Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

How To Find The Right ICD-10 Code

2,237 views

Published on

Here you will learn how to identify the right code for your diagnosis by applying different strategies that help reduce the probability of coding error and save time.

Published in: Healthcare
  • Be the first to comment

How To Find The Right ICD-10 Code

  1. 1. ICD-10 Boot Camp Part 3 - Code Selection Strategies 2 Presented by Evan M. Gwilliam, DC MBA BS CPC CCPC NCICS CCCPC CPC-I MCS-P CPMA Chief Product Officer
  2. 2. Dr. Evan Gwilliam • Education • Bachelor’s of Science, Accounting - Brigham Young University • Master’s of Business Administration - Broadview University • Doctor of Chiropractic, Valedictorian - Palmer College of Chiropractic • Certifications • Certified Professional Coder (CPC) - AAPC • Nationally Certified Insurance Coding Specialist (NCICS) - NCCT • Certified Chiropractic Professional Coder (CCPC) - AAPC • ChiroCode Certified Chiropractic Professional Coder (CCCPC) - ChiroCode • Certified Professional Coder – Instructor (CPC-I) - AAPC • Medical Compliance Specialist – Physician (MCS-P) - MCS • Certified Professional Medical Auditor (CPMA) – AAPC, NAMAS • Certified ICD-10 Trainer - AAPC 3
  3. 3. Overview • Part 1 - ICD-10 fundamentals and navigation • Part 2 - Coding conventions and guidelines • Part 3 - ICD-10 code selection strategies • Part 4 - Documentation improvement 4
  4. 4. 1. Common codes list (but don’t stop there!) 2. GEMs code map (don’t stop here either!) 3. Alphabetic Index (still not safe!) Always confirm the code using the Tabular List 5 Find the code
  5. 5. 6
  6. 6. 7 1. Common Codes
  7. 7. 2. GEMs 8
  8. 8. 9 2. GEMs General Equivalence Mappings (GEMs) o Created by the National Center for Health Statistics, part of the CDC o Forward maps from ICD-9 to ICD-10 o Backward maps from ICD-10 to ICD-9 o Approximations only
  9. 9. 3. Alphabetic Index 10
  10. 10. Example #1 Patient is an 18-month old fussy, white female with a three-day history of otalgia, runny nose and fever of 100. There is no exposure to tobacco smoke. Otoscopic examination reveals acute serous otitis media of the right ear. Assessment: Acute serous otitis media, right ear. On September 30, 2015, the diagnosis is 381.01 Acute serous otitis media. On October 1, 2015, it is: 11
  11. 11. 1. Common codes list (but don’t stop there!) 2. GEMs code map (don’t stop here either!) 3. Alphabetic Index (still not safe!) Always confirm the code using the Tabular List 12 Find the code
  12. 12. 1. Common Codes 13
  13. 13. 1. Common codes list (but don’t stop there!) 2. GEMs code map (don’t stop here either!) 3. Alphabetic Index (still not safe!) Always confirm the code using the Tabular List 14 Find the code
  14. 14. 15 2. GEMs
  15. 15. 1. Common codes list (but don’t stop there!) 2. GEMs code map (don’t stop here either!) 3. Alphabetic Index (still not safe!) Always confirm the code using the Tabular List 16 Find the code
  16. 16. 17 3. Alphabetic Index
  17. 17. 18 3. Alphabetic Index
  18. 18. 1. Common codes list (but don’t stop there!) 2. GEMs code map (don’t stop here either!) 3. Alphabetic Index (still not safe!) Always confirm the code using the Tabular List 19 Find the code
  19. 19. 20 Tabular List
  20. 20. 21 Tabular List
  21. 21. Example #1 Patient is an 18-month old fussy, white female with a three-day history of otalgia, runny nose and fever of 100. There is no exposure to tobacco smoke. Otoscopic examination reveals acute serous otitis media of the right ear. Assessment: Acute serous otitis media, right ear. On September 30, 2015, the diagnosis is 381.01 Acute serous otitis media On October 1, 2015, it is: H65.01 Acute serous otitis media, right ear NOTE: • Common codes lists are just an expert guess • GEMs often leads to unspecified codes • Alphabetic Index often gives incomplete or multiple options 22
