ICD-9 Coding & 2010 Updates

Transcription

1 Welcome To The Digital Learning Center Presented by Your Partner In Building High Performance Practices Today s Presentation ICD-9 Coding & 2010 Updates Principles of Diagnosis Coding for Physicians, Surgeons & Staff Course Faculty R. Thomas (Tom) Loughrey, MBA, CCS-P Chairman, CEO & Co-Founder of Economedix Certified Coding Specialist BS Degree from Pennsylvania State University Earned an MBA in Health & Hospital Administration from the University of Florida Former Hospital Administrator Former Owner of a Medical Billing Company Consultant to Physician Practices & Medical Societies Member of Various Professional Organizations Dealing with Medical Practice Management Developed and Presented Thousands of Seminars & Workshops Dealing with Practice Management 1

2 ACCME Disclosure R. Thomas (Tom) Loughrey, MBA, CCS-P In accordance with the policies on disclosure of the Accreditation Council for Continuing Medical Education, presenters for this program, except for any noted below, have identified no personal relationships with a health care product company which, in the context of their topics, could be perceived as a real or apparent conflict of interest. No conflicts were disclosed Today s Course Organization of ICD-9 Common Conventions Volume II The Index Volume I The Tabular Listings Tables and Special Sections 2010 Updates Summary Organization of ICD-9 Two Volumes Volume I A tabular listing of terms, descriptions, codes and notes Volume II An alphabetic listing of diseases, illnesses, injuries, conditions, signs and symptoms V codes and E codes Tables Drugs and chemicals (poisons) Neoplasms and Hypertension Index to External Causes of Injury and Poisoning 2

3 ICD-9-CM Although usually referred to as simply, ICD-9, the formal name is International Classification of Diseases, 9 th Revision, Clinical Modification. ICD-9-CM is the version of ICD-9 most commonly used in the United States. It should not be confused with other texts called, ICD-9 that are used internationally. Guidelines for Selecting Codes Identify each service, procedure or supply with an ICD-9 code that explains the need for the item. CPT and HCPCS codes generally describe what was provided ICD-9 codes explain why it was done Guidelines for Selecting Codes Identify the services for circumstances other than disease and injuries, with V-codes Sometimes called, the walking-well codes, these are provided to describe reasons why otherwise healthy people might have an encounter for health services 3

4 Guidelines for Selecting Codes Code the primary diagnosis first Code secondary diagnoses next Code any co-existing diagnoses that affect the care and treatment Do not code diagnoses that are not applicable to the patient for any care or treatment Guidelines for Selecting Codes Code to the highest level of specificity ICD-9 codes have from three to five digits Example: 460 Acute nasopharyngitis (common cold) Acute sinusitis Frontal Acute bronchiolitis due to respiratory synctial virus Guidelines for Selecting Codes Code a chronic diagnosis as long as it is applicable to the treatment Example: It is appropriate to code for diabetes for a patient receiving an eye exam It is inappropriate to code for diabetes for a patient receiving an x-ray for a fracture (unless caused by the diabetes) 4

5 Guidelines for Selecting Codes When only ancillary services are provided (tests, x-rays, etc) the appropriate V-code should be coded first and the problem second. Example: Patient receiving physical therapy for a ruptured disk: V57.1 other physical therapy, except breathing Lumbar intervertebral disc without myelopathy Guidelines for Selecting Codes Look up codes in Volume II, the Index by name of condition, injury, circumstance, illness Assign a tentative code Look up code by number in Volume I, the tabular list Check notes and assign final code using complete code Example of Assigning Code 1. Patient is being treated for recurrent bilateral femoral hernias (obstructed) 2. Find by looking up hernia 3. Look up Recurrent followed by femoral then bilateral then obstructed (552.03) 4. Look up in Volume I Femoral hernia with obstruction (552.0) 5. Note specification of as bilateral, recurrent 5

