Preparing for ICD-10 and 5010 Friday, January 21, 2011 Gillette Stadium Clubhouse Cynthia Trapp CHFP, CMPE, CPCO, CPC, CPC...
The Latest ……. <ul><li>Final Rule issued January 16, 2009 </li></ul><ul><ul><li>HHS in 45 CFR Part 162 issued the FINAL Ru...
5010
Compliance Dates <ul><li>Effective Date – March 1, 2009 </li></ul><ul><li>Level I Compliance – December 31, 2010 </li></ul...
Compliance Dates
What and Why HIPAA 5010? <ul><li>Current version 4010/4010A1 </li></ul><ul><ul><li>Is outdated </li></ul></ul><ul><ul><li>...
What are the Versions? <ul><li>Version 5010 – New version of X12 Standards for HIPAA transactions </li></ul><ul><li>Versio...
What are HIPAA Transactions? <ul><li>HIPAA Act of 1996 required a standard format for Electronic Data Interchange (EDI) of...
Who are the covered entities? <ul><li>Health plans </li></ul><ul><li>Health care clearinghouses </li></ul><ul><li>Health c...
5010 Readiness Assessment <ul><li>Side by Side Comparison 4010 vs. 5010 </li></ul><ul><ul><li>http://www.cms.gov/Electroni...
Side by Side Comparison http://www.cms.gov/ElectronicBillingEDITrans/18_5010D0.asp
Side by Side Comparison http://www.cms.gov/ElectronicBillingEDITrans/Downloads/NCPDP51toD0.pdf
Side by Side Comparison <ul><li>Identify differences requiring change </li></ul>http://www.cms.gov/ElectronicBillingEDITra...
Checklist for Level I Testing http://www.cms.gov/Versions5010andD0/Downloads/w5010PrepChklst.pdf
EDI Resource Guide http://www.cms.gov/MLNProducts/downloads/5010EDI_RefCard_ICN904284.pdf
Provider Action Checklist http://www.cms.gov/Versions5010andD0/Downloads/w5010PvdrActionChklst.pdf
Why change  ICD-9-CM? <ul><li>ICD-9-CM is obsolete </li></ul><ul><ul><li>No longer supported by WHO </li></ul></ul><ul><ul...
ICD-10 CM/PCS
October 1, 2013
Why move to ICD-10? <ul><li>ICD-10-CM has better data for: </li></ul><ul><ul><li>Measuring Quality and Safety </li></ul></...
Why not SNOMED-CT ® ? <ul><li>SNOMED-CT ® </li></ul><ul><ul><li>Systematized Nomenclature of Medicine - Clinical Terms </l...
Characteristics of ICD-10-CM <ul><li>Changed Titles </li></ul><ul><li>Conditions re-grouped  </li></ul><ul><li>7 digits fo...
Characteristics of ICD-10-CM <ul><li>7 digits for higher specificity </li></ul><ul><li>Alphanumeric Codes  </li></ul><ul><...
Other differences… <ul><li>Injury classified by site then type rather than by type </li></ul><ul><li>Post op complications...
Other differences cont… <ul><li>Obstetrics, Injuries, and external causes of injuries will have 7 th  character extensions...
Other differences cont… <ul><li>Morphology codes are no longer in included </li></ul><ul><li>Changes in timeframes of code...
Characteristics of ICD-10-PCS <ul><li>Procedural coding system to replace the current inpatient procedural coding system  ...
Characteristics of ICD-10-PCS <ul><li>ICD-10-CM/PCS </li></ul><ul><li>Diagnoses   </li></ul><ul><li>21 Chapters </li></ul>...
Chapter Changes
Chapter Changes
Basic Structure of ICD-10 <ul><li>Volume I </li></ul><ul><ul><li>Tabular Lists containing cause-of-death titles and codes ...
What is the ICD-10-CM Change? <ul><li>ICD-10-CM Structure -- Format </li></ul>X X X X X X X Extension Etiology, anatomic s...
Basic Structure of ICD-10 <ul><li>Third Character Block </li></ul><ul><ul><li>Example:  Tuberculosis A15 – A19 </li></ul><...
Structure of ICD-10-CM <ul><li>Fourth Character </li></ul><ul><ul><li>Site, etiology, manifestation or state of the diseas...
Structure of ICD-10-CM <ul><li>Fifth – Sixth Character </li></ul><ul><ul><li>Higher specificity of patient’s condition or ...
Structure of ICD-10-CM <ul><li>Seventh Character </li></ul><ul><ul><li>Most precise level of specificity of patient’s cond...
Change as a new Alpha-number   Example: Malignancy of Uterus ICD-9-CM ICD-10-CM 179 Malignancy of uterus C55 Malignancy of...
Example:  ICD-9-CM vs. ICD-10-CM Diagnosis:  Chest Pain  ICD-9-CM ICD-10-CM 786.50 Chest pain:  NOS R07.9 Chest pain:  NOS
Example:  ICD-9-CM vs. ICD-10-CM Diagnosis:  Cerebrospinal Fluid Leak  (CSF)  ICD-9-CM ICD-10-CM 997.09 CSF G97.0 CSF <ul>...
Example:  ICD-9-CM vs. ICD-10-CM ICD-9-CM ICD-10-CM 401.9 Hypertension unspecified I11.◊ Hypertension <ul><li>401.9  Hyper...
Organizational Adjustments ICD-9-CM ICD-10-CM 274 Gout M10 Gout <ul><li>274  Gout </li></ul><ul><li>(Moved   from  Chapter...
Organizational Adjustments ICD-9-CM ICD-10-CM 729.81 Swelling of Limb M79.89 Swelling of Limb <ul><li>729.81 Swelling of L...
Organizational Adjustments <ul><ul><li>Osteoporosis with pathological fracture </li></ul></ul><ul><ul><li>M80.0  Postmenop...
Greater Specificity in ICD-10 ICD-9-CM ICD-10-CM 565.0  ANAL FISSURE K60.◊  ANAL FISSURE <ul><li>565.0 ANAL FISSURE </li><...
Example:  ICD-9-CM vs. ICD-10-CM ICD-9-CM ICD-10-CM 143 Malignant Neoplasm of Gum C03 Malignant Neoplasm of Gum <ul><li>14...
Example:  ICD-9-CM vs. ICD-10-CM I20.◊◊ Angina 413.9 Angina <ul><li>I20.0 Angina, unstable </li></ul><ul><li>I20.1 Angina ...
Example:  ICD-9-CM vs. ICD-10-CM I49.◊ Bradycardia 427.89 Bradycardia <ul><li>I49.5  Sick sinus syndrome </li></ul><ul><li...
Example:  ICD-9-CM vs. ICD-10-CM I47.◊ Arrhythmia 427.9 Arrhythmia <ul><li>I47.0 Re-entry Ventricular arrhythmia </li></ul...
Greater Specificity in ICD-10 ICD-9-CM ICD-10-CM 493.92  Asthma  Acute Exacerbation J45.◊1 Asthma Acute Exacerbation <ul><...
Greater Specificity in ICD-10 ICD-9-CM ICD-10-CM 424.1 Aortic Valve Disorders NOS,  except rheumatic I35.0 Nonrheumatic  A...
Greater Specificity in ICD-10 I42. Cardiomyopathy 425.4 Cardiomyopathy <ul><li>I42.0  Dilated   or  congestive  cardiomyop...
Greater Specificity in ICD-10 ICD-9-CM ICD-10-CM 433.10 Occlusion and stenosis of pre-cerebral arteries I65.2◊  Occlusion ...
Greater Specificity in ICD-10 ICD-9-CM ICD-10-CM 535.5 Unspecified Gastritis and Duodenitis K29.◊0 Gastritis and Duodeniti...
Greater Specificity in ICD-10 ICD-9-CM ICD-10-CM 555.9 Regional enteritis K50.90 Regional enteritis <ul><li>555.9  Regiona...
Greater Specificity in ICD-10 ICD-9-CM ICD-10-CM 365.83 Aqueous Misdirection H40.83 Aqueous Misdirection <ul><li>H40.831 A...
Greater Specificity in ICD-10 ICD-9-CM ICD-10-CM 883.0  Thumb laceration S61.01◊a  Thumb laceration <ul><li>883.0 Thumb la...
Hemorrhoids ICD - 9-CM = 10 codes  ~  ICD-10-CM = 32 codes ICD-9-CM ICD-10-CM 455.2 Internal Hemorrhoids with other compli...
New for 2010!   Example:  ICD-9-CM vs. ICD-10-CM Pain disorders related to psychological factors ICD-9-CM ICD-10-CM 307.8 ...
45-year-old established patient presented to her physician’s office for a routine physical exam. During the examination th...
Patient sees MD for follow-up for Rheumatoid Arthritis. MD documents in medical record “Rheumatoid Polyneuropathy with  Rh...
Asymptomatic 67-year-old female patient presents to the outpatient radiology department for a  bilateral mammogram. The ph...
74-year-old patient fell at home and sustained a subtrochanteric fracture of the left femur and was discharged home.  Phys...
A 54-year-old male is admitted into the hospital with a principal diagnosis of  surgical site infection  secondary to a  r...
Example:  ICD-9-CM vs. ICD-10-CM   Inpatient – Acute Care cont… **From V Codes to Z Codes:  Transitioning to ICD-10  by Ka...
A bit about ICD-10-PCS? **From V Codes to Z Codes:  Transitioning to ICD-10  by Karen M. Kostick, RHIIT, CCS, <ul><li>Proc...
Structure of ICD-10-PCS **From V Codes to Z Codes:  Transitioning to ICD-10  by Karen M. Kostick, RHIIT, CCS, <ul><li>Mult...
ICD-10-PCS Code 2010 Totals, By Section 2010 Release Summary **From V Codes to Z Codes:  Transitioning to ICD-10  by Karen...
Medical and Surgical Section   Body Systems   (Character 2) **From V Codes to Z Codes:  Transitioning to ICD-10  by Karen ...
Medical and Surgical Section   Root Operations   (Character 3) Alteration Bypass Change Control Creation Destruction Detac...
Medical and Surgical Section   Body Part  (Character 4) <ul><li>Defines the specific anatomical site where the procedure i...
Medical and Surgical Section   Approach  (Character 5) <ul><li>Defines the technique used to reach the site of the procedu...
Medical and Surgical Section   Device  (Character 6) <ul><li>The term “device” includes only devices that remain after the...
Medical and Surgical Section   Qualifier  (Character 7) <ul><li>Defines an additional attribute of the procedure performed...
