Medtronic Coronary and Peripheral Vascular ICD-10 Coding for Hospitals May 2015

Transcription

1 Medtronic Coronary and Peripheral Vascular ICD-10 Coding for Hospitals May 2015

2 Disclaimer Reimbursement information provided by Medtronic is for illustrative purposes only and does not constitute legal advice. Information provided is gathered from third party sources and is subject to change without notice due to frequently changing laws, rules and regulations. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other third party payers as to the correct form of billing or the amount that will be paid to providers of service. The provider of service has the responsibility to determine medical necessity and to submit appropriate codes and charges for care provided. Please contact your local payers, reimbursement specialists and/or legal counsel for interpretation of coding, coverage, and payment policies. Medtronic does not promote the use of its products outside FDA-approved labeling. 2

3 Topics Background and Framework ICD-10-CM Diagnosis Codes ICD-10-PCS Procedure Codes DRG Impact Appendix : Key Resources Questions Attachment : Diagnosis Code Crosswalks 3

4 Background and Framework 4

5 Effective Date ICD-10 goes into effect October 1, Use of ICD-10 in the United States was formally proposed in August 2008 and finalized in January Implementation of ICD-10 was initially scheduled for October 2013 and has been postponed twice since then. ICD-10 is effective by date of discharge, not by date of admission. ICD-10-CM for diagnosis codes and ICD-10-PCS for procedure codes go into effect together on the same date. 5

6 Who Uses What Hospitals, physicians and all other providers must use ICD-10 diagnosis codes. Hospitals must also use ICD-10-PCS procedure codes for inpatient cases. Implementation of ICD-10 does not affect use of CPT. Provider Setting Diagnoses Procedures Hospitals Inpatient ICD-10-CM ICD-10-PCS Hospitals Outpatient ICD-10-CM CPT Physicians Facility/Office ICD-10-CM CPT ASCs Outpatient ICD-10-CM CPT 6

7 ICD-10 Coding Guidelines Guidelines for use of ICD-10 are available from multiple credible sources. Instructions within the ICD-10 codebook itself The ICD-10 Official Guidelines for Coding and Reporting Coding Clinic and AHA Coding Clinic Advisor AHA ICD-10-CM and ICD-10-PCS Coding Handbook Minutes from meetings of the ICD-10 Coordination and Maintenance Committee ICD-10-PCS Reference Manual AHIMA ICD-10-PCS: An Applied Approach 7

8 General Equivalence Mappings General Equivalence Mappings (GEMs) are a useful tool for going back-and-forth between ICD-9 and ICD-10 codes, for both diagnoses and procedures. Forward GEMs go from ICD-9 to ICD-10; Backward GEMs go from ICD-10 to ICD-9. The GEMs can be found at: ICD-10-CM-and-GEMs.html GEMs can be a good starting place. But NCHS and CMS strongly recommend coding directly from the ICD-10 codebooks, as studies have consistently indicated that this is most accurate. 8

9 ICD-10-CM Diagnosis Codes 9

10 Diagnosis Code Structure Codes are organized by chapter, mostly by body system. The chapters are virtually identical to those in ICD-9-CM. Codes are alpha-numeric and can be 3 to 7 digits long. Category Decimal Details Extension S 2 5 alpha number 0 I x A alpha or number S25.00xA Minor laceration of thoracic aorta, initial encounter I70.1 Atherosclerosis of renal artery Z Z98.61 Coronary angioplasty status 10

11 Volume of Diagnosis Codes ICD-10-CM has far more diagnosis codes than ICD-9-CM and provides a greater level of specificity. Example: Carotid artery stenosis ICD-9-CM 14,567 codes ICD-10-CM 69,823 codes ICD-9-CM Occlusion and stenosis of carotid artery without mention of cerebral infarction ICD-10-CM I65.21 Occlusion and stenosis of right carotid artery, not resulting in cerebral infarction I65.22 Occlusion and stenosis of left carotid artery, not resulting in cerebral infarction I65.23 Occlusion and stenosis of bilateral carotid arteries, not resulting in cerebral infarction I65.29 Occlusion and stenosis of unspecified carotid artery, not resulting in cerebral infarction Example: Atherosclerosis of native arteries of extremity with gangrene ICD-9-CM Atherosclerosis of native arteries of extremities, with gangrene ICD-10-CM I Atherosclerosis, native arteries of extremities, with gangrene, right leg I Atherosclerosis, native arteries of extremities, with gangrene, left leg I Atherosclerosis, native arteries of extremities, with gangrene, bilateral legs I Atherosclerosis, native arteries of extremities, with gangrene, other extremity I Atherosclerosis, native arteries of extremities, with gangrene, unspecified extremity 11

