Transcript Lecture Title

ICD 10: What to
Expect
George A. Hill, MD
Director, Nashville Fertility Center
Nashville, TN 37203
LEARNING OBJECTIVES
At the conclusion of this presentation, participants should be
able to:
– Understand ICD-10 background and history, description, and
future
– Comprehend the key distinctions between ICD-9-CM and ICD10-CM
– Understand what physicians need to do now to prepare
– Understand the actions that practices need to take to
implement the change to ICD -10-CM on a timely basis
DISCLOSURE
● Committee Member: United Healthcare Women’s Health
Scientific Advisory Board
● Grant Recipient: EMD Serono Inc
Disclaimer
● ICD-10 codes included in this presentation are not valid prior
to the implementation date of October 1, 2014
● ICD-10 codes included in this presentation may be revised
prior to implementation
● ICD-9 codes should continue to be used until transition date
of October 1, 2014
Why the Change?
● ICD-9-CM is 30 years old, out of date and running out of
space!
● ICD-10 is the international standard and has been for a
number of years
● ICD is important to Health Information Technology (HIT) and
the change is needed to fully implement HIT
ICD-10 and HIT
Importance of a better coding classification system:
– Integral to HIT Strategy - especially the Electronic
Health Record (EHR)
– Improved clinical specificity = improved patient safety
– Improves understanding of disease / costs and allows
providers and others to improve on their delivery
– International Disease Surveillance
ICD-10: Current Status
● Some current opposition to implementation
● Per CMS, no delay or schedule change is pending (except!)
(postponed from 10/1/2013 to 10/1/2014)
● Physicians need to be prepared for the change in order to
prevent a revenue flow interruption on 10/1/2014
Understanding ICD
● ICD is part of the World Health Organization’s (WHO) system
of classification
● ICD-CM (clinical modification) used to track morbidity
● ICD used to report mortality
● In the United States, we (ASRM/ACOG Coding Committees)
work through the National Center for Health Statistics to
implement changes/updates
History of ICD-10
● ICD-10 adopted by WHO in 1990
● First modification in 1998
● U.S. only industrialized nation that has not yet implemented ICD-10
or a modification in some format
● U.S. first began exploring idea in 1994
● Draft versions available 2002, 2007, 2009, 2010, 2011
● Implementation Date: October 1, 2014!
Key Differences: ICD-9-CM to ICD-10-CM
● ICD-10-CM consists of 21 chapters compared to 17 in ICD-9CM
● Chapters divided into “blocks” of codes with additional
subcategories
● V and E code supplemental classifications incorporated into
main classifications
● Conditions of sense organs separated from nervous system
Key Differences: ICD-9-CM to ICD-10-CM
● Certain diseases reclassified to reflect current medical
knowledge
● ICD-10 classifies injuries by specific site then by type vs. ICD-9
classification by type
● Postoperative complications moved to procedure specific
system chapters (complications of GU surgery in GU chapter)
Key Differences: ICD-9-CM to ICD-10-CM
● ICD-10-CM codes are alphanumeric and up to 7 characters
ICD-9-CM are 3-5 characters in length (mostly numeric)
● ICD-10-CM includes full code titles vs. references to common
4th -5th digits
● Addition of 6th characters for some
● Addition of code extensions (7th digit)
● Addition of dummy placeholder “X”
New Features in ICD-10-CM
● Combination codes for conditions and common
symptoms/manifestations
● Combination codes for poisoning and external causes
● Added laterality for some codes (right vs. left)
Key Changes for Reproductive Endocrinology/Infertility
