IHIMA ICD-10 UPDATE Presented by: Kathy Craig, RHIA, CCS ICD-10-CM/PCS Certified Trainer Program Chair, HIT Program, Ivy Tech Bloomington.
Download ReportTranscript IHIMA ICD-10 UPDATE Presented by: Kathy Craig, RHIA, CCS ICD-10-CM/PCS Certified Trainer Program Chair, HIT Program, Ivy Tech Bloomington.
Slide 1
IHIMA
ICD-10 UPDATE
Presented by:
Kathy Craig, RHIA, CCS
ICD-10-CM/PCS Certified Trainer
Program Chair, HIT Program, Ivy Tech Bloomington
Slide 2
No Impact on Use of CPT ® and
HCPCS Level II Codes
CPT® and HCPCS Level II will continue to
be used for:
Reporting physician and other professional
services
Procedures performed in hospital
outpatient departments and other
outpatient facilities
2
Slide 3
ICD-10-CM/PCS Final Regulation
Physician
Behavioral
Health
Hospital
inpatient
All Other
Laboratory
outpatient
Long Term
Healthcare
3
Slide 4
Background
ICD-9-CM
Current coding classification system
Introduced 30 years ago
No longer fits with 21st century health system
ICD-10-CM & ICD-10-PCS
International standard - diagnostic classification for all general
epidemiological and many health management purposes
Track, report and compare morbidity and mortality
Supports achievement of EHR benefits
Transition to ICD-10 required by federal regulation
Slide 5
Global Use of ICD-10
Iceland
Norway
Sweden
Finland
Denmark
Poland
Ireland
Germany
UK
Czech Republic
The Netherlands
Austria
Belgium
France
Switzerland
Italy
Portugal
Spain
Canada
United States
Japan
China
Thailand
Costa Rica
Venezuela
Colombia
Singapore
Brazil
Australia
Argentina
New Zealand
Source: 3M Information Systems, Inc.
Slide 6
Background
ICD-10
Available since 1992
Approximately 100 countries use ICD-10 including Canada,
Australia, and the United Kingdom
United States: Only industrialized nation not using ICD-10
United States: ICD-10 go-live date is October 1, 2013
Slide 7
Background (continued)
Comparison of the two systems:
Expansion of codes
13,000 diagnosis codes in ICD-9-CM / 69,000 unique
diagnosis codes in ICD-10-CM
4,000 procedure codes in ICD-9-CM/ 72,000 procedure
codes in ICD-10-PCS
Different code structure, diagnoses for example
ICD-9-CM:
ICD-10-CM:
3 - 5 digits / limited alpha characters
3 -7 digits / additional alpha characters
Slide 8
Coding Categories
Code Examples
Diagnosis Codes Code Structure
All categories are 3 characters
All subcategories are either 4 or 5 characters
The first category is a letter
The second and third categories are numbers or letters
These categories may be letters or numbers
Codes are 4, 5 or 6 characters and the final character in a
code may be a letter or number (some categories have a 7th
character)
Slide 9
The Basics of the ICD-10 Change
An example of structural change
ICD-10
ICD-9
X
X
X
Category
.
X
X
X
Etiology, anatomic site,
manifestation
X
X
Category
.
X
X
X
.
X
Etiology, anatomic site, Extension
manifestation
An example of (1) ICD-9 code being represented by multiple ICD-10 codes
2
5
0
.
6
1
Diabetes mellitus with neurological
Manifestations type I not stated
as uncontrolled
E
1
0
E
1
0
E
1
0
E
1
0
.
.
.
.
4
0
Type I diabetes mellitus with
diabetic neuropathy, unspecified
4
1
Type I diabetes mellitus with
diabetic mononeuropathy
4
4
Type I diabetes mellitus with
diabetic amyotrophy
4
9
Type I diabetes mellitus with other
diabetic neurological complication
9
Slide 10
Coding Categories (continued)
3 Character Category examples
A00-A09
- Intestinal infectious diseases
A30-A49 - Other bacterial diseases
4 Character Category examples
C15.3
- Malignant neoplasm of upper third of
esophagus
C15.8 - Malignant neoplasm of overlapping lesion of
esophagus
Slide 11
Coding Categories (continued)
5/6 Character Subclassification example
S55.011
- Laceration of ulnar artery at
forearm level, right arm
7th Character Extension example
T50.B96D
- Underdosing of other viral
vaccines, subsequent encounter
Slide 12
A glimpse at ‘specificity’
ICD-9-CM
821.01 Fracture of femur, shaft, closed
ICD-10-CM
S72301A Unspecified fracture of shaft of right femur,
initial encounter for closed fracture
S72322A Displaced transverse fracture of shaft of
left femur, initial encounter for closed fracture
S72326A Nondisplaced transverse fracture of shaft of unspecified
femur, initial encounter for closed fracture
S72301G Unspecified fracture of shaft of right femur,
subsequent encounter for closed fracture with
delayed healing
S72322G Displaced transverse fracture of shaft of
left femur, subsequent encounter for closed fracture
with delayed healing
S72326G Nondisplaced transverse fracture of shaft of unspecified
femur, subsequent encounter for closed fracture with delayed
healing
S72302A Unspecified fracture of shaft of left femur,
initial encounter for closed fracture
S72323A Displaced transverse fracture of shaft of
unspecified femur, initial encounter for closed
fracture
S72331A Displaced oblique fracture of shaft of right femur, initial
encounter for closed fracture
S72302G Unspecified fracture of shaft of left femur,
subsequent encounter for closed fracture with
delayed healing
S72323G Displaced transverse fracture of shaft of
unspecified femur, subsequent encounter for closed
fracture with delayed healing
S72331G Displaced oblique fracture of shaft of right femur,
subsequent encounter for closed fracture with delayed healing
S72309A Unspecified fracture of shaft of unspecified
femur, initial encounter for closed fracture
S72324A Nondisplaced transverse fracture of shaft
of right femur, initial encounter for closed fracture
S72332A Displaced oblique fracture of shaft of left femur, initial
encounter for closed fracture
S72309G Unspecified fracture of shaft of unspecified
femur, subsequent encounter for closed fracture with
delayed healing
S72324G Nondisplaced transverse fracture of shaft
of right femur, subsequent encounter for closed
fracture with delayed healing
S72332G Displaced oblique fracture of shaft of left femur,
subsequent encounter for closed fracture with delayed healing
S72325A Nondisplaced transverse fracture of shaft
of left femur, initial encounter for closed fracture
S72333A Displaced oblique fracture of shaft of
unspecified femur, initial encounter for closed
fracture
S72321A Displaced transverse fracture of shaft of right femur,
initial encounter for closed fracture
S72325G Nondisplaced transverse fracture of shaft
of left femur, subsequent encounter for closed
fracture with delayed healing
S72333G Displaced oblique fracture of shaft of
unspecified femur, subsequent encounter for closed
fracture with delayed healing
S72321G Displaced transverse fracture of shaft of right femur,
subsequent encounter for closed fracture with delayed healing
12
Slide 13
Benefits
Higher quality information for measuring healthcare service
quality, safety, and efficacy
More accurate payment for new procedures
Fewer miscoded, rejected, and improperly reimbursed claims
Better understanding of the value of new procedures and
healthcare outcomes
Improved disease management
Data comparability internationally
Slide 14
Impacts
More than Just a Larger Coding Inventory of Systems
According to the Healthcare Information Management Systems Society (HIMSS)
Registration
Registration and scheduling
systems
Advance Beneficiary software
Performance management systems
Medical necessity edits
Clinical Systems
Clinical systems
Clinical protocols
Test ordering systems
Clinical reminder systems
Medical necessity software
Disease management
systems
Decision support systems
Pharmacy systems
HIM
DRG grouper
Encoding software
Abstract systems
Compliance software
Medical record
abstracting
Billing/Financial
DRG grouper
Conversion of other payment
methodologies
National and local coverage
determinations
System logic and edits
Billing systems
Financial systems
Claim submission systems
Compliance checking systems
Support Systems
Case Mix systems
Utilization management
Quality management
Case Management
Reporting
Provider profiling
Quality measurement
Utilization management
Disease management registries
Other registries
State reporting systems
Fraud management
Aggregate data reporting
Clinical systems
Patient assessment data sets (e.g. MDS,
RAI, OASIS)
Slide 15
Costs
Training
Lost productivity during implementation & training
System upgrades/changes
Contract re-negotiation
Additional resources to support and manage
implementation
Slide 16
Costs – System Implementation
Slide 17
Costs - Additional
Slide 18
The ‘B’ Word
Budget
$$’s
People
Process
Technology
Other…
18
Slide 19
POTENTIAL BUDGETING CATEGORIES
2010
2011
2012
2013
2014
Program Manager w/ Admin Support
x
x
x
x
x
Staff to review payer contracts/ renegotiate
x
x
x
HIM temporary during cross over period
x
x
PFS temporary during transition
x
x
Assessment/ Gap Analysis (internal +/or
external )
x
x
Documentation Improvement
x
x
Dual Systems?