6 Common Coding Conventions Notes: provide additional instruction and explanation. One of the most common notes concerns coding underlying diseases as primary. Example: Myopathy in endocrine diseases classified elsewhere Code first the underlying disease, as: Addison s Disease (255.4) Cushing s Syndrome (255.0) Hypopituitarism (253.2) Myxedema ( ) Thyrotoxicosis ( ) Italicized text always refers to secondary diagnoses. List the underlying disease first Notes Common Coding Conventions Includes and Excludes notes [ ] - brackets enclose synonyms, alternate words or explanatory phrases infectious organism [e.g., Staphylococcus 041.1] ( ) Parentheses enclose supplementary words that may be absent in the statement. streptococcal (391.2) Common Coding Conventions NOS Not otherwise specified. Indicates a nonspecific code. Coder should look for more information for more definitive code NEC Not elsewhere classifiable. To be used only when coder lacks additional information to code more specifically See usually directs coder to more specific terminology See also indicates additional information available 6

7 Common Coding Conventions Essential Modifiers subterms which are listed below the main term in alphabetic order. An essential modifier that clarifies a previous is indented two spaces. Example: Cystic see also condition breast, chronic corpora lutea degeneration, congenital brain kidney Medical Necessity Coding Basics Usually the first requirement of third party payers One diagnosis may be insufficient to document necessity of services Rationale for selected codes should be available in the medical record Coding Basics Primary Diagnosis The first diagnosis on the CMS-1500 claim form The primary reason the patient is being seen/treated The most specific primary diagnosis may be unavailable until test results are back Additional diagnoses may be used if the affect the treatment 7

8 Common Coding Problems Symptoms Hypertension Neoplasms Obstetrics Cardiac problems Injuries Complications Italicized codes Burns Accidents Poisonings Adverse Effects Late Effects Symptoms Code only what you know. This means that sometimes the only thing known are signs and symptoms Can be found in categories 780 to 789 Used as provisional diagnoses until more definitive diagnosis is known. Pay particular attention to the excludes notes Hypertension The general coding rule is to identify a code in the index and then look it up in the tabular list. This is an exception to the rule Check the hypertension table in the index. Table lists complete codes. Hypertension is subclassified as Benign, Malignant or Unspecified Benign no failure of an affected organ system Malignant involves failure of an organ system Unspecified status of organ system is not specified Most often coded as 401.9(very non-specific) or in place of high blood pressure reading (796.2) 8

9 Neoplasms Another exception to the rule. Neoplasm table is found in the index and all codes are complete. Four categories of Neoplasms Malignant Benign Uncertain behavior Unspecified Malignant Neoplasms Three categories of malignant neoplasms Primary Secondary (metasticized) Ca in situ Could be a tragic mistake to list a benign neoplasm as malignant prematurely Neoplasm Table Neoplasms are listed by anatomic site alphabetically Abdomen to Zuckerkandl s organ (an organ in the solar plexus at the aortic bifurcation) Connective tissue is further classified by anatomic site Some neoplasms may only be primary malignancies by definition or are never found in situ 9

10 Neoplasm Table If the descriptive language does not specify the sub-category, then the term will have to be looked up in the index. Example: Adenoma see also Neoplasm, benign Squamous cell carcinomas and epidermoid carcinomas are skin cancers and classified to skin of the site (arm, trunk, face, etc) Papillomas are skin neoplasms categorized to the benign categories of skin sites Past Neoplasms Patient returns for a follow-up visit several years after successful treatment for malignant neoplasm of breast. Patient had radical mastectomy. V10.3 Personal history of malignant neoplasm of breast V45.71 Acquired absence of breast Dealing With V Codes Difficult to look up in the index Relatively short section Persons with health hazards related to communicable diseases Persons with need for isolation Persons with potential health hazards related to personal & family history Related to reproduction & development Other circumstances Examinations and screenings no Dx 10

11 Injuries Fractures extensive fifth digits for bones and parts of the bones Internal injuries virtually all injuries to internal organs no open woundsextensive fifth digits for injury sites Open wounds head, neck, trunk separate from limbs Complications Complications of surgical and medical care If complication occurs with primary diagnosis, code complication secondary If complication follows primary problem, code the complication first Example: during cholecystectomy patient has cardiac arrest acute cholecystitis cardiac complications Italicized Codes Always secondary even if being treated primary Example: Chronic mycotic otitis externa Code first underlying disease aspergillosis (117.3) otomycosis NOS (111.9) 11