12 Angina and Coronary Artery Disease Angina codes (I20) are not assigned separately if the patient also has CAD. A combination code is used instead. A cause-and-effect relationship between angina and CAD can be assumed. 1 To code CAD in ICD-10-CM, the coder must know three things: Does the patient also have angina? What kind of vessel has coronary atherosclerosis? What kind of angina? Code Description Notes I25.10 I I Atherosclerotic heart disease of native coronary artery without angina pectoris Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris Atherosclerosis of coronary artery bypass graft(s), unspecified, with unspecified angina pectoris Use for CAD or ASHD NOS without angina Use for CAD or ASHD NOS with angina Use for CAD or ASHD with CABG with angina ICD-10-CM Official Guidelines for Coding and Reporting (Diagnoses), FY 2015, p.42

13 Atherosclerosis of Extremity A single code identifies the site of ulcer. A separate code is assigned for severity of ulcer ICD-9-CM Atherosclerosis of native arteries of extremities, with ulceration ICD-10-CM I Atherosclerosis, native arteries of right leg with ulceration of thigh I Atherosclerosis, native arteries of right leg with ulceration of calf I Atherosclerosis, native arteries of right leg with ulceration of ankle I Atherosclerosis, native arteries of right leg with ulceration of heel and midfoot I Atherosclerosis, native arteries of right leg with ulceration of other part of foot I Atherosclerosis, native arteries of right leg with ulceration of other part of lower right leg I Atherosclerosis, native arteries of right leg with ulceration of unspecified site Codes for atherosclerosis of bypass graft identify the type of graft, as well as laterality, manifestations, and site of ulceration. I70.3~~ I70.4~~ 170.5~~ I70.6~~ I70.7~~ ICD-10-CM Atherosclerosis of unspecified type of bypass graft of extremities Atherosclerosis of autologous vein bypass graft of extremities Atherosclerosis of nonautologous biological bypass graft of extremities Atherosclerosis of nonbiological bypass graft of extremities Atherosclerosis of other type of bypass graft of extremities Used when atherosclerosis is present in a bypass graft and The type of bypass graft is not documented or not known The bypass graft is composed of a vein harvested from the patient s body, eg, saphenous vein The bypass graft is composed of a cadaveric vessel The bypass graft is composed of Gore-Tex or another synthetic material - new classification The composition of the bypass graft is specified but none of the above, eg. an autologous artery new classification 13

14 Acute Myocardial Infarction ICD-10-CM handles acute myocardial infarction differently from ICD-9-CM. AMI: ICD-9-CM ICD-9-CM 410.0x Acute myocardial infarction, of anterolateral wall 410.1x Acute myocardial infarction, of other anterior wall 410.2x Acute myocardial infarction, of inferolateral wall 410.3x Acute myocardial infarction, of inferoposterior wall 410.4x Acute myocardial infarction, of other inferior wall 410.5x Acute myocardial infarction, of other lateral wall 410.6x Acute myocardial infarction, true posterior wall 410.7x Acute myocardial infarction, subendocardial (NSTEMI) 410.8x Acute myocardial infarction, of other specified sites 410.9x Acute myocardial infarction, unspecified site 5 th digit 0 unspecified episode of care 1 initial episode of care 2 subsequent episode of care AMI: ICD-10-CM Episode of care is not identified per se. AMI is differentiated between initial AMI (I21) and subsequent AMI (I22). The AMI site identifies the specific coronary artery involved ( culprit lesion ). 14

