ICD-10-CM Coding Conventions & Guidelines

Transcription

1 ICD-10-CM Coding Conventions & Guidelines Presenter: Gail Harrington, RHIT, CCS, CIRCC AVP, Coding Compliance RegionalCare Hospital Partners 2011 ICD-10-CM is available at or ICD-10-CM Index to Diseases and Injuries 2011 ICD-10-CM Tabular List of Diseases and Injuries Instructional Notations

2 2011 Official Guidelines for Coding and Reporting 2011 Table of Drugs and Chemicals 2011 Neoplasm Table 2011 Index to External Causes 2011 Mapping ICD-9-CM to ICD-10-CM and ICD-10-CM to ICD-9-CM ICD-9 VS ICD-10 Diagnosis Codes ICD-9-CM 13,000 diagnosis codes Uses 3 to 5 digit codes

3 1 st character can be alpha or numeric (E or V) Congestive heart failure Congestive heart failure ICD-10-CM 68,000 diagnosis codes Uses 3 to 7 digit codes

4 1 st character is alpha 2 nd character is numeric All letters used except U (U reserved by WHO for new diseases of uncertain etiology (U00-U49) or for bacterial agents resistant to antibiotics (U80- U89) Congestive heart failure I50.9 Heart failure, unspecified ICD-10-CM Similar Features ICD-10-CM Format EX: J18.9 Pneumonia, NOS

5 ICD-9 VS ICD-10 Diagnosis Codes ICD-9-CM Acute on chronic combined

6 systolic/diastolic heart failure Congestive heart failure 486 Pneumonia, NOS COPD w/acute ex Urosepsis ICD-10-CM I50.43 Acute on chronic combined systolic

7 (congestive) diastolic (congestive) heart failure J18.9 Pneumonia, NOS J44.1 COPD w/acute ex. no default code for urosepsis While grilling in the back yard, pt suffered 2 nd degree burn of left hand and stabbed right foot with grill fork. Phy documented alcohol abuse, blood alcohol level of 24 mg/100ml. ICD-9-CM nd degree burn, hand Alcohol abuse, unspecified use Elevated blood alcohol level Open wound of foot

8 E920.4 Accident caused by hand tools E89.5 Accident caused by fire E01.51 Activity, grilling & smoking food E849.0 Injury occurring at home ICD-10-CM T23.292A Burn, 2 nd degree, left hand, initial encounter X08.8XXA Contact with fire/flames, initial encounter S91.331A Open wound, right foot, initial encounter W27.4XXA Contact with kitchen utensil, initial encounter Y Yard in single family home Y93.62 Activity, grilling & smoking food F10.10 Alcohol abuse, uncomplicated Y90.1 Blood alcohol level, 20-39mg/100 ml Pt admitted for pneumonia. Pt developed UTI in the hospital corridor due to indwelling foley catheter. Pt also has chronic atrial fibrillation treated with meds. ICD-9-CM 486 Pneumonia, unspecified Infection & inflammatory reaction due to indwelling urinary catheter UTI

9 E879.6 Urinary catheterization with abnormal reaction/late complication E849.7 Injury or poisoning occurring at/in residential institution Atrial fibrillation V58.61 Long-term use of anticoagulants ICD-10-CM J18.9 Pneumonia, unspecified T83.51XA Infection & inflammatory reaction due to indwelling urinary catheter, initial encounter N39.0 UTI Y84.6 Urinary catheterization as cause of abnormal reaction of the patient, or of later complication Y Hospital corridor as place of occurrence I48.2 Chronic atrial fibrillation Z79.01 Long-term use of anti-coagulants

10 ICD-10 CM Conventions- Placeholder ICD-10-CM codes must be assigned to the highest number of characters available or to the highest level of specificity. Placeholder Character- X

11 Since the character position determines the meaning, there must be a placeholder character for any empty positions. The 7 th character must always be the 7 th character. If a code that requires a 7th character is not 6 characters long, a placeholder x must be used to fill in the empty characters.

