Icd9 2011 fast preparation

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ICD9 2011 Fast Preparation

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Icd9 2011 fast preparation

  1. 1. ICD-9-CM2011 GET PREPPED FASTGET PREPPED FAST Jen Godreau, BA, CPC, CPEDC, Content DirectorJen Godreau, BA, CPC, CPEDC, Content Director Mary Compton, PhD, CPC, Editorial DirectorMary Compton, PhD, CPC, Editorial Director Suzanne Leder, BA, M.Phil, CPC, COBGC, Editorial ManagerSuzanne Leder, BA, M.Phil, CPC, COBGC, Editorial Manager The Coding Institute, LLC . SuperCoder.comThe Coding Institute, LLC . SuperCoder.com Downloads Handouts: www.supercoder.com/conference/ www.scribd.com/doc/ AAPC CEU certificate www.supercoder.com/icd92011-aapc-ceu/
  2. 2. The Trend for2011The Trend for2011 “Codes continue to become more and more specific necessitating a provider to document clearly and thoroughly to allow for selection of the most specific and accurate code.” -- JenniferSwindle, RHIT, CCS-P, CEMC, CFPC, CCP-P, PCS
  3. 3. H1N1: Lookat ManifestationH1N1: Lookat Manifestation  Deletions: 488.0, 488.1  New: Six five-digit codes: • 488.0x --Influe nz a due to ide ntifie d avian influe nz a virus • 488.1x --Influe nz a due to ide ntifie d no ve l H1 N1 influe nz a virus Pay attention to two details:  Influenza identified in medical record  manifestation Changes Tips on Selecting New Codes
  4. 4. 488 Changes Mirror487 Details488 Changes Mirror487 Details With the change “category 488 (Influe nz a due to ce rtain ide ntifie d influe nz a viruse s ) would mirrorthe structure of category 487 (Influe nz a).” The current 488.x sub-category didn’t provide the level of detail that category 487 (Influe nz a) does. So urce : Sum m ary o f March 20 1 0 ICD-9 -CMCo o rdinatio n and Mainte nance Co m m itte e Me e ting
  5. 5. 488.0x, 488.1x Cheat Sheet488.0x, 488.1x Cheat Sheet Comorbid Manifestation Avian H1N1 Pneumonia 488.01 * 488.11 * Other respiratory  manifestations 488.02  488.12 Other manifestations 488.09  488.19 488.01, 488.11 List Additional Note: Identify pneumonia – 480.0-480.9, 481, 482.0-482.9, 483.0-483.8, 485 488.01, 488.11 List Additional Note: Identify pneumonia – 480.0-480.9, 481, 482.0-482.9, 483.0-483.8, 485
  6. 6. Post Traumatic SeizuresPost Traumatic Seizures  Definition: Acute, symptomatic seizures following a head injury.  Rationale: “A unique code for this type of seizure is important because these patients need to be followed for treatment as well as prognostic and epidemiologic considerations.” So urce : ICD-9 -CMCo o rdinatio n and Mainte nance Co m m itte e , CDC re le ase
  7. 7. Traumatic Seizure ChangesTraumatic Seizure Changes 2010 way: Must use 780.3x (Convulsions) to report patient’s symptoms. New code: 780.33 (Post traumatic seizures) will further specify this type of seizure.
  8. 8. 788.30 Helps TBI State788.30 Helps TBI State ComplianceCompliance  New state laws mandating specific care for post-TBI (traumatic brain injury) patients and diagnosis code changes coincide with a CDC campaign aimed at prevention and early diagnosis of TBI.  “These laws and education have had a huge impact on family medicine physicians who see patients who have had head injuries from sports or falls, indigent populations, and returning military personnel.” -- Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPC-I, CCC, COBGC manager of compliance education University of Washington Physicians and Children’s University Medical Group Compliance Program
  9. 9. Late Effects CodeLate Effects Code  Post-traumatic seizures may not occur until weeks or months after the injury.  Delay means seizure may be considered a late effect of the head injury.  Rely on documentation to determine whether to code late effects (such as 907.0, Late e ffe ct o f intracranial injury witho ut m e ntio n o f skull fracture ) as a secondary diagnosis.  When to add on: Documentation shows causal relationship between the current condition/symptom/sign and the underlying etiology. The Condition Should You Add a Code?
