other Consequences of External Causes ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix.

Strains and Sprains

• Strain – injury to a muscle or tendon • Tendons connect muscle to bone • Quadriceps tendon to superior pole of patella • S76.119A

Strain

of unspecified

quadriceps muscle

, fascia and tendon, initial encounter • Sprain – stretching or tearing of a ligament • Ligaments connect bone to bone • Anterior cruciate ligament • S83.519A

Sprain

of anterior cruciate

ligament

Herniated Disk 722.10

ICD-9

Barrett’s Esophagus

Same ICD-9 code Different codes in ICD-10

Precancerous changes Severe precancerous changes

K22.70 Barrett’s esophagus without dysplasia Barrett’s esophagus NOS

NOS – Not Otherwise Specified

Carrier Policy Treatment of Barrett’s

• Radiofrequency ablation is considered

investigational

as a treatment of Barrett’s esophagus in the

absence of dysplasia (Nondysplastic Barrett’s)

• Radiofrequency ablation may be considered

medically necessary

for treatment of Barrett’s esophagus with

low-grade dysplasia

, when the initial diagnosis of low-grade dysplasia is confirmed by a

second pathologist

who is an expert in GI [gastrointestinal] pathology • Radiofrequency ablation may be considered

medically necessary

for treatment of Barrett’s esophagus with

high-grade dysplasia

The diagnosis of high-grade dysplasia should be confirmed by two pathologists prior to radiofrequency ablation BCBS of NC

Colon Polyps 211.3

Adenomatous polyps are site specific and code to benign neoplasms Hyperplastic polyps code to K63.5

Hyperplastic polyps of anus/rectum

Screening

• Testing for disease in seemingly well individuals • Testing to rule out or confirm a sign or symptom is a diagnostic exam and not a screening • List the screening code as the primary diagnosis • Conditions found during screening exam should be listed as additional diagnoses ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved

“Accidental” Dural Puncture 998.2

ICD-9 Diagnosis Coding 1.

Complications (998.2 Accidental puncture or laceration)

Female pelvic pain with lysis of adhesions and destruction of endometriosis. Colon is perforated during/while lysing adhesions.

K91.71

Accidental puncture and laceration of a digestive system organ or structure during a digestive system procedure

K91.72

Accidental puncture and laceration of a digestive system organ or structure during other procedure

Chapter 11 Diseases of the digestive system K00-K94

While placing tape during a TVT procedure, the bladder is perforated.

N99.71

Accidental puncture and laceration of a genitourinary system organ or structure during a genitourinary system procedure

N99.72

Accidental puncture and laceration of a genitourinary system organ or structure during other procedure

Chapter 14 Diseases of the Genitourinary System N00-N99

Discontinued Procedure

V64.1 – Surgical or other procedure not carried our because of contraindication

(unacceptable primary diagnosis in ICD-9)

Z53.09 – Procedure and treatment not carried out because of other contraindication

DO NOT USE V64.1 (ICD-9) OR Z53.09 (ICD-10) AS A PRIMARY OR FIRST LISTED DIAGNOSIS

Chapter 20 External Causes of Morbidity Chapter 21 Factors Influencing Health Status

ICD-9 ICD-10

Daycare worker bitten by child, bleeding wound on right forearm

S51.851A Open bite right forearm, initial encounter Y04.1XXA Assault by human bite, initial encounter Y92.210 Daycare center as the place of occurrence of the external cause Y93.F9 Activity, other caregiving Y99.0 Civilian activity done for income or pay

Unless a provider is subject to state-based reporting or these codes are required by a specific payer - reporting of External Causes of Morbidity codes is not required

CMS-1500 Claim Forms

Z12.11

D12.3

45385 PT A B

ICD-10-CM Complete Official Draft Code Set

2014 Ingenix.

ICD-10 Testing Week: November 17-21, 2014

• Test claims with ICD-10 codes must be submitted with current dates of service (i.e. October 1, 2014 through November 17, 2014), since testing does not support future dated claims. • Test claims will be subject to all existing EDI front-end edits including Submitter authentication and NPI validation. • Test claims will receive the 277CA or 999 acknowledgement as appropriate, to

confirm that the claim was accepted or rejected in the system

. •

Testing will not confirm claim payment

or produce remittance advice.

Next test dates - March 2-6, 2015, June 1-5, 2015

FUTURE : Local Coverage Determination (LCD): (L35350) UPPER GASTROINTESTINAL ENDOSCOPY (DIAGNOSTIC AND THERAPEUTIC) Effective: Oct. 1, 2015

FUTURE : Local Coverage Determination (LCD): (L34974) Facet Joint Injections Effective: Oct. 1, 2015

Code Comparison • • Approximately

264

ICD-10 LCD diagnosis codes

ICD-9 LCD diagnosis codes •

Diagnosis codes with “A” Encounters only

FUTURE : Local Coverage Determination (LCD): (L34974) Facet Joint Injections

Spondylolysis M43.00 – M43.09

•

Aka. Pars defect

Spondylolisthesis M43.10 – M43.19

•

Pars defect-vertebra slips forward

Spondylosis M47.11 – M47.9

•

Osteoarthritis, Osteoarthrosis Osteoarthropathy