15 Acute Myocardial Infarction Initial AMI (I21) ICD-10-CM I21.01 ST elevation (STEMI) myocardial infarction involving left main coronary artery I21.02 ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery I21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall I21.11 ST elevation (STEMI) myocardial infarction involving right coronary artery I21.19 ST elevation (STEMI) myocardial infarction involving other coronary artery I21.21 ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery I21.29 ST elevation (STEMI) myocardial infarction involving other sites I21.3 ST elevation (STEMI) myocardial infarction of unspecified site I21.4 Non-ST elevation (NSTEMI) myocardial infarction Initial AMI codes I21 continue to be assigned to encounters for continued care, including transfer to another hospital or post-acute setting, while the AMI is within 28 days of onset. 2 If the AMI is documented as NSTEMI (subendocardial, nontransmural) and a site is provided, it is still coded as NSTEMI ICD-10-PCS Official Guidelines for Coding and Reporting (Diagnosis), FY 2015, Section I, C9.e(1 ) 3. ICD-10-PCS Official Guidelines for Coding and Reporting (Diagnosis), FY 2015, Section I, C9.e(3 ) 15

16 Acute Myocardial Infarction Subsequent AMI (I22) ICD-10-CM I22.0 Subsequent ST elevation (STEMI) myocardial infarction of anterior wall I22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wall I22.2 Subsequent non-st elevation (NSTEMI) myocardial infarction I22.8 Subsequent ST elevation (STEMI) myocardial infarction of other sites I22.9 Subsequent ST elevation (STEMI) myocardial infarction of unspecified site A subsequent AMI is a new AMI that occurs within 28 days of a previous AMI, regardless of site. 4 Codes from I22 cannot be assigned alone. They must always be assigned with a code from I21. Sequencing of the codes depends on the circumstances of the encounter ICD-10-PCS Official Guidelines for Coding and Reporting (Diagnosis), FY 2015, Section I, C9.e(4 ) 16

17 Device Complications For mechanical complication, ICD-10-CM differentiates certain types of complication and specifies certain devices ICD-9-CM Mechanical complication of other vascular device, implant or graft ICD-10-CM T82.310A Breakdown (mechanical) of aortic (bifurcation) graft (replacement) T82.320A Displacement of aortic (bifurcation) graft (replacement) T82.330A Leakage of aortic (bifurcation) graft (replacement) T82.390A Other mechanical complication of aortic (bifurcation) graft (replacement) For other complications, ICD-10-CM differentiates the type of complication but not the type of device, eg. in-stent restenosis: ICD-9-CM ICD-10-CM Other complication due to other cardiac device, implant and graft Other complication due to other vascular device, implant and graft T82.857A T82.858A Stenosis of cardiac prosthetic devices, implants and grafts, initial encounter Stenosis of vascular prosthetic devices, implants and grafts, initial encounter A proposals has already been made to ICD-10 C&M Committee to create new codes specifically defined for in-stent restenosis March19-20, 2014 meeting of ICD-10 Coordination and Maintenance Committee

18 Status ICD-10-CM codes indicate that the patient is status post angioplasty in coronary and peripheral vessels. The ICD-10-CM codes also specifically identify if angioplasty included placement of a stent. V45.82 ICD-9-CM Percutaneous transluminal coronary angioplasty status ICD-10-CM Z95.5 Presence of coronary angioplasty implant and graft Z98.61 Coronary angioplasty status Z Peripheral vascular angioplasty status with implants and grafts Z98.62 Peripheral vascular angioplasty status 18

19 ICD-10-PCS Procedure Codes 19

20 ICD-10-PCS Format Codes are alpha-numeric and are always 7 digits long. There is no decimal point. There are virtually no unspecified or default codes. Each position in an ICD-10-PCS procedure code represents a distinct element section root operation approach qualifier body system body part device 20

21 Structure of ICD-10-PCS Codes In ICD-10-PCS, codes are not assigned per se. They are constructed, character by character. ICD-10-PCS contains no instructional notes. Standardized terms and definitions are used throughout. 21

22 Volume of Procedure Codes ICD-10-PCS has far more procedure codes than ICD-9-CM and provides much greater specificity. Angioplasty of LE Arteries ICD-9-CM ICD-10-PCS 1 code 19 codes ICD-9-CM 3,882 codes ICD-10-PCS 71,924 codes Use of ICD-10-PCS requires in-depth clinical and technical coding knowledge: Relevant clinical anatomy Procedural components Exact nature of devices used Standard terms, particularly Root Operation Procedure coding guidelines and precedents 22

