Transcript UNDERSTANDING ICD-10-CM - Indianapolis Medical Society

WHAT DOES IT MEAN TO YOUR PRACTICE?
HOW SHOULD YOUR OFFICE PREPARE?
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- ICD-10 is a diagnostic coding system implemented by
the World Health Organization (WHO) in 1993 to replace
ICD-9. ICD-10 is in almost every country in the world,
except for the United States.
ICD-10 will be the most radical change to the healthcare
industry in 20 years.
Practices, billing services and vendors will have to
maintain both the ICD-9 & ICD-10 code sets for some
time in the future beyond the 10/2014 deadline.
• Maintained by the US National Center for Health Statistics
• Designed for greater clinical specificity
• Anatomic
• Procedural
• Visit specific information
• Technology (Compliance with 5010 is necessary)
◦ Cannot describe 21st century care
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Many categories are full
No detail on patient medical conditions
Has outdated and obsolete terminology
Used outdated codes
Produces inaccurate and limited data
Inconsistent with current medical practice
ICD-10 CODE SETS EXPLODE
ICD-10-CM
- 68,000 diagnosis codes
ICD-9
vs.
- 13,000 diagnosis codes
ICD-10 IS A COMPLETELY NEW SET OF CODES
The format is completely different
- Codes start with a letter
- Up to 7 characters
- Includes modifiers to
describe initial, subsequent or
sequela visits and other information
- Very specific codes
- RT and LT
- Upper and lower
- Fewer NOS codes
- More guidelines
WHAT DOES SEQUELA MEAN ?
Wikipedia: Sequela is a pathological condition resulting from a
disease, injury, or other trauma. Typically, a sequela is a
chronic condition that is a complication of an acute condition
that begins during that acute condition. This is a contrast to a
late effect.
Examples and Uses: Chronic kidney disease, for example, is
sometimes a sequela of diabetes, and neck pain is a
common sequela of whiplash or other trauma to the cervical
vertebrae.
ICD-9 Format
X
X
X
-----/------category
.
ICD-10 Format
X
X
X
X
X
----/----
----/-----
etiology,
anatomic site,
manifestation
category
.
X
X
X
-----/---etiology,
anatomic site,
severity
X
-/extension
• ICD-10 codes have the potential to reveal more about quality of care,
so that the data can be used in a more meaningful way to better
understand complications, better design clinically robust algorithms,
and better tract the outcomes of care.
• ICD-10 incorporates greater specificity and clinical detail to provide
information for clinical decision making and outcomes research.
• This means greater need for physician/practitioner involvement with
coding.
ICD-10 vs. ICD 9 DIAGNOSIS – FINGER LACERATION
ICD-9
- Is it simple or
complicated?
- Is there tendon
involvement
- Simple = 883.0
ICD – 10
- What finger is it?
- Is it the right hand or left hand?
- What part of the finger is
lacerated?
- Is it the initial encounter,
subsequent encounter or
sequela?
- Is the nail damaged?
- Are there fractures?
- Is there a Foreign Body?
- Are tendons injured?
• Laceration w/o FB right index
finger w/o damage to nail,
initial encounter
• = S61.210A
FRACTURE CLASSIFICATION
IN ICD-10-CM
Fracture coding in ICD-10-CM requires documentation of site,
laterality, type of fracture, whether it is displaced or nondisplaced, and the stage of healing (encounter), which includes
open fracture classification.
TAKE THE FEAR OUT OF ICD-10-CM
FRACTURE CODING
A 35-year old man suffered open displaced
tibia and fibula fractures of the right leg as the
result of an automobile accident. In addition,
he lost a lot of blood, also from the right leg
To assign the correct ICD-10-CM code, coders
will need to know:
• Which leg and which specific bone(s) the
patient injured. (In this example, it’s the right
tibia and fibula)
• Whether the fracture is open or closed (in this
case, open)
• Whether the fracture is displaced (in this case,
displaced)
FRACTURE CODING CONT……
For open fractures, coders will also need
to know what type of associated trauma
the patient suffered to choose the
appropriate character based on the
Gustilo-Anderson Classification system.
Gustilo-Anderson Classification System:
• ICD-10 categories
• S52 (fracture of forearm)
• S72 (fracture of femur)
• S82 (Fracture of lower leg, including ankle)
• All the above require additional seventh character
extensions.
SEVENTH CHARACTERS: CODING FOR A CLOSED
FRACTURE.
• A - Initial encounter of for fracture
• D – 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 - Sequela
SOME SILLY ICD-10 CODES
V9733xD – “Sucked into jet engine,
Subsequent encounter”…. They survived
the first time!?
Z631 – “Problems in relationship with in-laws”….really!?
Where’s the subsequent encounter?
X35.xxD – “Volcanic eruption, subsequent encounter”…. That’s some really
bad luck!
W61.49xA – “Other contact with turkey, initial encounter”….Every Thanksgiving!
Z621 – “Parental overprotection”….aren’t all parents “guilty” of this every now
and then.
ICD-10 DOCUMENTATION EXAMPLE:
The following case highlights the increased specificity required to code for ICD-10.