X
X
Decision Support /Home Grown System
Remediation (and/or Translation Software)
X
Payer Integration and/or Readiness
(mitigation)
x
Communications to internal/ external
constituents
PEOPLE (HUMAN RESOURCE)
# FTEs/ Contract Workers
PROCESSES (not including potential
process improvement gains)
x
x
x
x
x
X
X
X
X
TECHNOLOGY
X
X
X
X
Vendor Systems (ICD-10fees?
x
x
x
Vendor Interface charges?
X
X
X
New Vendors?
x
19
Slide 20
Preparation
Early Preparation
A well-planned, well-managed implementation process will increase the
chances of a smooth, successful transition
Experience in other countries has shown that early preparation is the key to
success.
An early start allows for resource allocation, such as costs for systems
changes and education, process evaluation and change, as well as staff
time devoted to implementation processes, to be spread over several years.
Potential Consequences of Inadequate Preparation:
Decreased coding accuracy
Decreased coding productivity
Increased compliance risks
Increased claims rejection
An adverse impact on patient care and administrative decision-making
Slide 21
HIPAA 5010 Background
HIPAA legislation mandates that the healthcare industry use standard
formats for electronic claims and related transactions
The formats currently used must be upgraded from X12 Version 4010A1 to
5010 and from NCPDP 5.1 to D.0
Version 5010 includes changes to the following transactions:
270/271, Eligibility Benefit Inquiry and Response
276/277, Claim Status Request and Response
278, Health Care Services – Request for Review and Response
820, Premium Payment for Insurance Products
834, Benefit Enrollment and Maintenance
835, Claim Payment/Advice
837, Claim including Coordination of Benefits (COB) and subrogation
claims
NCPDP D.0, Pharmacy Claim
Required to prepare the infrastructure needed to support ICD-10
Slide 22
HIPAA 5010 Background cont’d
Level I Compliance by: December 31, 2010
Level II Compliance by: December 31, 2011
Level I compliance means "that a covered entity can demonstrably create and
receive compliant transactions, resulting from the compliance of all design/build
activities and internal testing."
Level II compliance means "that a covered entity has completed end-to-end
testing with each of its trading partners, and is able to operate in production
mode with the new versions of the standards."
All covered entities have to be fully compliant on: January 1,
2012
Slide 23
5010 Compliance Timeline per Federal Rule
Slide 24
Slide 25
Top Ten Things You Need to Know
(to Prepare for ICD-10)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
The date is not flexible
Everyone will be affected
Private and public health plans will not accept and pay
based on ICD-9 codes
ICD-10 is not an ICD-9 maintenance update
Automated conversions are not possible (forward &
backward mapping of codes)
ICD-10 cannot wait for Electronic Health Records & other
health IT initiatives
Must implement both 5010 and ICD-10
ICD-10 is more than a compliance activity
Planning and implementation must begin now
The first step is a comprehensive Risk Readiness
Assessment followed by an Impact Analysis
25
Slide 26
Next Steps
Continue to investigate systems for potential impact
Incorporate ICD10 in system inventory
Secure project manager for ICD10
Determine official project sponsorship
Identify point of contact for all facilities and
organizations
Formal collaboration between HIPAA 5010 and
ICD10 teams
Continue and expand leadership education efforts
Slide 27
Questions?
Slide 28
Resources
American Health Information Management Association (AHIMA)
Hay Group, Inc.
Healthcare Information Management Systems Society (HIMSS)
RAND
Robert E. Nolan Company
Pricewaterhouse Coopers
http://www.cms.hhs.gov/TransactionCodeSetsStands/02_Transactio
nsandCodeSetsRegulations.asp
http://www.cms.gov/ElectronicBillingEDITrans/18_5010D0.asp
Slide 29
Slide 30
ICD-10CM
Similarities
30
Slide 31
How is ICD-10-CM Similar to ICD-9-CM?
Format
Tabular
List and Index
Chapters in Tabular structured similarly to ICD9-CM, with minor exceptions
A few chapters have been restructured
Sense organs (eye and ear) separated from
Nervous System chapter and moved to their own
chapters
Index structured the same as ICD-9-CM
Alphabetic Index of Diseases and Injuries
Alphabetic Index of External Causes
Table of Neoplasms
Table of Drugs and Chemicals
31
Slide 32
How is ICD-10-CM Similar to ICD-9-CM?
Divided into Alphabetic Index and
Tabular List
Structure
and format are the same
Index is alphabetical list of terms and their
corresponding codes
Alphabetic Index lists main terms in alphabetical
order with indented subterms under main terms
Index is divided into 2 parts: Index to Diseases
and Injuries and Index to External Causes
32
Slide 33
How is ICD-10-CM Similar to ICD-9-CM?
Tabular List is a chronological list of codes
divided into chapters based on body system or
condition
Tabular List is presented in code number order
Same hierarchical structure
Codes are invalid if they are missing an
applicable character
Codes are looked up the same way
Look up diagnostic terms in Alphabetic Index
Then verify code number in Tabular List
33
Slide 34
How is ICD-10-CM Similar to ICD-9-CM?
Many conventions have same meaning
Abbreviations, punctuation, symbols, notes such as
“code first” and “use additional code”
Nonspecific codes (“unspecified” or “not otherwise
specified”) are available to use when detailed
documentation to support more specific code is not
available
ICD-10-CM Official Guidelines for Coding and Reporting
accompany and complement ICD-10-CM conventions
and instructions
Adherence to the official coding guidelines in all
healthcare settings is required under the Health
Insurance Portability and Accountability Act
34
Slide 35
ICD-10CM
Differences
35
Slide 36
How is ICD-10-CM Different From
ICD-9-CM?