Example:  ICD-10-PCS Percutaneous placement of pacemaker lead into the left atrium A M 3 7 H 2 0 7 Qualifier 6 Device 5 Ap...
Example of ICD-10-PCS cont… <ul><li>1 – Section ( Medical/Surgical )   0 </li></ul><ul><li>2 – Body System ( Heart and Gre...
Example:  ICD-9-CM vs. ICD-10-PCS Repair of fracture, radius w/internal fixation device 1 Section 2 Body System 3 Root Ope...
Example of ICD-10-PCS cont… <ul><li>1 – Section ( Medical/Surgical )  0 </li></ul><ul><li>2 – Body System ( Upper Bones ) ...
Example:  ICD-9-CM vs. ICD-10-PCS *Percutaneous Transluminal Coronary Angioplasty with Stent 1 Section 2 Body System 3 Roo...
Example of ICD-10-PCS cont… <ul><li>1 – Section ( Medical/Surgical )  0 </li></ul><ul><li>2 – Body System ( Heart and Grea...
Varying Specificity  Approaches Unique to Pituitary Gland ICD-9-CM ICD-10-CM 07.◊◊ Excision of Pituitary Gland 0GT00ZZ Exc...
What are GEMS?
What are GEMS? General Equivalence Mapping <ul><li>“ The Centers for Medicare and Medicaid Services (CMS) and the and the ...
General Equivalence Mapping  ICD-9 to ICD-10  -  ICD-10 to ICD-9 <ul><ul><li>GEMs are more complex than a simple one-to-on...
General Equivalence Mapping  ICD-9 to ICD-10  -  ICD-10 to ICD-9 <ul><li>Difficult to find two corresponding descriptions ...
General Equivalence Mapping (GEM) No Mirror Image ©  AHIMA “Putting the ICD-10-CM?PCS GEMs into Practice.” Journal of AHIM...
General Equivalence Mapping (GEM) No Mirror Image ©  AHIMA “Putting the ICD-10-CM?PCS GEMs into Practice.” Journal of AHIM...
General Equivalence Mapping (GEM) No Mirror Image ©  AHIMA “Putting the ICD-10-CM?PCS GEMs into Practice.” Journal of AHIM...
General Equivalence Mapping   Who should use GEMs? <ul><li>Users include… </li></ul><ul><ul><ul><li>Payers  </li></ul></ul...
General Equivalence Mapping Number of Translation Alternatives in each GEM Backward GEMs ICD-10-CM codes with one ICD-9-CM...
General Equivalence Mapping Number of Translation Alternatives in each GEM Forward GEMs ICD-9-CM diagnosis codes with only...
General Equivalence Mapping  Glossary of Terms <ul><li>Applied mapping:  distillation of a reference mapping to conform to...
General Equivalence Mapping   Example of ICD-10-CM mapping CMS Downloads General Equivalence Mappings and User’s Guides Ma...
General Equivalence Mapping Why do they go in both direction ICD-9 to ICD-10 and ICD-10 to ICD-9? <ul><li>GEMs are designe...
General Equivalence Mapping Why do they go in both direction ICD-9 to ICD-10 and ICD-10 to ICD-9? <ul><li>A &quot;reverse ...
General Equivalence Mapping GEMs consists of three basic steps <ul><li>Step 1: EXTRACT  </li></ul><ul><ul><li>Select all r...
So Now What??? <ul><li>What is affected by this change? </li></ul><ul><li>What does this mean to practices? </li></ul><ul>...
What will be affected by ICD-10? <ul><li>All computer systems that use ICD-9 </li></ul><ul><ul><li>Billing, coding, lab, p...
What must be considered? IT Readiness Physician/Clinician Adoption Vendor Readiness Coder / Staff Training Payer Readiness...
What do organizations need to do? <ul><li>Analyze and plan for costs and budget implications </li></ul><ul><li>Analyze and...
What do organizations need to do? <ul><li>Communicate to all physicians and leaders </li></ul><ul><ul><li>Managers, Direct...
Who needs to be involved? Any one else who touches ICD-9 today, HIM, Reporting, etc… Administrative Staff, Nursing Staff Q...
What are the Cost Implications? <ul><li>System transitions </li></ul><ul><li>Interface transitions </li></ul><ul><li>Train...
Strategic decisions to consider…. <ul><li>Will you use ICD-10 in your strategy Initiatives? </li></ul><ul><li>To improve r...
Prepare Readiness Chart Payer Analysis Contract Negotiation Granularity to our advantage Payer Integration Internal Readin...
What is your Code Impact? <ul><li>What is your volume of codes used? </li></ul><ul><li>How often is each code used? </li><...
What can you do to prepare? <ul><li>Start to communicate and plan for change </li></ul><ul><li>Educate your MD’s on the im...
Updating Encounter Forms ICD-9-CM ICD-10-CM <ul><li>211.3    Colon polyp </li></ul><ul><li>564.00  Constipation </li></ul>...
Updating Encounter Forms ICD-9-CM ICD-10-CM <ul><li>272.4  Hyperlipidemia: NOS </li></ul><ul><li>401.9  Hypertension unspe...
Biggest change…we need to…. <ul><li>THINK… </li></ul><ul><li>Documentation </li></ul><ul><li>THINK… </li></ul><ul><li>Spec...
Biggest change…we need to…. “ Documentation is the Cornerstone to Successful Implementation” Deborah Grider President, AAP...
  ?
<ul><li>Centers for Medicare and Medicaid </li></ul><ul><ul><li>http://www.cms.hhs.gov  </li></ul></ul><ul><ul><li>http://...
<ul><li>National Center for Vital and Health Statistics </li></ul><ul><ul><li>http://www.cdc.gov/nchs/about/otheract/icd9/...
<ul><li>Health and Human Services </li></ul><ul><ul><li>http://www.hhs.gov/agencies / </li></ul></ul><ul><li>Ingenix Onlin...
<ul><li>National Center for Vital and Health Statistics </li></ul><ul><li>World Health Organization (WHO) </li></ul><ul><l...
<ul><li>“ The Future of Coding:  10 Strategies for Successful Implementation of ICD-10-CM”, © Deborah Grider, CMA, CPC, CP...
<ul><li>“ ICD-10 Made Easy”, © Medicode, Inc. </li></ul><ul><li>“ HIT Legislation – It’s Still the Data”, AHIMA </li></ul>...
All information was current at the time this presentation was written.  All information was obtained from the sources site...
Cynthia A. Trapp CHFP, CMPE, CPCO, CPC, CPC-I, CCS-P, CHC, PCA [email_address] Contact Information
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HFMA 1-21-11 On 5010 And ICD-10

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HFMA 1-21-11 On 5010 And ICD-10

  1. 1. Preparing for ICD-10 and 5010 Friday, January 21, 2011 Gillette Stadium Clubhouse Cynthia Trapp CHFP, CMPE, CPCO, CPC, CPC-I, CCS-P, CHC, PCA
  2. 2. The Latest ……. <ul><li>Final Rule issued January 16, 2009 </li></ul><ul><ul><li>HHS in 45 CFR Part 162 issued the FINAL Rule effective March 17, 2009 </li></ul></ul><ul><li>Two parts: </li></ul><ul><ul><li>Replace ICD-9-CM code sets with ICD-10 code sets </li></ul></ul><ul><ul><ul><li>Compliance date – October 1, 2013 </li></ul></ul></ul><ul><ul><li>Implement HIPAA 5010 standards for electronic transactions </li></ul></ul><ul><ul><ul><li>Compliance date – January 1, 2012 </li></ul></ul></ul>*Federal Register / Vol. 74, No. 11 / Friday, January 16, 2009 / Rules and Regulations
  3. 3. 5010
  4. 4. Compliance Dates <ul><li>Effective Date – March 1, 2009 </li></ul><ul><li>Level I Compliance – December 31, 2010 </li></ul><ul><ul><li>&quot;that a covered entity can demonstrably create and receive compliant transactions, resulting from the compliance of all design/build activities and internal testing.&quot;  </li></ul></ul><ul><li>Level II Compliance – December 31, 2011 </li></ul><ul><ul><li>&quot;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.&quot; </li></ul></ul><ul><li>Fully Compliant – January 1, 2012 </li></ul><ul><ul><li>Exception: </li></ul></ul><ul><ul><ul><li>Small Health plans for Medicaid – January 1, 2013 </li></ul></ul></ul>*Federal Register / Vol. 74, No. 11 / Friday, January 16, 2009 / Rules and Regulations
  5. 5. Compliance Dates
  6. 6. What and Why HIPAA 5010? <ul><li>Current version 4010/4010A1 </li></ul><ul><ul><li>Is outdated </li></ul></ul><ul><ul><li>Lacks necessary functionality </li></ul></ul><ul><ul><li>Does not support ICD-10 </li></ul></ul><ul><li>New Version 5010/DO </li></ul><ul><ul><li>Contains structural, technical, and data content improvements </li></ul></ul><ul><ul><li>Allows for more specific data </li></ul></ul><ul><ul><li>Supports ICD-10 </li></ul></ul><ul><ul><li>Supports Pharmacy Standards </li></ul></ul>
  7. 7. What are the Versions? <ul><li>Version 5010 – New version of X12 Standards for HIPAA transactions </li></ul><ul><li>Version DO – New version of the National Council for Prescription Drug Program (NCPDP) standards for pharmacy and supplier transactions </li></ul><ul><li>Version 3.0 – New NCPDP standard for Medicaid pharmacy subrogation </li></ul>
  8. 8. What are HIPAA Transactions? <ul><li>HIPAA Act of 1996 required a standard format for Electronic Data Interchange (EDI) of health care data for covered entities </li></ul><ul><li>Claims and encounter information </li></ul><ul><li>Payment and remittance advice </li></ul><ul><li>Claims status </li></ul><ul><li>Eligibility </li></ul><ul><li>Enrollment and disenrollment </li></ul><ul><li>Referrals and authorizations </li></ul><ul><li>Premium payment </li></ul>
  9. 9. Who are the covered entities? <ul><li>Health plans </li></ul><ul><li>Health care clearinghouses </li></ul><ul><li>Health care providers </li></ul>
  10. 10. 5010 Readiness Assessment <ul><li>Side by Side Comparison 4010 vs. 5010 </li></ul><ul><ul><li>http://www.cms.gov/ElectronicBillingEDITrans/18_5010D0.asp </li></ul></ul><ul><ul><li>Claims, Claim Status, Remittances, Eligibility </li></ul></ul><ul><li>Software modification to meet new standards </li></ul><ul><li>Testing with external vendors, payers, NOW…..Target date – January, 2011 </li></ul><ul><ul><li>Errata testing target date – April, 2011 </li></ul></ul><ul><li>Contact MAC early for testing! </li></ul>
