Transcript Presentation Title - ICD-10

International
Classification of
Disease, 10th
Revision, Clinical
Module
(ICD-10-CM)
Steven M. Verno, CMBS, CMSCS, CEMCS, CPM-MCS
Disclaimer
• I am not a Lawyer. I am a practice
manager, medical coder and medical
biller. I do not provide any legal
advice. This presentation contains no
legal advice. The contents are provided
for training purposes only!
It’s true!!
• There is No Longer any Rumor!
• ICD-10-CM BECOMES OUR CURRENT
DIAGNOSIS CODE SET AS OF
OCTOBER 1, 2013
What I won’t be Discussing!
• I will not be discussing ICD-10-PCS
When is ICD-10-CM Effective?
• October 1, 2013!
What Changes with ICD-10-CM?
The disease remains the same:
• Chicken Pox is still chicken pox
• Measles is still measles
• Chest pain is still chest pain.
The numbers change!
Comparing ICD-9 to ICD-10 Codes
Chicken Pox:
ICD-9-CM:
• V05.4 Varicella
• Chicken pox
ICD-10-CM
B01.9 - Varicella without complication
Comparing ICD-9 to ICD-10 Codes
Measles
ICD-9-CM:
• 055 Measles
• 056 Rubella
ICD-10-CM
B05.9 - Measles without complication
B06.9 - Rubella without complication
Comparing ICD-9 to ICD-10 Codes
Chest pain
ICD-9-CM:
• 786.50 Chest pain, unspecified
ICD-10-CM
R07.9 - Chest pain, unspecified
What doesn’t change?
Coding Conventions don’t change:
ICD-9-CM
• 370.2 Superficial keratitis without conjunctivitis
• Excludes: dendritic [herpes simplex] keratitis (054.42)
• 370.20 Superficial keratitis, unspecified
ICD-10
• H10 Conjunctivitis
• Excludes: keratoconjunctivitis ( H16.2 )
• H10.0 Mucopurulent conjunctivitis
• H10.3 Acute conjunctivitis, unspecified
• Excludes: ophthalmia neonatorum
• NOS ( P39.1 )
What doesn’t change?
NEC “Not elsewhere classifiable”
• This abbreviation in the Index represents “other specified”. When a
specific code is not available for a condition, the Index directs the coder to
the “other specified” code in the Tabular.
NOS “Not otherwise specified”
• This abbreviation is the equivalent of unspecified.
What doesn’t change?
• [ ] Brackets are used in the tabular list to enclose synonyms,
alternative wording or explanatory phrases. Brackets are used
in the Index to identify manifestation codes.
• ( ) Parentheses are used in both the Index and Tabular to
enclose supplementary words that may be present or absent
in the statement of a disease or procedure without affecting
the code number to which it is assigned. The terms within the
parentheses are referred to as nonessential modifiers.
• : Colons are used in the Tabular List after an incomplete term
which needs one or more of the modifiers following the colon
to make it assignable to a given category.
“Unspecified” codes
• Codes (usually a code with a 4th digit 9 or 5th digit 0 for
diagnosis codes) titled “unspecified” are for use when the
information in the medical record is insufficient to assign a
more specific code. For those categories for which an
unspecified code is not provided, the “other specified” code
may represent both other and unspecified.
Includes Notes
• This note appears immediately under a three-digit code title
to further define, or give examples of, the content of the
category.
Inclusion terms
• List of terms is included under some codes. These terms are
the conditions for which that code is to be used. The terms
may be synonyms of the code title, or, in the case of “other
specified” codes, the terms are a list of the various conditions
assigned to that code. The inclusion terms are not necessarily
exhaustive. Additional terms found only in the Index may also
be assigned to a code.
Excludes Notes
• ICD-10-CM has two types of excludes notes. Each type of note
has a different definition for use but they are all similar in that
they indicate that codes excluded from each other are
independent of each other.
Many Guidelines remain the same
ICD-9
• Signs and symptoms
• Codes that describe symptoms and signs, as opposed to diagnoses, are
acceptable for reporting purposes when a related definitive diagnosis has
not been established (confirmed) by the physician. Chapter 16 of ICD-9CM, Symptoms, Signs, and Ill-defined conditions (codes 780.0 -799.9)
contain many, but not all codes for symptoms.
ICD-10
• Codes for symptoms, signs, and ill-defined conditions
• Codes for symptoms, signs, and ill-defined conditions from Chapter 18
are not to be used as principal diagnosis when a related definitive
diagnosis has been established.
ICD-9
• Conditions that are an integral part of a disease process
• Signs and symptoms that are integral to the disease process should not be
assigned as additional codes.
ICD-10
• Conditions that are an integral part of a disease process
• Signs and symptoms that are associated routinely with a disease process
should not be assigned as additional codes, unless otherwise instructed
by the classification.