 Inclusion of trimesters in obstetric codes
 Separate codes to indicate gestational week
 Elimination of episodes of care for obstetric codes
 Changes in time frames:
 Abortion vs. Fetal death ( 20 weeks)
 Early vs. Late pregnancy (20 weeks)
 Extensions to denote specific fetus
 New GU codes and notes including category title changes
Structure and Format of ICD-10-CM
● First character is always alphabetic letter
– Chapter 14 Diseases of the GU system (N00-N99)
– Chapter 15 Pregnancy, Childbirth and Puerperium (O00-O9A)
● Second character is always a number
● Characters 3-7 alpha or numeric
– O9A.311: Physical abuse complicating pregnancy, first trimester
Structure and Format of ICD-10-CM
● Alphabetic Index: Alphabetic Listing of Terms and Codes
–
–
–
–
Index to Diseases and Injury
Index to External Causes of Injury
Neoplasm Table
Table of Drugs and Chemicals
● Tabular List: Chronological list divided into chapters based on
body system or condition
Structure and Format of ICD-10-CM
● Code Format: XXX.XXX X
o XXX= Category
o XXX= Etiology, anatomic site, severity
o X= Extension
● Placeholder Character X
– Used with certain codes for potential future expansion
– When placeholder exists, must use X in that location for valid
code
Structure and Format of ICD-10-CM
● Labor and delivery complicated by cord around neck, without
compression: O69.81X2
– O69:Labor and delivery complicated by umbilical cord
complications
– 81:Cord around neck, without compression
– X: Placeholder
– 2: Fetus 2
General Coding Guidelines
● Locate code in Alphabetic Index and confirm in Tabular list
● Report the highest number of characters available
● Signs and symptoms are acceptable if diagnosis has not been
confirmed by provider (Chapter 18 contains many but not all)
General Coding Guidelines
● Combination codes should be reported when code fully
describes condition
– Combination code is single code that describes:
o Two diagnoses
o Diagnosis with an associated secondary process
(manifestation)
o Diagnosis with an associated complication
2012 ICD-10-CM Codes Applicable to RE/I
●
●
●
●
●
C00-D99
E00-E89
N00-N99
O00-09A
Q00-Q99
● R00-R99
Neoplasms
Endocrine, nutritional and metabolic diseases
Diseases of the genitourinary system
Pregnancy, childbirth, and the puerperium
Congenital Malformation, deformations, and
chromosomal abnormalities
Symptoms, signs and abnormal clinical and
laboratory findings, not elsewhere classified
N00-N99
Diseases of the Genitourinary Sytem
● N70-N77
● N80-N98
● N99-N99
Inflammatory diseases of female pelvic organs
Noninflammatory disorders of female genital tract
Intraoperative and postprocedural complications
and disorders of genitourinary system, not
elsewhere classified
N80-N98
Noninflammatory disorders of female
genital tract
● N80
● N83
Endometriosis
Noninflammatory disorders of ovary, fallopian
tube, and broad ligament
Polyp of female genital tract
Excessive, frequent, and irregular menstruation
Recurrent Pregnancy Loss
Female Infertility
Complications associated with artificial
fertilization
●
●
●
●
●
N84
N92
N96
N97
N98
Some Diagnoses will be
Straight Crosswalks
N80 Endometriosis
ICD-9-CM
Description
ICD-10-CM
617.0
Endometriosis of uterus
N80.0
617.1
Endometriosis of ovary
N80.1
617.3
Endometriosis of pelvic peritoneum
N80.3
617.5
Endometriosis of intestine
N80.5
N97 Female Infertility
ICD-9-CM
Description
ICD-10-CM
628.0
Female Infertility associated with anovulation
N97.0
628.2
Female Infertility of tubal origin
N97.1
628.3
Female Infertility of uterine origin
N97.2
628.8
Female Infertility of other origin
N97.8
628.9
Female Infertility, unspecified
N97.9
N97
Female Infertility—What are Excludes?