  11. 11. Side by Side Comparison http://www.cms.gov/ElectronicBillingEDITrans/18_5010D0.asp
  12. 12. Side by Side Comparison http://www.cms.gov/ElectronicBillingEDITrans/Downloads/NCPDP51toD0.pdf
  13. 13. Side by Side Comparison <ul><li>Identify differences requiring change </li></ul>http://www.cms.gov/ElectronicBillingEDITrans/Downloads/NCPDP51toD0.pdf
  14. 14. Checklist for Level I Testing http://www.cms.gov/Versions5010andD0/Downloads/w5010PrepChklst.pdf
  15. 15. EDI Resource Guide http://www.cms.gov/MLNProducts/downloads/5010EDI_RefCard_ICN904284.pdf
  16. 16. Provider Action Checklist http://www.cms.gov/Versions5010andD0/Downloads/w5010PvdrActionChklst.pdf
  17. 17. Why change ICD-9-CM? <ul><li>ICD-9-CM is obsolete </li></ul><ul><ul><li>No longer supported by WHO </li></ul></ul><ul><ul><li>Over 30 Years old </li></ul></ul><ul><ul><li>Does not meet guidelines for </li></ul></ul><ul><ul><ul><li>HIPAA Code standards </li></ul></ul></ul><ul><ul><ul><li>Benefits Improvement and Protection Act of 2000 (BIPA) </li></ul></ul></ul><ul><ul><ul><li>1993 coding system outlined by NCVHS </li></ul></ul></ul><ul><ul><li>Can not describe today’s diseases </li></ul></ul><ul><ul><li>Inaccurate data for making healthcare decisions </li></ul></ul><ul><ul><li>Unable to track international public health issues </li></ul></ul><ul><ul><li>Unable to compare costs and outcomes of modern technology </li></ul></ul>
  18. 18. ICD-10 CM/PCS
  19. 19. October 1, 2013
  20. 20. Why move to ICD-10? <ul><li>ICD-10-CM has better data for: </li></ul><ul><ul><li>Measuring Quality and Safety </li></ul></ul><ul><ul><li>Pay-for-performance initiatives </li></ul></ul><ul><ul><li>Public Health Reporting (e.g. SARS, West Nile Virus) </li></ul></ul><ul><ul><li>Bioterrorism Monitoring </li></ul></ul><ul><ul><li>Reimbursement Rates </li></ul></ul><ul><ul><li>Medical Necessity </li></ul></ul><ul><ul><li>Research and Clinical Trials </li></ul></ul><ul><ul><li>Mapping from SNOMED – CT ® </li></ul></ul><ul><ul><li>Meeting HIPAA requirements (5010,D.0 version) </li></ul></ul>
  21. 21. Why not SNOMED-CT ® ? <ul><li>SNOMED-CT ® </li></ul><ul><ul><li>Systematized Nomenclature of Medicine - Clinical Terms </li></ul></ul><ul><ul><li>Input system </li></ul></ul><ul><ul><ul><li>Designed for documentation of clinical care </li></ul></ul></ul><ul><ul><ul><li>Can only be used with EHR </li></ul></ul></ul><ul><li>ICD-9-CM, ICD-10-CM, ICD-10-PCS </li></ul><ul><ul><li>Output systems </li></ul></ul><ul><ul><ul><li>Designed for reporting and/or aggregation of data </li></ul></ul></ul><ul><ul><ul><li>Designed for paper or EHR systems </li></ul></ul></ul><ul><ul><ul><li>Not used for documentation of clinical care </li></ul></ul></ul>
  22. 22. Characteristics of ICD-10-CM <ul><li>Changed Titles </li></ul><ul><li>Conditions re-grouped </li></ul><ul><li>7 digits for higher specificity </li></ul><ul><li>Diagnostic codes more precise/complete </li></ul><ul><li>Code combinations to reduce use of multiple coding </li></ul><ul><li>Includes full code titles for all codes </li></ul><ul><li>Injury coding expanded </li></ul><ul><li>Room for future expansion </li></ul><ul><li>Structured by blocks </li></ul>
  23. 23. Characteristics of ICD-10-CM <ul><li>7 digits for higher specificity </li></ul><ul><li>Alphanumeric Codes </li></ul><ul><ul><li>Character 1 is always Alpha </li></ul></ul><ul><ul><li>Character 2 is always Numeric </li></ul></ul><ul><ul><li>Character 3-7 can be either Alpha or Numeric </li></ul></ul><ul><ul><li>All letters used except “U” </li></ul></ul><ul><li>Decimal after the 1 st three characters </li></ul><ul><li>Alpha characters are not case sensitive </li></ul><ul><li>Uses Zeros and Ones as well as I’s and O’s </li></ul>
  24. 24. Other differences… <ul><li>Injury classified by site then type rather than by type </li></ul><ul><li>Post op complications moved to procedure specific body systems </li></ul><ul><li>V-codes and E-codes are incorporated into main classification </li></ul><ul><li>Eyes and Ears have their own chapters </li></ul><ul><li>Addition of sixth character in some chapters </li></ul><ul><li>Some chapters will have placeholder “x” where there is no 6 th character </li></ul>
  25. 25. Other differences cont… <ul><li>Obstetrics, Injuries, and external causes of injuries will have 7 th character extensions </li></ul><ul><li>All codes must go out to the 7 th digit “if” there is a need for a seventh character extension </li></ul><ul><li>Combination codes for common symptoms or manifestations </li></ul><ul><li>Combination codes for poisonings and external causes </li></ul><ul><li>7 th Character for episode of care (initial, subsequent) </li></ul><ul><li>Expanded diabetes, injuries, alcohol and substance abuse, post op complications </li></ul><ul><li>Trimesters in OB and eliminate 5 th digit for episode of care </li></ul>
  26. 26. Other differences cont… <ul><li>Morphology codes are no longer in included </li></ul><ul><li>Changes in timeframes of codes </li></ul><ul><ul><li>Acute Myocardial Infarction from 8 wks to 4 wks </li></ul></ul><ul><ul><li>Abortion vs. fetal death from 22 wks to 20 wks </li></ul></ul><ul><li>Addition of Standard definitions for Excludes notes </li></ul><ul><ul><li>Excludes 1 = Not coded here </li></ul></ul><ul><ul><ul><li>The two conditions can not be coded together </li></ul></ul></ul><ul><ul><li>Excludes 2 = Not included here </li></ul></ul><ul><ul><ul><li>The condition is not included in this code so can be coded together </li></ul></ul></ul>
  27. 27. Characteristics of ICD-10-PCS <ul><li>Procedural coding system to replace the current inpatient procedural coding system </li></ul><ul><li>(Volume 3 of ICD-9-CM) for the DRG code assignment. </li></ul><ul><li>Alphanumeric Codes </li></ul><ul><li>7 digits for higher specificity </li></ul><ul><li>It is expandable and multi-axial </li></ul><ul><li>Standardized Terminology </li></ul><ul><li>Unique code for each substantially different procedure </li></ul><ul><li>Uses Zero’s and One’s but not I’s and O’s </li></ul><ul><li>New “Look and Feel” to code selection </li></ul>
  28. 28. Characteristics of ICD-10-PCS <ul><li>ICD-10-CM/PCS </li></ul><ul><li>Diagnoses </li></ul><ul><li>21 Chapters </li></ul><ul><ul><li>No supplements </li></ul></ul><ul><li>7 characters </li></ul><ul><li>Alpha-numeric categories </li></ul><ul><li>Alpha-numeric codes </li></ul><ul><li>69,101 Codes </li></ul><ul><li>2,033 Code categories </li></ul><ul><li>Procedures </li></ul><ul><li>ICD-10-PCS </li></ul><ul><li>71,957 Procedure codes </li></ul><ul><li>7 Alpha-numeric Characters </li></ul><ul><li>ICD-9-CM </li></ul><ul><li>Diagnoses </li></ul><ul><li>17 Chapters </li></ul><ul><ul><li>2 supplements </li></ul></ul><ul><li>3-5 characters </li></ul><ul><li>Numeric categories </li></ul><ul><li>Numeric codes </li></ul><ul><li>13,000 Diagnosis codes </li></ul><ul><li>855 Code categories </li></ul><ul><li>Procedures </li></ul><ul><li>Volume 3 </li></ul><ul><li>4,000 Procedure codes </li></ul><ul><li>4 Numeric Characters </li></ul>
  29. 29. Chapter Changes
  30. 30. Chapter Changes
  31. 31. Basic Structure of ICD-10 <ul><li>Volume I </li></ul><ul><ul><li>Tabular Lists containing cause-of-death titles and codes </li></ul></ul><ul><ul><li>Inclusion and exclusion terms for cause-of-death titles </li></ul></ul><ul><li>Volume II </li></ul><ul><ul><li>Alphabetic index to diseases and nature of injury </li></ul></ul><ul><ul><li>External causes of injury </li></ul></ul><ul><ul><li>Descriptions, guidelines, and coding rules </li></ul></ul><ul><li>Volume III </li></ul><ul><ul><li>Table of drugs and chemicals </li></ul></ul>
  32. 32. What is the ICD-10-CM Change? <ul><li>ICD-10-CM Structure -- Format </li></ul>X X X X X X X Extension Etiology, anatomic site , severity Category
  33. 33. Basic Structure of ICD-10 <ul><li>Third Character Block </li></ul><ul><ul><li>Example: Tuberculosis A15 – A19 </li></ul></ul><ul><ul><ul><li>A15 Respiratory Tuberculosis </li></ul></ul></ul><ul><ul><ul><li>A17 Tuberculosis of Nervous System </li></ul></ul></ul><ul><ul><ul><li>A18 Tuberculosis of Other Organs </li></ul></ul></ul><ul><ul><ul><li>A19 Miliary Tuberculosis </li></ul></ul></ul>*“The Future of Coding: 10 Strategies for Successful Implementation of ICD-10-CM”, © Deborah Grider, CMA, CPC, CPC-H, CPC-P, CCS-P, EMS
