1 Todays Panelists: Sandy Giangreco, RHIT, CCS, RCC, CPC, CPC-H, CPC-I, PCS, AHIMA Approved ICD-10 CM/PCS Trainer CHIMA ICD-10 Task Force Robin Linker, CHCA, CHCAS, CPC-I, CCS-P, CPC-H, CPC-P, MCS-P, CHC Approved ICD-10-CM / PCS Trainer (AHCAE, AMA, AAPC) Robin Linker & Associates, Inc. and Executive Director, Association of Health Care Auditors and Educators 2
ICD-10-CM Basics ICD-10-CM is very similar to ICD-9-CM as far as look up and basic guideline information Total number of codes expands from about 14,000 ICD-9-CM codes to well over 68,000 in ICD-10-CM ICD-10 Uses full code titles, ICD-9 does not Plenty of room for expansion
in ICD-10 3 ICD-9-CM Diagnosis Codes Are 35 digits; The first digit is alpha (E or V) or numeric (alpha characters are not case sensitive); Digits 25 are numeric; and A decimal is used after the third character. Examples: 496 496 Chronic airway obstruction, not elsewhere classified (NEC); 511.9 Unspecified pleural effusion; and V02.61 Hepatitis B carrier
4 ICD-10-CM Diagnosis Codes Are 37 digits; Digit 1 is alpha; Digit 2 is numeric; Digits 37 are alpha or numeric (alpha characters are not case sensitive); and A decimal is used after the third character. Examples: 496 A78 Q fever; A69.21 Meningitis due to Lyme disease; and S52.131A Displaced fracture of neck of right radius, initial encounter for closed fracture.
5 ICD-10-CM Code Structure Category first three characters M84 Disorder of continuity of bone Etiology, anatomic site, severity, fourth, fifth, sixth
characters (if applicable) M84.311- Stress fracture, right shoulder Extension seventh character (if applicable) M84.311A Stress fracture, right 6 shoulder; initial encounter
New Features in ICD-10-CM Laterality (Left, Right, Bilateral) Combination codes for certain conditions and common associated symptoms and manifestations Combination codes for poisonings and their associated external cause Obstetric codes identify trimester instead of episode of care 7 New Features in ICD-10-CM Placeholder X Character
4. Placeholder character The ICD-10-CM utilizes a placeholder character X. The X is used as a placeholder at certain codes to allow for future expansion. An example of this is at the poisoning, adverse effect and underdosing codes, categories T36-T50. Where a placeholder exists, the X must be used in order for the code to be considered a valid code. Example: 496 H40.11X1 Mild stage primary open-angle glaucoma
8 5. 7th Characters Certain ICD-10-CM categories have applicable 7th characters. The applicable 7th character is required for all codes within the category, or as the notes in the Tabular List instruct. The 7th character must always be the 7th character in the data field. If a code that requires a 7th character is not 6 characters, a placeholder X must be used to fill in the empty characters. Example 1: 496 T79.0XXA Initial encounter for a traumatic air embolism Some codes have even more!
Example 2: 496 W06.XXXD Subsequent encounter for a fall from a bed 9 2014 ICD-10-CM Guideline Change 10 New Features in ICD-10-CM cont. The 7th character in ICD-10-CM is used in several chapters (for example, the Obstetrics, Injury,
Musculoskeletal, and External Cause chapters). It has a different meaning depending on the section where it is being used (for example, in the Injury and External Cause sections, the 7th character often classifies an initial encounter, subsequent encounter, or sequelae (late effect) but may include others. Primarily, changes in ICD-10-CM are in its organization and structure, code composition and level of detail. 11 Examples of the Numbers by Specialty Specialty
# ICD-9 Codes # ICD-10 Codes Gastroenterologists 596 706 Pulmonologists
255 336 Urologists 389 591 Endocrinologists 335
675 Neurologists 459 591 Pediatricians 702
591 1,270 1,056 Infectious Disease 12 Where are most of the new codes? The majority are in musculoskeletal and injury/ poisoning: 496
- Increased specificity of type of fracture, laterality, specific bone and encounter information.* - Increased doesnt mean increased complexity, if you take away the 7th character for encounter, the number of codes drop significantly. *Tip documenting these additional elements will simplify the ICD-10 transition. 13 Questions? Z00.121 Routine infant/child exam with abnormal findings Does this include a separate and identifiable
problem like an ear infection or is this limited to a problem within normal growth and development such as failing a hearing screen? Section IV. Diagnostic Coding and Reporting Guidelines for Outpatient Services P. Encounters for general medical examinations with abnormal findings The subcategories for encounters for general medical examinations, Z00.0-, provide codes for with and without abnormal findings. Should a general medical examination result in an abnormal finding, the code for general medical examination with abnormal finding should be assigned as the first-listed diagnosis. A secondary code for the abnormal finding should 14 also be coded. Questions?
We frequently use 079.99 Viral syndrome And have identified a couple of options: 496 B34.9 Viral infection, unspecified, or B97.89 Other viral agents as the cause of disease classified elsewhere (Use of this code requires we have diagnosed a disease.) When we see these kids, the disease is a basket of symptoms that point to a viral illness. Which one should we use? Lets look at GEMSThese can be found on the CMS website or the CDC website 15
GEMS (General Equivalency Mapping System) ICD-9-CM ICD-10-CM 07999 B9789 080 A750 Flag 10000 00000
Meaning Approximate Match Exact Match CAUTION! You cannot rely simply on the GEMS system to cross-match everything. If the flag is other than 00000 there are other potential possibilities. Its best to start in the alphabetic index and then complete the look up process in the 16 Questions? Lets look up Viral syndrome in ICD-10-CM
1.Alphabetic Index 2. Tabular Index Syndrome B34.9 Viral Infection, - virus B34.9 Unspecified 17 Useful Website Resources to Assist! AHIMA: https: 496 //www.ahima.org/icd10/ AMA: https: 496 //www.ama-assn.org/go/icd-10
CMS: https: 496 //www.cms.gov/icd10/ CDC: 496 http: 496 //www.cdc.gov/nchs/icd/icd10cm.htm 18 19 20 21 Questions?
22 Next Steps September 17th panel discussion with private payers October 15th panel discussion with government payers Email questions to [email protected] 23 www.cms.org/icd-10 24