● Type 1 Excludes
– Female infertility associated with:
o Hypopituitarism (E23.0_)
o Stein Leventhal Syndrome (E28.2_)
● Type 2 Excludes
– Incompetence of cervix uteri (N88.3_)
Type 1 Excludes
● A type 1 excludes note is a pure excludes. It means “not
coded here”
● A type 1 excludes note indicates that the code excluded
should never be used at the same time as (N97)
● Used when 2 conditions cannot occur together
Type 2 Excludes
● A type 2 excludes note represents “not included here”
● A type 2 excludes note indicates that the condition excluded is
not part of the condition it is excluded from but a patient may
have both conditions at the same time
● When a type 2 excluded note appears under a code it is
acceptable to use both the code (N97) and the excluded code
together
N97
Female Infertility
● Type 1 Excludes
– Female infertility associated with:
o Hypopituitarism (E23.0_)
o Stein Leventhal Syndrome (E28.2_)
● Type 2 Excludes
– Incompetence of cervix uteri (N88.3_)
N96
Recurrent Pregnancy Loss
● Type 1 Excludes
– Recurrent pregnancy loss with current pregnancy (O26.2-)
o O26.20
o O26.21
o O26.22
o O26.23
…unspecified
…first trimester
…second trimester
…third trimester
Some Codes may be less
specific
O00
Ectopic Pregnancy
ICD-9-CM
Description
633.0 Abdominal pregnancy
633.1 Tubal pregnancy
633.10 without intrauterine pregnancy
633.11 with intrauterine pregnancy
633.2 Ovarian pregnancy
633.8 Other ectopic pregnancy
633.9 Ectopic pregnancy, unspecified
ICD-10-CM
O00.0
O00.1
O00.2
O00.8
O00.9
Some codes may have the
same specificity
O02 Other abnormal products of conception
● O02.81
Inappropriate change in quantitative human
chorionic gonadotropin (hCG) in early pregnancy
● Currently in ICD-9-CM: 631.0
Some codes may be more
specific
O30
Multiple Gestation
ICD-9-CM
Description
651.0_ Twin pregnancy
V91.02 Twin pregnancy, monochorionic/diamniotic
…first trimester
V91.03 Twin pregnancy, dichorionic/diamniotic
…first trimester
651.1_ Triplet pregnancy
Triplet pregnancy with 2 or more monochorionic
V91.11 fetuses
…first trimester
ICD-10-CM
O30.0
O30.03
O30.031
O30.04
O30.041
O30.1
O30.11
O30.111
Some codes will replace
multiple codes, some will be
new
N98 Complications associated with
artificial fertilization
N98.1
N98.3
Hyperstimulation of ovaries (620.8, 256.1,
E932.4)
Complications of attempted introduction
of embryo in embryo transfer
What about
Fibroids?
Neoplasms
(C00-D49)
● (D10-D36) Benign neoplasms, except benign neuroendocrine
tumors
– D25
Leiomyoma of Uterus
D25
Leiomyoma of Uterus
ICD-9-CM
Description
ICD-10-CM
218.0
Submucous leiomyoma of uterus
D25.0
218.1
Intramural leiomyoma of uterus
D25.1
218.2
Subserous leiomyoma of uterus
D25.2
218.9
Leiomyoma of uterus, unspecified
D25.9
Z31
Encounter for Procreative Management
● Z31.41
Encounter for fertility testing (V26.21)
Z32
Encounter for pregnancy test and childbirth
and childcare instruction
ICD-9-CM
V72.4
Description
Encounter for pregnancy test
ICD-10-CM
Z32.0
V72.40
…result unknown
Z32.00
V72.42
…result positive
Z32.01
V72.41
…result negative
Z32.02
Summary
● Greatly increased number of codes in ICD-10, but RE/I will still
only routinely use a small subset of the new code set
● Due to greater specificity, ICD-10 often allows the use of
fewer codes than ICD-9 to adequately capture specific patient
conditions
● The general coding principles/diagnosis code selection
processes that apply to ICD-9-CM will also apply to ICD-10-CM
Summary
● System changes will be necessary to accommodate increased
digits and character changes
● May require changes in medical record documentation to
support increased specificity
● Education will be necessary for staff and providers
What to Do Now
● Assess the quality of medical record documentation
– Consider conducting a documentation assessment audit
● Implement documentation improvement strategies if
necessary based on audit results
● Monitor the impact of any documentation improvement
strategies
● Reassess and refine
● DO NOT PANIC!!
