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Icd 10 general presentation

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Icd 10 general presentation

  1. 1. ICD 10 Basics Taino Consultants Inc. Dr. Jose I. Delgado
  2. 2. Battered by child: E96.794 Taino Consultants Inc. 2
  3. 3. Grandma got run over by a reindeer: V06.00xA Taino Consultants Inc. 3
  4. 4. Problems in relationship with in laws: Z63.1 Taino Consultants Inc. 4
  5. 5. Uncongenial work environment : Z63.1 Taino Consultants Inc. 5
  6. 6. Crushed by Alligator: W5803XA Taino Consultants Inc. 6
  7. 7. What Is ICD-10?  ICD-10 is the updated version of codes used for coding: • Diagnoses for all providers (ICD-10-CM) • Inpatient hospital procedures (ICD-10-PCS)  ICD-10-CM is the US “clinical modification” of the WHO ICD-10 code set  ICD-10-PCS is a U.S. creation  These are “classification” code sets Taino Consultants Inc. 7
  8. 8. Major Changes from ICD-9 to ICD-10  Not just the usual annual update  ICD-10 markedly different from ICD-9  Requires changes to almost all clinical and administrative systems  Requires changes to business processes  Changes to reimbursement and coverage  Will enable significant improvements in care management, public health reporting, research, and quality measurement  Why? Taino Consultants Inc. 8
  9. 9. Specific Changes  Diagnosis Codes (ICD-9 to ICD-10-CM) • From 5 positions (first one alphanumeric, others numeric) to 7 positions, all alphanumeric • From 13,000 existing codes to 68,000 codes • Much greater specificity • Full description and consistency within the code set • Uses modern terminology for descriptions • Creation of combination diagnosis/symptom codes to reduce the number of codes needed to fully describe a condition Taino Consultants Inc. 9
  10. 10. Specific Changes  Enables laterality (right vs. left designations) • It makes a difference whether the right or left limb is the subject of the problem  Restructures reporting of obstetric diagnoses • In ICD-9-CM, the patient is classified by diagnosis in relation to the episode of care. • In ICD-10-CM, the patient is classified by diagnosis in relation to the patient’s stage of pregnancy Taino Consultants Inc. 10
  11. 11. Difference in Organization  The ICD-10 codes are organized differently than the ICD-9 codes  Example: • Sense organs have been separated from nervous system disorders • Injuries are grouped by anatomical site rather than injury category • Postoperative complications have been moved to procedure-specific body system chapter Taino Consultants Inc. 11
  12. 12. Examples of ICD-10-CM Specificity  Sports injuries now coded with sport and reason for injury • ICD-9 code - Striking against or struck accidentally in sports without subsequent fall (E917.0) • 24 ICD-10-CM Detail Codes Taino Consultants Inc. 12
  13. 13. Examples of ICD-10 Specificity V43.51 Car driver injured in collision with sport utility vehicle in traffic accident V43.61 Car passenger injured in collision with sport utility vehicle in traffic accident V43.53 Car driver injured in collision with pick-up truck in traffic accident V43.63 Car passenger injured in collision with pick-up truck in traffic accident V55.5 Driver of pick-up truck or van injured in collision with railway train or railway vehicle in traffic accident V55.6 Passenger in pick-up truck or van injured in collision with railway train or railway vehicle in traffic accident V73.6 Passenger on bus injured in collision with car, pick-up truck or van in traffic accident Notes: • On above remember to add 7th digit character: A – initial encounter, D – subsequent encounter or S – sequel • Also remember placeholders when needed (i.e.: V43.51xA) Taino Consultants Inc. 13
  14. 14. Place of Occurrence Specificity Y92 Place of occurrence of the external cause • More specificity in rooms of home or public place Y92.0 Non-institutional (private) residence Y92.010 Kitchen Y92.011 Dining room Y92.012 Bathroom Y92.013 Bedroom Y92.014 Private driveway Y92.015 Private garage Y92.016 Swimming-pool Y92.017 Garden or yard Y92.02 Mobile home as the place of occurrence Y92.03 Apartment as the place of occurrence (Condominium or Co-op apartment) Y92.12 Nursing home as the place of occurrence of the external cause Y92.14 Prison as the place of occurrence of the external cause Y92.143 Cell of prison as the place of occurrence of the external cause Y92.147 Courtyard of prison as the place of occurrence of the external cause Taino Consultants Inc. 14
  15. 15. New Concepts • Timeline changes for postpartum and other conditions o 072.3 Postpartum coagulation defects o 090.4 Postpartum acute kidney failure o 090.6 Postpartum mood disturbance • New concepts such as coding trimester & fetus number • New concept such as underdosing that is not seen in ICD-9 • New chapters for both eyes & ears, which are currently in the Nervous Systems & Sense Organs chapter • Many codes in ICD-10-CM include site & laterality (i.e. Chapter 13) o M25.511 Pain in right shoulder o M25.512 Pain in left shoulder • Combination codes that are new in ICD-10-CM Taino Consultants Inc. 15