12 Alpha characters in ICD- 10-CM are not case sensitive Ref: ICD-10-CM coding guidelines I.A.4 and I.A.5 Nausea & vomiting due to Darvon taken as prescribed in the kitchen of patient s mobile home ICD-9-CM Nausea w/vomiting E935.8 Analgesics /antipyretics causing adverse effect in therapeutic use E849.0 Injury or poisoning occurring at home

13 sequencing is same for 2012 ICD-10-CM using 2012 guidelines R11.2 Nausea & vomiting T39.8X5A Adverse effect of other non-opioid analgesics & antipyretics, NEC, initial encounter (single category for specific type of drug (T39) that includes poisonings, adverse effects & underdosing) Codes in categories T36 T65 are combination codes that include substances related to adverse effects, poisonings, toxic effects and under-dosing, and external causes. No additional external cause code is required for poisonings, toxic effects, adverse effects & under-dosing codes. Y Kitchen in mobile home as place of occurrence Changes were made to sequencing guidelines in 2012 for adverse effects and manifestation - Codes that identify the manifestation of the adverse effect are sequenced first, followed by the code that identifies the drug causing the adverse effect (T codes).

14 Fainting spell due to heat. Patient was working in garden at home. ICD-9-CM Heat syncope E849.0 Injury or poisoning occurring at home

15 E01.61 Activity involving gardening & landscaping ICD-10-CM T671XXA Heat syncope, initial encounter Y Garden or yard in single family house as place of occurrence Y93H2 Activity involving gardening & landscaping

16 *Note: most injury codes will have a 7 th character extension that identifies the encounter initial, subsequent, sequela ICD-10 CM Conventions -Excludes Notes 2 types of excludes notes. Each type of note has a different definition for use but they are all similar in that they

17 indicate that codes excluded from each other are independent of each other. Excludes1 Excludes2 2 Types of Excludes Notes Excludes1 a pure excludes note- NOT CODED HERE! the code excluded should never be used at the

18 same time as the code above the Excludes1 note. used when two conditions cannot occur together Congenital vs acquired form Excludes2 note represents Not included here indicates that the condition excluded is not

19 part of the condition represented by the code -but a patient may have both conditions at the same time When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate. Types of Excludes Notes Excludes1

20 NOT CODED HERE! Category J45 Asthma Excludes1 detergent asthma J69.8 wheezing NOS R06.2 Nonrheumatic aortic valve stenosis I35.0 Excludes1 congenital Q23.0 rheumatic I06.- Excludes2 Not included here

21 J04.2 Acute laryngotracheitis Excludes1 acute obstructive laryngotracheitis J05.0 Excludes2 Chronic larynotracheitis J37.1 Includes Notes Includes notes appear immediately under a three character code title further define, or give examples of, the content of the category.

22 J44 COPD includes: asthma w/copd chronic asthmatic bronchitis chronic bronchitis w/airways obstruction chronic bronchitis w/emphysema chronic obstructive bronchitis chronic obstructitve tracheobronchitis Inclusion terms (it s all bread) List of terms included under some codes. are the conditions for which that code is to be used. may be synonyms of the code title, or, in the case of other specified codes, the terms are a list of the various conditions assigned to that code. inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.

23 Inclusion terms (it s all bread) J44.1 Chronic Obstructive Pulmonary Disease with acute exacerbation decompensated COPD decompensated COPD with acute exacerbation General Coding Guidelines I.B.10. Sequela

24 The term late effect is referenced in ICD-10-CM as sequela A sequela is the residual effect (condition produced) after the acute phase of an illness or injury has terminated. There is no time limit on when a sequela code can

25 be used. The residual may be apparent early, such as in cerebral infarction, or it may occur months or years later, such as that due to a previous injury. Coding of sequela generally requires two codes sequenced in the following order: The condition or nature of the

26 sequela is sequenced first. The sequela code is sequenced second. Sequela of Injury 19. Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88) a. Application of 7th Characters in Chapter 19

27 7th character S, sequela, is for use for complications or conditions that arise as a direct result of a condition ex: scar formation after a burn. The scars are sequelae of the burn. When using 7th character S, use both the injury code that precipitated the sequela and the code for the sequela itself.

28 The S is added only to the injury code, not the sequela code. The 7th character S identifies the injury responsible for the sequela. The specific type of sequela (e.g. scar) is sequenced first, followed by the injury code. Patient seen for removal of scar tissue on right elbow which is result of burn suffered 6 months prior.

29 ICD-9-CM Scar conditons & fibrosis of skin Late effect of burn of extremity ICD-10-CM L90.5 Scar conditons & fibrosis of skin

30 T22.321S Burn, 3 rd degree, right elbow, sequela *Note: most injury codes will have a 7 th character extension that identifies the encounter initial, subsequent, sequela Questions?