Let s look at ICD-10-PCS How it is set up Coding Guidelines Root Operations Approach and Device Examples/Comparisons

Transcription

1 Karen Scott, MEd, RHIA, CCS-P, CPC AHIMA Certified ICD-10 Trainer Let s look at ICD-10-PCS How it is set up Coding Guidelines Root Operations Approach and Device Examples/Comparisons 1

2 Medical and Surgical Obstetrics Placement Administration Measurement & Monitoring Imaging Nuclear Medicine Radiation Oncology Osteopathic Rehabilitation and Diagnostic Audiology Extracorporeal Assistance & Performance Extracorporeal Therapies Laboratory Mental Health Chiropractic Miscellaneous Karen Scott Seminars and Consulting One of the characters specifies the precise type of procedure being performed (e.g., excision, resection, etc.) Other characters specify additional information Such as body part on which the procedure is being performed. Karen Scott Seminars and Consulting 2

3 Dilation Eustachian Tube, Right Transorifice using Intraluminal Device. 0 Surgical Section 9 Body System-Ear, nose, sinus 7 procedure is a Dilation F Eustachian tube, right 7 Via natural or artificial opening Approach D Intraluminal Device NEC Z No Qualifier Karen Scott Seminars and Consulting 0: Medical and Surgical Section D Gastrointestinal System B: EXCISION: Cutting out or off, without replacement, a portion of a body part. 1 Esophagus, upper 2 Esophagus, middle 3 Esophagus, lower 4 Esophagogastric junction 6 Stomach 7 Stomach, pylorus 9 Duodenum A Jejunum B Ileum C Ileocecal valve H Cecum J Appendix K Ascending Colon L Transverse Colon M Descending Colon N Sigmoid Colon P Rectum Q Anus R Anal Sphincter 0 Open 1 Open Intraluminal 2 Open Intraluminal Endoscopic 3 Percutaneous 4 Percutaneous Endoscopic 5 Percutaneous Intraluminal 6 Percutaneous Intraluminal Endoscopic 7 Transorifice Intraluminal 8 Transorifice Intraluminal Endoscopic 0 Open 3 Percutaneous 4 Percutaneous Endoscopic Z None Z None X Diagnostic Z None X Diagnostic Z None S Greater Omentum T Lesser Omentum V Mesentery W Peritoneum 0 Open 3 Percutaneous 4 Percutaneous Endoscopic 7 Transorifice Intraluminal 8 Transorifice Intraluminal Endoscopic Z None X Diagnostic Z None 3

4 In using the tables, you can only select choices in that row. Do not combine code choices from different rows. Karen Scott Seminars and Consulting Official Coding Guideline: A9 Within a PCS table, valid codes include all combinations of choices in characters 4 through 7 contained in the same row of the table. In the example below, 0JHT3VZ is a valid code, and 0JHW3VZ is not a valid code. Section: 0 Medical and Surgical Body System: J Subcutaneous Tissue and Fascia Operation: H Insertion: Putting in a nonbiological appliance that monitors, assists, performs, or prevents a physiological function but does not physically take the place of a body part Body Part Approach Device Qualifier S Subcutaneous Tissue 0 Open 1 Radioactive Element Z No Qualifier and Fascia, Head and Neck 3 Percutaneous 3 Infusion Device V Subcutaneous Tissue and Fascia, Upper Extremity W Subcutaneous Tissue and Fascia, Lower Extremity T Subcutaneous Tissue 0 Open 1 Radioactive Element Z No Qualifier and Fascia, Trunk 3 Percutaneous 3 Infusion Device V Infusion Pump 4

5 Each section may have different definitions based on procedures for that area (OB vs Administration) Each root procedure is defined Words having overlapping meanings are defined Excision, Resection, Removal (Device) Karen Scott Seminars and Consulting The root operation term used in the description of a procedure is based on the objective of the procedure If a procedure involves distinct parts, multiple codes are assigned Karen Scott Seminars and Consulting 5

6 Example: Liver is used when the specific liver lobe is not identified Approach: Open, Percutaneous and Transorifice are used when the more specific type of approach is not documented and cannot otherwise be determined Root Operation: Repair is used when the documentation of an operation is not sufficient to identify the specific root operation performed and the information cannot otherwise be obtained Karen Scott Seminars and Consulting A11 Many of the terms used to construct PCS codes are defined within the system. It is the coder s responsibility to determine what the documentation in the medical record equates to in the PCS definitions. The physician is not expected to use the terms used in PCS code descriptions, nor is the coder required to query the physician when the correlation between the documentation and the defined PCS terms is clear. 6

