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ICD-10 part one of six
- 1. ICD-10-CM Training LART Consulting Group, Inc. 2015 1 Kimyatta Turner, MBA, RHIA LART Consulting Group, Inc.
- 2. • October 1, 2015 • ICD-10-CM • Greater detail, granularity Introduction 2LART Consulting Group, Inc. 2015
- 3. Introduction Session 1: Coding process 3LART Consulting Group, Inc. 2015
- 4. Introduction • 69,000 ICD-10-CM >14,000 ICD-9-CM • Specificity • Sixth and seventh digit extensions are required. 4LART Consulting Group, Inc. 2015
- 5. ICD-9-CM ICD-10-CM Consists of three to five digits First digit is numeric or alpha (E or V) Second, third, fourth, and fifth digits are numeric Always at least three digits Decimal placed after the first three digits Alpha characters are not case- sensitive Consists of three to seven characters First character is alpha All letters are used except U Character 2 always numeric Characters 3 through 7 can be alpha or numeric Decimal placed after the first three characters Alpha characters are not case- sensitive ICD-9-CM Code Format ICD-10-CM Code Format X X X . X X category etiology, anatomic site, manifestation X X X . X X X X category etiology, extension anatomic site, severity Introduction Code Structure 5LART Consulting Group, Inc. 2015
- 6. Chapter 1 The Coding Process • First sequenced, most important – The Uniform Hospital Discharge Data Set (UHDDS) definition states: “that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.” • Principal diagnosis/first listed code: sequencing based first on conventions • No sequencing instructions: based on the condition that brought patient Selection of Principal or First Listed Diagnosis 6LART Consulting Group, Inc. 2015
- 7. Chapter 1 The Coding Process ―List the principal/first listed diagnosis ―Assign the code to the highest level of specificity. ―Never use a “rule-out,” “probable,” “possible,” or “suspect” statement ―Be specific ICD-10-CM and Medical Necessity 7LART Consulting Group, Inc. 2015
- 8. Chapter 1 The Coding Process • ICD-10-CM codes partnership with CPT procedural • Diagnosis codes identify the medical necessity • CPT codes nor ICD-10-CM codes can stand alone! ICD-10-CM and Medical Necessity LART Consulting Group, Inc. 2015 8
- 9. Chapter 1 The Coding Process –Acute and chronic conditions. –Identify acute condition (i.e. coma, loss of consciousness, hemorrhage). –Identify chronic complaints, or secondary diagnoses. –Identify how injuries occur. ICD-10-CM and Medical Necessity 9LART Consulting Group, Inc. 2015
- 10. Chapter 1 The Coding Process • Diagnoses: responsibility of the rendering provider. • Joint effort is essential • Guidelines were developed to assist General Coding Guidelines 10LART Consulting Group, Inc. 2015
- 11. Chapter 1 The Coding Process Steps in the Coding Process • Alphabetic Index (Volume 2) and the Tabular List (Volume 1). • Reads all instructional notes in both the Index and Tabular List. • Never code from the Alphabetic • Always reference the Tabular List for the final code selection. 11LART Consulting Group, Inc. 2015
- 12. Chapter 1 The Coding Process Six Essential Steps • Step 1: Identify the main term. • Step 2: Locate in the Alphabetic Index, Volume 2. • Step 3: Refer to any cross-references and notes. • Step 4: Refer to any modifiers. • Step 5: Verify the code number in the Tabular List, Volume 1. • Step 6: Code to the highest level of specificity. 12LART Consulting Group, Inc. 2015
- 13. Chapter 1 The Coding Process • Do not code diagnoses as “probable,” “possible,” “suspected,” “questionable,” or “rule out.” • Code the signs, symptoms, and abnormal test result(s) or other reason for the visit. • Manifestations are characteristic signs or symptoms of an illness. • Signs and symptoms that point rather definitely to a given diagnosis are assigned to the appropriate ICD-10- CM code. Coding Uncertain Diagnoses 13LART Consulting Group, Inc. 2015
- 14. Chapter 1 The Coding Process • Sign or symptom used only when no definitive diagnosis • Confirmed prior to coding ... Guideline Tip 14LART Consulting Group, Inc. 2015
- 15. Chapter 1 The Coding Process • Bilateral sites: Final character indicates laterality. • Right side: Character 1 • Left side: Character 2 • Bilateral code: Always 3 • Unspecified side code either a character 0 or 9 Laterality LART Consulting Group, Inc. 2015 15
- 16. Chapter 1 The Coding Process • Assign three-character codes only if there are no fourth-character code(s) within that code category. • Assign a fourth-character code only if there is no fifth-character subclassification for that category. • Assign the fifth- or sixth-character subclassification code for those categories where it exists. • Don’t forget to assign the seventh-character extension which further identifies the condition if available, and use dummy placeholders “x” when a fifth or sixth character is not defined in the code. Follow these guidelines 16LART Consulting Group, Inc. 2015
- 17. References American Medical Association (2012). American Health Information Management Association (2015). 2015 ICD-10-CM Coder training manual. Chicago, IL: AHIMA. 17LART Consulting Group, Inc. 2015
Editor's Notes
- Hello and welcome to Session 1 of ICD-10 training by LART Consulting Group. I am Kimyatta Vinson, a Registered Health Information Administrator and I will be your presenter throughout this training. These trainings are broken down into sessions that are easy to digest along with action steps for you to take in order to begin to master ICD-10-CM.