ICD-9 Level of Detail in Coding
•
•
•
•
Diagnosis and procedure codes are to be used at their highest number of digits available.
ICD-9-CM diagnosis codes are composed of codes with either 3, 4, or 5 digits. Codes with three digits are
included in ICD-9-CM as the heading of a category of codes that may be further subdivided by the use of
fourth and/or fifth digits, which provide greater detail.
A three-digit code is to be used only if it is not further subdivided. Where fourth-digit subcategories
and/or fifth-digit subclassifications are provided, they must be assigned. A code is invalid if it has not been
coded to the full number of digits required for that code. For example, Acute myocardial infarction, code
410, has fourth digits that describe the location of the infarction (e.g., 410.2, Of inferolateral wall), and
fifth digits that identify the episode of care. It would be incorrect to report a code in category 410 without
a fourth and fifth digit.
ICD-9-CM Volume 3 procedure codes are composed of codes with either 3 or 4 digits. Codes with two
digits are included in ICD-9-CM as the heading of a category of codes that may be further subdivided by
the use of third and/or fourth digits, which provide greater detail.
ICD-10 Level of Detail in Coding
•
•
•
Diagnosis codes are to be used and reported at their highest number of digits available.
ICD-10-CM diagnosis codes are composed of codes with 3, 4, 5, 6 or 7 digits. Codes with
three digits are included in ICD-10-CM as the heading of a category of codes that may be
further subdivided by the use of fourth and/or fifth digits, which provide greater detail.
A three-digit code is to be used only if it is not further subdivided. A code is invalid if it has
not been coded to the full number of characters required for that code, including the 7th
character, if applicable.
Some guidelines changed or do not
exist in ICD-10
ICD-9
15. Admissions/Encounters for Rehabilitation
•When the purpose for the admission/encounter is rehabilitation, sequence the
appropriate V code from category V57, Care involving use of rehabilitation
procedures, as the principal/first-listed diagnosis. The code for the condition for
which the service is being performed should be reported as an additional diagnosis.
•Only one code from category V57 is required. Code V57.89, Other specified
rehabilitation procedures, should be assigned if more than one type of rehabilitation
is performed during a single encounter. A procedure code should be reported to
identify each type of rehabilitation therapy actually performed.
ICD-10
Does not exist in ICD-10
How do I look up a code?
ICD-9-CM:
1. Use of Both Alphabetic Index and Tabular List
• Use both the Alphabetic Index and the Tabular List when locating and
assigning a code. Reliance on only the Alphabetic Index or the Tabular List
leads to errors in code assignments and less specificity in code selection.
2. Locate each term in the Alphabetic Index
• Locate each term in the Alphabetic Index and verify the code selected in
the Tabular List. Read and be guided by instructional notations that appear
in both the Alphabetic Index and the Tabular List.
Locating a code in the ICD-10-CM
• It is essential to use both the Index and Tabular List when locating and
assigning a code. The Index does not always provide the full code.
Selection of the full code, including laterality and any applicable 7th
character can only be done in the Tabular list. A dash (-) at the end of an
Index entry indicates that additional characters are required. Even if a
dash is not included at the Index entry, it is necessary to refer to the
Tabular list to verify that no 7th character is required.
Chap ICD-9ter
CM Descriptor
1
001-139 Infectious and Parasitic Diseases
2
140-239 Neoplasms
ICD-10CM
Descriptor
A00-B99 Certain infectious and parasitic diseases
C00-D48 Neoplasms
240-279
289-289
230-319
320-389
390-459
460-519
520-579
580-629
D50-D89
E00-E90
F00-F99
G00-G99
H00-H59
H60-H95
I00-I99
J00-J99
11
12
Endocrine, Nutritional, and Metabolic Diseases and
Immunity Disorders
Diseases of Blood and Blood Forming Organs
Mental Disorders
Diseases of Nervous System and Sense Organs
Diseases of Circulatory System
Diseases of Respiratory System
Diseases of Digestive System
Diseases of Genitourinary System
Complications of Pregnancy, Childbirth, and the
630-677 Puerperium
680-709 Diseases Skin and Subcutaneous Tissue
13
14
15