7 When the physician documents partial resection the coder can independently correlate partial resection to the root operation Excision without querying the physician for clarification. B3.1b Components of a procedure specified in the Components of a procedure specified in the root operation definition and explanation are not coded separately. Procedural steps necessary to reach the operative site and close the operative site are also not coded separately. 7

8 Resection of a joint as part of a joint replacement procedure is included in the root operation definition of Replacement and is not coded separately. Laparotomy performed to reach the site of an open liver biopsy is not coded separately. B3.2 During the same operative episode, multiple procedures are coded if: a. The same root operation is performed on different body parts as defined by distinct values of the body part character. Example: Diagnostic excision of liver and pancreas are coded separately. 8

9 b. The same root operation is repeated at different body sites that are included in the same body part value. Example: Excision of the sartorius muscle and excision of the gracilis muscle are both included in the upper leg muscle body part value, and multiple procedures are coded. c. Multiple root operations with distinct objectives are performed on the same body part. Example: Destruction of sigmoid lesion and bypass of sigmoid colon are coded separately. d. The intended root operation is attempted t using one approach, but is converted to a different approach. Example: Laparoscopic Example: Laparoscopic cholecystectomy converted to an open cholecystectomy is coded as percutaneous endoscopic Inspection and open Resection. 9

10 B3.3 If the intended procedure is discontinued, code the procedure to the root operation performed. If a procedure is discontinued before any other root operation is performed, code the root operation Inspection of the body part or anatomical region inspected. A planned aortic valve replacement procedure is discontinued d after the initial thoracotomy and before any incision is made in the heart muscle, when the patient becomes hemodynamically unstable. This procedure is coded as an open Inspection of the mediastinum. 10

11 take out some/all of a body part take out solids/fluids/gasses / from a body part involving cutting or separation only put in/put back or move some/all of a body part alter the diameter/route of a tubular body part always involve a device involving examination only include other repairs include other objectives Definition Cutting out or off, without replacement, a portion of a body part Explanation Involves the act of cutting with either a sharp instrument or other method such as a hot knife or laser Examples Partial nephrectomy Wedge ostectomy Pulmonary segmentectomy Karen Scott Seminars and Consulting 11

12 Qualifier diagnostic = biopsies diagnostic excision i (biopsy) followed by therapeutic ti excision at the same procedure site or resection of body part during same operative episode only therapeutic excision/resection is coded breast biopsy followed by partial mastectomy same procedure site, only partial mastectomy procedure is coded similar to excision except involves cutting out or off, without replacement, all of body part includes all of body part or any subdivision of body part having its own body part value in ICD-10-PCS Examples total nephrectomy total lobectomy of lung total mastectomy resection cecum Prostatectomy Cholecystectomy 12

13 Resection of specific anatomical subdivision body part coded whenever possible Right upper lung lobectomy = resection upper lung lobe, right NOT excision of lung, right. Prostatectomy TURP 13

14 Prostatectomy-removal of the prostate=resection Transurethral resection of the prostate (TURP) removes section of prostate Excision Detachment Root Operation 6 cutting goff all or part of the upper or lower extremities exclusively for amputation procedures Destruction Root Operation 5 eradication of all or portion of body part by direct use of energy, force, or a destructive agent ablation, destruction, fulguration, cryotherapy, and cautery 14

15 Extraction Root Operation D pulling or stripping out or off all or portion of body part by use of force Minor cutting, such as that used in vein stripping procedures, is included in extraction if objective of procedure is met by pulling or stripping. dilation and curettage, g, vein stripping, suction dilation and curettage, phacoemulsification without intraocular lens implant, nonexcisional debridement of skin, extraction of teeth, bone marrow biopsy, endometrial biopsy Removal of a toenail Removal of a toenail Removal of a breast Removal of part of body part by fulguration 15

16 Toenail: Extraction Breast: Resection Fulguration: Destruction Drainage Root Operation 9 taking or letting out fluids or gases from a body part diagnostic paracentesis, thoracentesis, incision and drainage of abscess, chest tube placement, and Foley catheter placement 16