  10. 10. Test YourselfTest Yourself  Question: A 17-year-old male new patient presents with spells of “blanking out” over the last several weeks. The patient reports this started a few days after he was hit in the head with a softball. The FP performs a comprehensive history and exam, focusing on possible late effects of the head injury; during moderate-complexity medical decision making, the FP orders neurologic  testing and requests an evaluation from a local TBI clinic.  Final diagnosis is “mild seizures, status post-TBI.” What ICD- 9 code(s) would you use? Answer: 1.780.33 2.907.0 (Late e ffe cts o f injurie s to the ne rvo us syste m ; late e ffe ct o f intracranialinjury witho ut m e ntio n o f skullfracture ) 3.E007.3 (Activitie s invo lving o the r spo rts and athle tics playe d as a te am o r g ro up; base ball; so ftball) Answer: 1.780.33 2.907.0 (Late e ffe cts o f injurie s to the ne rvo us syste m ; late e ffe ct o f intracranialinjury witho ut m e ntio n o f skullfracture ) 3.E007.3 (Activitie s invo lving o the r spo rts and athle tics playe d as a te am o r g ro up; base ball; so ftball)
  11. 11. More Specific Pain DiagnosisMore Specific Pain Diagnosis  2010 way:  No specific code exists for jaw pain. Best bet may be 526.9 (Unspe cifie d dise ase s o f the jaws)  New code: • 784.92 (Jaw pain)  Benefit: Could help support dental problem complaints.
  12. 12. CheckFecal IncontinenceCheckFecal Incontinence SymptomsSymptoms New 5-Digit Code Descriptor 787.60  Full incontinence of feces  787.61 Incomplete defecation 787.62  Fecal smearing 787.63  Fecal urgency Deleted Code: 787.6 (Inco ntine nce o f fe ce s) Deleted Code: 787.6 (Inco ntine nce o f fe ce s)
  13. 13. V13.2x SupportsV13.2x Supports Dysplasia Check-UpDysplasia Check-Up  Physician may see patients who have had vaginal or vulvar dysplasia to verify that there has been no recurrence.  2010 Problem: No way to reflect history as the sole reason for the encounter.  2011 Solution: New codes for • V13.23 -- Pe rso nal histo ry o f vag inal dysplasia • V13.24 -- Pe rso nal histo ry o f vulvar dysplasia . Suzanne Leder, CPC, COBGC
  14. 14. V49.8x Increases StatusV49.8x Increases Status OptionsOptions • V49.86 – Do no t re suscitate status • V49.87 – Physical re straints status.  Capture ‘status’ of a patient  Indicate DNRorder  Show patient needs restraining  Useful in:  inpatient (POS 21)  NF (POS 31-32). New Codes Usage Tips
  15. 15. More 40-Plus BMI CodesMore 40-Plus BMI Codes  Past: One general V code (V85.4) to represent a body mass index (BMI) index greater than 40  New: Five fifth-digit BMI codes allow capturing of higher BMIs V Code Short Descriptor V85.41 40 . 0  –  44. 9 ,  adult V85.42 45. 0  –  49 . 9 ,  adult V85.43 50 . 0  –  59 . 9 ,  adult V85.44 6 0 . 0  –  6 9 . 9 ,  adult V85.45 7 0  and o ve r,  adult
  16. 16. BMI Expansion ConsiderationsBMI Expansion Considerations  Allow for better tracking of heavier individuals  Help support weight management treatment  Always report BMI codes as secondary diagnoses  can be coded based on clinical assessment  Before coding obesity as primary diagnosis, obesity must be documented by the physician Benefits Warnings