  34. 34. Structure of ICD-10-CM <ul><li>Fourth Character </li></ul><ul><ul><li>Site, etiology, manifestation or state of the disease or condition </li></ul></ul><ul><ul><li>Example: </li></ul></ul><ul><ul><ul><li>C15 Malignant Neoplasm of the Esophagus </li></ul></ul></ul><ul><ul><ul><ul><li>C15.3 Malignant neoplasm of upper third of esophagus </li></ul></ul></ul></ul><ul><ul><ul><ul><li>C15.4 Malignant neoplasm of middle third of esophagus </li></ul></ul></ul></ul><ul><ul><ul><ul><li>C15.5 Malignant neoplasm of lower third of esophagus </li></ul></ul></ul></ul><ul><ul><ul><ul><li>C15.8 Malignant neoplasm of overlapping lesion of esophagus </li></ul></ul></ul></ul><ul><ul><ul><ul><li>C15.9 Malignant neoplasm of esophagus, unspecified </li></ul></ul></ul></ul>*“The Future of Coding: 10 Strategies for Successful Implementation of ICD-10-CM”, © Deborah Grider, CMA, CPC, CPC-H, CPC-P, CCS-P, EMS
  35. 35. Structure of ICD-10-CM <ul><li>Fifth – Sixth Character </li></ul><ul><ul><li>Higher specificity of patient’s condition or diagnosis </li></ul></ul><ul><ul><li>Example: </li></ul></ul><ul><ul><ul><li>F50.0 Anorexia Nervosa </li></ul></ul></ul><ul><ul><ul><ul><li>F50.00 Anorexia Nervosa, unspecified </li></ul></ul></ul></ul><ul><ul><ul><ul><li>F50.01 Anorexia Nervosa, restrictive type </li></ul></ul></ul></ul><ul><ul><ul><ul><li>F50.02 Anorexia Nervosa, binge eating/purging type </li></ul></ul></ul></ul>*“The Future of Coding: 10 Strategies for Successful Implementation of ICD-10-CM”, © Deborah Grider, CMA, CPC, CPC-H, CPC-P, CCS-P, EMS
  36. 36. Structure of ICD-10-CM <ul><li>Seventh Character </li></ul><ul><ul><li>Most precise level of specificity of patient’s condition or diagnosis </li></ul></ul><ul><ul><li>Example: </li></ul></ul><ul><ul><ul><li>S42.215 Fracture (abduction) (adduction) (separation) Upper end  Surgical neck (displaced) Non-displaced Left </li></ul></ul></ul><ul><ul><ul><ul><li>A  initial encounter for closed fracture </li></ul></ul></ul></ul><ul><ul><ul><ul><li>B  initial encounter for open fracture </li></ul></ul></ul></ul><ul><ul><ul><ul><li>D  subsequent encounter for fracture with routine healing </li></ul></ul></ul></ul><ul><ul><ul><ul><li>G  subsequent encounter for fracture with delayed healing </li></ul></ul></ul></ul><ul><ul><ul><ul><li>J   subsequent encounter for fracture with nonunion </li></ul></ul></ul></ul><ul><ul><ul><ul><li>M  subsequent encounter for fracture with malunion </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Q  sequela </li></ul></ul></ul></ul><ul><ul><ul><li>If A fracture not designated as open or closed should be coded to closed </li></ul></ul></ul>*“The Future of Coding: 10 Strategies for Successful Implementation of ICD-10-CM”, © Deborah Grider, CMA, CPC, CPC-H, CPC-P, CCS-P, EMS
  37. 37. Change as a new Alpha-number Example: Malignancy of Uterus ICD-9-CM ICD-10-CM 179 Malignancy of uterus C55 Malignancy of uterus <ul><li>179 Malignant neoplasm of the uterus, part unspecified </li></ul><ul><li>C55 Malignant neoplasm of the uterus, part unspecified </li></ul>
  38. 38. Example: ICD-9-CM vs. ICD-10-CM Diagnosis: Chest Pain ICD-9-CM ICD-10-CM 786.50 Chest pain: NOS R07.9 Chest pain: NOS
  39. 39. Example: ICD-9-CM vs. ICD-10-CM Diagnosis: Cerebrospinal Fluid Leak (CSF) ICD-9-CM ICD-10-CM 997.09 CSF G97.0 CSF <ul><li>997.01 Cerebrospinal Fluid Leak from spinal puncture </li></ul><ul><li>G96.0 Cerebrospinal Fluid Leak from spinal puncture </li></ul>
  40. 40. Example: ICD-9-CM vs. ICD-10-CM ICD-9-CM ICD-10-CM 401.9 Hypertension unspecified I11.◊ Hypertension <ul><li>401.9 Hypertension, unspecified </li></ul><ul><li>I11.0 Hypertensive heart disease with heart failure </li></ul><ul><li>I00.1 Hypertensive heart disease w/o heart failure </li></ul>
  41. 41. Organizational Adjustments ICD-9-CM ICD-10-CM 274 Gout M10 Gout <ul><li>274 Gout </li></ul><ul><li>(Moved from Chapter 3) </li></ul><ul><li>Endocrine, Nutritional, Metabolic & Immunity Disorders </li></ul><ul><li>M10 Gout </li></ul><ul><li>(Moved to Chapter 13) </li></ul><ul><li>Disease of the Musculoskeletal System & Connective Tissue </li></ul>
  42. 42. Organizational Adjustments ICD-9-CM ICD-10-CM 729.81 Swelling of Limb M79.89 Swelling of Limb <ul><li>729.81 Swelling of Limb </li></ul><ul><li>Swelling of limb has been deleted in ICD-10 </li></ul><ul><li>M79.8 Other specified soft tissue disorders </li></ul>
  43. 43. Organizational Adjustments <ul><ul><li>Osteoporosis with pathological fracture </li></ul></ul><ul><ul><li>M80.0 Postmenopausal osteoporosis with pathological fracture </li></ul></ul><ul><ul><li>M80.1 Post-oophorectomy osteoporosis with pathological fracture </li></ul></ul><ul><ul><li>M80.2 Osteoporosis of disuse with pathological fracture </li></ul></ul><ul><ul><li>M80.3 Post-surgical malabsorption osteoporosis with pathological fracture </li></ul></ul><ul><ul><li>M80.4 Drug-induced osteoporosis with pathological fracture </li></ul></ul><ul><ul><li>M80.5 Idiopathic osteoporosis with pathological fracture </li></ul></ul><ul><ul><li>M80.8 Other osteoporosis with current pathological fracture </li></ul></ul>
  44. 44. Greater Specificity in ICD-10 ICD-9-CM ICD-10-CM 565.0 ANAL FISSURE K60.◊ ANAL FISSURE <ul><li>565.0 ANAL FISSURE </li></ul><ul><li>K60.0 ANAL FISSURE acute </li></ul><ul><li>K60.1 ANAL FISSURE chronic </li></ul><ul><li>K60.2 ANAL FISSURE unspecified </li></ul>
  45. 45. Example: ICD-9-CM vs. ICD-10-CM ICD-9-CM ICD-10-CM 143 Malignant Neoplasm of Gum C03 Malignant Neoplasm of Gum <ul><li>143.0 Upper Gum </li></ul><ul><li>143.1 Lower Gum </li></ul><ul><li>C03.0 Malignant Neoplasm of Upper Gum </li></ul><ul><li>C03.1 Malignant Neoplasm of Lower Gum </li></ul>
  46. 46. Example: ICD-9-CM vs. ICD-10-CM I20.◊◊ Angina 413.9 Angina <ul><li>I20.0 Angina, unstable </li></ul><ul><li>I20.1 Angina pectoris with documented spasm </li></ul><ul><li>I20.8 Angina pectoris, other forms </li></ul><ul><li>I20.9 Angina pectoris, unspecified </li></ul>ICD-9-CM ICD-10-CM
  47. 47. Example: ICD-9-CM vs. ICD-10-CM I49.◊ Bradycardia 427.89 Bradycardia <ul><li>I49.5 Sick sinus syndrome </li></ul><ul><li>I49.8 Other specified cardiac arrythmias </li></ul><ul><li>I49.9 Cardiac arrhythmia, unspecified </li></ul>ICD-9-CM ICD-10-CM
  48. 48. Example: ICD-9-CM vs. ICD-10-CM I47.◊ Arrhythmia 427.9 Arrhythmia <ul><li>I47.0 Re-entry Ventricular arrhythmia </li></ul><ul><li>I47.1 Supraventricular tachycardia </li></ul><ul><li>I47.2 Ventricular tachycardia </li></ul><ul><li>I47.9 Paroxysmal tachycardia </li></ul>ICD-9-CM ICD-10-CM
  49. 49. Greater Specificity in ICD-10 ICD-9-CM ICD-10-CM 493.92 Asthma Acute Exacerbation J45.◊1 Asthma Acute Exacerbation <ul><li>493.92 Asthma, Acute Exacerbation </li></ul><ul><li>J45.21 Mild, intermittent </li></ul><ul><li>w/acute exacerbation </li></ul><ul><li>J45.41 Moderate, persistent w/acute exacerbation </li></ul><ul><li>J45.51 Severe, persistent w/acute exacerbation </li></ul>
  50. 50. Greater Specificity in ICD-10 ICD-9-CM ICD-10-CM 424.1 Aortic Valve Disorders NOS, except rheumatic I35.0 Nonrheumatic Aortic Valve Disorders <ul><li>I35.0 Non rheumatic aortic valve stenosis </li></ul><ul><li>I35.1 Non rheumatic aortic valve insufficiency </li></ul><ul><li>I35.2 Non rheumatic aortic valve stenosis </li></ul><ul><li>I35.8 Other nonrheumatic aortic valve disorders </li></ul><ul><li>I35.9 Non rheumatic aortic valve disorder, unspecified </li></ul>
  51. 51. Greater Specificity in ICD-10 I42. Cardiomyopathy 425.4 Cardiomyopathy <ul><li>I42.0 Dilated or congestive cardiomyopathy </li></ul><ul><li>I42.1 Obstructive hypertrophic cardiomyopathy </li></ul><ul><li>I49.2 Other hypertrophic cardiomyopathy </li></ul><ul><li>I49.3 Endomyocardial (consinophilic) disease </li></ul><ul><li>I49.4 Endocardial fibroelastosis </li></ul><ul><li>I49.5 Other restrictive cardiomyopathy </li></ul><ul><li>I49.6 Alcoholic cardiomyopathy </li></ul><ul><li>I49.7 Cardiomyopathy due to drugs and external agent </li></ul><ul><li>I49.8 Other cardiomyopathy </li></ul><ul><li>I49.9 Cardiomyopathy, unspecified </li></ul>ICD-9-CM ICD-10-CM
  52. 52. Greater Specificity in ICD-10 ICD-9-CM ICD-10-CM 433.10 Occlusion and stenosis of pre-cerebral arteries I65.2◊ Occlusion and stenosis of pre-cerebral arteries <ul><li>433.10 Occlusion and stenosis of carotid artery without mention of cerebral infarction </li></ul><ul><li>I65.21 Occlusion and stenosis of right carotid artery not resulting in cerebral infarction </li></ul><ul><li>I65.22 Occlusion and stenosis of left carotid artery not resulting in cerebral infarction </li></ul><ul><li>I65.23 Occlusion and stenosis of bilateral carotid artery not resulting in cerebral infarction </li></ul>
  53. 53. Greater Specificity in ICD-10 ICD-9-CM ICD-10-CM 535.5 Unspecified Gastritis and Duodenitis K29.◊0 Gastritis and Duodenitis <ul><li>535.50 Unspecified Gastritis and Duodenitis without mention of hemorrhage </li></ul><ul><li>K29.70 Unspecified gastritis w/o bleeding </li></ul><ul><li>K29.90 Unspecified gastroduodenitis w/o bleeding </li></ul>
  54. 54. Greater Specificity in ICD-10 ICD-9-CM ICD-10-CM 555.9 Regional enteritis K50.90 Regional enteritis <ul><li>555.9 Regional enteritis, unspecified site </li></ul><ul><li>K50.90 Crohn’s Disease – unspecified, without complications </li></ul><ul><li>Additional 27 choices for Crohn’s Disease based on site and complications </li></ul>