17 Extirpation Root Operation C taking or cutting out solid matter or material from a body part with objective to remove solid material foreign body, thrombus, or calculus from the body part with no appreciable amount of body part being taken out thrombectomy, removal of foreign body, choledocholithotomy, removal of calculus Fragmentation Root Operation F breaking b apart of solid matter in body part solid matter is fragmented but not removed from the body Pieces of solid matter eliminated or absorbed by body extracorporeal shockwave lithotripsy, transurethral cystoscopy with fragmentation of calculus, endoscopic retrograde cholangiopancreatography with lithotripsy, and transurethral lithotripsy. 17

18 Division Root Operation 8 cutting into body part without t draining i fluids or gases from the body part in order to separate or transect the body part all or portion of body part can be separated into two or more portions objective is to cut into, transect, t or otherwise separate all or a portion of a body part. osteotomy, sacral rhizotomy, anal sphincterotomy, division of a tendon, and spinal cordotomy. Release Root Operation N freeing body part from abnormal physical constraint by cutting or by use of force Some of restraining tissue may be removednone of actual body part is removed or taken ou. carpal tunnel release, adhesiolysis, frenulotomy for treatment of tongue-tie syndrome, tendon release, and manual rupture of joint adhesions 18

19 Transplantation Root Operation Y putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place or function of all or a portion of a similar body part kidney, heart, and liver transplants. Reattachment Root Operation M putting back in or on all or a portion of a separated body part to its normal location or other suitable location body part cut off or avulsed, nerves and blood vessels may or may not be reconnected reattachment of a severed left ear, reattachment of an avulsed kidney, and replantation of avulsed teeth. 19

20 Transfer Root Operation X moving, without taking out, all or a portion of a body part to another location to take over the function of all or a portion of a body part without disrupting vascular and nervous supply skin pedicle flap transfer, skin transfer flap, tendon transfer, TRAM pedicle flap reconstruction, nerve transfer. Reposition Root Operation S move all or a portion of a body part to its normal location or other suitable location reduction of fractures, reposition of undescended testicle, transposition of a nerve, repositioning of ligament 20

21 Restriction Root Operation V partially closing an orifice or the lumen of a tubular body part objective to narrow diameter of tubular body part or orifice esophagogastric h i fundoplication, i cervical cerclage, and clipping of an aneurysm. Occlusion Root Operation L completely closing orifice or lumen of tubular body part fallopian tube ligation and ligation of inferior i vena cava. 21

22 Dilation Root Operation 7 Expanding orifice or lumen of tubular body part by stretching a using intraluminal pressure or cutting part of orifice or wall percutaneous transluminal angioplasty, dilation of the common bile duct, and percutaneous transluminal coronary angioplasty Bypass Root Operation 1 altering route of passage of contents of tubular body part anastomoses coded according to the direction of flow of the contents of a tubular body part-origin of bypass, qualifier-destination of bypass coronary arteries -body part value =number of coronary artery sites bypassed, qualifier = origin of bypass coronary artery bypass graft, gastric bypass, colostomy formation. 22

23 Control Root Operation 3 stopping, or attempting to stop, postprocedural bleeding If another root operation is performed to stop bleeding (e.g., excision, extraction, or resection), then control is not coded separately. control of post-prostatectomy hemorrhage, post-tonsillectomy hemorrhage. Repair Root Operation Q restoring, to the extent t possible, a body part to its normal anatomic structure and function used only when method to accomplish repair is not one of the other root operations "not elsewhere classified used when procedure performed does not meet definition of other root operations herniorrhapy and suture of laceration. 23

24 Insertion Root Operation H putting in nonbiological appliance that monitors, assists, performs, or prevents physiological function but does not physically take place of a body part sole objective-put in a device without doing anything else to a body part insertion i of a radioactive i implant, insertion i of a central venous catheter, placement of a dual chamber pacemaker, placement of a bone growth stimulator, and port-a-cath placement Replacement Root Operation R putting in or on biological or synthetic material that physically y takes the place and/or function of all or a portion of a body part body part may be taken out and/or replaced, physically eradicated, or rendered nonfunctional during procedure Removal is coded for taking out device used in previous replacement procedure total hip replacement, bone graft, free skin graft, phacoemulsification with IOL implant, aortic valve replacement, and total right knee arthroplasty with prosthesis. 24