  22. 22. 1. Common codes list (but don’t stop there!) 2. GEMs code map (don’t stop here either!) 3. Alphabetic Index (still not safe!) Always confirm the code using the Tabular List 23 Find the code
  23. 23. The next step for converting to ICD-10 24 1. Go to the Tabular List o Look at the following: 1. Notes 2. Includes and alternative wording 3. Excludes1 4. Excludes2 5. Code Also, Code First, Use Additional 6. Seventh character extensions 2. Repeat at the level of the code, then the subcategory, category, block, and chapter 3. Reverse map for confirmation if necessary
  24. 24. 25 Tabular List
  25. 25. Example #2 This 30-year old white male sustained a right knee injury while playing basketball on Saturday. He was seen in our urgent care clinic and sent for MRI of the right knee to rule out meniscal tear. MRI revealed right bucket-handle medial meniscal tear and tear of the anterior cruciate ligament (ACL). Patient will be scheduled for surgery on Tuesday. On September 30, 2015, the diagnosis is 836.0 Bucket handle tear, meniscus, knee On October 1, 2015, it is: 26
  26. 26. 1. Common codes list (but don’t stop there!) 2. GEMs code map (don’t stop here either!) 3. Alphabetic Index (still not safe!) Always confirm the code using the Tabular List 27 Find the code
  27. 27. 1. Common Codes 28
  28. 28. 1. Common codes list (but don’t stop there!) 2. GEMs code map (don’t stop here either!) 3. Alphabetic Index (still not safe!) Always confirm the code using the Tabular List 29 Find the code
  29. 29. 1. Common Codes 30 2. GEMs
  30. 30. 31 Tabular List
  31. 31. 32 2. GEMs
  32. 32. 33 Tabular List
  33. 33. 1. Common codes list (but don’t stop there!) 2. GEMs code map (don’t stop here either!) 3. Alphabetic Index (still not safe!) Always confirm the code using the Tabular List 34 Find the code
  34. 34. 35 3. Alphabetic Index
  35. 35. 36 Tabular List
  36. 36. The next step for converting to ICD-10 37 1. Go to the Tabular List o Look at the following: 1. Notes 2. Includes and alternative wording 3. Excludes1 4. Excludes2 5. Code Also, Code First, Use Additional 6. Seventh character extensions 2. Repeat at the level of the code, then the subcategory, category, block, and chapter 3. Reverse map for confirmation if necessary
  37. 37. The next step for converting to ICD-10 38 1. Go to the Tabular List o Look at the following: 1. Notes 2. Includes and alternative wording 3. Excludes1 4. Excludes2 5. Code Also, Code First, Use Additional 6. Seventh character extensions 2. Repeat at the level of the code, then the subcategory, category, block, and chapter 3. Reverse map for confirmation if necessary
  38. 38. 39 Tabular List
  39. 39. 40 Tabular List
  40. 40. 41 Tabular List
  41. 41. 42
  42. 42. 43
  43. 43. The next step for converting to ICD-10 44 1. Go to the Tabular List o Look at the following: 1. Notes 2. Includes and alternative wording 3. Excludes1 4. Excludes2 5. Code Also, Code First, Use Additional 6. Seventh character extensions 2. Repeat at the level of the code, then the subcategory, category, block, and chapter 3. Reverse map for confirmation if necessary
  44. 44. 45
  45. 45. 46 Tabular List
  46. 46. Example #2 This 30-year old white male sustained a right knee injury while playing basketball on Saturday. He was seen in our urgent care clinic and sent for MRI of the right knee to rule out meniscal tear. MRI revealed right bucket-handle medial meniscal tear and tear of the anterior cruciate ligament (ACL). Patient will be scheduled for surgery on Tuesday. On September 30, 2015, the diagnosis is 836.0 Bucket handle tear, meniscus, knee On October 1, 2015, it is: S83.212A Bucket handle tear of medial meniscus, right knee 47
  47. 47. 34 specialty specific ICD-10 books • More than 70 pages which teach • Conventions • Guidelines • Implementation steps • Documentation strategies • Provider Documentation Guides • Specialty specific • GEMs mapping • Alpha Index • Abridged Tabular List Use “CureMD20” to save $20 at InstaCode.com
  48. 48. 49
  49. 49. 50
  50. 50. 51
  51. 51. 52
  52. 52. 53

×