Alphanumeric
(alpha characters are not case-
sensitive)
Codes can be up to 7 characters in length
Code titles are more complete
Specificity and detail significantly expanded
Certain diseases reclassified to reflect current
medical knowledge
36
Slide 37
ICD-10-CM New Features
Combination codes for conditions
and common symptoms or
manifestations
Combination codes for poisonings
and external causes
Added laterality
Expanded codes (injury, diabetes,
alcohol/substance abuse,
postoperative complications)
Injuries grouped by anatomical site
rather than injury category
37
Slide 38
ICD-10-CM - Combination Codes
I25.110 Atherosclerotic heart disease of native
coronary artery with unstable angina pectoris
K71.51 Toxic liver disease with chronic active
hepatitis with ascites
K50.814 Crohn’s disease of both small and large
intestine with abscess
N41.01 Acute prostatitis with hematuria
E11.311 Type 2 diabetes mellitus with unspecified
diabetic retinopathy with macular edema
K57.21 Diverticulitis of large intestine with perforation
and abscess with bleeding
38
Slide 39
ICD-10-CM - Laterality Examples
C50.211 Malignant neoplasm of upper-inner
quadrant of right female breast
H02.032 Senile entropion of right lower eyelid
M05.271 Rheumatoid vasculitis with rheumatoid
arthritis of right ankle and foot
S80.261A Insect bite (nonvenomous), right knee,
initial encounter
39
Slide 40
Diabetes
ICD-9-CM
ICD-10-CM
250.x Diabetes mellitus
• 5th digit “1” – Type I
• 5th digit “0” – Type II or
unspecified
• 5th digit “2” & “3” –
uncontrolled
249.x Secondary diabetes
mellitus
• 5th digit “0” & “1” –
uncontrolled
648.0x – Diabetes mellitus
complicating pregnancy,
childbirth or puerperium
40
Combination codes include
type of complication
Five categories
• E08 Diabetes mellitus due to
underlying condition
• E09 Drug or chemical
induced diabetes mellitus
• E10 Type 1 diabetes mellitus
• E11 Type 2 diabetes mellitus
• E13 Other specified
diabetes mellitus
O24 DM in pregnancy,
childbirth, puerperium
Slide 41
ICD-10-CM - Diabetes Mellitus
Examples
E09.01
E10.11
E11.40
E13.621
Drug or chemical induced diabetes
mellitus with hyperosmolarity with
coma
Type 1 diabetes mellitus with
ketoacidosis with coma
Type 2 diabetes mellitus with
diabetic nephropathy, unspecified
Other specified diabetes mellitus
with foot ulcer
41
Slide 42
Pressure Ulcers
ICD-9-CM
707.0x Pressure ulcer by
site
707.2x – Pressure ulcer
stages
Code first site of pressure
ulcer
42
ICD-10-CM
L89 Pressure ulcer by
site and stage
Site and stage captured
by single code
Specific codes for
pressure ulcer of
contiguous site of back,
buttock, and hip
Code first any associated
gangrene
Slide 43
Epilepsy, Recurrent Seizures
ICD-9-CM
345.00-345.91 Epilepsy, recurrent seizures
Intractable or not
Generalized convulsive and nonconvulsive
Petit mal status vs. grand mal status
Localization-related (focal) (partial) epilepsy and
epileptic syndromes with simple or complex
partial seizures
Infantile spasms
Epilepsia partialis continua
43
Slide 44
Epilepsy, Recurrent Seizures
ICD-10-CM
G40.001-G40.919 Epilepsy and recurrent seizures
Localization-related (focal) (partial) idiopathic epilepsy
and epileptic syndromes with seizures of localized onset
Localization-related (focal) (partial) idiopathic epilepsy
and epileptic syndromes with simple or complex partial
seizures
Generalized idiopathic epilepsy and epileptic syndromes
Other generalized epilepsy and epileptic syndromes
Special epileptic syndromes
Other epilepsy and seizures
Intractable or not
With or without status epilepticus
44
Slide 45
Asthma
ICD-9-CM
493.00-493.92 Asthma
Extrinsic vs. intrinsic
Chronic obstructive asthma
With status asthmaticus
With exacerbation
Exercise induced bronchospasm
Cough variant asthma
45
Slide 46
Asthma
ICD-10-CM
J45.20-J45.998 Asthma
Mild intermittent
Mild persistent
Moderate persistent
Severe persistent
With status asthmaticus
With exacerbation
Exercise induced bronchospasm
Cough variant asthma
Excludes chronic obstructive asthma
46
Slide 47
ICD-10-CM Circulatory
System Changes
Age definition for acute myocardial infarction has
changed (4 weeks instead of 8 weeks)
New category for subsequent acute myocardial
infarction
New category for complications within 28 days of
acute myocardial infarction
Transient ischemic attacks re-classified to nervous
system chapter
Late effects of stroke differentiated by type of stroke
Combination codes for common
etiologies/manifestations
47
Slide 48
ICD-10-CM Obstetrics
Addition of trimester
Deletion of episode of care
O15.03 Eclampsia in pregnancy, third trimester
O23.12 Infections of bladder in pregnancy, second
trimester
O22.21 Superficial thrombophlebitis in pregnancy,
first trimester
Documentation of trimester
Counted from first day of last menstrual period
Document number of weeks
48
Slide 49
ICD-10-CM Obstetrics
Obstructed labor codes incorporate reason for
obstruction
Code extensions to identify specific fetus
(1-5) affected by obstetric condition
O64.1xx2 Obstructed labor due to breech
presentation, fetus 2
49
Slide 50
ICD-10-CM - Injury Changes
ICD-9-CM
Fractures (800-829)
Dislocations (830-839)
Sprains and strains(840-848)
ICD-10-CM
Injuries to the head (S00-S09)
Injuries to the neck (S10-S19)
Injuries to the thorax (S20-S29)
50
Slide 51
ICD-10-CM - Fractures
Displaced vs. non-displaced
Type of fracture
Site of fracture
Laterality
7th character indicating:
Open vs. closed
Routine vs. delayed healing
Nonunion, malunion
Initial encounter, subsequent encounter, sequela
51
Slide 52
ICD-10-CM - Injury and External
Cause 7th Character
A Initial encounter
D Subsequent encounter
S Sequelae
52
Slide 53
ICD-10-CM - Fracture Extensions
A Initial encounter for closed fracture
B Initial encounter for open 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 Sequelae
53
Slide 54
ICD-10-CM – Fracture Extensions (con’t)
A Initial encounter for closed fracture
B Initial encounter for open fracture type I or II
(open NOS)
C Initial encounter for open fracture type IIIA, IIIB, or IIIC
D Subsequent encounter for closed fracture with routine
healing
E Subsequent encounter for open fracture type I or II
with routine healing
F Subsequent encounter for open fracture type IIIA, IIIB,
or IIIC with routine healing
G Subsequent encounter for closed fracture with
delayed healing
54
Slide 55
ICD-10-CM - Fracture Extensions (con’t)
H Subsequent encounter for open fracture type I or