25 Supplement Root Operation U putting in or on biologic or synthetic material that physically reinforces and/or augments function of portion of body part, can be nonliving or living from same individual. herniorrhaphy using mesh, free nerve graft, putting in a new acetabular liner in a previous hip replacement, abdominal wall herniorrhaphy using mesh Change Root Operation 2 taking t out or off a device from a body part and putting back an identical or similar device in or on the same body part without cutting or puncturing the skin or a mucous membrane using the external approach. urinary catheter change, gastrostomy tube change, tracheostomy tube exchange, chest tube exchange, drainage tube change 25

26 Removal Root Operation P taking out or off a device from a body part coded if not an integral part of another root operation and regardless of the approach drainage tube removal, cardiac pacemaker removal, central line removal, endotracheal tube removal, removal of external fixator, and removal of PEG tube. Revision Root Operation W correcting, to the extent t possible, a malfunctioning or displaced device, can include correcting malfunctioning device by taking out and/or putting in part of device. adjustment of pacemaker lead, adjustment or revision of hip prosthesis, revision of pacemaker insertion, and reposition of Swan-Ganz catheter. 26

27 Inspection Root Operation J visually and/or manually exploring body part, with or without optical instrumentation, directly or through intervening body layers. Procedures discontinued without any other root operation being performed are also coded to inspection. diagnostic arthroscopy, exploratory laparotomy, diagnostic cystoscopy, diagnostic laryngoscopy, digital rectal exam, and laparotomy with palpation of liver. Map Root Operation K locating route of passage of electrical impulses and/or locating functional areas in body part, applicable only to cardiac conduction mechanism and central nervous system. only two body systems central nervous system (00K) and heart and great vessels (02K). cardiac mapping, cortical mapping, cardiac electrophysiological study, and intraoperative cardiac mapping during open heart surgery. 27

28 Fusion Root Operation G joining together portions of articular body part, rendering the articular body part immobile joined together by fixation device, bone graft, or other means, performed only on joints spinal fusion, ankle arthrodesis, intercarpal fusion of hand with bone graft, and interphalangeal fusion of great toe with percutaneous pin fixation. Alteration Root Operation 0 Modifying natural anatomic structure of body part without affecting function of body part to improve appearance. Not used for medical reasons for surgery cosmetic face lift, breast augmentation, abdominoplasty, and liposuction. Creation Root Operation 4 making new genital structure does not physically take place of body part, used only for sex change operations. creation of vagina in a male and creation of penis in a female. 28

29 Open approach with percutaneous endoscopic assistance B5.2 Procedures performed using the open approach with percutaneous endoscopic assistance are coded to the approach Open. Example: Laparoscopic-assisted assisted sigmoidectomy is coded to the approach Open. External approach B5.3a Procedures performed within an orifice on structures that are visible without the aid of any instrumentation are coded to the approach External. Example: Resection of tonsils is coded to the approach External. B5.3b Procedures performed indirectly by the application i of external force through h the intervening body layers are coded to the approach External. Example: Closed reduction of fracture is coded to the approach External. 29

30 Percutaneous procedure via device B5.4 Procedures performed percutaneously via a device placed for the procedure are coded to the approach Percutaneous. Example: Fragmentation of kidney stone performed via percutaneous nephrostomy is coded to the approach Percutaneous. PERCUTANEOUS Entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach the site of the operation Example: Needle biopsy of liver Karen Scott Seminars and Consulting 30

31 General guidelines B6.1a A device is coded only if a device remains after the procedure is completed. If no device remains, the device value No Device is coded. B6.1b Materials such as sutures, ligatures, radiological markers and temporary post-operative wound drains are considered integral to the performance of a procedure and are not coded as devices. 31

32 B6.1c Procedures performed on a device only and not on a body part are specified in the root operations Change, Irrigation, Removal and Revision, and are coded to the procedure performed. Example: Irrigation of percutaneous nephrostomy tube is coded to the root operation Irrigation of indwelling device in the Administration section. Drainage device B6.2 A separate procedure to put in a drainage device is coded to the root operation Drainage with the device value Drainage Device. Drainage device Radioactive element Autograft Extraluminal device Intraluminal device Synthetic substitute Tissue substitute Device NEC None Karen Scott Seminars and Consulting 32