Planning for the Transition
● Verify with software vendors plans for testing and
implementation
● Assign internal implementation team
–
–
–
–
Include physicians and other providers
Clinical staff (nursing, lab, etc)
Administrative staff
Coding/ Billing staff
Planning for the Transition
● Assess current uses and users of ICD-9 in practice
– Assess skills and understanding of ICD
● Determine who needs ICD-10 training
● Evaluate training options
● Evaluate current documentation practices
● Plan for changes to charge capture documents
ACOG:
ICD-10-CM Resources
● ICD-10 page on ACOG website
● Monthly Subscription Listserv (contains latest ICD-10 news,
updates and links)
ACOG:
ICD-10-CM Resources
ICD Training Plan
– 2013
o Increased number of Coding Workshops (14)
o All Workshops presented using only ICD-10 codes
o ICD-10 to ICD-9 / ICD-9 to ICD-10 Crosswalks included
for each Workshop module
o Each Workshop attendee will receive a draft copy of the
current ICD-10 code set
o Separate (1/2 day) ICD-10 only training modules
 Focused exercises using the new code set
 Staff may attend alone
ACOG:
ICD-10-CM Resources
● Separate (1 page) ICD-10 and CPT Encounter Forms and Quick
Reference Sheets in 2013
● Coding Publications
– Essential Guide, Frequently Asked Questions, (all coding
publications with ICD info) will be updated to include ICD-10
content
What will ASRM do?
● Coding courses at the Annual Clinical Meeting
● Information in the Coding Corner of the Website
● Communicate with the ASRM Coding Committee any ideas
you have that would be beneficial in helping our members
implement ICD-10-CM
ICD-10-CM Resources
● CMS
– http://www.cms.gov/ICD10
● NCHS (CDC)
– http://www.cdc.gov/nchs/icd/icd10.htm
● AHIMA
– http://www.ahima.org/icd10/
● AAPC
– http://www.aapc.com/icd-10/
ICD-10-CM Resources
● The best web site I have found to help with looking
up ICD-10-CM codes:
ICD10Data.com
ICD Future
ICD -11 is on the horizon internationally:
Tweaked version of ICD-10, not a huge change from 10 to 11
● ICD-11 initial version made available for public review - May
2011
● WHO plans to present ICD-11 to the World Health Assembly in
2015
Other Important Codes in ICD-10
● W61.11XA: Bitten by macaw, initial
encounter
● W61.11XD: Bitten by macaw, subsequent
encounter
● W61.11XS: Bitten by macaw, sequela
● W61.12XA: Struck by macaw, initial
encounter
● W61.12XD: Struck by macaw, subsequent
encounter
● W61.12XS: Struck by macaw, sequela
● W61.19XA: Other contact with macaw, initial
encounter
● W61.19XD: Other contact with macaw,
subsequent encounter
● W61.19XS: Other contact with macaw,
sequela
Important Codes in ICD-10
●
●
●
●
●
●
●
●
●
●
●
V90.27XA: Drowning and submersion due to falling or
jumping from burning water-skis, initial encounter
V90.27XD: Drowning and submersion due to falling or
jumping from burning water-skis, subsequent encounter
V90.27XS: Drowning and submersion due to falling or jumping
from burning water-skis, sequela
V90.37XA: Drowning and submersion due to falling or
jumping from crushed water-skis, initial encounter
V90.37XD: Drowning and submersion due to falling or
jumping from crushed water-skis, subsequent encounter
V90.37XS: Drowning and submersion due to falling or jumping
from crushed water-skis, sequela
V90.87XA: Drowning and submersion due to other accident to
water-skis, initial encounter
V90.87XD: Drowning and submersion due to other accident to
water-skis, subsequent encounter
V90.87XS: Drowning and submersion due to other accident to
water-skis, sequela
V91.07XA: Burn due to water-skis on fire, initial encounter
V91.07XD: Burn due to water-skis on fire, subsequent
encounter
●
●
●
●
●
●
●
●
V92.07XA: Drowning and submersion due to fall
off water-skis, initial encounter
V92.07XD: Drowning and submersion due to fall
off water-skis, subsequent encounter
V92.07XS: Drowning and submersion due to fall
off water-skis, sequela
V92.27XA: Drowning and submersion due to
being washed overboard from water-skis, initial
encounter
V92.27XD: Drowning and submersion due to
being washed overboard from water-skis,
subsequent encounter
V92.27XS: Drowning and submersion due to
being washed overboard from water-skis,
sequela
V93.87XA: Other injury due to other accident on
board water-skis, initial encounter
V93.87XD: Other injury due to other accident on
board water-skis
September 2014 rolls around, You haven’t
prepared!
● TIME TO PANIC!!
QUESTIONS?