Mrs. Finley Presents today after having a new cabinet fall on her last week. (EXTERNAL CAUSE)
suffering a concussion, as well as some cervicalgia.
She was cooking dinner at the home she shares with her husband, (ACTIVITY)
She did not seek treatment at the time (7th CHARACTER)
She states that the people that put in the cabinet in her kitchen (LOCATION) missed the stud by
about two inches.
Her Husband, who was home with her at the time told her she was “out cold” for about two
minutes. (APPLIED SPECIFICITY) CONCUSSION
The headaches come on suddenly, last for long periods of time, and occur every day. They are
not relieved by Advil. (RELIEF OR NO RELIEF).
Patient suffers acute (ACUTE OR CHRONIC) persistent headaches post concussion.
CONT…..
SEVEN CHARACTERS TO CONSIDER WHEN CODING ICD-10
1. EXTERNAL CAUSE: The falling of the cabinet is what caused the injuries. Description of the
cause is required.
2. ACTIVITY: In ICD-10 the activity of the patient needs to be documented. An activity code is only
used once at the initial encounter.
3. 7TH CHARACTER: Injury codes require a 7th character extender that identifies the encounter.
Documentation must be clear so that the correct extender can be applied.
4. LOCATION: Documentation needs to indicate the location of the patient at the time of injury.
In ICD-10 the details include the actual room of the house the patient was in when the injury
occurred.
5. APPLIED SPECIFICITY: Concussion. For a concussion, documentation needs to include if the
patient suffered loss of consciousness.
6. RELIEF OR NO RELIEF: Intractable vs. not intractable are an inherent part of the ICD-10 code for
headaches and documentation needs to be clear to assign the appropriate code.
7. ACUTE VS. CHRONIC: Documentation of the patient’s condition must include acute or chronic
to assign the most appropriate ICD-10 code
CONT….
ICD-10 CODES THAT DESCRIBE PATIENTS VISIT
ICD-10-CM
DESCRIPTION
SPECIFICITY
S06.0X1A
Concussion with loss of
consciousness of 30 minutes or less
Initial encounter
G44.311
Acute post traumatic headache
Intractable
M54.2
Cervicalgia
M99.01
Segmental and somatic
dysfunction of cervical region
W208XXA
Struck by falling object
(accidentally)
Y93.G3
Activity, Cooking and baking
Y92.010
Place of occurrence, house,
single family, kitchen
Initial encounter
HOW MUCH TIME DO I HAVE TO
PREPARE?
On October 1, 2014, the ICD-9 code sets to report medical
diagnoses and inpatient procedures will be replaced by ICD-10
code sets.
For providers who have not yet
started to transition to ICD-10,
they should take action steps
now.
UNDERSTAND THE
EFFECTS ON YOUR
PRACTICE.
* CMS and the commercial payors are
anticipating two years of claims and
payments disruptions are possible after
October 2014.
Part of your Implementation Plan should be to acquire a line of credit
or loan now to cover expenses in the disruption of cash flow.
PERSONNEL
• Physicians/Nurses
• Greater detail requires more
work at the provider/EMR level
• ICD-10 coding education
• ICD-10 reference materials
• Payer code combination changes
with ICD-10
• Billing Office/Coding Specialist
• Greater detail requires more research/understanding
• ICD-10 coding education and reference materials
• Payer code combination changes with ICD-10
• Front Desk/Management
• Greater detail required on Encounter/Superbill
• ICD-10 code understanding, reference materials
• Changes to all printed materials
IS YOUR CODER?
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•
You
Staff
Certified Professional
Outsourced
Software assisted
EHR
• Who will train them?
• When will you train them?
• When will YOU learn the new
conventions?
• Are updates required?
• Where do you find help?
SUMMARY……
 You must start NOW!
 Prepare your practice. Set timelines.
 ICD-10 Training and Education is a must for staff and
providers.
 Consider outsourcing billing to professionals
 Software Compliance for 5010 as the Gateway
 Code mapping applications to convert ICD-9 to ICD-10
 Charting Changes – EMR vs. Paper updates to
accommodate ICD-10
 Detailed documentation from the providers is the key to
successful coding and reimbursement.
12 months until compliance and although its tempting to
put this out past the 5010 deadline – DO NOT WAIT
Resources for ICD-10
• General Information/Education/Resource Materials
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CMS – www.cms.org
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HHS – www.hhs.org
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AHIMA – www.ahima.org
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ICD-10 Made Easy – www.icd10madeeasy.com
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Workgroup for EDI – www.wedi.org
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ZirMed – http://icd.zirmed.com
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AMA – www.ama-assn.org/go/ICD-10
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AAOS – www.aaos.org/ICD10
• Mapping of ICD-9 to ICD-10
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Practice Management System & EMR Vendors
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ZirMed
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Navicure
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Ingenix
*MedPro Services does not endorse these companies or their services, this
is merely a reference to available resources in the industry.
Rebecca Kieffner, President & CEO
MedPro Services, Inc.
300 West Second Street
Bloomington, IN 47403
Telephone: (812) 334-1333
Fax: (812) 334-1444
Toll Free: (866) 633-7768
[email protected]
www.orthopaedicsbilling.com