ICD-10: The First Year Kelly Canter, BA, RHIT, CCS CAC Coding Development Manager
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1 ICD-10: The First Year Kelly Canter, BA, RHIT, CCS CAC Coding Development Manager
2 The Plan Where does the data come from? ICD-10-CM ICD-10-PCS What about MS-DRGs?
3 The Data 29 Health Systems 72 Hospitals At least 1,000 discharges in 1Q ,359 Inpatient claims
4 ICD-10-CM
5 B95-B97
6 B95-B97 Pharyngitis Streptococcal MSSA J02.0 J02.8 B95.61 J02.8 A49.01
7 B34.9 versus B97.89
8
9 Coding Clinic 4Q 2013, pg. 114
10 Coding Clinic 1Q2016
11 Coding Clinic 2Q2016
12
13 Heart Failure Coding Clinic 1Q 2016 Page 10 HFpEF Preserved ejection fraction Preserved systolic function Diastolic heart failure I50.3- HFrEF Reduced ejection fraction Reduced systolic function Systolic heart failure I50.2-
14 Nicotine Dependence Smoker Packs per day ecigarettes History of or in remission AHA CC 4Q2013 page 108
15 Psychoactive substance USE F14.9- Must meet secondary diagnosis criteria F12.9- F10.9- F15.9- F11.9- F16.9- Must be associated with a mental or behavioral disorder and documented as such F13.9- CG I.C.5.b.3
16 Screening Mammograms EXCLUDES 1
17 ICD-10-PCS
18 Open and Percutaneous
19 CVC/PICC Injections and Infusions
20 CVC/PICC Body/System Region When the site where the substance is introduced is distant from the point of entry into the artery or vein.
21 Great Vessels: PICC Insertion 3Q 2013, pg. 18 Section Body System Root Operation Body Part Approach Device Qualifier Medical Surgical 0 Heart and Great Vessels 2 Insertion H Where the device ends SVC V Percutaneous 3 Infusion Device 3 No qualifier Z
22 OB coding - Epidurals ICD-9-CM does not include codes for the administration of spinal, local, or inhalation anesthesia provided in the performance of a surgical, surgicalrelated, or obstetrical procedure. (AHA CC 4Q 1988)
23
24 OB Coding - Repairs 0WQN0ZZ Repair Female Perineum If no further information, use degrees: 1. Skin 2. Muscle 3. Anal sphincter 4. Rectum There were second degree perineal lacerations which were repaired by Doe, Jane, MD, using chromic sutures. 0KQM0ZZ K = muscle From AHA Coding Clinic 1st Quarter 2016 p. 6; AHA Coding Clinic 4 th Quarter 2014, p. 43
25 OB Coding - Repairs
26 EGD without site specified Procedures(s): Laparoscopic Gastric Sleeve, Lysis Of Adhesions, Esophagogastroduodenoscopy Anesthesia Type: General Description of Procedure: The patient was draped and prepped in the normal sterile manner[...]once we had finished this, we then performed an EGD and found no obvious leak. 0DJ08ZZ 0 = upper intestinal tract From AHA Coding Clinic 3 rd Quarter 2015
27 MS-DRGs
28 A minimal hospital payment decrease of 0.04 percent was found using the ICD-10 version 30 of MS- DRGs. The estimate is shown to be critically dependent on the methods used to recode ICD-9 data into ICD-10. Estimating the Impact of the Transition to ICD-10 on Medicare Inpatient Hospital Payments 2/25/2013
29 Findings: Changes in DRG Weight What is the impact of ICD-10 on DRG weights? What is the impact of MS-DRG Version 33? Prediction:.04% decrease Observed: 4.3% increase 1 Observed:.017% increase 1 1 Final inpatient billing, approximately 275,000 cases 2015, 276,000 cases 2016
30 Medical vs Surgical
31 Med vs Surg example
32 Top 10 DRG Distribution
33 Top 20 Distribution
34 DRG 945 Rehab with CC/MCC
35 ICD-9 MS-DRG 945 ICD-10 Coding Guidelines section I.B.15. Code from category V57 as PDX; code procedures Coding Guidelines section II.K. Code the condition as PDX
36 DRG 945
37 Top 25 most frequent DRG groups 53.53% of DRGs in the data set 57% shift to higher weights
38 Highlights DRG Description Weight Diff 291 Heart Failure and Shock with MCC Heart Failure and Shock with CC Heart Failure and Shock without MCC/CC Chronic Obstructive Pulmonary Disease with MCC Chronic Obstructive Pulmonary Disease with CC Chronic Obstructive Pulmonary Disease without MCC/CC Bronchitis and Asthma with CC/MCC Bronchitis and Asthma without CC/MCC Respiratory Signs and Symptoms
39 Highlights DRG Description Weight Diff 329 Major Large and Small Bowel Procedures with MCC Major Large and Small Bowel Procedures with CC Major Large and Small Bowel Procedures without CC/MCC Kidney and Urinary Tract Infections with MCC Kidney and Urinary Tract Infections without MCC
40 Were the predictions correct?
41
42 Kelly Canter, RHIT, CCS
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