33 Guidelines will be added Guidelines above are for Medical and Surgical Sections only, not necessarily the same or used in other sections. Medical and Surgical Obstetrics Placement Administration Measurement & Monitoring Imaging Nuclear Medicine Radiation Oncology Osteopathic Rehabilitation and Diagnostic Audiology Extracorporeal Assistance & Performance Extracorporeal Therapies Laboratory Mental Health Chiropractic Miscellaneous Karen Scott Seminars and Consulting 33

34 C. Obstetrics Section Products of conception C1 Procedures performed on the products of conception are coded to the Obstetrics section. Procedures performed on the pregnant female other than the products of conception are coded to the appropriate root operation in the Medical and Surgical section. Example: Amniocentesis is coded to the products of conception body part in the Obstetrics section. Repair of obstetric urethral laceration is coded to the urethra body part in the Medical and Surgical section. C2 Procedures performed following a delivery or abortion for curettage of the endometrium or evacuation of retained products of conception are all coded in the Obstetrics section, to the root operation Extraction and the body part Products of Conception, Retained. Diagnostic or therapeutic dilation and curettage performed during times other than the postpartum or post-abortion period are all coded in the Medical and Surgical section, to the root operation Extraction and the body part Endometrium. 34

35 Gap Analysis Use GEMs Mapping to compare current code documentation requirements with future requirements with ICD-10-PCS GEMS are not to be used for coding, but can help in comparison For more specific comparisons, use the actual codes and descriptions from ICD-10- PCS ICD-9-CM code Phacoemulsification And Aspiration Of Cataract ICD-10-PCS code(s) 08DJ3ZZ Extraction of Right Lens, Percutaneous Approach 08DK3ZZ Extraction of Left Lens, Percutaneous Approach 35

36 ICD-9-CM code Insertion Of Intraocular Lens Prosthesis At Time Of Cataract Extraction, One-Stage ICD-10-PCS code(s) 08RJ3JZ Replacement of Right Lens with Synthetic Substitute, Percutaneous Approach 08RK3JZ Replacement of Left Lens with Synthetic Substitute, Percutaneous Approach ICD-9-CM code Total Knee Replacement ICD-10-PCS code(s) 0SRC07Z Replacement of Right Knee Joint with Autologous Tissue Substitute, Open Approach 0SRC0JZ Replacement of Right Knee Joint with Synthetic Substitute, Open Approach 0SRC0KZ Replacement of Right Knee Joint with Nonautologous Tissue Substitute, Open Approach 0SRD07Z Replacement of Left Knee Joint with Autologous Tissue Substitute, Open Approach 0SRD0JZ Replacement of Left Knee Joint with Synthetic Substitute, Open Approach 0SRD0KZ Replacement of Left Knee Joint with Nonautologous Tissue Substitute, Open Approach 0SRT07Z Replacement of Right Knee Joint, Femoral Surface with Autologous Tissue Substitute, Open Approach 0SRT0JZ Replacement of Right Knee Joint, Femoral Surface with Synthetic Substitute, Open Approach 0SRT0KZ Replacement of Right Knee Joint, Femoral Surface with Nonautologous Tissue Substitute, Open Approach 0SRU07Z Replacement of Left Knee Joint, Femoral Surface with Autologous Tissue Substitute, Open Approach 0SRU0JZ Replacement of Left Knee Joint, Femoral Surface with Synthetic Substitute, Open Approach 0SRU0KZ Replacement of Left Knee Joint, Femoral Surface with Nonautologous Tissue Substitute, Open Approach 0SRV07Z Replacement of Right Knee Joint, Tibial Surface with Autologous Tissue Substitute, Open Approach 0SRV0JZ Replacement of Right Knee Joint, Tibial Surface with Synthetic Substitute, Open Approach 0SRV0KZ Replacement of Right Knee Joint, Tibial Surface with Nonautologous Tissue Substitute, Open Approach 0SRW07Z Replacement of Left Knee Joint, Tibial Surface with Autologous Tissue Substitute, Open Approach 0SRW0JZ Replacement of Left Knee Joint, Tibial Surface with Synthetic Substitute, Open Approach 0SRW0KZ Replacement of Left Knee Joint, Tibial Surface with Nonautologous Tissue Substitute, Open Approach 36