  55. 55. Greater Specificity in ICD-10 ICD-9-CM ICD-10-CM 365.83 Aqueous Misdirection H40.83 Aqueous Misdirection <ul><li>H40.831 Aqueous Misdirection, right eye </li></ul><ul><li>H40.832 Aqueous Misdirection, left eye </li></ul><ul><li>H40.833 Aqueous Misdirection, bilateral </li></ul><ul><li>H40.839 Aqueous Misdirection, Unspecified eye </li></ul>
  56. 56. Greater Specificity in ICD-10 ICD-9-CM ICD-10-CM 883.0 Thumb laceration S61.01◊a Thumb laceration <ul><li>883.0 Thumb laceration w/o mention of complication </li></ul><ul><li>(needs modifier for left or right thumb) </li></ul><ul><li>S61.011a* Laceration w/o FB, RT Thumb, w/o nail damage, initial encounter </li></ul><ul><li>S61.012a* Laceration w/o FB, LT Thumb, w/o nail damage, initial encounter </li></ul><ul><li>(*a = initial encounter) </li></ul>
  57. 57. Hemorrhoids ICD - 9-CM = 10 codes ~ ICD-10-CM = 32 codes ICD-9-CM ICD-10-CM 455.2 Internal Hemorrhoids with other complication I84.11 Internal Hemorrhoids with other complication <ul><li>455.2 Internal Hemorrhoids with other complication </li></ul><ul><li>I84.111 Internal Bleeding </li></ul><ul><li>Hemorrhoids </li></ul><ul><li>I84.112 Internal Prolapsed Hemorrhoids </li></ul><ul><li>I84.113 Internal Strangulated Hemorrhoids </li></ul><ul><li>I84.114 Internal Ulcerated Hemorrhoids </li></ul>
  58. 58. New for 2010! Example: ICD-9-CM vs. ICD-10-CM Pain disorders related to psychological factors ICD-9-CM ICD-10-CM 307.8 Pain disorders related to psychological factors F45.4 Pain disorder related to psychological factors <ul><li>307.80 Psychogenic pain, site unspecified </li></ul><ul><li>F45.41 Pain disorder exclusively related to psychological factors </li></ul><ul><li>Somatoform pain disorder (persistent) </li></ul><ul><li>F45.42 Pain disorder with related psychological factors </li></ul><ul><li>Code also associated acute or chronic pain (G89.-) </li></ul>
  59. 59. 45-year-old established patient presented to her physician’s office for a routine physical exam. During the examination the physician identified an enlarged thyroid. The physician ordered a laboratory test and requested to see the patient in two weeks. Example: ICD-9-CM vs. ICD-10-CM Physician Office – Routine Exam **From V Codes to Z Codes: Transitioning to ICD-10 by Karen M. Kostick, RHIIT, CCS, ICD-9-CM ICD-10-CM <ul><li>V70.0 Routine general medical examination at a healthcare facility </li></ul><ul><li>240.9 Goiter, nontoxic, unspecified </li></ul><ul><li>Z00.011 Encounter for general medical examination with abnormal findings </li></ul><ul><li>E04.9 Nontoxic goiter, unspecified </li></ul>
  60. 60. Patient sees MD for follow-up for Rheumatoid Arthritis. MD documents in medical record “Rheumatoid Polyneuropathy with Rheumatoid arthritis of the right ankle and foot .” Example: ICD-9-CM vs. ICD-10-CM ICD-9-CM ICD-10-CM <ul><li>714.0 Rheumatoid Arthritis </li></ul><ul><li>357.1 Polyneuropathy in collagen vascular disease </li></ul><ul><li>M05.571 Rheumatoid polyneuropathy with rheumatoid arthritis of right ankle and foot </li></ul>
  61. 61. Asymptomatic 67-year-old female patient presents to the outpatient radiology department for a bilateral mammogram. The physician’s order documented breast cancer screening. The radiology report notes clusters of microcalcification in the left breast. Example: ICD-9-CM vs. ICD-10-CM Outpatient Facility – Screening Scenario **From V Codes to Z Codes: Transitioning to ICD-10 by Karen M. Kostick, RHIIT, CCS, ICD-9-CM ICD-10-CM <ul><li>V76.12 Other screening mammogram </li></ul><ul><li>793.81 Mammographic microcalcification </li></ul><ul><li>Z12.31 Encounter for screening mammogram for malignancy of breast </li></ul><ul><li>R92.0 Mammographic micro-calcification found on diagnostic imaging of breast </li></ul>
  62. 62. 74-year-old patient fell at home and sustained a subtrochanteric fracture of the left femur and was discharged home. Physician ordered physical therapy for difficulty in walking and exercise three times a week for one month. Example: ICD-9-CM vs. ICD-10-CM Home Health – Aftercare visit **From V Codes to Z Codes: Transitioning to ICD-10 by Karen M. Kostick, RHIIT, CCS, ICD-9-CM ICD-10-CM <ul><li>V57.1 Other physical </li></ul><ul><li>719.7 Difficulty in walking </li></ul><ul><li>V54.13 Aftercare for healing traumatic fracture of hip </li></ul><ul><li>S72.22xd Displaced subtrochanteric fracture of left femur, subsequent encounter for closed fracture with routine healing </li></ul><ul><li>R26.2 Difficulty in walking, not elsewhere classified </li></ul>
  63. 63. A 54-year-old male is admitted into the hospital with a principal diagnosis of surgical site infection secondary to a recent right side below the knee amputation . Patient is a type I diabetic with diabetic peripheral vascular disease and congestive heart failure . The patient sought treatment when the wound began to exude purulent drainage. On the second day of his hospitalization he had developed nausea, uncontrolled diabetes, and ketoacidosis . Moist saline dressings were applied twice daily to the wound. Wound culture tested positive for Staphylococcus aureus and was resistant to flucloxacillin . Ciprofloxacin effectively treated the infection. Diabetic ketoacidosis managed well and blood glucose was brought under control. Patient was discharged to a rehabilitation facility for continued wound management. Example: ICD-9-CM vs. ICD-10-CM Inpatient – Acute Care **From V Codes to Z Codes: Transitioning to ICD-10 by Karen M. Kostick, RHIIT, CCS,
  64. 64. Example: ICD-9-CM vs. ICD-10-CM Inpatient – Acute Care cont… **From V Codes to Z Codes: Transitioning to ICD-10 by Karen M. Kostick, RHIIT, CCS, ICD-9-CM ICD-10-CM <ul><li>997.62 Amputation stump infection </li></ul><ul><li>041.11 Staphylococcus aureus </li></ul><ul><li>V09.0 Infection with microorganisms resistant to penicillin's </li></ul><ul><li>250.13 Diabetes with ketoacidosis </li></ul><ul><li>250.73 Diabetes uncontrolled with peripheral circulatory disorders </li></ul><ul><li>443.81 Peripheral angiopathy in diseases classified elsewhere </li></ul><ul><li>428.0 Congestive heart failure, unspecified </li></ul><ul><li>T87.43 Infection of amputation stump, right lower extremity </li></ul><ul><li>B95.6 Staphylococcus aureus as the cause of diseases classified elsewhere </li></ul><ul><li>Z16 Infection with drug-resistant microorganisms </li></ul><ul><li>E10.10 Type 1 diabetes mellitus with ketoacidosis without coma </li></ul><ul><li>E10.51 Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene </li></ul><ul><li>I50.9 Congestive heart failure, NOS </li></ul>
  65. 65. A bit about ICD-10-PCS? **From V Codes to Z Codes: Transitioning to ICD-10 by Karen M. Kostick, RHIIT, CCS, <ul><li>Procedural coding system to replace the current inpatient procedural coding system </li></ul><ul><li>(Volume 3 of ICD-9-CM) for the DRG code assignment. </li></ul><ul><li>71,957 codes </li></ul><ul><li>Alphanumeric Codes </li></ul><ul><li>7 digits for higher specificity </li></ul><ul><li>It is expandable and multi-axial </li></ul><ul><li>Standardized Terminology </li></ul><ul><li>Unique code for each substantially different procedure </li></ul><ul><li>Uses Zero’s and One’s but not I’s and O’s </li></ul><ul><li>New “Look and Feel” to code selection </li></ul>
  66. 66. Structure of ICD-10-PCS **From V Codes to Z Codes: Transitioning to ICD-10 by Karen M. Kostick, RHIIT, CCS, <ul><li>Multi-axial Definition: Multiple characters in the code string make up the complete code description </li></ul>1 Section 2 Body System 3 Root Operation 4 Body Part 5 Approach 6 Device 7 Qualifier
  67. 67. ICD-10-PCS Code 2010 Totals, By Section 2010 Release Summary **From V Codes to Z Codes: Transitioning to ICD-10 by Karen M. Kostick, RHIIT, CCS, <ul><li>Medical and Surgical 62,123 </li></ul><ul><li>Obstetric 338 </li></ul><ul><li>Placement 864 </li></ul><ul><li>Administration 1,435 </li></ul><ul><li>Measurement and Monitoring 326 </li></ul><ul><li>Extracorporeal Assistance and Performance 43 </li></ul><ul><li>Extracorporeal Therapies 42 </li></ul><ul><li>Osteopathic 100 </li></ul><ul><li>Other Procedures 60 </li></ul><ul><li>Chiropractic 90 </li></ul><ul><li>Imaging 2,673 </li></ul><ul><li>Nuclear Medicine 463 </li></ul><ul><li>Radiation Oncology 1,929 </li></ul><ul><li>Rehabilitation and Diagnostic Audiology 1,382 </li></ul><ul><li>Mental Health 30 </li></ul><ul><li>Substance Abuse Treatment 59 </li></ul><ul><li>Total 71,957 </li></ul>
  68. 68. Medical and Surgical Section Body Systems (Character 2) **From V Codes to Z Codes: Transitioning to ICD-10 by Karen M. Kostick, RHIIT, CCS, Central Nervous Peripheral Nervous Heart and Great Vessels Upper Arteries Lower Arteries Upper Veins Lower Veins Lymphatic and Hemic Eye Ear, Nose, Sinus Respiratory Mouth and Throat Gastrointestinal Hepatobiliary and Pancreas Endocrine Skin and Breast Subcutaneous Tissue and Fascia Muscles Tendons Bursae and Ligaments Head and Facial Bones Upper Bones Lower Bones Upper Joints Lower Joints Urinary Female Reproductive Male Reproductive Anatomical Regions, General Anatomical Regions, Upper Extremities Anatomical Regions, Lower Extremities