II with delayed healing
J Subsequent encounter for open fracture type IIIA,
IIIB, or IIIC with delayed healing
K Subsequent encounter for closed fracture with
nonunion
M Subsequent encounter for open fracture type I or
II with nonunion
N Subsequent encounter for open fracture type IIIA,
IIIB, or IIIC with nonunion
55
Slide 56
ICD-10-CM - Fracture Extensions (con’t)
P Subsequent encounter for closed fracture with
malunion
Q Subsequent encounter for open fracture type I or
II with malunion
R Subsequent encounter for open fracture type IIIA,
IIIB, or IIIC with malunion
S Sequelae
56
Slide 57
ICD-10-CM Open Fracture Designations
7th characters for open fractures are based on Gustilo
classification – requires physician documentation of open
fracture type:
I – wound less than 1 cm with minimal soft tissue injury
II - wound greater than 1 cm with moderate soft tissue
injury
III – High energy wound greater than 1 cm with extensive
soft tissue damage
IIIA – adequate soft tissue cover
IIIB – inadequate soft tissue cover, requiring regional
or free flap
IIIC – involves vascular injury requiring repair
57
Slide 58
ICD-10-CM Coding Examples
Hypertension
Step 1
Look up term in Alphabetic Index:
Hypertension, hypertensive (accelerated)
(benign) (essential) (idiopathic) (malignant)
(systemic) I10
58
Slide 59
ICD-10-CM Coding Examples
Hypertension (con’t)
Step 2
Verify code in Tabular:
I10 Essential (primary) hypertension
Includes: high blood pressure
hypertension (arterial) (benign) (essential)
(malignant) (primary) (systemic)
Excludes1: hypertensive disease complicating pregnancy,
childbirth and the puerperium (O10-O11,
O13-O16)
Excludes2: essential (primary) hypertension involving
vessels of brain (I60-I69)
essential (primary) hypertension involving
vessels of eye (H35.0)
59
Slide 60
ICD-10-CM Coding Examples
Type I diabetes mellitus with diabetic
nephropathy
Step 1
Look up term in Alphabetic Index:
Diabetes, diabetic (mellitus) (sugar) E11.9
type 1 E10.9
with
nephropathy E10.21
60
Slide 61
ICD-10-CM Coding Examples
Type I diabetes mellitus with diabetic nephropathy (con’t)
Step 2
Verify code in Tabular:
E10 Type 1 diabetes mellitus
E10.2 Type 1 diabetes mellitus with kidney
complications
E10.21 Type 1 diabetes mellitus with
diabetic nephropathy
Type 1 diabetes mellitus with intercapillary
glomerulosclerosis
Type 1 diabetes mellitus with intracapillary
glomerulonephrosis
Type 1 diabetes mellitus with Kimmelstiel-Wilson
disease
61
Slide 62
Next Steps
• Begin preparing for the transition to ICD-10CM/PCS and new HIPAA electronic
transactions standards NOW!
• A successful transition depends on careful
planning
62
Slide 63
Role-Based ICD-10-CM/PCS
Training Model
Landing Page
63
Slide 64
Using the Role-Based Training Model
Healthcare
Providers
• Inpatient coder
• Outpatient coder
• Managers of data
Health Plans
• Tasks for 5010 &
• ICD-10-CM/PCS
compliance
Academic
64
• Educators
• Current students
• Prospective students
Slide 65
READY
www.ahima.org/IC
D10/role/aspx
Physician model
65
Slide 66
ICD-10 Facts vs. Myths
Myth: The Oct. 1, 2013 date for implementation should be
considered a flexible date.
Fact: All HIPAA covered entities MUST implement the
new code sets with dates of service, or date of
discharge for inpatients, that occur on or after Oct. 1,
2013.
Myth: Implementation planning should be undertaken with the
assumption that HHS will grant an extension.
Fact: HHS has no plans to extend compliance date for
implementation of ICD-10-CM/PCS; covered entities
should plan to complete steps required to implement
on Oct. 1, 2013.
66
Slide 67
ICD-10 Facts vs. Myths
Myth: There will be no hard-copy code
books and all coding will need to be
performed electronically.
Fact: ICD-10-CM and ICD-10-PCS code
books are already available and are a
manageable size. The use of ICD-10CM is not predicated on the use of
electronic hardware and software.
67
Slide 68
ICD-10
Facts vs. Myths
Myth: Unnecessarily detailed medical record
documentation will be required.
Fact: As with ICD-9-CM, ICD-10 codes should be
based on medical record documentation. While
documentation supporting accurate and specific
codes will result in higher-quality data, nonspecific
codes are still available for use when
documentation doesn’t support a higher level of
specificity. As demonstrated by the AHA/AHIMA
field testing study, much of the detail contained in
ICD-10-CM is already in medical record
documentation but is not currently needed for ICD9-CM coding.
68
Slide 69
ICD-10 Facts vs. Myths
Myth: The increased number of codes will make ICD-10CM/PCS impossible to use.
Fact: Just as the size of a dictionary doesn’t make it
more difficult to use, a higher number of codes
doesn’t necessarily increase the complexity of the
coding system – in fact, it makes it easier to find
the right code.
Fact: Greater specificity and clinical accuracy make
ICD-10 easier to use than ICD-9-CM.
Fact: Because ICD-10-CM/PCS is much more
specific, is more clinically accurate, and uses a
more logical structure, it is much easier to use
than ICD-9-CM.
69
Slide 70
ICD-10 Facts vs. Myths
Myth: The increased number of codes will make ICD-10CM/PCS impossible to use (con’t).
Fact: Just as it isn’t necessary to search the entire
list of ICD-9-CM codes for the proper code, it is
also not necessary to conduct searches of the
entire list of ICD-10 codes.
Fact: The Alphabetic Index and electronic coding
tools will continue to facilitate proper code
selection.
Fact: It is anticipated that the improved structure
and specificity of ICD-10-CM/PCS will facilitate the
development of increasingly sophisticated
electronic coding tools that will assist in faster
code selection.
70
Slide 71
ICD-10 Facts vs. Myths
Myth: ICD-10-CM/PCS was developed without
clinical input.
Fact: The development of ICD-10-CM/PCS
involved significant clinical input. A number of
medical specialty societies contributed to the
development of the coding systems.
71
Slide 72
ICD-10 Facts vs. Myths
Myth: ICD-10-CM-based super bills will be too
long or too complex to be of much use.
Fact: Practices may continue to create super
bills that contain the most common diagnosis
codes used in their practice. ICD-10-CM-based
super bills will not necessarily be longer or
more complex than ICD-9-CM-based super
bills. Neither currently-used super bills nor
ICD-10-CM-based super bills provide all
possible code options for many conditions.