23 Coronary and Peripheral Procedures Coronary Angioplasty and Stenting Coronary Aspiration Thrombectomy Peripheral Angioplasty and Stenting Drug-Coated Balloon Angioplasty Peripheral Atherectomy Carotid Artery Stenting Abdominal Aortic Stent Graft Thoracic Aortic Stent Graft Cardiac Catheterization Coronary and Peripheral Angiography 23

24 Coronary Angioplasty and Stenting Coronary angioplasty and coronary stenting use the same root operation. Root Operation 7 Dilation : Expanding an orifice or the lumen of a tubular body part Coding Guidelines The body part for coronary artery is defined by the number of discrete sites treated, regardless of whether they are within the same coronary artery, and not by the number of coronary arteries or their names. 6 Because stenting is considered to inherently require angioplasty, stent insertion is shown by the Device character. Separate codes are assigned for each coronary artery site dilated when the device value differs AHA ICD-10-CM and ICD-10-PCS Coding Handbook, FY 2015, p.421 see also General Equivalence Mappings - Documentation for Technical Users, 2015, p ICD-10-PCS Official Guidelines for Coding and Reporting (Procedures), FY 2015, B4.4 see also AHA ICD-10-CM and ICD-10-PCS Coding Handbook, FY 2015, p.422

25 Coronary Angioplasty and Stenting Devices 4 Intraluminal Device, Drug-Eluting : Resolute Integrity D Intraluminal Device : Integrity, Driver (bare metal) Example Angioplasty of two LAD sites-1 st site: two drug-eluting stents at bifurcation, 2 nd site: no stent, plus angioplasty of one RCA site with bare metal stent Dilation of coronary artery, one site, bifurcation, with drug-eluting intraluminal device, percutaneous approach 02703ZZ Dilation of coronary artery, one site, percutaneous approach 02703DZ Dilation of coronary artery, one site, with intraluminal device, perc 25

26 Coronary Angioplasty and Stenting Notes ICD-10-PCS does not have a mechanism to identify the total number of stents placed. There is no equivalent to ICD-9-CM procedure codes A proposal has already been made to ICD-10 C&M Committee to expand the device values to show the number placed for both drugeluting and non-drug-eluting stents. 8 This proposal also provided an option to change the body part for coronary artery from site to artery. 8. March19, 2014 meeting of ICD-10 Coordination and Maintenance Committee 26

27 Coronary Aspiration Thrombectomy Coronary artery thrombus is typically removed in conjunction with other percutaneous coronary interventions as treatment for an AMI. Root Operation C Extirpation : Taking or cutting out solid matter from a body part Example Removal of thrombus in the left anterior descending coronary artery via Export aspiration catheter 02C03ZZ Extirpation of matter from coronary artery, one site, percutaneous approach 27 Notes A C&M proposal has already been made to add a qualifier for bifurcation.

28 Peripheral Angioplasty and Stenting As with coronary, peripheral angioplasty and stenting use the same root operation and stent insertion is shown by the Device character. Root Operation 7 Dilation : Expanding an orifice or the lumen of a tubular body part Coding Guidelines Separate codes are assigned for each peripheral vessel dilated when the device value differs. Devices D Intraluminal Device : EverFlex, Complete, Assurant (bare metal) 28

29 Peripheral Angioplasty and Stenting Example Insertion of two bare metal stents in right superficial femoral artery 047K3DZ Dilation of right femoral artery with intraluminal device, percutaneous approach Notes A C&M proposal has already been made to expand device values for the number of peripheral stents placed, and to add a qualifier for bifurcation. 29

30 Drug-Coated Balloon Angioplasty DCB is a newly-approved form of angioplasty. It is intended to reduce restenosis, combining the benefits of angioplasty and drug elution while avoiding the potential complications of a permanent stent. 9 New codes go into effect October 1, A new qualifier value was added to code table 047 for DCB for the femoral artery and popliteal artery body parts. Medtronic s DCB is the IN.PACT Admiral. 9. September 23, 2014 meeting of ICD-10 Coordination and Maintenance Committee Federal Register, HIPPS proposed rule, April 30, 2015, p