  17. 17. Test YourselfTest Yourself  A new patient with a BMI of 45 presents complaining of shortness of breath and related symptoms. The physician determines that all of the symptoms are related to the patient’s morbid obesity and proceeds to counsel the patient on options for addressing his weight. What diagnoses should you report?Answer: 1.278.01 (Overweight, obesity, andother hyperalimentation; overweight andobesity; morbid obesity) 2.V85.42 Answer: 1.278.01 (Overweight, obesity, andother hyperalimentation; overweight andobesity; morbid obesity) 2.V85.42
  18. 18. V Codes Support MoreV Codes Support More MonitoringMonitoring  Problem: When a patient carrying twins has only one placenta with two amniotic sacs, you currently have no way to reflect the higher risk of complications.  Solution: New V category • V91.00 – Twin g e statio n,  unspe cifie d num be r o f place nta,  unspe cifie d num be r o f am nio tic  sacs • V91.01 – Twin g e statio n,  m o no cho rio nic/m o no am nio tic (o ne  place nta,  o ne  am nio tic sac) • V91.02 – Twin g e statio n,  m o no cho rio nic/diam nio tic (o ne  place nta,  two  am nio tic sacs) • V91.03 – Twin g e statio n,  dicho rio nic/diam nio tic (two  place nta,  two  am nio tic sacs) • V91.09 – Twin g e statio n,  unable  to  de te rm ine  num be r o f place nta and num be r o f am nio tic  sacs.  Bonus: You’ll find similar V codes for triplet gestations (V91.10-V91.19), quadruplet gestations (V91.20-29), and other unspecified multiple gestations (V91.91-V91.99).  Benefits:  Allows for better data collection  When reported during the antepartum period, may help establish medical need for interventions or closer monitoring that cannot be adequately captured using the V23 high riskcodes.
  19. 19. Test YourselfTest Yourself  Question: An ob-gyn delivers twins vaginally with two placentae and two amniotic sacs. How would you report the delivery global care package? Answer: 1.59400 (Ro utine  o bste tric care  including  ante partum  care ,   vag inal de live ry [with o r witho ut e pisio to m y,  and/o r fo rce ps]  and po stpartum  care ) for the first baby 2.59409-51 (Vag inal de live ry o nly [with o r witho ut e pisio to m y  and/o r fo rce ps];  Multiple  pro ce dure s ) for the second 3.651.01 (Twin pre g nancy;  de live re d) 4.V91.03 5.V27.2 (Twins,  bo th live bo rn) Answer: 1.59400 (Ro utine  o bste tric care  including  ante partum  care ,   vag inal de live ry [with o r witho ut e pisio to m y,  and/o r fo rce ps]  and po stpartum  care ) for the first baby 2.59409-51 (Vag inal de live ry o nly [with o r witho ut e pisio to m y  and/o r fo rce ps];  Multiple  pro ce dure s ) for the second 3.651.01 (Twin pre g nancy;  de live re d) 4.V91.03 5.V27.2 (Twins,  bo th live bo rn)
  20. 20. Military Wanted V90Military Wanted V90  Rationale: The Department of Defense requested codes to help identify retained objects resulting from explosion injuries, but the codes could prove useful in other cases, as well.  Example: An embedded magnetic object (V90.11) is a contraindication to an MRI exam. So urce :  CDC ICD-9 -CM  Update s
  21. 21. Is FBRDx Allowed?Is FBRDx Allowed?  Pieces of wood, glass, or bullet shrapnel might be left in during foreign body removal. The fragment may break or split, making removing the entire foreign body impossible.  With splinter removal, sometimes the procedure removes some foreign body, but not all of it.