710-739 Diseases of Musculoskeletal and Connective Tissue
740-759 Congenital Anomalies
760-799 Newborn (Perinatal) Guidelines
K00-K93 Diseases of the digestive system
L00-L99 Diseases of the skin and subcutaneous tissue
Diseases of the musculoskeletal system and
M00-M99 connective tissue
N00-N99 Diseases of the genitourinary system
O00-O99 Pregnancy, childbirth and the puerperium
16
780-799 Signs, Symptoms and Ill-Defined Conditions
17
800-999 Injury and Poisoning
Classification of Factors Influencing Health Status
V01-V89 and Contact with Health Service
E800- Supplemental Classification of External Causes of
E999 Injury and Poisoning
3
4
5
6
7
8
9
10
18
19
20
21
22
Diseases of the blood and blood-forming organs and
certain disorders involving the immune mechanism
Endocrine, nutritional and metabolic diseases
Mental and behavioural disorders
Diseases of the nervous system
Diseases of the eye and adnexa
Diseases of the ear and mastoid process
Diseases of the circulatory system
Diseases of the respiratory system
# Codes **
455
622
696
2,230
1,163
792
296
214
3,885
1,439
1,560
322
1,374
1,046
600
P00-P96 Certain conditions originating in the perinatal period
213
Congenital malformations, deformations and
Q00-Q99 chromosomal abnormalities
240
Symptoms, signs and abnormal clinical and
R00-R99 laboratory findings, not elsewhere classified
1,585
Injury, poisoning and certain other consequences of
S00-T98 external causes
1,235
V01-98 External causes of morbidity and mortality
714
Factors influencing health status and contact with
Z00-Z98 health services
2,441
U00-U99 Codes for special purposes
Total Codes
23,122
Note: ** Information Obtained from data compiled by AHA &
AHIMA
ICD-9 Table of Drugs and Biologicals
Substance
Poisoning
Accident
Therapeutic Use
Suicide Attempt Assault
Undetermined
1-propanol
980.3
E860.4
-
E950.9
E962.1
E980.9
2-propanol
980.2
E860.3
-
E950.9
E962.1
E980.9
2, 4-D (dichlorophen-oxyacetic
989.4
acid)
E863.5
-
E950.6
E962.1
E980.7
2, 4-toluene diisocyanate
983.0
E864.0
-
E950.7
E962.1
E980.6
2, 4, 5-T (trichlorophenoxyacetic acid)
989.2
E863.5
-
E950.6
E962.1
E980.7
14-hydroxydihydromorphinone
965.09
E850.2
E935.2
E950.0
E962.0
E980.0
ABOB
961.7
E857
E931.7
E950.4
E962.0
E980.4
Abrus (seed)
988.2
E865.3
-
E950.9
E962.1
E980.9
Absinthe
980.0
E860.1
-
E950.9
E962.1
E980.9
ICD-10 Table of Drugs and Biologicals
Substance
1-propanol
2-propanol
2,4-D (dichlorophen-oxyacetic acid)
2,4-toluene diisocyanate
2,4,5-T (trichloro-phenoxyacetic acid)
14-hydroxydihydro-morphinone
ABOB
Abrine
Abrus (seed)
Absinthe
- beverage
Poisoning
Poisoning
Acicidental Intentional
Unintentional Self harm
Poisoning
Assault
Poisoning
Adverse
undetermined effect
Underdosing
T51.3x1
T51.2x1
T60.3x1
T65.0x1
T60.1x1
T40.2x1
T37.5x1
T62.2x1
T62.2x1
T51.0x1
T51.0x1
T51.3x3
T51.2x3
T60.3x3
T65.0x3
T60.1x3
T40.2x3
T37.5x3
T62.2x3
T62.2x3
T51.0x3
T51.0x3
T51.3x4
T51.2x4
T60.3x4
T65.0x4
T60.1x4
T40.2x4
T37.5x4
T62.2x4
T62.2x4
T51.0x4
T51.0x4
-----T40.2x6
T37.5x6
-----
T51.3x2
T51.2x2
T60.3x2
T65.0x2
T60.1x2
T40.2x2
T37.5x2
T62.2x2
T62.2x2
T51.0x2
T51.0x2
-----T40.2x5
T37.5x5
-----
Under ICD-9, Accidental poisoning by Absinthe would be 980.0 .
Under ICD-10, this code would be T51.0x1
When looking at T51.0, you find this:
T51.0 Toxic effect of ethanol
Toxic effect of ethyl alcohol Excludes2: acute alcohol intoxication or "hangover" effects
drunkenness pathological alcohol intoxication
T51.0x Toxic effect of ethanol
T51.0x1 Toxic effect of ethanol, accidental (unintentional)
Toxic effect of ethanol NOS
Getting Ready for ICD-10-CM
Documentation
ICD-10 takes a disease down to the Nth degree, due to
the availability of more codes to select. Therefore,
the provider must be exact with the medical
condition of the patient. Not being as detailed as
possible with the documentation can delay the
coding of the claim as well as the possible selection
of an incomplete or incorrect code.
Start your personnel training early
• You don’t want to wait until the last minute to train your staff
on the new changes.
• Be cautious of “fly-by-night” offers to provide your staff with
ICD-10 training. Obtain your training guidance from a
reputable organization.
• The certifying agencies are working now to update their
certification tests to change from ICD-9-CM to ICD-10-CM.
New Manuals
• You will be left in the dust and not using current coding manuals could be
very costly to your business, the provider and the patient.
