Overview of ICD-10-CM
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The following information was taken from Chapter 2 of Buck's Step-by-Step Medical Coding, 2019 Edition. The book is cited on the last slide of the presentation. All information is relevant as of 2019. Any updates after November 2019 will not be in this presentation. This presentation was created through Canva.
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Overview of ICD-10-CM
- 1. AN OVERVIEW OF ICD-10-CM step-by-step medical coding MEDICAL CODING 101
- 2. Chapter 2 Breakdown TOPICS: The ICD-10-CM ICD-10-CM Format Index Tabular Official Instructional Notations in the ICD-10- CM C O D I N G 1 0 1 | 2 0 1 9
- 3. THE ICD-10-CM OVERVIEW International Classification of Diseases, 10th Revision, Clinical Modification Designed for the classification of patient morbidity and mortality information for statistical purposes and for the indexing of health records by disease and operations, data storage and retrieval. A classification system enables people to track morbidity and mortality by having a condition or disease be coded in one code.
- 4. THE ICD-10-CM HISTORY Issued by the World Health Organization in 1993, and is responsible to maintain it Original WHO version did not have procedure classification. Each government is responsible in implementing ICD-10. In the US, there are two institutions responsible for it's development: 1. Centers for Medicare and Medicaid Services - develops the procedures (ICC-19-PCS) 2.National Center for Health Statistics(NCHS)- responsible for disease classification system(ICD-10-CM)
- 5. THE ICD-10-CM FUUNCTIONS Facilitate payment of health services Evaluate patient's use of healthcare facilities Study health care costs Research the quality of health care Predict health care trends Plan for future health care needs 1. 2. 3. 4. 5. 6.
- 6. ICD-10-CM Format THE FORMAT I-10 ALPHABETIC INDEX AND TABULAR used in outpatient setting to substantiate the reason for receiving medical services (medical necessity) by assigning a diagnosis. ICD-10-PCS used for coding surgical, therapeutic, and diagnostic procedures and is primarily used by hospitals
- 7. ICD-10-CM Format THE FORMAT ORGANIZATIONS THAT DEAL WITH THE PRINCIPLES AND PRACTICES OF CODING: Center for Medicare and Medicaid Services (CMS) National Center for Health Services (NCHS) American Health Information Management Services (AHIMA) American Hospital Organization (AHA)
- 8. C O D I N G 1 0 1 INDEX OVERVIEW AND FORMATS Everything in the index is listed by condition in alphabetical order The Alphabetic Index is composed of three sections: Index to Diseases and Injuries -Gray area Table of Drugs and Chemicals- Violet(Lighter purple) External Cause of Injuries Index- Orange Within the Index to Diseases and Injuries, there is a table for the subcategories of Neoplasms(blue between gray and violet).
- 9. C O D I N G 1 0 1 INDEX OVERVIEW AND FORMATS The ICD-10-CM utilizes three levels of indention in the Alphabetic index: Main terms- Bold, red, indented to the left, begins with a capital letter Subterms- under the main term, indented to the right, lowercase Carryover lines- exist when there is not enough space on single entry line, indented to the farther right
- 10. C O D I N G 1 0 1 INDEX TYPES OF SUBTERMS Essential Modifiers modify the main term specifies further the condition Connecting Words define a relationship between a main term or a subterm and an associated condition or etiology ex. with, without, associated with, due to, with mention of, in
- 11. TABULAR TABULAR SYSTEM listing of all the codes available for assignment CHAPTERS the main division of the ICD-10-CM manual 21 chapters a chapter may use more than one letter SECTION a group of three-digit categories that represent a group of conditions or related conditions ex. M20-M25
- 12. TABULAR CATEGORY a three character code that represents a single condition or disease ex. A10, B15, R23, H08, SUBCATEGORY a four digit category code that provides more information or specifity ex.M25.5 SUBCLASSIFICATION a five to seven code that adds even more information and specifity ex. M25.50,
- 13. OFFICIAL INSTRUCTIONAL NOTATIONS IN THE ICD-10-CM CONVENTIONS NEC NOS BRACKETS COLON PARENTHESES AND AND WITH INCLUDES EXCLUDES EXCLUDE1 EXCLUDE2 CODE FIRST/USE ADDITIONAL CODE CODE ALSO DEFAULT CODES CODE ASSIGNMENTS AND CLINICAL CRITERIA 7TH CHARACTERS AND PLACEHOLDER X CROSS-REFERENCES Instructional notations- provides guidance to the coder
- 14. CONVENTIONS "not otherwise specified" equivalent of unspecified used when information at hand does not permit a specific code assignment NOS NEC represents "other specified" Alphabetic index- used when a specific code is not available Tabular index- code may not fully describe the disease process or medical condition Used in two ways: directs the coder to other classifications, if appropriate when the ICD-10-CM does not have any codes that provide grater specifity Tabular List - enclose synonyms, alternative wording, or explanatory phrases Alphabetic Index - used to identify manifestation codes Brackets [] located in the Tabular List after an incomplete term that needs one or more of the modifiers that follow in order to make the condition assignable to a given category Colon
- 15. CONVENTIONS different meanings in ICD-10-CM And should be interpreted to mean either “and” or “or” when it appears in a title With should be interpreted to mean “associated with” or “due to” when it appears in a code title, the Alphabetic Index (either under a main term or subterm), or an instructional note in the Tabular List classification presumes a causal relationship between the two conditions linked by these terms in the Alphabetic Index or Tabular List. And and With Parentheses () enclose supplementary words (nonessential modifiers) that may be present or absent in the statement of a disease or procedure without affecting code assignment Nonessential modifiers - words that may be used to clarify the diagnosis but do not affect code assignment ex. ileus - K56.7 inhibitory ileus- K56.7
- 16. INCLUDES "not included here" the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together. Excludes2 appears immediately under a three character code title to further define, or give examples of, the content of the category EXCLUDES EXCLUDES1 pure excludes means "not coded here" indicates that the code excluded should not be assigned at the same time as the code above used when two conditions cannot occur together An exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other.
- 17. CODE FIRST/ USE ADDITIONAL CODE indicate etiology/manifestation paired codes etiology -study of causation coding convention requires that the underlying condition be sequenced first followed by the manifestation seen when in "in diseases classified elsewhere" appears 1. "Use additional code" note first the etiology code 2. "Code first" note for manifestation code CODE ALSO instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction sequencing depends on the circumstances of the encounter. DEFAULT CODES code listed next to a main term in the ICD-10-CM Alphabetic Index represents that condition that is most commonly associated with the main term, or is the unspecified code for the condition assigned when a condition is documented in a medical record without any additional information
- 18. CODE ASSIGNMENT AND CLINICAL CRITERIA assignment of a diagnosis code is based on the provider’s diagnostic statement that the condition exists Code assignment is not based on clinical criteria used by the provider to establish the diagnosis. If a code that requires a 7th character is not 6 characters, a placeholder X must be used to fill in the empty characters within the category, or as the notes in theTabular List instruct CROSS REFERENCES provide the coder with possible alternatives or synonyms for a term three types see explicit direction to look elsewhere used to reference the appropriate main term under which all the information concerning a specific disease will be located see also see category 7TH CHARACTERS AND PLACEHOLDER X “X” is used as a placeholder at certain codes to allow for future expansion X must be used in order for the code to be considered a valid code 7th character is required for all codes
- 19. SOURCE: BUCK,C.J., KOESTERMAN, J.G.(2019). BUCK'S STEP-BY-STEP MEDICAL CODING, 2019 EDITION. ELSEVIER HEALTH SCIENCES. THANK YOU!