72
Slide 73
Super bill
conversion process
Conduct review (include
removing rarely used
codes) AND
Map common codes
• Use ICD-10-CM code book OR
• General Equivalence Mappings
(GEMs)
73
Slide 74
Resource/Reference List
National Center for Health Statistics – CDC - ICD-10-CM
www.cdc.gov/nchs/icd/icd10cm.htm
CMS Medicare Learning Network - ICD-10-CM/PCS Myths
& Facts
www.cms.hhs.gov/ICD10
ICD-10 and HIPAA Federal Register Notices
www.access.gpo.gov/su_docs/fedreg/a080822c.html
www.access.gpo.gov/su_docs/fedreg/a090116c.html
74
Slide 75
Questions
75
IHIMA
ICD-10 UPDATE
Presented by:
Kathy Craig, RHIA, CCS
ICD-10-CM/PCS Certified Trainer
Program Chair, HIT Program, Ivy Tech Bloomington
Slide 2
No Impact on Use of CPT ® and
HCPCS Level II Codes
CPT® and HCPCS Level II will continue to
be used for:
Reporting physician and other professional
services
Procedures performed in hospital
outpatient departments and other
outpatient facilities
2
Slide 3
ICD-10-CM/PCS Final Regulation
Physician
Behavioral
Health
Hospital
inpatient
All Other
Laboratory
outpatient
Long Term
Healthcare
3
Slide 4
Background
ICD-9-CM
Current coding classification system
Introduced 30 years ago
No longer fits with 21st century health system
ICD-10-CM & ICD-10-PCS
International standard - diagnostic classification for all general
epidemiological and many health management purposes
Track, report and compare morbidity and mortality
Supports achievement of EHR benefits
Transition to ICD-10 required by federal regulation
Slide 5
Global Use of ICD-10
Iceland
Norway
Sweden
Finland
Denmark
Poland
Ireland
Germany
UK
Czech Republic
The Netherlands
Austria
Belgium
France
Switzerland
Italy
Portugal
Spain
Canada
United States
Japan
China
Thailand
Costa Rica
Venezuela
Colombia
Singapore
Brazil
Australia
Argentina
New Zealand
Source: 3M Information Systems, Inc.
Slide 6
Background
ICD-10
Available since 1992
Approximately 100 countries use ICD-10 including Canada,
Australia, and the United Kingdom
United States: Only industrialized nation not using ICD-10
United States: ICD-10 go-live date is October 1, 2013
Slide 7
Background (continued)
Comparison of the two systems:
Expansion of codes
13,000 diagnosis codes in ICD-9-CM / 69,000 unique
diagnosis codes in ICD-10-CM
4,000 procedure codes in ICD-9-CM/ 72,000 procedure
codes in ICD-10-PCS
Different code structure, diagnoses for example
ICD-9-CM:
ICD-10-CM:
3 - 5 digits / limited alpha characters
3 -7 digits / additional alpha characters
Slide 8
Coding Categories
Code Examples
Diagnosis Codes Code Structure
All categories are 3 characters
All subcategories are either 4 or 5 characters
The first category is a letter
The second and third categories are numbers or letters
These categories may be letters or numbers
Codes are 4, 5 or 6 characters and the final character in a
code may be a letter or number (some categories have a 7th
character)
Slide 9
The Basics of the ICD-10 Change
An example of structural change
ICD-10
ICD-9
X
X
X
Category
.
X
X
X
Etiology, anatomic site,
manifestation
X
X
Category
.
X
X
X
.
X
Etiology, anatomic site, Extension
manifestation
An example of (1) ICD-9 code being represented by multiple ICD-10 codes
2
5
0
.
6
1
Diabetes mellitus with neurological
Manifestations type I not stated
as uncontrolled
E
1
0
E
1
0
E
1
0
E
1
0
.
.
.
.
4
0
Type I diabetes mellitus with
diabetic neuropathy, unspecified
4
1
Type I diabetes mellitus with
diabetic mononeuropathy
4
4
Type I diabetes mellitus with
diabetic amyotrophy
4
9
Type I diabetes mellitus with other
diabetic neurological complication
9
Slide 10
Coding Categories (continued)
3 Character Category examples
A00-A09
- Intestinal infectious diseases
A30-A49 - Other bacterial diseases
4 Character Category examples
C15.3
- Malignant neoplasm of upper third of
esophagus
C15.8 - Malignant neoplasm of overlapping lesion of
esophagus
Slide 11
Coding Categories (continued)
5/6 Character Subclassification example
S55.011
- Laceration of ulnar artery at
forearm level, right arm
7th Character Extension example
T50.B96D
- Underdosing of other viral
vaccines, subsequent encounter
Slide 12
A glimpse at ‘specificity’
ICD-9-CM
821.01 Fracture of femur, shaft, closed
ICD-10-CM
S72301A Unspecified fracture of shaft of right femur,
initial encounter for closed fracture
S72322A Displaced transverse fracture of shaft of
left femur, initial encounter for closed fracture
S72326A Nondisplaced transverse fracture of shaft of unspecified
femur, initial encounter for closed fracture
S72301G Unspecified fracture of shaft of right femur,
subsequent encounter for closed fracture with
delayed healing
S72322G Displaced transverse fracture of shaft of
left femur, subsequent encounter for closed fracture
with delayed healing
S72326G Nondisplaced transverse fracture of shaft of unspecified
femur, subsequent encounter for closed fracture with delayed
healing
S72302A Unspecified fracture of shaft of left femur,
initial encounter for closed fracture
S72323A Displaced transverse fracture of shaft of
unspecified femur, initial encounter for closed
fracture
S72331A Displaced oblique fracture of shaft of right femur, initial
encounter for closed fracture
S72302G Unspecified fracture of shaft of left femur,
subsequent encounter for closed fracture with
delayed healing
S72323G Displaced transverse fracture of shaft of
unspecified femur, subsequent encounter for closed
fracture with delayed healing
S72331G Displaced oblique fracture of shaft of right femur,
subsequent encounter for closed fracture with delayed healing
S72309A Unspecified fracture of shaft of unspecified
femur, initial encounter for closed fracture
S72324A Nondisplaced transverse fracture of shaft
of right femur, initial encounter for closed fracture
S72332A Displaced oblique fracture of shaft of left femur, initial
encounter for closed fracture
S72309G Unspecified fracture of shaft of unspecified
femur, subsequent encounter for closed fracture with
delayed healing
S72324G Nondisplaced transverse fracture of shaft
of right femur, subsequent encounter for closed
fracture with delayed healing
S72332G Displaced oblique fracture of shaft of left femur,
subsequent encounter for closed fracture with delayed healing
S72325A Nondisplaced transverse fracture of shaft
of left femur, initial encounter for closed fracture
S72333A Displaced oblique fracture of shaft of
unspecified femur, initial encounter for closed
fracture
S72321A Displaced transverse fracture of shaft of right femur,
initial encounter for closed fracture
S72325G Nondisplaced transverse fracture of shaft
of left femur, subsequent encounter for closed
fracture with delayed healing
S72333G Displaced oblique fracture of shaft of
unspecified femur, subsequent encounter for closed
fracture with delayed healing
S72321G Displaced transverse fracture of shaft of right femur,
subsequent encounter for closed fracture with delayed healing
12
Slide 13
Benefits
Higher quality information for measuring healthcare service
quality, safety, and efficacy
More accurate payment for new procedures
Fewer miscoded, rejected, and improperly reimbursed claims
Better understanding of the value of new procedures and
healthcare outcomes
Improved disease management
Data comparability internationally
Slide 14
Impacts
More than Just a Larger Coding Inventory of Systems
According to the Healthcare Information Management Systems Society (HIMSS)
Registration
Registration and scheduling
systems
Advance Beneficiary software
Performance management systems
Medical necessity edits
Clinical Systems
Clinical systems
Clinical protocols
Test ordering systems
Clinical reminder systems
Medical necessity software
Disease management
systems
Decision support systems
Pharmacy systems
HIM
DRG grouper
Encoding software
Abstract systems
Compliance software
Medical record
abstracting
Billing/Financial
DRG grouper
Conversion of other payment
methodologies
National and local coverage
determinations
System logic and edits
Billing systems
Financial systems
Claim submission systems
Compliance checking systems
Support Systems
Case Mix systems
Utilization management
Quality management
Case Management
Reporting
Provider profiling
Quality measurement
Utilization management
Disease management registries
Other registries
State reporting systems
Fraud management
Aggregate data reporting
Clinical systems
Patient assessment data sets (e.g. MDS,
RAI, OASIS)
Slide 15
Costs
Training
Lost productivity during implementation & training
System upgrades/changes
Contract re-negotiation
Additional resources to support and manage
implementation
Slide 16
Costs – System Implementation
Slide 17
Costs - Additional
Slide 18
The ‘B’ Word
Budget
$$’s
People
Process
Technology
Other…
18
Slide 19
POTENTIAL BUDGETING CATEGORIES
2010
2011
2012
2013
2014
Program Manager w/ Admin Support
x
x
x
x
x
Staff to review payer contracts/ renegotiate
x
x
x
HIM temporary during cross over period
x
x
PFS temporary during transition
x
x
Assessment/ Gap Analysis (internal +/or
external )
x
x
Documentation Improvement
x
x
Dual Systems?