• There are some websites that currently allow you to look up ICD-9-CM
codes for free. Whether these sites are changed or will be open is
unknown at this time.
• DO NOT Rely on any association or coding forum to do your coding for you.
Your coders should be highly trained, Certified and ready to use the new
codes the minute they are effective.
Contact Your Billing Software Vendor
• Your billing software may have to be upgraded to hold both ICD-9 and
ICD-10 because the claims you submit on September 30, 2013 will need
the ICD-9 Codes for all claims prior to October 1, 2011. You can expect
and plan on delays in payments while insurance companies work out the
bugs with their systems as they too will need to keep the ICD-9 codes in
their system for all pre October 1, 2013 claims. You may have to perform
claims testing with your upgraded software so that it does not send
claims after October 1, 2013 with ICD-9-CM codes.
HIPAA ANSI 5010
Date
January 1, 2010
December 31, 2010
January 1, 2011
December 31, 2011
January 1, 2012
October 1, 2013
http://www3.cms.gov/ICD10/03_ICD10andVersion5010ComplianceTimelines.asp#TopOfPage
Compliance Step
Payers and providers should begin internal
testing of Version 5010 standards for electronic
claims
Internal testing of Version 5010 must be
complete to achieve Level I Version 5010
compliance
•
Payers and providers should begin external
testing of Version 5010 for electronic claims
•
CMS begins accepting Version 5010 claims
•
Version 4010 claims continue to be
accepted
External testing of Version 5010 for electronic
claims must be complete to achieve Level II
Version 5010 compliance
•
All electronic claims must use Version
5010
•
Version 4010 claims are no longer
accepted
•
Claims for services provided on or after
this date must use ICD-10 codes for medical
diagnosis and inpatient procedures
•
CPT codes will continue to be used for
outpatient services
28
Contact the Insurance Companies
• Find out their coding policies as it relates to ICD-10 and benefit restrictions
based on diagnoses.
• Double check your current provider contracts regarding coding
requirements. If your provider agreed to the carrier coding policies, you
want to ensure that the carrier and your provider are on the same sheet
of music.
• Check with them to see when they are ready to accept claims using the
ICD-10. Find out what delays may be expected with claims and payment.
This could have an affect on your current provider contract with detailed
payment timeframes.
Update your Compliance Plans
• Many Compliance Plans address ICD-9 coding issues. Make sure yours is
changed to reflect the ICD-10 and any problems that may come with it.
What will you do if 90% of the charts contain insufficient information to
select the proper code out of 25 different codes for the condition. How
will you resolve these problems? How often will you conduct internal
coding audits? How many claims are being denied for coding issues and
how will you address this? These should be part of your compliance plan.
Update your appeals
• Go through your appeals that relate to any coding issues,
specifically diagnosis coding.
• Make sure they are changed to reflect the new ICD-10-CM
codes.
• Proofread any appeals you send to make sure the appeal
does not reference ICD-9-CM if an ICD-10 code was used.
Updated Superbills
• Some superbills may contain a checklist of ICD-9 codes. Make sure you
convert the ICD-9 code to the appropriate ICD-10 code(s).
• This may be a project that may take many days to accomplish. Once
completed, have the superbill proof read by a trained certified coding
staff member who has been trained in ICD-10.
• Don’t forget to include the provider and staff in your updated training.
• www.donself.com (superbill examples)
Fight Fraud and Abuse
• Just because there is a huge change coming in the future,
you should be on your toes to watch out for intentional or
unintentional upcoding or downcoding using the new ICD-10
codes. You do not want to be the subject of an audit by
Medicare, Medicaid, the OIG or any other insurance audit. If
you do what is right, you aren't afraid of any audits.
What does this mean for you??
•
•
•
•
•
•
•
•
•
New Coding Books ICD-10-CM
Updated Training
Updating Billing Software
Test Claims
Updating Superbills
Keeping an eye on claims denials or claims review
Keeping your provider’s AR to keep it down
Staying in close contact with the insurance companies
Possible updating of provider contracts to include clauses
to prevent coding problems.
• More Out of Pocket Expenses to get ready
ICD-9-CM
1600 Pennsylvania Avenue
36
ICD-10-CM
W01.9 Pennsylvania Avenue
37
ICD-10-CM is NOT scary
ICD-10 is friendly to a trained coder
Helpful Websites
•
•
•
•
•
•
•
•
•
•
Don Self: www.donself.com
AAPC: www.aapc.com
PAHCS: www.pahcs.org
POMAA: www.pomaa.net
MAB Forum: http://medicalassociationofbillers.yuku.com/
BC Advantage: http://www.billing-coding.com/forum/
CDC: www.cdc.gov/nchs/icd9.htm
www.cdc.gov/nchs/about/
major/dvs/mortdata.htm
www.cdc.gov/nchs
Questions?
[email protected]
Thank You!