  16. 16. New Concepts • Postoperative & intraoperative complications are now found at the end of each body system chapter o K91.7- Accidental puncture and laceration of a digestive system organ or structure during a procedure  K91.71 Accidental puncture and laceration of a digestive system organ or structure during a digestive system procedure  K91.72 Accidental puncture and laceration of a digestive system organ or structure during other procedure Note: that K91.7 may not be used without additional characters. • Seven digit extensions to indicate encounter & healing such as nonunion & malunion fractures: • Seventh digit K - subsequent encounter for fracture with nonunion • Seventh digit P - subsequent encounter for fracture with malunion Taino Consultants Inc. 16
  17. 17. Examples 718.86Knee Instability Lower Leg M23.50 Chronic instability of knee, unspecified knee M23.8X9 Other internal derangements of unspecified knee M23.51 Chronic instability of knee, right knee M23.52 Chronic instability of knee, left knee M25.261 Flail joint, right knee M25.262 Flail joint, left knee M25.269 Flail joint, unspecified knee M25.361 Other instability, right knee M25.362 Other instability, left knee M25.369 Other instability, unspecified knee 719.41Shoulder Pain Generalized M25.519 Pain in unspecified shoulder M25.511 Pain in right shoulder M25.512 Pain in left shoulder Taino Consultants Inc. 17
  18. 18. Structure of ICD-10 PCS Taino Consultants Inc. 18
  19. 19. • Documentation of diagnoses and procedures ● Codes must be supported by medical documentation ● ICD-10-CM codes are more specific ● Requires more documentation to support codes ● Expect a 15% increase in documentation time (per American Academy of Professional Coders) ● Revenue Impacts of specificity ▫ Denials ▫ Additional Documentation Provider Impacts Taino Consultants Inc. 19
  20. 20. • Coverage and Payment o New coding system will mean new coverage policies, new medical review edits, new reimbursement schedules o Changes will be made to accommodate increased specificity o May need to discuss changes with patients Provider Impacts Taino Consultants Inc. 20
  21. 21. • Relationship with Plans ● Coding more specific and includes severity ● Changes will be based on new coding, coverage, and reimbursement ● Difficult to measure what the changes will mean to overall reimbursement Provider Impacts Taino Consultants Inc. 21
  22. 22. • Billing and Eligibility Transactions o Updated transactions include support for ICD-10 o New codes mean more specificity o Expect increased reject, denials, and pendings as both plans and providers get used to new codes Provider Impacts Taino Consultants Inc. 22
  23. 23. EXCEPTION AND CHALLENGES TO ICD-10  Workers Compensation and Auto carriers are excluded from conversion to ICD-10  How will workers compensation claims be submitted?  How will health plans handle in subrogation? Taino Consultants Inc. 23
  24. 24. ICD-10-CM MYTHS  Providers will need to change how they practice medicine  Documentation is critical as the same must support the ICD 10 code. In other words, high probability of an increase in time to complete paperwork and collect information from each patient  Providers and coders need to start learning the new code set now  Too late. Now is time to cram!!!  They must implement an Electronic Medical Record with ICD-10-CM  Electronic records are not required. Paper records are still allowed.  They must hire additional staff to handle the workload  Potentially as there is a high probability of an increase in paperwork, coding and billing process Taino Consultants Inc. 24
  25. 25. ICD-10-CM MYTHS  ICD-10 is not currently used in the US No. It has been used to classify causes of death  ICD-10 is replacing CPT No. CPT is the service provided ICD is the reason plus other circumstances related to the cause  Providers do not need to know about – PCS Hospital services requires ICD 10 PCS coding  CMS will change the deadline  Dates are firm; no delays; no grace period Taino Consultants Inc. 25
  26. 26. Latest Guidance as of Sep 24, 2015 • While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 implementation, if a valid ICD- 10 code from the right family is submitted, Medicare fee-for-service will process such code and not audit Example o Right Code: • G43.711 (Chronic migraine without aura, intractable, with status migrainosus). o Right Family: • G43.701 (Chronic migraine without aura) or • G43.719 (Chronic migraine without aura, intractable without status migrainosus) Under the audit flexibilities, occurring till Oct 1, 2016, there is no need to audit since they are all in the same family of codes. Taino Consultants Inc. 26
  27. 27. Family of Codes • “Family of codes” is the same as the ICD-10 three- character category. Example: K50 Crohn’s disease o K50.00 Crohn's disease of small intestine without complications o K50.012 Crohn's disease of small intestine with intestinal obstruction o K50.90 Crohn's disease, unspecified, without complications Taino Consultants Inc. 27
  28. 28. Reminder Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/ practitioner uses a valid code from the right family of codes. Taino Consultants Inc. 28
  29. 29. REFERENCES http://icd10crosswords.com/whats_new.htm CMS ICD 10, ICD-10 Planning and Assessment Presentation ICD-10 will be here before you know it…Are you Ready?, Gianni Gonzalez, HealthCare Management Solutions, LLC A complete list of the 2016 ICD-10-CM valid codes and code titles is posted on the CMS website at http://www.cms.gov/Medicare/Coding/ICD10/2016- ICD-10-CM-and-GEMs.html. Taino Consultants Inc. 29
  30. 30. Dr. Jose I Delgado Tel 904-794-7830 DrDelgado@Tainoconsultants.c om www.tainoconsultants.com

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