X
X
Decision Support /Home Grown System
Remediation (and/or Translation Software)
X
Payer Integration and/or Readiness
(mitigation)
x
Communications to internal/ external
constituents
PEOPLE (HUMAN RESOURCE)
# FTEs/ Contract Workers
PROCESSES (not including potential
process improvement gains)
x
x
x
x
x
X
X
X
X
TECHNOLOGY
X
X
X
X
Vendor Systems (ICD-10fees?
x
x
x
Vendor Interface charges?
X
X
X
New Vendors?
x
19
Slide 20
Preparation
Early Preparation
A well-planned, well-managed implementation process will increase the
chances of a smooth, successful transition
Experience in other countries has shown that early preparation is the key to
success.
An early start allows for resource allocation, such as costs for systems
changes and education, process evaluation and change, as well as staff
time devoted to implementation processes, to be spread over several years.
Potential Consequences of Inadequate Preparation:
Decreased coding accuracy
Decreased coding productivity
Increased compliance risks
Increased claims rejection
An adverse impact on patient care and administrative decision-making
Slide 21
HIPAA 5010 Background
HIPAA legislation mandates that the healthcare industry use standard
formats for electronic claims and related transactions
The formats currently used must be upgraded from X12 Version 4010A1 to
5010 and from NCPDP 5.1 to D.0
Version 5010 includes changes to the following transactions:
270/271, Eligibility Benefit Inquiry and Response
276/277, Claim Status Request and Response
278, Health Care Services – Request for Review and Response
820, Premium Payment for Insurance Products
834, Benefit Enrollment and Maintenance
835, Claim Payment/Advice
837, Claim including Coordination of Benefits (COB) and subrogation
claims
NCPDP D.0, Pharmacy Claim
Required to prepare the infrastructure needed to support ICD-10
Slide 22
HIPAA 5010 Background cont’d
Level I Compliance by: December 31, 2010
Level II Compliance by: December 31, 2011
Level I compliance means "that a covered entity can demonstrably create and
receive compliant transactions, resulting from the compliance of all design/build
activities and internal testing."
Level II compliance means "that a covered entity has completed end-to-end
testing with each of its trading partners, and is able to operate in production
mode with the new versions of the standards."
All covered entities have to be fully compliant on: January 1,
2012
Slide 23
5010 Compliance Timeline per Federal Rule
Slide 24
Slide 25
Top Ten Things You Need to Know
(to Prepare for ICD-10)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
The date is not flexible
Everyone will be affected
Private and public health plans will not accept and pay
based on ICD-9 codes
ICD-10 is not an ICD-9 maintenance update
Automated conversions are not possible (forward &
backward mapping of codes)
ICD-10 cannot wait for Electronic Health Records & other
health IT initiatives
Must implement both 5010 and ICD-10
ICD-10 is more than a compliance activity
Planning and implementation must begin now
The first step is a comprehensive Risk Readiness
Assessment followed by an Impact Analysis
25
Slide 26
Next Steps
Continue to investigate systems for potential impact
Incorporate ICD10 in system inventory
Secure project manager for ICD10
Determine official project sponsorship
Identify point of contact for all facilities and
organizations
Formal collaboration between HIPAA 5010 and
ICD10 teams
Continue and expand leadership education efforts
Slide 27
Questions?
Slide 28
Resources
American Health Information Management Association (AHIMA)
Hay Group, Inc.
Healthcare Information Management Systems Society (HIMSS)
RAND
Robert E. Nolan Company
Pricewaterhouse Coopers
http://www.cms.hhs.gov/TransactionCodeSetsStands/02_Transactio
nsandCodeSetsRegulations.asp
http://www.cms.gov/ElectronicBillingEDITrans/18_5010D0.asp
Slide 29
Slide 30
ICD-10CM
Similarities
30
Slide 31
How is ICD-10-CM Similar to ICD-9-CM?
Format
Tabular
List and Index
Chapters in Tabular structured similarly to ICD9-CM, with minor exceptions
A few chapters have been restructured
Sense organs (eye and ear) separated from
Nervous System chapter and moved to their own
chapters
Index structured the same as ICD-9-CM
Alphabetic Index of Diseases and Injuries
Alphabetic Index of External Causes
Table of Neoplasms
Table of Drugs and Chemicals
31
Slide 32
How is ICD-10-CM Similar to ICD-9-CM?
Divided into Alphabetic Index and
Tabular List
Structure
and format are the same
Index is alphabetical list of terms and their
corresponding codes
Alphabetic Index lists main terms in alphabetical
order with indented subterms under main terms
Index is divided into 2 parts: Index to Diseases
and Injuries and Index to External Causes
32
Slide 33
How is ICD-10-CM Similar to ICD-9-CM?
Tabular List is a chronological list of codes
divided into chapters based on body system or
condition
Tabular List is presented in code number order
Same hierarchical structure
Codes are invalid if they are missing an
applicable character
Codes are looked up the same way
Look up diagnostic terms in Alphabetic Index
Then verify code number in Tabular List
33
Slide 34
How is ICD-10-CM Similar to ICD-9-CM?
Many conventions have same meaning
Abbreviations, punctuation, symbols, notes such as
“code first” and “use additional code”
Nonspecific codes (“unspecified” or “not otherwise
specified”) are available to use when detailed
documentation to support more specific code is not
available
ICD-10-CM Official Guidelines for Coding and Reporting
accompany and complement ICD-10-CM conventions
and instructions
Adherence to the official coding guidelines in all
healthcare settings is required under the Health
Insurance Portability and Accountability Act
34
Slide 35
ICD-10CM
Differences
35
Slide 36
How is ICD-10-CM Different From
ICD-9-CM?