37 ICD-9-CM code (Aorto)Coronary Bypass Of Three Coronary Arteries The single most appropriate ICD-10-PCS code should be selected. ICD-10-PCS code(s) () W Bypass Coronary Artery, Three Sites to Aorta with Autologous Venous Tissue, Open Approach 02120AW Bypass Coronary Artery, Three Sites to Aorta with Autologous Arterial Tissue, Open Approach 02120JW Bypass Coronary Artery, Three Sites to Aorta with Synthetic Substitute, Open Approach 02120KW Bypass Coronary Artery, Three Sites to Aorta with Nonautologous Tissue Substitute, Open Approach W Bypass Coronary Artery, Three Sites to Aorta with Autologous Venous Tissue, Percutaneous Endoscopic Approach 02124AW Bypass Coronary Artery, Three Sites to Aorta with Autologous Arterial Tissue, Percutaneous Endoscopic Approach 02124JW Bypass Coronary Artery, Three Sites to Aorta with Synthetic Substitute, Percutaneous Endoscopic Approach 02124KW Bypass Coronary Artery, Three Sites to Aorta with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach ICD-9-CM code Double Internal Mammary-Coronary Artery Bypass ICD-10-PCS code(s) Bypass Coronary Artery, Two Sites to Right Internal Mammary with Autologous Venous Tissue, Open Approach Bypass Coronary Artery, Two Sites to Left Internal Mammary with Autologous Venous Tissue, Open Approach C Bypass Coronary Artery, Two Sites to Thoracic Artery with Autologous Venous Tissue, Open Approach 02110A8 Bypass Coronary Artery, Two Sites to Right Internal Mammary with Autologous Arterial Tissue, Open Approach 02110A9 Bypass Coronary Artery, Two Sites to Left Internal Mammary with Autologous Arterial Tissue, Open Approach 02110AC Bypass Coronary Artery, Two Sites to Thoracic Artery with Autologous Arterial Tissue, Open Approach 02110J8 Bypass Coronary Artery, Two Sites to Right Internal Mammary with Synthetic Substitute, Open Approach 02110J9 Bypass Coronary Artery, Two Sites to Left Internal Mammary with Synthetic Substitute, Open Approach 02110JC Bypass Coronary Artery, Two Sites to Thoracic Artery with Synthetic Substitute, Open Approach 02110K8 Bypass Coronary Artery, Two Sites to Right Internal Mammary with Nonautologous Tissue Substitute, Open Approach 02110K9 Bypass Coronary Artery, Two Sites to Left Internal Mammary with Nonautologous Tissue Substitute, Open Approach 37