  69. 69. Medical and Surgical Section Root Operations (Character 3) Alteration Bypass Change Control Creation Destruction Detachment Dilation Division Excision Extirpation Extraction Fragmentation Fusion Insertion Inspection Map Occlusion Release Removal Repair Replacement Reposition Resection Restriction Revision Transfer
  70. 70. Medical and Surgical Section Body Part (Character 4) <ul><li>Defines the specific anatomical site where the procedure is performed </li></ul><ul><li>34 possible body part values for each body system value </li></ul>
  71. 71. Medical and Surgical Section Approach (Character 5) <ul><li>Defines the technique used to reach the site of the procedure </li></ul><ul><li>8 different approach values </li></ul><ul><ul><li>Open </li></ul></ul><ul><ul><li>Open Endoscopic </li></ul></ul><ul><ul><li>Percutaneous </li></ul></ul><ul><ul><li>Percutaneous Endoscopic </li></ul></ul><ul><ul><li>Open with percutaneous endoscopic assistance </li></ul></ul><ul><ul><li>Via natural or artificial opening </li></ul></ul><ul><ul><li>Via Natural or artificial opening endoscopic </li></ul></ul>
  72. 72. Medical and Surgical Section Device (Character 6) <ul><li>The term “device” includes only devices that remain after the procedure is completed </li></ul><ul><li>Instruments used to perform the procedure are not specified in the device character </li></ul><ul><ul><li>Instruments for visualization are specified in the approach character </li></ul></ul><ul><li>Materials incidental to a procedure such as clips and sutures are not considered devices </li></ul>
  73. 73. Medical and Surgical Section Qualifier (Character 7) <ul><li>Defines an additional attribute of the procedure performed, if applicable </li></ul><ul><li>May have a unique meaning, depending on the root operation, body system, or body part </li></ul><ul><li>Examples of qualifiers include: </li></ul><ul><li>Diagnostic and Stereotactic </li></ul>
  74. 74. Example: ICD-10-PCS Percutaneous placement of pacemaker lead into the left atrium A M 3 7 H 2 0 7 Qualifier 6 Device 5 Approach 4 Body Part 3 Root Operation 2 Body System 1 Section
  75. 75. Example of ICD-10-PCS cont… <ul><li>1 – Section ( Medical/Surgical ) 0 </li></ul><ul><li>2 – Body System ( Heart and Great Vessels ) 2 </li></ul><ul><li>3 – Root Operation ( Insertion ) H </li></ul><ul><li>4 – Body Part ( Atrium, left ) 7 </li></ul><ul><li>5 – Approach ( Percutaneous ) 3 </li></ul><ul><li>6 – Device ( Cardiac Lead ) M </li></ul><ul><li>7 – Qualifier ( Pacemaker Lead ) A </li></ul>A M 3 7 H 2 0
  76. 76. Example: ICD-9-CM vs. ICD-10-PCS Repair of fracture, radius w/internal fixation device 1 Section 2 Body System 3 Root Operation 4 Body Part 5 Approach 6 Device 7 Qualifier ICD-9-CM ICD-10-PCS 79.32 0PQJ04Z 0 P Q J 0 4 Z
  77. 77. Example of ICD-10-PCS cont… <ul><li>1 – Section ( Medical/Surgical ) 0 </li></ul><ul><li>2 – Body System ( Upper Bones ) P </li></ul><ul><li>3 – Root Operation ( Repair ) Q </li></ul><ul><li>4 – Body Part ( Left Radius ) J </li></ul><ul><li>5 – Approach ( Open ) 0 </li></ul><ul><li>6 – Device ( Internal Fixation Device ) 4 </li></ul><ul><li>7 – Qualifier ( None ) Z </li></ul>
  78. 78. Example: ICD-9-CM vs. ICD-10-PCS *Percutaneous Transluminal Coronary Angioplasty with Stent 1 Section 2 Body System 3 Root Operation 4 Body Part 5 Approach 6 Device 7 Qualifier 0 2 7 0 3 D Z ICD-9-CM ICD-10-PCS 00.66 36.06 02703DZ
  79. 79. Example of ICD-10-PCS cont… <ul><li>1 – Section ( Medical/Surgical ) 0 </li></ul><ul><li>2 – Body System ( Heart and Great Vessels ) 2 </li></ul><ul><li>3 – Root Operation ( Dilation ) 7 </li></ul><ul><li>4 – Body Part ( Coronary Artery ) 0 </li></ul><ul><li>5 – Approach ( Percutaneous ) 3 </li></ul><ul><li>6 – Device ( Intraluminal ) D </li></ul><ul><li>7 – Qualifier ( None ) Z </li></ul>
  80. 80. Varying Specificity Approaches Unique to Pituitary Gland ICD-9-CM ICD-10-CM 07.◊◊ Excision of Pituitary Gland 0GT00ZZ Excision of Pituitary Gland <ul><li>07.64 – Total excision of pituitary gland, transfrontal approach </li></ul><ul><li>07.65 – Total excision of pituitary gland, transsphenoidal approach </li></ul><ul><li>07.68 – Total excision of pituitary gland, </li></ul><ul><li>other specific approach </li></ul><ul><li>07.69 – Total excision of pituitary gland, unspecified approach </li></ul><ul><li>0GT00ZZ – Resection of Pituitary Gland, Open Approach </li></ul>
  81. 81. What are GEMS?
  82. 82. What are GEMS? General Equivalence Mapping <ul><li>“ The Centers for Medicare and Medicaid Services (CMS) and the and the Centers for Disease Control and Prevention (CDC) created the General Equivalence Mappings created GEMs to ensure consistent national data when the US makes the transition, October 1, 2013”. </li></ul><ul><ul><li>AHIMA “Putting the ICD-10-CM?PCS GEMs into Practice.” Journal of AHIMA 81,no.3 (March 201): 46-52 </li></ul></ul>
  83. 83. General Equivalence Mapping ICD-9 to ICD-10 - ICD-10 to ICD-9 <ul><ul><li>GEMs are more complex than a simple one-to-one crosswalk </li></ul></ul><ul><ul><li>Convert large databases and test system applications </li></ul></ul><ul><ul><li>Link data in long-term clinical studies </li></ul></ul><ul><ul><li>Develop application-specific mappings </li></ul></ul><ul><ul><li>Analyze data collected before and after the transition to ICD-10-CM/PCS </li></ul></ul><ul><ul><li>Created to fill a specific, limited, short-term need </li></ul></ul><ul><ul><li>© AHIMA “Putting the ICD-10-CM?PCS GEMs into Practice.” Journal of AHIMA 81,no.3 (March 201): 46-52 </li></ul></ul>
  84. 84. General Equivalence Mapping ICD-9 to ICD-10 - ICD-10 to ICD-9 <ul><li>Difficult to find two corresponding descriptions that are identical in level of specificity and terminology used </li></ul><ul><li>Method used to reconcile those differences may vary, depending on whether the data is used for research, claims adjudication, or analyzing coding patterns between the two code sets </li></ul><ul><li>Some areas of the classification translating between the codes is straightforward (infectious disease, neoplasm, eye, and ear) </li></ul><ul><li>In other areas whole chapters are organized along a different axis of classification (obstetrics) </li></ul>
  85. 85. General Equivalence Mapping (GEM) No Mirror Image © AHIMA “Putting the ICD-10-CM?PCS GEMs into Practice.” Journal of AHIMA 81,no.3 (March 201): 46-52 Fracture of unspecified part of neck of right femur, initial encounter for closed fracture Fracture of unspecified part of neck of left femur, initial encounter for closed fracture Fracture of unspecified part of neck of femur, initial encounter for closed fracture S72.001A Or S72.002A Or S72.009A links from <––– (backward Fracture of unspecified part of neck of femur, closed 820.8 ICD-10-CM ICD-9-CM Fracture of unspecified part of neck of right femur, initial encounter for closed fracture S72.009A links to ––– > (forward Fracture of unspecified part of neck of femur, closed 820.8 ICD-10-CM ICD-9-CM
  86. 86. General Equivalence Mapping (GEM) No Mirror Image © AHIMA “Putting the ICD-10-CM?PCS GEMs into Practice.” Journal of AHIMA 81,no.3 (March 201): 46-52 “ In the table’s GEM forward –––> example, ICD-9-CM code 820.8 does not map to ICD-10-CM codes S72.001A or S72002A because the ICD-9-CM code does not included information about which side of the body the fracture occurred, and this information is needed in order to link to these ICD-10-CM codes”. Fracture of unspecified part of neck of right femur, initial encounter for closed fracture S72.009A links to ––– > (forward Fracture of unspecified part of neck of femur, closed 820.8 ICD-10-CM ICD-9-CM
  87. 87. General Equivalence Mapping (GEM) No Mirror Image © AHIMA “Putting the ICD-10-CM?PCS GEMs into Practice.” Journal of AHIMA 81,no.3 (March 201): 46-52 However, in the <––– backward GEM CD-10-CM codes S72.001A and S72.002A map do map back to ICD-9-CM code 820.8 because laterally is not specified in ICD-9-CM and therefore both the left and right sides are included in this ICD-9-CM code. Fracture of unspecified part of neck of right femur, initial encounter for closed fracture Fracture of unspecified part of neck of left femur, initial encounter for closed fracture Fracture of unspecified part of neck of femur, initial encounter for closed fracture S72.001A Or S72.002A Or S72.009A links from <––– (backward Fracture of unspecified part of neck of femur, closed 820.8 ICD-10-CM ICD-9-CM
  88. 88. General Equivalence Mapping Who should use GEMs? <ul><li>Users include… </li></ul><ul><ul><ul><li>Payers </li></ul></ul></ul><ul><ul><ul><li>Providers </li></ul></ul></ul><ul><ul><ul><li>HIM professionals </li></ul></ul></ul><ul><ul><ul><li>Researchers </li></ul></ul></ul><ul><ul><ul><li>Informatics professionals </li></ul></ul></ul><ul><ul><ul><li>Utilization managers </li></ul></ul></ul><ul><ul><ul><li>Quality managers </li></ul></ul></ul><ul><ul><ul><li>Developers of quality measures </li></ul></ul></ul><ul><ul><ul><li>Software vendors </li></ul></ul></ul>© AHIMA “Putting the ICD-10-CM?PCS GEMs into Practice.” Journal of AHIMA 81,no.3 (March 201): 46-52