Alphanumeric
(alpha characters are not case-
sensitive)
Codes can be up to 7 characters in length
Code titles are more complete
Specificity and detail significantly expanded
Certain diseases reclassified to reflect current
medical knowledge
36
Slide 37
ICD-10-CM New Features
Combination codes for conditions
and common symptoms or
manifestations
Combination codes for poisonings
and external causes
Added laterality
Expanded codes (injury, diabetes,
alcohol/substance abuse,
postoperative complications)
Injuries grouped by anatomical site
rather than injury category
37
Slide 38
ICD-10-CM - Combination Codes
I25.110 Atherosclerotic heart disease of native
coronary artery with unstable angina pectoris
K71.51 Toxic liver disease with chronic active
hepatitis with ascites
K50.814 Crohn’s disease of both small and large
intestine with abscess
N41.01 Acute prostatitis with hematuria
E11.311 Type 2 diabetes mellitus with unspecified
diabetic retinopathy with macular edema
K57.21 Diverticulitis of large intestine with perforation
and abscess with bleeding
38
Slide 39
ICD-10-CM - Laterality Examples
C50.211 Malignant neoplasm of upper-inner
quadrant of right female breast
H02.032 Senile entropion of right lower eyelid
M05.271 Rheumatoid vasculitis with rheumatoid
arthritis of right ankle and foot
S80.261A Insect bite (nonvenomous), right knee,
initial encounter
39
Slide 40
Diabetes
ICD-9-CM
ICD-10-CM
250.x Diabetes mellitus
• 5th digit “1” – Type I
• 5th digit “0” – Type II or
unspecified
• 5th digit “2” & “3” –
uncontrolled
249.x Secondary diabetes
mellitus
• 5th digit “0” & “1” –
uncontrolled
648.0x – Diabetes mellitus
complicating pregnancy,
childbirth or puerperium
40
Combination codes include
type of complication
Five categories
• E08 Diabetes mellitus due to
underlying condition
• E09 Drug or chemical
induced diabetes mellitus
• E10 Type 1 diabetes mellitus
• E11 Type 2 diabetes mellitus
• E13 Other specified
diabetes mellitus
O24 DM in pregnancy,
childbirth, puerperium
Slide 41
ICD-10-CM - Diabetes Mellitus
Examples
E09.01
E10.11
E11.40
E13.621
Drug or chemical induced diabetes
mellitus with hyperosmolarity with
coma
Type 1 diabetes mellitus with
ketoacidosis with coma
Type 2 diabetes mellitus with
diabetic nephropathy, unspecified
Other specified diabetes mellitus
with foot ulcer
41
Slide 42
Pressure Ulcers
ICD-9-CM
707.0x Pressure ulcer by
site
707.2x – Pressure ulcer
stages
Code first site of pressure
ulcer
42
ICD-10-CM
L89 Pressure ulcer by
site and stage
Site and stage captured
by single code
Specific codes for
pressure ulcer of
contiguous site of back,
buttock, and hip
Code first any associated
gangrene
Slide 43
Epilepsy, Recurrent Seizures
ICD-9-CM
345.00-345.91 Epilepsy, recurrent seizures
Intractable or not
Generalized convulsive and nonconvulsive
Petit mal status vs. grand mal status
Localization-related (focal) (partial) epilepsy and
epileptic syndromes with simple or complex
partial seizures
Infantile spasms
Epilepsia partialis continua
43
Slide 44
Epilepsy, Recurrent Seizures
ICD-10-CM
G40.001-G40.919 Epilepsy and recurrent seizures
Localization-related (focal) (partial) idiopathic epilepsy
and epileptic syndromes with seizures of localized onset
Localization-related (focal) (partial) idiopathic epilepsy
and epileptic syndromes with simple or complex partial
seizures
Generalized idiopathic epilepsy and epileptic syndromes
Other generalized epilepsy and epileptic syndromes
Special epileptic syndromes
Other epilepsy and seizures
Intractable or not
With or without status epilepticus
44
Slide 45
Asthma
ICD-9-CM
493.00-493.92 Asthma
Extrinsic vs. intrinsic
Chronic obstructive asthma
With status asthmaticus
With exacerbation
Exercise induced bronchospasm
Cough variant asthma
45
Slide 46
Asthma
ICD-10-CM
J45.20-J45.998 Asthma
Mild intermittent
Mild persistent
Moderate persistent
Severe persistent
With status asthmaticus
With exacerbation
Exercise induced bronchospasm
Cough variant asthma
Excludes chronic obstructive asthma
46
Slide 47
ICD-10-CM Circulatory
System Changes
Age definition for acute myocardial infarction has
changed (4 weeks instead of 8 weeks)
New category for subsequent acute myocardial
infarction
New category for complications within 28 days of
acute myocardial infarction
Transient ischemic attacks re-classified to nervous
system chapter
Late effects of stroke differentiated by type of stroke
Combination codes for common
etiologies/manifestations
47
Slide 48
ICD-10-CM Obstetrics
Addition of trimester
Deletion of episode of care
O15.03 Eclampsia in pregnancy, third trimester
O23.12 Infections of bladder in pregnancy, second
trimester
O22.21 Superficial thrombophlebitis in pregnancy,
first trimester
Documentation of trimester
Counted from first day of last menstrual period
Document number of weeks
48
Slide 49
ICD-10-CM Obstetrics
Obstructed labor codes incorporate reason for
obstruction
Code extensions to identify specific fetus
(1-5) affected by obstetric condition
O64.1xx2 Obstructed labor due to breech
presentation, fetus 2
49
Slide 50
ICD-10-CM - Injury Changes
ICD-9-CM
Fractures (800-829)
Dislocations (830-839)
Sprains and strains(840-848)
ICD-10-CM
Injuries to the head (S00-S09)
Injuries to the neck (S10-S19)
Injuries to the thorax (S20-S29)
50
Slide 51
ICD-10-CM - Fractures
Displaced vs. non-displaced
Type of fracture
Site of fracture
Laterality
7th character indicating:
Open vs. closed
Routine vs. delayed healing
Nonunion, malunion
Initial encounter, subsequent encounter, sequela
51
Slide 52
ICD-10-CM - Injury and External
Cause 7th Character
A Initial encounter
D Subsequent encounter
S Sequelae
52
Slide 53
ICD-10-CM - Fracture Extensions
A Initial encounter for closed fracture
B Initial encounter for open 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 Sequelae
53
Slide 54
ICD-10-CM – Fracture Extensions (con’t)
A Initial encounter for closed fracture
B Initial encounter for open fracture type I or II
(open NOS)
C Initial encounter for open fracture type IIIA, IIIB, or IIIC
D Subsequent encounter for closed fracture with routine
healing
E Subsequent encounter for open fracture type I or II
with routine healing
F Subsequent encounter for open fracture type IIIA, IIIB,
or IIIC with routine healing
G Subsequent encounter for closed fracture with
delayed healing
54
Slide 55
ICD-10-CM - Fracture Extensions (con’t)
H Subsequent encounter for open fracture type I or
II with delayed healing
J Subsequent encounter for open fracture type IIIA,
IIIB, or IIIC with delayed healing
K Subsequent encounter for closed fracture with
nonunion
M Subsequent encounter for open fracture type I or
II with nonunion
N Subsequent encounter for open fracture type IIIA,
IIIB, or IIIC with nonunion
55
Slide 56
ICD-10-CM - Fracture Extensions (con’t)
P Subsequent encounter for closed fracture with
malunion
Q Subsequent encounter for open fracture type I or