38 02110KC Bypass Coronary Artery, Two Sites to Thoracic Artery with Nonautologous Tissue Substitute, Open Approach 02110Z8 Bypass Coronary Artery, Two Sites to Right Internal Mammary, Open Approach 02110Z9 Bypass Coronary Artery, Two Sites to Left Internal Mammary, Open Approach 02110ZC Bypass Coronary Artery, Two Sites to Thoracic Artery, Open Approach Bypass Coronary Artery, Two Sites to Right Internal Mammary with Autologous Venous Tissue, Percutaneous Endoscopic Approach Bypass Coronary Artery, Two Sites to Left Internal Mammary with Autologous Venous Tissue, Percutaneous Endoscopic Approach C Bypass Coronary Artery, Two Sites to Thoracic Artery with Autologous Venous Tissue, Percutaneous Endoscopic Approach 02114A8 Bypass Coronary Artery, Two Sites to Right Internal Mammary with Autologous Arterial Tissue, Percutaneous Endoscopic Approach 02114A9 Bypass Coronary Artery, Two Sites to Left Internal Mammary with Autologous Arterial Tissue, Percutaneous Endoscopic Approach 02114AC Bypass Coronary Artery, Two Sites to Thoracic Artery with Autologous Arterial Tissue, Percutaneous Endoscopic Approach 02114J8 Bypass Coronary Artery, Two Sites to Right Internal Mammary with Synthetic Substitute, Percutaneous Endoscopic Approach 02114J9 Bypass Coronary Artery, Two Sites to Left Internal Mammary with Synthetic Substitute, Percutaneous Endoscopic Approach 02114JC Bypass Coronary Artery, Two Sites to Thoracic Artery with Synthetic Substitute, Percutaneous Endoscopic Approach 02114K8 Bypass Coronary Artery, Two Sites to Right Internal Mammary with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach 02114K9 Bypass Coronary Artery, Two Sites to Left Internal Mammary with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach 02114KC Bypass Coronary Artery, Two Sites to Thoracic Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach 02114Z8 Bypass Coronary Artery, Two Sites to Right Internal Mammary, Percutaneous Endoscopic Approach 02114Z9 Bypass Coronary Artery, Two Sites to Left Internal Mammary, Percutaneous Endoscopic Approach 02114ZC Bypass Coronary Artery, Two Sites to Thoracic Artery, Percutaneous Endoscopic Approach C Bypass Coronary Artery, Three Sites to Thoracic Artery with Autologous Venous Tissue, Open Approach 02120AC Bypass Coronary Artery, Three Sites to Thoracic Artery with Autologous Arterial Tissue, Open Approach 02120JC Bypass Coronary Artery, Three Sites to Thoracic Artery with Synthetic Substitute, Open Approach 02120KC Bypass Coronary Artery, Three Sites to Thoracic Artery with Nonautologous Tissue Substitute, Open Approach 02120ZC Bypass Coronary Artery, Three Sites to Thoracic Artery, Open Approach C Bypass Coronary Artery, Three Sites to Thoracic Artery with Autologous Venous Tissue, Percutaneous Endoscopic Approach 02124AC Bypass Coronary Artery, Three Sites to Thoracic Artery with Autologous Arterial Tissue, Percutaneous Endoscopic Approach 02124JC Bypass Coronary Artery, Three Sites to Thoracic Artery with Synthetic Substitute, Percutaneous Endoscopic Approach 02124KC Bypass Coronary Artery, Three Sites to Thoracic Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach 38

39 02124ZC Bypass Coronary Artery, Three Sites to Thoracic Artery, Percutaneous Endoscopic Approach C Bypass Coronary Artery, Four or More Sites to Thoracic Artery with Autologous Venous Tissue, Open Approach 02130AC Bypass Coronary Artery, Four or More Sites to Thoracic Artery with Autologous Arterial Tissue, Open Approach 02130JC Bypass Coronary Artery, Four or More Sites to Thoracic Artery with Synthetic Substitute, Open Approach 02130KC Bypass Coronary Artery, Four or More Sites to Thoracic Artery with Nonautologous Tissue Substitute, Open Approach 02130ZC Bypass Coronary Artery, Four or More Sites to Thoracic Artery, Open Approach C Bypass Coronary Artery, Four or More Sites to Thoracic Artery with Autologous Venous Tissue, Percutaneous Endoscopic Approach 02134AC Bypass Coronary Artery, Four or More Sites to Thoracic Artery with Autologous Arterial Tissue, Percutaneous Endoscopic Approach 02134JC Bypass Coronary Artery, Four or More Sites to Thoracic Artery with Synthetic Substitute, Percutaneous Endoscopic Approach 02134KC Bypass Coronary Artery, Four or More Sites to Thoracic Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach 02134ZC Bypass Coronary Artery, Four or More Sites to Thoracic Artery, Percutaneous Endoscopic Approach Don t wait Facilities should be well into Phase II now Assessment of impact should be completed Comparison of training plans from different vendors Contracts for back up coding Remember the good companies are already getting booked up, so if you wait until late in 2012 to do this, you may not have the resources you want and/or cost will go up! 39

40 AHIMA.org Karen Scott Seminars and Consulting ICD-10-PCS information Medicare rules and laws Proposed and final changes ICD-9-CM procedure updates Karen Scott Seminars and Consulting 40

41 ICD-10-CM CM ICD-9-CM diagnosis updates Vital statistics Karen Scott Seminars and Consulting One thing I can conclude One has to learn havin' fun is just smilin' through Those Changes in Latitudes, Changes in Attitudes Take it from me cuz I've found If you leave it then somebody else is bound To find that treasure, that moment of pleasure When yours, it could have been Some people never find it Some... only pretend, but me: I just want to live happily ever after every now and then Jimmy Buffett, Every Now and Then 41