12 Accidents Type of Injury Location of the injury Cause of Injury Example: Open wound of fingers with tendon involvement E849.0 Place of occurrence, home E900.2 Accident caused by garbage disposal Adverse Effects An adverse effect of some treatment Example: Patient experiencing severe nausea and vomiting. Prescription for tranquilizer. Returns with vertigo and headache Vertigo Headache E939.1 Adverse effects in therapeutic use, phenothiazine based tranquilizers Poisonings What was the poison and what caused it? Use Table of Drugs and Chemicals Example: Child ingests aspirin and is brought to ER unconscious Poisoning by salicylates other alteration of consciousness E850.3 Accidental poisoning by salicylates 12

13 E Codes Best found in the Table of Drugs and Chemicals for poisonings and, In the Index to External Causes Alphabetic listing by cause E827 Collision with an animal drawn vehicle E884.6 Fall off toilet E909.4 Tsunami Always secondary diagnoses What Are Your Top 25? The top 25 reasons you see patients probably accounts for the majority of patient contacts (and revenue!) Every year determine the top 25 ICD- 9 codes you used and become expert in those codes. Understand the sections they fall in, the notes to the codes and the procedures most commonly identified with them 2010 ICD-9 Changes Invalid Codes Usually result from adding additional digits Ex Respiratory complications Revised Codes New Codes Usually result from adding additional digits to existing codes Ex or Ventilator Associated Pneumonia or Other respiratory complications 13

14 New Flu Codes 2009 ICD-9 Changes Influenza due to identified avian influenza virus Avian flu Bird flu Influenza A/H5N Influenza due to identified novel H1N1 influenza virus 2009 H1N1 influenza virus Novel 2009 influenza H1N1 Swine flu Note: only to be used with verified types of these flu strains, otherwise use flu codes from (prophylactic vaccination is V04.81) 2010 ICD-9 Changes New codes related to female reproductive system and complications of the puerperium (the time immediately after a delivery): 2010 ICD-9 Changes 14

15 2010 ICD-9 Changes 2010 ICD-9 Changes Poisoning by Anti-depressants poisoning by antidepressant, unspecified poisoning by monoamine oxidase inhibitors poisoning by selective serotonin and norepinephrine reuptake inhibitors poisoning by selective serotonin uptake inhibitors poisoning by tetracyclic antidepressants poisoning by tricyclic antidepressants poisoning by other antidepressants 2010 ICD-9 Changes New Sports related E-codes ( this is getting ready for ICD-10) E001.1 activities involving running E002.0 activities involving swimming E activities involving roller skating/skateboarding E activities involving bike riding E006.5 activities involving jumping rope E activities involving soccer 15

16 2010 ICD-9 Changes New daily living related E-codes ( this is getting ready for ICD-10) These codes help document injuries or conditions resulting from long-term cumulative effects of an activity E activities involving knitting and crocheting E activities involving laundry E activities involving floor mopping and cleaning E activities involving cooking and baking E activities involving digging, shoveling and raking E activities involving gardening and landscaping 2010 ICD-9 Changes New V-codes involving family circumstances Added at behest of American Academy of Pediatrics V61.23 counseling for parent-biological child problem V61.24 counseling for parent-adopted child problem V61.25 counseling for parent [guardian]-foster child problem V61.42 substance abuse in family Resource for ICD-9 Books AMA Press Ingenix INGENIX ( ) PMIC MED-SHOP 16

17 Summary ICD-9 codes explain why you do the work you do. It provides the primary basis for establishing the medical necessity of your work It explains why you may need to deviate from the norm under certain circumstances Check your charge master and your charge tickets for new, revised and invalid codes Thank you for participating in this seminar presentation from Economedix! Please direct questions to To earn CME credits for this course please complete the Evaluation / CME Form and FAX it back to Economedix within 7 days of the teleconference. 17