31 Peripheral Atherectomy Root Operation C Extirpation : Taking or cutting out solid matter from a body part Coding Guidelines If atherectomy is performed together with angioplasty or stenting, separate codes are assigned for both of the procedures. 11 Minor intimal tears in the vessel wall that occur during atherectomy are considered an unavoidable part of the procedure and are not coded as complications AHA ICD-10-CM and ICD-10-PCS Coding Handbook, FY 2015, p

32 Peripheral Atherectomy Example Removal of atherosclerotic plaque in the left popliteal artery via SilverHawk atherectomy catheter 04CN3ZZ Extirpation of matter from left popliteal artery, percutaneous approach Notes A C&M proposal has already been made to add a qualifier for bifurcation. 32

33 Carotid Artery Stenting Root Operation 7 Dilation Example Device D Intraluminal Device : Protégé RX (bare metal) Stenting of the right common carotid artery using Protégé RX with Spider FX embolic protection device 037H3DZ Dilation of right common carotid artery with intraluminal device, percutaneous approach Notes A C&M proposal has already been made to add a qualifier for bifurcation. 33

34 Abdominal Aortic Stent Graft Abdominal aortic stent grafts are placed for endovascular aneurysm repair (EVAR). The AAA stent graft relines the aorta and provides a secure channel for blood flow, excluding the aneurysm sac. Root Operation V Restriction : Partially closing an orifice or the lumen of a tubular body part 12 Device D Intraluminal Device : Endurant AAA Stent Graft Coding Guidelines One source implies that a separate code is not assigned for extension of the stent graft into the common iliac artery strictly as a landing zone without pathology AHA ICD-10-CM and ICD-10-PCS Coding Handbook, FY 2015, p AHIMA ICD-10-PCS: An Applied Approach 2015 (with answers), Chapter 11, Case Study 2, p

35 Abdominal Aortic Stent Graft Example EVAR of infrarenal abdominal aortic aneurysm with Endurant stent graft, anchored by ipsilateral and contralateral limbs in the common iliac arteries (patent iliac arteries) 04V03DZ Restriction of abdominal aorta with intraluminal device, perc approach 35

36 Thoracic Aortic Stent Graft Thoracic Aorta Anatomy The thoracic aorta runs from the aortic valve to the diaphragm. The precerebral arteries arise from the thoracic aortic arch. Blood flow to these critical vessels must be preserved. Medtronic thoracic aortic stent grafts are used in the descending thoracic aorta. 36

37 Thoracic Aortic Stent Graft Thoracic aortic stent grafts are placed for endovascular aneurysm repair. Root Operation V Restriction Example Device D Intraluminal Device : Valiant Thoracic Stent Graft, Talent Thoracic Stent Graft EVAR of descending thoracic aortic aneurysm with Talent stent graft 02VW3DZ Restriction of thoracic aorta with intraluminal device, perc approach Notes A C&M proposal has already been made to expand body part values to differentiate descending thoracic aorta from ascending/arch September 19, 2012 meeting of ICD-10 Coordination and Maintenance Committee 37

38 Thoracic Aortic Stent Graft Although less common than aneurysm, thoracic aortic stent grafts are also placed for blunt traumatic aortic injury, such as aortic transection. Coding Guidelines It is not yet clear whether placement of a thoracic aortic stent graft for indications such as aortic transection are also coded to the root operation V Restriction or if they are coded to another root operation such as U Supplement. 38

39 Cardiac Catheterization Cardiac catheterization is coded in the Measurement and Monitoring section. It consists of threading a catheter into one of the chambers of the heart and performing hemodynamic recordings. Coding Guidelines Angiography, which is almost always performed with a cardiac catheterization, is coded separately. Example Right and left cardiac catheterization 4A023N8 Measurement of cardiac sampling and pressure, bilateral 39

40 Coronary and Peripheral Angiography Angiography is coded in the Imaging section. This involves injecting dye (contrast) and obtaining fluoroscopic images. Example: Coronary Angiography of left main, LAD, and left circumflex coronary arteries and left ventriculography using Omnipaque B2111ZZ B2151ZZ Fluoroscopy of multiple coronary arteries using low osmolar contrast Fluoroscopy of left heart using low osmolar contrast 40