II with malunion
R Subsequent encounter for open fracture type IIIA,
IIIB, or IIIC with malunion
S Sequelae
56
Slide 57
ICD-10-CM Open Fracture Designations
7th characters for open fractures are based on Gustilo
classification – requires physician documentation of open
fracture type:
I – wound less than 1 cm with minimal soft tissue injury
II - wound greater than 1 cm with moderate soft tissue
injury
III – High energy wound greater than 1 cm with extensive
soft tissue damage
IIIA – adequate soft tissue cover
IIIB – inadequate soft tissue cover, requiring regional
or free flap
IIIC – involves vascular injury requiring repair
57
Slide 58
ICD-10-CM Coding Examples
Hypertension
Step 1
Look up term in Alphabetic Index:
Hypertension, hypertensive (accelerated)
(benign) (essential) (idiopathic) (malignant)
(systemic) I10
58
Slide 59
ICD-10-CM Coding Examples
Hypertension (con’t)
Step 2
Verify code in Tabular:
I10 Essential (primary) hypertension
Includes: high blood pressure
hypertension (arterial) (benign) (essential)
(malignant) (primary) (systemic)
Excludes1: hypertensive disease complicating pregnancy,
childbirth and the puerperium (O10-O11,
O13-O16)
Excludes2: essential (primary) hypertension involving
vessels of brain (I60-I69)
essential (primary) hypertension involving
vessels of eye (H35.0)
59
Slide 60
ICD-10-CM Coding Examples
Type I diabetes mellitus with diabetic
nephropathy
Step 1
Look up term in Alphabetic Index:
Diabetes, diabetic (mellitus) (sugar) E11.9
type 1 E10.9
with
nephropathy E10.21
60
Slide 61
ICD-10-CM Coding Examples
Type I diabetes mellitus with diabetic nephropathy (con’t)
Step 2
Verify code in Tabular:
E10 Type 1 diabetes mellitus
E10.2 Type 1 diabetes mellitus with kidney
complications
E10.21 Type 1 diabetes mellitus with
diabetic nephropathy
Type 1 diabetes mellitus with intercapillary
glomerulosclerosis
Type 1 diabetes mellitus with intracapillary
glomerulonephrosis
Type 1 diabetes mellitus with Kimmelstiel-Wilson
disease
61
Slide 62
Next Steps
• Begin preparing for the transition to ICD-10CM/PCS and new HIPAA electronic
transactions standards NOW!
• A successful transition depends on careful
planning
62
Slide 63
Role-Based ICD-10-CM/PCS
Training Model
Landing Page
63
Slide 64
Using the Role-Based Training Model
Healthcare
Providers
• Inpatient coder
• Outpatient coder
• Managers of data
Health Plans
• Tasks for 5010 &
• ICD-10-CM/PCS
compliance
Academic
64
• Educators
• Current students
• Prospective students
Slide 65
READY
www.ahima.org/IC
D10/role/aspx
Physician model
65
Slide 66
ICD-10 Facts vs. Myths
Myth: The Oct. 1, 2013 date for implementation should be
considered a flexible date.
Fact: All HIPAA covered entities MUST implement the
new code sets with dates of service, or date of
discharge for inpatients, that occur on or after Oct. 1,
2013.
Myth: Implementation planning should be undertaken with the
assumption that HHS will grant an extension.
Fact: HHS has no plans to extend compliance date for
implementation of ICD-10-CM/PCS; covered entities
should plan to complete steps required to implement
on Oct. 1, 2013.
66
Slide 67
ICD-10 Facts vs. Myths
Myth: There will be no hard-copy code
books and all coding will need to be
performed electronically.
Fact: ICD-10-CM and ICD-10-PCS code
books are already available and are a
manageable size. The use of ICD-10CM is not predicated on the use of
electronic hardware and software.
67
Slide 68
ICD-10
Facts vs. Myths
Myth: Unnecessarily detailed medical record
documentation will be required.
Fact: As with ICD-9-CM, ICD-10 codes should be
based on medical record documentation. While
documentation supporting accurate and specific
codes will result in higher-quality data, nonspecific
codes are still available for use when
documentation doesn’t support a higher level of
specificity. As demonstrated by the AHA/AHIMA
field testing study, much of the detail contained in
ICD-10-CM is already in medical record
documentation but is not currently needed for ICD9-CM coding.
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Slide 69
ICD-10 Facts vs. Myths
Myth: The increased number of codes will make ICD-10CM/PCS impossible to use.
Fact: Just as the size of a dictionary doesn’t make it
more difficult to use, a higher number of codes
doesn’t necessarily increase the complexity of the
coding system – in fact, it makes it easier to find
the right code.
Fact: Greater specificity and clinical accuracy make
ICD-10 easier to use than ICD-9-CM.
Fact: Because ICD-10-CM/PCS is much more
specific, is more clinically accurate, and uses a
more logical structure, it is much easier to use
than ICD-9-CM.
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Slide 70
ICD-10 Facts vs. Myths
Myth: The increased number of codes will make ICD-10CM/PCS impossible to use (con’t).
Fact: Just as it isn’t necessary to search the entire
list of ICD-9-CM codes for the proper code, it is
also not necessary to conduct searches of the
entire list of ICD-10 codes.
Fact: The Alphabetic Index and electronic coding
tools will continue to facilitate proper code
selection.
Fact: It is anticipated that the improved structure
and specificity of ICD-10-CM/PCS will facilitate the
development of increasingly sophisticated
electronic coding tools that will assist in faster
code selection.
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Slide 71
ICD-10 Facts vs. Myths
Myth: ICD-10-CM/PCS was developed without
clinical input.
Fact: The development of ICD-10-CM/PCS
involved significant clinical input. A number of
medical specialty societies contributed to the
development of the coding systems.
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Slide 72
ICD-10 Facts vs. Myths
Myth: ICD-10-CM-based super bills will be too
long or too complex to be of much use.
Fact: Practices may continue to create super
bills that contain the most common diagnosis
codes used in their practice. ICD-10-CM-based
super bills will not necessarily be longer or
more complex than ICD-9-CM-based super
bills. Neither currently-used super bills nor
ICD-10-CM-based super bills provide all
possible code options for many conditions.
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Slide 73
Super bill
conversion process
Conduct review (include
removing rarely used
codes) AND
Map common codes
• Use ICD-10-CM code book OR
• General Equivalence Mappings
(GEMs)
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Slide 74
Resource/Reference List
National Center for Health Statistics – CDC - ICD-10-CM
www.cdc.gov/nchs/icd/icd10cm.htm
CMS Medicare Learning Network - ICD-10-CM/PCS Myths
& Facts
www.cms.hhs.gov/ICD10
ICD-10 and HIPAA Federal Register Notices
www.access.gpo.gov/su_docs/fedreg/a080822c.html
www.access.gpo.gov/su_docs/fedreg/a090116c.html
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Slide 75
Questions
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