4/17/2014 Paragraph Page #1 - Header ICD-10 ICD 10-CM M For the - PDF document

4/17/2014 Paragraph Page #1 - Header ICD-10 ICD 10-CM M For the Audit ditor Subhead It May Be Delayed But It’s Not Going Away Add text in here. Add text in here. Add text in here. Add text in here. Add text in here. Add text in here. Add text in here. Add text in here. Add text in here. Add text in here. Add text in here. Add text in here. John F. Burns, CPMA, CPC, CPC-I, CEMC Add text in here. Add text in here. Add text in here. Add text in here. AHIMA Ambassador and ICD-10 Trainer Add text in here. Add text in here. Add text in here. Add text in here. Add text in here. Add text in here. Add text in here. Add text in here. Webinar: April 22, 2014 This on-demand training is pre- approved for AAPC CEU’s Your Faculty • John Frederick Burns • Rome, NY native • SUNY Cortland (Health Science -1995) • CPC, CPC-I, CPMA, CEMC • AHIMA Ambassador and ICD-10 Trainer • 19 years in Healthcare • DoctorsManagement, NAMAS (2013-present) • NAMAS and DoctorsManagement Senior Auditor and Consultant • Modern Conventions in Compliance, Inc (2004-2012) • Medical Management Institute (1995-2004) ICD-10-CM Background • International Classification of Disease (ICD) has been around since 1893 o 1948: WHO took over o 1970s (late): US has used ICD-9-CM  1988: Required on claims • 1990: ICD-10-CM adopted by 43 rd World Health Assembly • Used in many other countries around the world since 1994 • According to WHO, ICD-11 is already in the works and will be completed in 2015 1

4/17/2014 The “New” ICD -10-CM Timetable • Final Rule published April 1 , 2011 • October 1, 2014= Compliance date for implementation of ICD-10-CM and ICD-10- PCS • H.R. 4302 passed both the House and Senate with Presidential approval on March 31, 2014 o SGR “patch” and 1 year ICD -10 delay (Effective October 1, 2015) ICD-10-CM vs. ICD-9-CM • 68,000+ ICD-10-CM codes compared to 13,000+ in ICD-9-CM • 21 chapters in ICD-10-CM compared to 17 in ICD-9-CM • ICD-10-CM codes are 3-7 characters compared to 3-5 digits in ICD-9-CM o All alpha characters used (except letter “U”) • Expanded injury codes o External causes and places of occurrence • Much greater specificity o Laterality, episodes of care, under-dosing (Table of Drugs/Chem) • V-codes and E-codes are assigned in applicable chapters • Combination codes (diagnosis/symptom) Basic Comparison of Code Sets ICD-9-CM ICD-10-CM Three to five characters Three to seven characters First digit is numeric but can be alpha First character always alpha (E or V) 2 – 5 are numeric All letters used except U Always at least three digits Character 2 always numeric: 3 – 7 can be alpha or numeric Decimal placed after the first three Always at least three digits characters (or with E codes, placed after the first four characters) Alpha characters are not case-sensitive Decimal placed after the first three characters Alpha characters are not case-sensitive 2