  22. 22. V90 Solves Partial RemovalV90 Solves Partial Removal  V90.xx indicates a foreign body was partially removed.  Explain a follow-up check for infection after complete removal with V15.53 (Pe rso nal histo ry o f re taine d fo re ig n bo dy fully re m o ve d). ICD-9 codes for retained fragment s of:
  23. 23. ICD-9-CM 2011 Staff Quiz H1N1 Gains Specificity Question 1: What new info will you need to correctly assign a diagnosis of H1N1 starting Oct. 1? A. if the patient has previously had H1N1 B. if the H1N1 involves fever, aching C. if the H1N1 involves pneumonia, other respiratory manifestations, or other manifestations D. no new info is needed Fecal Impaction Has New Options Question 2: True/False: Encopresis, NOS, fecal impaction is sufficient to have the claim paid without the code (787.6) triggering a denial. Pain Gets 1 More Symptom Question 3: ICD-9 2011 provides a new specific pain location: A. arm B. breast C. jaw D. vagina
  24. 24. Staff Quiz Answer Key H1N1 Gains Specificity Answer 1: C. Talking point: The new codes for H1N1 (488.1x) have fifth digits to indicate if the H1N1 involves pneumonia (1), other respiratory manifestations (2), or other manifestations (9) occurring with this type of influenza. Fecal Impaction Has New Options Answer 2: False. Talking point: Fecal impaction is now broken into more detail and requires a fifth digit (787.6x) to indicate full incontinence of feces (0), incomplete defecation (1), fecal smearing (2), or fecal urgency (3). Pain Gets 1 More Symptom Answer: C. Talking point: Jaw pain did not previously have a specific code to use. ICD-9 2011 solves that riddle with 784.92 (Jaw pain).
  25. 25. ResourcesResources  Fam ily Practice Co ding Ale rt, The Coding Institute.  ICD-9-CM CD-ROM. Ninth Version. Centers for Disease Control & Prevention and the National Center for Health Statistics.  ICD-9-CM Coordination and Maintenance Committee release, Centers for Disease Control & Prevention and the National Center for Health Statistics.  ICD-9-CM – Updates. Centers for Disease Control & Prevention and the National Center for Health Statistics. May 26, 2010  Ob-Gyn Co ding Ale rt, The Coding Institute.  Part BInside r, The Coding Institute.  Summary of March 2010 ICD-9-CM Coordination and Maintenance Committee Meeting
  26. 26. Save the Date!Save the Date! Modifier59: BreakBundles When You Should FREE Webinar Tuesday, Oct 19 12:00 pm EST Speakers: Mary Compton, PhD, CPC Jen Godreau, BA, CPC, CPEDC Suzanne Leder, M.Phil., CPC, COBGC • Rules to follow for proper CCI compliance • Review cases to test your skills • Collect deserved monies without penalty. Registerat: www.supercoder.co m/events/webinars/
  27. 27. You’reinvitedto…You’reinvitedto…CHOOSE FROM: 2011 ICD-9-CMUpdate forOb-Gyn September 30, 2010 presenter: Melanie Witt, RN, CPC, COBGC, MA 2011 ICD-9-CMUpdate forPrimary Care October 5, 2010 presenter: Jennifer Godreau, BA, CPC, CPEDC 2011 ICD-9-CMUpdate forRadiology On-demand October 11 - 15, 2010 presenter: Deborah Dorton, JD, MA, CPC ICD-9 Changes for 2011 On-demand October 11 – 29, 2010 (30 minutes) presenter: Torrey Kim, MA, CPC 2011 ICD-9-CMUpdate for Cardiology On-demand October 18 - 22, 2010 presenter: Deborah Dorton , JD, MA, CPC 2011 ICD-9-CMUpdate forPathology and Oncology On-demand October 25 - 29, presenter: Deborah Dorton , JD, MA, CPC SCCICD925 Save $25 on any ICD-9 event at Exclusively for Webinar attendees and SuperCoder.com subscribers! Order any ICD-9 event and enter promo code SCCICD925 at checkout. When you place your order, be sure to use the same email address you used to register at SuperCoder or our webinar! (Web orders only. Offer valid until 12/31/10.)
  28. 28. Ensuring reimbursement. Insuring coders.Ensuring reimbursement. Insuring coders. Questions: Mary Compton, Editorial Director Neurosurgery Jen Godreau, Content Director, Supercoder.com Family Practice, Pediatrics, Otolaryngology Suzanne Leder, Executive Editor Ob-Gyn , Orthopedics www.supercoder.com/forum/

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