  89. 89. General Equivalence Mapping Number of Translation Alternatives in each GEM Backward GEMs ICD-10-CM codes with one ICD-9-CM translation alternative: 64,961 ICD-10-CM codes with more than one ICD-9-CM alternative: 4,140 (5%) ICD-10-CM codes with no translation in ICD-9-CM: 593 ICD-10-PCS codes with only one ICD-9-CM alternative: 67,126 ICD-10-PCS codes with more than one ICD-9-CM alternative: 4,831 (6%) ICD-10-PCS codes with no translation in ICD-9-CM: 0 © AHIMA “Putting the ICD-10-CM?PCS GEMs into Practice.” Journal of AHIMA 81,no.3 (March 201): 46-52
  90. 90. General Equivalence Mapping Number of Translation Alternatives in each GEM Forward GEMs ICD-9-CM diagnosis codes with only one ICD-10-CM alternative: 11,344 ICD-9-CM diagnosis codes with more than one ICD-10-CM alternative: 2,971 (20%) ICD-9-CM codes with no translation in ICD-10-CM: 416 ICD-9-CM procedure codes with only one ICD-10-PCS alternative: 352 ICD-9-CM procedure codes with more than one ICD-10-PCS alternative: 3,486 (90%) ICD-9-CM procedure codes with no translation in ICD-10-PCS: 209 © AHIMA “Putting the ICD-10-CM?PCS GEMs into Practice.” Journal of AHIMA 81,no.3 (March 201): 46-52
  91. 91. General Equivalence Mapping Glossary of Terms <ul><li>Applied mapping: distillation of a reference mapping to conform to the needs of a particular application (e.g., data quality, reimbursement, research). </li></ul><ul><li>Backward mapping: mapping from a newer code set to an older code set. </li></ul><ul><li>Cluster: a combination of codes in the target system that represent a single translation alternative. </li></ul><ul><li>Entry: the relationship between a code in the source system and possible equivalents in the target system. </li></ul><ul><li>Forward mapping: mapping from an older code set to a newer code set. </li></ul><ul><li>Reference mapping: mapping that includes all possible valid relationships between a source system and a target system. </li></ul><ul><li>Reverse lookup: the process of looking up a target system code in a GEM to see all the source system codes that translate to it. </li></ul><ul><li>Source system: the code set of origin in the mapping; the set being mapped from. </li></ul><ul><li>Target system: the destination code set in the mapping; the set being mapped to GEMs. </li></ul>© AHIMA “Putting the ICD-10-CM?PCS GEMs into Practice.” Journal of AHIMA 81,no.3 (March 201): 46-52
  92. 92. General Equivalence Mapping Example of ICD-10-CM mapping CMS Downloads General Equivalence Mappings and User’s Guides May 2009 10000 9085 T1500xS 10112 E914 T1500xD 10111 9300 T1500xD 10112 E914 T1500xA 10111 9300 T1500xA Flags ICD-9-CM Target Code ICD-10-CM Source Code
  93. 93. General Equivalence Mapping Why do they go in both direction ICD-9 to ICD-10 and ICD-10 to ICD-9? <ul><li>GEMs are designed to be used like a bi-directional translation dictionary </li></ul><ul><li>Look up a code according to the concepts and structure </li></ul><ul><li>Similar to Spanish-English and English-Spanish dictionary design </li></ul><ul><li>Neither are a mirror image of each other </li></ul><ul><li>Translation alternatives are based on the meaning of the code you are looking up </li></ul><ul><li>Based on index entries, tabular instruction, and applicable Coding Clinic advice </li></ul><ul><ul><li>CMS FAQ Published 03/26/2009 10:35 AM/Updated 03/30/2010/Answer ID 9663 </li></ul></ul>
  94. 94. General Equivalence Mapping Why do they go in both direction ICD-9 to ICD-10 and ICD-10 to ICD-9? <ul><li>A &quot;reverse lookup&quot; of the backward mappings can be used to convert payment logic or coverage decisions </li></ul><ul><li>Could be used in examining trend data over multiple years </li></ul><ul><li>In 2013 going backwards it will be possible to compare how frequencies changed for a specific condition using an ICD-10 code compared to prior years using ICD-9-CM codes </li></ul><ul><li>Forward mapping (ICD-9-CM to ICD-10-CM/PCS GEMs) can be used to convert ICD-9-CM-based edits and can be used for analysis or conversion projects </li></ul><ul><ul><li>CMS FAQ Published 03/26/2009 10:35 AM/Updated 03/30/2010/Answer ID 9663 </li></ul></ul>
  95. 95. General Equivalence Mapping GEMs consists of three basic steps <ul><li>Step 1: EXTRACT </li></ul><ul><ul><li>Select all rows containing the code in the source system. </li></ul></ul><ul><li>Step 2: ANALYZE </li></ul><ul><ul><li>Note any flags applied to the code and understand what they convey about the entry. </li></ul></ul><ul><li>Step 3: REFINE </li></ul><ul><ul><li>Select the row (s) of an entry that meet the requirements of the applied mapping . </li></ul></ul><ul><ul><li>2010 release of the National Center for Health Statistics (NCHS) public domain diagnosis code reference mappings </li></ul></ul>
  96. 96. So Now What??? <ul><li>What is affected by this change? </li></ul><ul><li>What does this mean to practices? </li></ul><ul><li>What does this mean to physicians? </li></ul><ul><li>What do our organizations need to do? </li></ul><ul><li>What can you do? </li></ul><ul><ul><li>2010 release of the National Center for Health Statistics (NCHS) public domain diagnosis code reference mappings </li></ul></ul>
  97. 97. What will be affected by ICD-10? <ul><li>All computer systems that use ICD-9 </li></ul><ul><ul><li>Billing, coding, lab, pharmacy, EMR, etc… </li></ul></ul><ul><li>All Vendors that supply or support ICD-9 products </li></ul><ul><li>All Interfaces from system to system that pass ICD-9 </li></ul><ul><li>All staff, MD’s, coders, billers, etc… </li></ul><ul><li>All diagnostic tests ordered/all orders placed </li></ul><ul><li>All claims/charges processed </li></ul><ul><li>All reports generated with ICD codes </li></ul><ul><li>Compliance efforts/Budgets/Training </li></ul><ul><li>Other projects/timelines </li></ul>
  98. 98. What must be considered? IT Readiness Physician/Clinician Adoption Vendor Readiness Coder / Staff Training Payer Readiness Quality, Compliance and Audit Readiness Reporting Readiness Strategic Planning Financial Impact Senior Leadership Support
  99. 99. What do organizations need to do? <ul><li>Analyze and plan for costs and budget implications </li></ul><ul><li>Analyze and plan for revenue and productivity impact </li></ul><ul><li>Update all computer systems </li></ul><ul><li>Update all interfaces </li></ul><ul><li>Manage competing projects/timelines </li></ul><ul><li>Perform testing with Vendors and internal systems </li></ul><ul><li>Perform testing with payers </li></ul><ul><li>Plan for migration of diagnostic tests and orders placed </li></ul>
  100. 100. What do organizations need to do? <ul><li>Communicate to all physicians and leaders </li></ul><ul><ul><li>Managers, Directors, Finance liaisons, coders, billers, etc. </li></ul></ul><ul><li>Train all staff, MD’s, coders, billers, etc… </li></ul><ul><li>Migrate diagnostic tests orders placed </li></ul><ul><li>Update all encounter forms and other forms </li></ul><ul><li>Plan to manage claims/charges through transition and after on both ICD-9 and ICD-10 </li></ul><ul><li>Plan a transition of all reports generated with ICD codes </li></ul><ul><li>Anticipate Compliance issues </li></ul>
  101. 101. Who needs to be involved? Any one else who touches ICD-9 today, HIM, Reporting, etc… Administrative Staff, Nursing Staff Quality, Compliance, Audit Registration and Scheduling Staff, Pre-cert Staff Finance and Billing All Ancillary System Administrators, Vendors, Payers Coding, Finance, and Billing Information Services and Technology Physicians and Clinical Staff Senior Leadership
  102. 102. What are the Cost Implications? <ul><li>System transitions </li></ul><ul><li>Interface transitions </li></ul><ul><li>Training </li></ul><ul><li>Testing, Support </li></ul><ul><li>Dual Coding efforts </li></ul><ul><li>Productivity </li></ul><ul><li>Revenue impact (potential loss due to rejections) </li></ul><ul><li>Revenue cost due to re-work </li></ul><ul><li>Compliance impact (medical necessity) </li></ul>
  103. 103. Strategic decisions to consider…. <ul><li>Will you use ICD-10 in your strategy Initiatives? </li></ul><ul><li>To improve reporting with external entities </li></ul><ul><li>To enhance disease wellness and management </li></ul><ul><li>To support initiatives to improve quality </li></ul><ul><li>To reduce cost of care </li></ul><ul><li>To enhance incentive based contracts with payers </li></ul><ul><li>To leverage cost savings/payments </li></ul>
  104. 104. Prepare Readiness Chart Payer Analysis Contract Negotiation Granularity to our advantage Payer Integration Internal Readiness Strategic Support Gap Analysis Vendor Readiness Gap Analysis Competing Projects Staffing Needs Assessment Tools Assessment Awareness Timeline Budget Lahey Readiness Vendor Integration IT Readiness Education Strategic Planning