4/17/2014 The Guidelines: Section I: C. Chapter Specific Coding Guidelines o Chapter 1: Infectious and Parasitic Disease (A00-B99) o Chapter 2: Neoplasms (C00-D49) o Chapter 3: Diseases of Blood and Blood Forming Organs (D50-D89) o Chapter 4: Endocrine, Nutritional and Metabolic Diseases (E00-E89) • Diabetes is located in this section (E08-E13) o Chapter 5: Mental and Behavioral Disorders (F01-F99) o Chapter 6: Diseases of the Nervous System and Sense Organs (G00-G99) o Chapter 7: Diseases of the Eye and Adnexa (H00-H59) o Chapter 8: Diseases of the Ear and Mastoid Process (H60-H95) o Chapter 9: Disease of the Circulatory System (I00-I99) • Hypertension is located in this section (I10-I15), R03.0 for elevated BP (ICD-9 code 796.2) o Chapter 10: Diseases of the Respiratory System (J00-J99) o Chapter 11: Diseases of the Digestive System (K00-K94) o Chapter 12: Diseases of Skin and Subcutaneous Tissue (L00-L99) o Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00-M99) The Guidelines: Section I: C. Chapter Specific Coding Guidelines o Chapter 14: Diseases of the Genitourinary System (N00-N99) o Chapter 15: Pregnancy, Childbirth, Pueperium (O00-O9A) • OB, Delivery and Postpartum Services (Beware of 7 th characters) o Chapter 16: Newborn (Perinatal) Guidelines (P00-P96) o Chapter 17: Congenital Malformations, Deformations, and Chromosomal Abnormalities (Q00-Q99)  Chapter 18 : Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99) • Codes that describe symptoms and signs are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider. o Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) o Chapter 20: External Causes of Morbidity (V01-Y99) o Chapter 21: Factors Influencing Health Status and Contact With Health Services (Z00-Z99) General Equivalence Mappings (GEMS) • Mappings between ICD-9-CM and ICD-10-CM classification systems have been developed to facilitate the transition from ICD-9 to ICD-10. • Two GEM files available ICD-9-CM to ICD-10-CM (forward mapping) o o ICD-10-CM to ICD-9-CM (backward mapping) • May be used along with ICD-9-CM utilization data to assist in cross- walking your “key” diagnosis codes o Obtain the top 50 ICD-9 codes your practice utilizes and use as basis to begin training and education for providers and staff 3

4/17/2014 The Index and Tabular List • Both ICD-9-CM and ICD-10-CM require users to consult the index and then the Tabular • Tabular List and Alphabetic Index • Chapters in Tabular structured similarly to ICD-9-CM , with minor exceptions such as Eye and Ear separated from the Nervous System chapter in ICD-9-CM • 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 Similarities With ICD-9 and ICD-10 • The Official Reporting Guidelines should be carefully consulted to understand proper reporting • Code to the highest levels of specificity and certainty • “Code first” provides sequencing guidance while “code also” does not • All “categories” within both ICD -9 and ICD-10 are 3 characters long • Code conditions as long as the patient receives active treatment Structure of the Tabular List • NEVER code from the Alphabetic Index • Categories (3 characters) o Subcategories  Codes • All Categories are 3 characters (decimal point follows) o A 3-character category without 4 th -7 th characters is a reportable code  J17 (Pneumonia in diseases classified elsewhere) • A code with an applicable 7 th character is invalid without the 7 th character…use an “X” placeholder o Placeholders are common with fractures, injuries, external causes, maternal care, labor and delivery, glaucoma, etc. 4

4/17/2014 Auditing Diagnostic Codes When Specific Codes Are Not Available • Nonspecific codes (“unspecified” or “not otherwise specified”) are available to use when detailed documentation to support a more specific code is not available…auditors be aware! • “Other” and “other specified” are not to be interpreted to mean “unspecified” o Reserved for when the information in the medical record provides detail for which a specific code does not exist (ICD-10-CM Coding Guideline I.A.9.a) • Many conventions have the same meaning o Abbreviations, punctuation, symbols, notes such as “code first” and “use additional code” ICD-10-CM Conventions • Placeholder Character “X” o ICD- 10 instructs users to place an “X” in the 4 th , 5 th and/or 6 th positions when a 7 th character is required but the 4 th , 5 th and/or 6 th characters are not provided. ICD-10-CM Coding Guideline I.A.5 states that the seventh • character must always be the seventh character in the data field. If a code that requires a seventh character is not six characters long, a placeholder X must be used to fill in the empty characters. Additionally, Guideline A.4 indicates that ICD-10-CM utilizes a placeholder character X and where a placeholder exists, the X must be used in order for the code to be considered a valid code. Example: T37.0 X 1 A Poisoning by sulfonamides, accident (unintentional), initial encounter Dashes in the Alphabetic Index • The indexes utilize the dash at the end of a code number to indicate the code is incomplete. To determine the additional character(s), locate the code in the Tabular List, review the options, and assign the appropriate code. • Example: Fracture, pathologic ankle M84.47- carpus M84.44- 5