- The adoption of ICD-10-CM (diagnoses) will affect all components of the healthcare industry on October 1, 2015. The use of ICD-10-CM will offer greater detail and granularity and will greatly enhance the HHS’s capability to measure quality outcomes, such as performance outcome measures used in the hospital pay for reporting program. The greater detail and granularity of ICD-10-CM/PCS will also provide more precision for claims based, value based purchase initiatives such as the hospital acquired condition or HAC policy.
- In this session, we will cover the coding process
- ICD-10-CM far exceeds ICD-9-CM by the sheer number of codes and concepts provided. ICD-10-CM has over 69,000 codes in comparison to 14,000 codes in ICD-9-CM. Specificity at the sixth digit level and with a seventh digit extension. Sixth and seventh digit extensions are not optional but are required.
- The first character of an ICD-10-CM code is an alphabetic letter. All the letters of the alphabet are utilized with the exception of the letter U, which has been reserved by the World Health Organization for the provisional assignment of new diseases of uncertain etiology and for bacterial agent resistant to antibiotics. Some conditions in ICD-10-CM are not limited to the use of a single letter. For instance, neoplasm codes may begin with the letter c or d. ICD-10-CM differs from ICD-9-CM in its organization and structure, code composition, and level of detail.
- The code sequenced first on a medical record at the end of an encounter is most important because it defines the main reason for the encounter as determined at the end of the encounter. Selection of principal diagnosis/first listed code is based first on the conventions in the classification that provide sequencing instructions. If no sequencing instructions apply, then sequencing is based on the condition(s) that brought the patient into the hospital or physician office and the condition that was the primary focus of treatment.
- Apply the following principles to diagnosis coding to properly demonstrate medical necessity for physician or outpatient services: List the principal/first listed diagnosis, condition, problem, or other reason for the medical service or procedure. Assign the code to the highest level of specificity. Never use a “rule-out,” “probable,” “possible,” or “suspect” statement; this could label the patient with a condition that does not exist. Code signs, symptoms, abnormal test results, or other reason for the visit if no definitive diagnosis is determined. Be specific in describing the patient’s condition, illness, or disease
- ICD-10-CM codes form a crucial partnership with CPT procedural codes by supporting the medical necessity of the CPT procedure or service performed. Diagnosis codes identify the medical necessity of services provided by describing the circumstances of the patient’s condition. An important point to realize when filing claims is that neither CPT codes nor ICD-10-CM codes can stand alone!
- To continue the discussion on medical necessity for physician or outpatient services, it is also important to: Distinguish between acute and chronic conditions, when appropriate. Identify the acute condition of an emergency situation (eg, coma, loss of consciousness, hemorrhage). Identify chronic complaints, or secondary diagnoses, only when treatment is provided or when they impact the overall management of the patient’s care. Identify how injuries occur.
- So, here are some general coding guidelines. Diagnoses reported in the medical record remain the responsibility of the rendering provider. A joint effort between the provider and the coder is essential in reporting accurate documentation and code selection. Guidelines in ICD-10-CM were developed to assist the provider and coder in assigning the appropriate diagnosis.
- Always remember to use both the Alphabetic Index (Volume 2) and the Tabular List (Volume 1). Make sure the user reads all instructional notes in both the Index and Tabular List and verifies that the documentation in the medical record supports the code assigned. Even if a dash is not included in the Alphabetic Index, the user should never code from this volume and always reference the Tabular List for the final code selection.
- Step 1: Identify the main term in the diagnostic statement. Step 2: Locate the main term in the Alphabetic Index, Volume 2. Step 3: Refer to any cross-references and notes under the main term. Step 4: Refer to any modifiers of the main term. Step 5: Verify the code number in the Tabular List, Volume 1. Step 6: Code to the highest level of specificity.
- Do not code diagnoses as “probable,” “possible,” “suspected,” “questionable,” or “rule out.” Instead, code the signs, symptoms, and abnormal test result(s) or other reason for the visit. Manifestations are characteristic signs or symptoms of an illness. Signs and symptoms that point rather definitely to a given diagnosis are assigned to the appropriate ICD-10-CM code.
- A sign or symptom is only to be used if no definitive diagnosis is established at the time the patient encounter is coded. When the diagnosis is confirmed prior to coding the encounter, the confirmed diagnosis is reported
- For bilateral sites, the final character of the codes in the ICD-10-CM indicates laterality. The right side is always character 1, the left side character 2. In those cases where a bilateral code is provided, the bilateral character is always 3. An unspecified side code is also provided for when the side is not identified in the medical record. The unspecified side is either a character 0 or 9 depending on whether it is a fifth or sixth character.
- Assign three-character codes only if there are no fourth-character code(s) within that code category. Assign a fourth-character code only if there is no fifth-character subclassification for that category. Assign the fifth- or sixth-character subclassification code for those categories where it exists. Don’t forget to assign the seventh-character extension which further identifies the condition if available, and use dummy placeholders “x” when a fifth or sixth character is not defined in the code.