  105. 105. What is your Code Impact? <ul><li>What is your volume of codes used? </li></ul><ul><li>How often is each code used? </li></ul><ul><li>How many in the first position? </li></ul><ul><li>Through what systems? </li></ul><ul><li>How many will change? </li></ul><ul><li>How many will require more complex documentation? </li></ul>
  106. 106. What can you do to prepare? <ul><li>Start to communicate and plan for change </li></ul><ul><li>Educate your MD’s on the importance of being specific in documentation </li></ul><ul><li>Review all systems that need to change </li></ul><ul><li>Update all encounter forms </li></ul><ul><li>Help establish a timeframe for implementation </li></ul><ul><li>Identify training needs in your organization </li></ul><ul><li>Review potential expenses and budget </li></ul><ul><li>Get ready for October 1, 2013 </li></ul>
  107. 107. Updating Encounter Forms ICD-9-CM ICD-10-CM <ul><li>211.3   Colon polyp </li></ul><ul><li>564.00  Constipation </li></ul><ul><li>555.9  Crohn's disease </li></ul><ul><li>787.91  Diarrhea: NOS </li></ul><ul><li>536.9   Digestive disorder </li></ul><ul><li>536.8 Dyspepsia </li></ul><ul><li>787.20  Dysphagia, unspecified </li></ul><ul><li>790.5  Enzyme levels, abnormal </li></ul><ul><li>530.10  Esophagitis </li></ul><ul><li>V16.0   Family history of GI cancer </li></ul><ul><li>535.50  Gastritis: NOS </li></ul><ul><li>K63.5   Colon polyp </li></ul><ul><li>K59.00  Constipation </li></ul><ul><li>K50.90  Crohn's disease </li></ul><ul><li>R19.7   Diarrhea: NOS </li></ul><ul><li>K92.9   Digestive disorder </li></ul><ul><li>K30  Dyspepsia </li></ul><ul><li>R47.02  Dysphagia, unspecified </li></ul><ul><li>R74.9  Enzyme levels, abnormal </li></ul><ul><li>K20.9   Esophagitis </li></ul><ul><li>Z83.7   Family history of GI cancer </li></ul><ul><li>K29.70  Gastritis: NOS </li></ul>
  108. 108. Updating Encounter Forms ICD-9-CM ICD-10-CM <ul><li>272.4 Hyperlipidemia: NOS </li></ul><ul><li>401.9  Hypertension unspecified </li></ul><ul><li>401.1  Hypertension, benign </li></ul><ul><li>401.0  Hypertension, malignant </li></ul><ul><li>412.  MI, old </li></ul><ul><li>424.0  Mitral valve prolapse </li></ul><ul><li>785.2  Murmur </li></ul><ul><li>785.1  Palpitations </li></ul><ul><li>782.3  Pedal edema </li></ul><ul><li>423.9  Pericarditis </li></ul><ul><li>443.9  Peripheral vascular disease </li></ul><ul><li>443.0  Raynaud's syndrome </li></ul><ul><li>396.3  Regurgitation / mitral </li></ul><ul><li>780.2  Syncope & collapse </li></ul><ul><li>785.0  Tachycardia </li></ul><ul><li>435.9 TIA </li></ul><ul><li>E78.2 Hyperlipidemia: NOS </li></ul><ul><li>I11.9 Hypertension unspecified </li></ul><ul><li>I10 Hypertension, benign </li></ul><ul><li>I10x Hypertension, malignant </li></ul><ul><li>I25.2 MI, old </li></ul><ul><li>I05.1 Mitral valve prolapse </li></ul><ul><li>R01.1 Murmur </li></ul><ul><li>R00.2 Palpitations </li></ul><ul><li>R60.0 Pedal edema </li></ul><ul><li>I31.9 Pericarditis </li></ul><ul><li>I73.9 Peripheral vascular dis </li></ul><ul><li>I73.0 Raynaud's syndrome </li></ul><ul><li>Q23.3 Regurgitation / mitral </li></ul><ul><li>R55 Syncope & collapse </li></ul><ul><li>R00.0 Tachycardia </li></ul><ul><li>G45.9 TIA </li></ul>
  109. 109. Biggest change…we need to…. <ul><li>THINK… </li></ul><ul><li>Documentation </li></ul><ul><li>THINK… </li></ul><ul><li>Specificity </li></ul>
  110. 110. Biggest change…we need to…. “ Documentation is the Cornerstone to Successful Implementation” Deborah Grider President, AAPC *“The Future of Coding: 10 Strategies for Successful Implementation of ICD-10-CM”, © Deborah Grider, CMA, CPC, CPC-H, CPC-P, CCS-P, EMS
  111. 111. ?
  112. 112. <ul><li>Centers for Medicare and Medicaid </li></ul><ul><ul><li>http://www.cms.hhs.gov </li></ul></ul><ul><ul><li>http://www.cms.gov/ElectronicBillingEDITrans/18_5010D0.asp </li></ul></ul><ul><ul><li>http://www.cms.gov/Versions5010andD0/ </li></ul></ul><ul><ul><li>http://www.cms.gov/Versions5010andD0/10_background.asp#TopOfPage </li></ul></ul><ul><ul><li>http://www.cms.gov/MLNProducts/downloads/5010EDI_RefCard_ICN904284.pdf </li></ul></ul><ul><ul><li>http://www.cms.gov/Versions5010andD0/Downloads/w5010PrepChklst.pdf </li></ul></ul><ul><ul><li>http://www.cms.gov/Versions5010andD0/Downloads/w5010PvdrActionChklst.pdf </li></ul></ul><ul><ul><li>https://questions.cms.hhs.gov/app/answers/list/kw/5010 </li></ul></ul>Useful Websites for 5010
  113. 113. <ul><li>National Center for Vital and Health Statistics </li></ul><ul><ul><li>http://www.cdc.gov/nchs/about/otheract/icd9/abticd10.htm </li></ul></ul><ul><li>World Health Organization (WHO) </li></ul><ul><ul><li>http://www.who.int/aboutwho/en/mission.html </li></ul></ul><ul><li>Centers for Medicare and Medicaid </li></ul><ul><ul><li>http://www.cms.hhs.gov/paymentsystems/icd9/icd10.asp </li></ul></ul><ul><ul><li>http://www.cms.hhs.gov/medlearn/icd9code.asp </li></ul></ul>Useful Websites for ICD-10
  114. 114. <ul><li>Health and Human Services </li></ul><ul><ul><li>http://www.hhs.gov/agencies / </li></ul></ul><ul><li>Ingenix Online: </li></ul><ul><ul><li>http://www.ingenixonline.com/content/icd10/resources.asp </li></ul></ul><ul><li>WHO 2010 Version of ICD-10 </li></ul><ul><ul><li>http://www.who.int/classifications/apps/icd/icd10online / </li></ul></ul>Useful Websites for ICD-10
  115. 115. <ul><li>National Center for Vital and Health Statistics </li></ul><ul><li>World Health Organization (WHO) </li></ul><ul><li>Centers for Medicare and Medicaid </li></ul><ul><li>Health and Human Services </li></ul><ul><li>“ About the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), CDC, http://www.cdc.gov/nchs/about/otheract/icd9/abticd10.htm </li></ul><ul><li>“ July 2010 Release* International Classification of Diseases, Tenth Revision (ICD-10), CDC, http://www.cdc.gov/nchs/about/otheract/icd10cm.htm </li></ul><ul><li>“ International Classification of Diseases, Tenth Revision (ICD-10), CDC, http://www.cdc.gov/nchs/about/major/dvs/icd10des.htm </li></ul><ul><li>“ Transition to ICD-10”, Ingenix, Inc. © 2005 </li></ul>Sources of Information
  116. 116. <ul><li>“ The Future of Coding: 10 Strategies for Successful Implementation of ICD-10-CM”, © Deborah Grider, CMA, CPC, CPC-H, CPC-P, CCS-P, EMS </li></ul><ul><li>“ Why ICD-9-CM Needs to be replaced”, AHIMA, http://www.ahima.org/icd10/icd9.asp </li></ul><ul><li>“ US must adopt and implement ICD-10-CM and ICD-10-PCS”, July 2007 AHIMA, www.ahima.org/icd10 </li></ul><ul><li>“ The Regulatory Journey to Destination 10: Understanding the Process for Adoption of ICD-10-CM and ICD-10-PCS”, Giannangelo, RHIA, CCS, AHIMA, http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_023199.hcsp?dDoc </li></ul><ul><li>“ Destination 10: Healthcare Organization Preparation for ICD-10-CM and ICD-10-PCS”, AHIMA Practice Brief, Journal of AHIMA 75, no.3 (March 2004): 56A-D. </li></ul>Sources of Information
  117. 117. <ul><li>“ ICD-10 Made Easy”, © Medicode, Inc. </li></ul><ul><li>“ HIT Legislation – It’s Still the Data”, AHIMA </li></ul><ul><li>“ AHIMA’s Advocacy Effort”, AHIMA, http://www.ahima.org/icd10/advocacy.asp </li></ul><ul><li>“ Understanding ICD-10 ”, AHIMA, http://www.ahima.org/icd10/understand.asp </li></ul><ul><li>“ ICD-10 Regulatory Process”, AHIMA, http://www.ahima.org/icd10/regulatory.asp </li></ul><ul><li>“ Relationship of Classifications and Terminologies ”, AHIMA, http://www.ahima.org/icd10/relationship.asp </li></ul><ul><li>“ Preparing for ICD-10”, AHIMA, http://www.ahima.org/icd10/prepare.asp </li></ul><ul><li>“ ICD-10: Essential Components of the 21 st Century Healthcare System”, AHIMA, http://www.ahima.org/icd10/index.asp </li></ul>Sources of Information
  118. 118. All information was current at the time this presentation was written. All information was obtained from the sources sited on this document. Use of pictures, examples, etc…are for educational purposes only. All reasonable effort has been taken to ensure accuracy of information and to site sources. Author and agents do not guarantee accuracy and assume no responsibility or liability for content. Any references should be followed from applicable laws, regulations, and guidelines or rulings from appropriate sources. &quot;CPT copyright 2010 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.&quot; Applicable FARS/DFARS Restrictions Apply to Government Use Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not par of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The U.S. Copyright Law, under Chapter One, Section 107, exempts certain limited use of copyrighted works, referred to a &quot;fair use&quot; and such uses are permissible without a license. A good faith attempt at “fair use” has been made and believed to be sufficient for any use of this material. U. S. Copyright Law, Chapter One, Section 107, Fair Use (PDF) Disclaimer
  119. 119. Cynthia A. Trapp CHFP, CMPE, CPCO, CPC, CPC-I, CCS-P, CHC, PCA [email_address] Contact Information
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