41 Coronary and Peripheral Angiography Example: Peripheral Angiography of abdominal aorta with bilateral runoff using Omnipaque B41D1ZZ Fluoroscopy of aorta and bilateral lower extremity arteries using low osmolar contrast 41

42 DRG Impact 42

43 ICD-10 DRG Conversion The conversion of the DRG Grouper is about coding, not about grouping. CMS has repeatedly stated its goal in the DRG conversion: The same DRG will be assigned regardless of whether the case is coded in ICD-9 or ICD-10. The conversion process has involved only replacing the ICD-9-CM codes with the equivalent ICD-10 codes. DRG titles and underlying DRG logic has not changed, but some minor DRG variations are unavoidable. In a study of 10 million FY 2013 MedPAR records, CMS found a DRG shift of 1.07%, with reimbursement change of -0.04% 15 If the same DRG is not assigned, recheck the codes 15. Estimating the Impact of the Transition to ICD-10 on Medicare Inpatient Hospital Payments 43

44 Sample CCs Code Description E44.0-E46 other malnutrition E87.0 hypernatremia E87.1 hyponatremia I31.4 cardiac tamponade cardiomyopathy (non-ischemic) I42.0, I42.5, (dilated, congestive, constrictive, I42.8-I42.9 restrictive) I44.2 AV block, complete I45.2 bifascicular block I45.3 trifascicular block I45.89 other conduction disorder I47.2 ventricular tachycardia I50.1 left ventricular failure I50.20 systolic heart failure, unspecified I50.22 systolic heart failure, chronic I50.30 diastolic heart failure, unspecified I50.32 diastolic heart failure, chronic I50.40 combined diastolic/systolic heart failure, unspecified I50.42 combined diastolic/systolic heart failure, chronic Code Description I I venous thrombosis and embolism J44.1 acute exacerbation of COPD J80 acute respiratory distress syndrome (adult, child) J90, J94.2, J94.8 pleural effusion, hemothorax, hydrothorax (non-traumatic) J J iatrogenic pneumothorax, air leak J96.10-J96.12 respiratory failure, chronic J98.11-J98.19 atelectasis, pulmonary collapse K56.0, K56.60-K56.7 bowel obstruction, ileus N17.8-N17.9 acute renal failure, other and unspecified N18.4 CKD, stage IV N18.5 CKD, stage V N39.0 urinary tract infection R65.10 SIRS R78.81 bacteremia Z68.1 BMI less than 19, adult Z68.41-Z68.45 BMI 40 and over, adult 44

45 Sample MCCs Code Description A40.0-A40.9, A41.01-A41.9 septicemia, sepsis E41-E43 severe malnutrition I21.01-I21.4, I22.0-I22.9 acute myocardial infarction I26.01-I26.99 pulmonary embolism I50.21 systolic heart failure, acute I50.23 systolic heart failure, acute on chronic I50.31 diastolic heart failure, acute I50.33 diastolic heart failure, acute on chronic I50.41 combined diastolic/systolic heart failure, acute I50.43 combined diastolic/systolic heart failure, acute on chronic J12.0-J18.9 pneumonia J69.0 aspiration pneumonia J81.0 acute pulmonary edema J96.00-J96.02 respiratory failure, acute J96.20-J96.22 respiratory failure, acute on chronic N17.0-N17.2 acute renal failure, specified lesion N18.6 ESRD R65.20-R65.21 severe sepsis 45

46 Appendix: Key Resources 46

47 Key Websites NCHS and CMS have a wealth of ICD-10 resources and educational materials available on-line. 47 NCHS ICD-10-CM Tabular and Index Diagnosis code GEMS Official ICD-10-CM guidelines (diagnoses) CMS ICD-10-PCS Code Tables and Index Procedure code GEMs Official ICD-10-CM guidelines (procedures) ICD-10 Coordination and Maintenance Committee Diagnoses: Procedures: ICD-9-CM-C-and-M-Meeting-Materials.html Code proposals, presentation slides, videos, summaries

48 Medtronic Contacts Medtronic is available to assist with your ICD-10 questions and issues. We re here to help make Hotline: this transition smoother for us: you Visit our reimbursement website at: products-therapies/cardiovascular/therapies/codingcoverage-reimbursement-resources/index.htm 48

49 Questions