Unlocking Combina.on Codes in ICD-10-CM

Transcription

1 Unlocking Combina.on Codes in ICD-10-CM Training for all Healthcare Employees

2 What We ll Cover Today Today s Objec.ves Objec'ves: Provide an overview of selected ICD-10-CM guidelines Iden'fy various diagnoses that are combina'on codes Iden'fy various ways of coding different scenarios Understand how to report combina'on codes in ICD-10 Recognize combina'on codes that carry higher specificity and carry more value in risk adjustment models.

3 ICD-10 Basics and Reminders

4 New ICD-10 Features There were many new features in ICD-10-CM Ø Combina'on Codes Ø Expanded Codes Ø Laterality Ø 7 th Character Ø 2 types of Excludes notes

5 New ICD 10 Feature: Combina.on Codes Combina'ons codes allow for more specific code selec'on for condi'ons with symptoms or manifesta'ons (these required more than one code in ICD-9-CM) E10.21, Type I Diabetes Mellitus with Diabe'c Nephropathy I25.110, Atherosclero'c heart disease of na've coronary artery with unstable angina pectoris K50.112, Crohn s disease of large intes'ne with intes'nal obstruc'on Combina'ons are also found to describe poisonings and their external causes T36.0x1D, Poisoning by penicillin's, accidental (uninten'onal), subsequent encounter T42.4x5A, Adverse effect of benzodiazepines, ini'al encounter

6 New ICD 10 Feature: Laterality (Right, LeM, Unspecified) When appropriate, codes specify anatomical loca'on of issue/ problem as pertaining to the right side, le` side, or unspecified Right side is usually character 1 and Le` is usually 2, Bilateral is usually 3, Unspecified is usually a 0 or 9, depending if a 5 th or 6 th character (some situa'ons do not follow this) H60.332, Swimmer s ear, lem ear M94.211, Chondromalacia, right shoulder S40.259A, Superficial foreign body of unspecified shoulder, ini'al encounter

7 New ICD 10 Feature: Expanded Codes Expanded codes allow for more complex condi'ons to be described in full. They are seen in diabetes, alcohol and substance abuse, injuries, and postopera've complica'ons E11.341, Type 2 diabetes mellitus with severe nonprolifera've diabe'c re'nopathy with macular edema F14.221, Cocaine dependence with intoxica'on delirium K91.71, Accidental puncture and lacera'on of a diges've system organ or structure during a diges've system procedure

8 New ICD 10 Feature: 7 th Character (Episode Of Care, Staging, Trimester, etc.) 7 th character extensions are used to communicate the episode of care (sequelae) injuries, and external causes of injuries The 7 th characters are different for each chapter that uses them, for example in glaucoma, they are used to show stage, and in OB they show trimester If a 7 th character extension is used, it must always be the 7 th and last character of the code. If the code is less than 7 characters, then placeholder x must be used to fill any empty character(s) M80.051A, Age-related osteoporosis with current pathological fracture, right femur, ini.al encounter for fracture S06.0x1A, Concussion with loss of consciousness of 30 minutes or less, ini.al encounter S52.132B, Displaced fracture of neck of le` radius, ini.al encounter for open fracture Type I or II or ini.al encounter for open fracture, NOS

9 New ICD 10 Feature: Use of 7 th Character Obstetrics Injuries Injury & External Causes of Injury: 7 th Character Identifies Injury External Causes of Injuries Alpha or numeric Placeholder x INITIAL Receiving active treatment SUBSEQUENT Receiving routine care during healing or recovery, AFTER active treatment SEQUELA Complications or conditions arising as a result of a condition Character meaning varies in each chapter

10 ICD-10-CM Code Structure Alpha (Except U) 2 Numeric 3-7 Numeric or Alpha Additional Characters. M S X A X 0 X 2. X 6 X 5 X x X A Category Etiology, anatomic site, severity Added 7 th character for obstetrics, injuries, and external causes of injuries

11 NEC vs. NOS Not Elsewhere Classified (NEC): This provides a code for other or other specified H26.8 Other specified cataract I25.89 Other forms of chronic ischemic heart disease *No'ce 4 th digit 8 Not Otherwise Specified(NOS): This provides a code when the documenta.on is insufficient to assign a more specific code H40.9 Unspecified glaucoma J12.9 Viral pneumonia, unspecified * No'ce 4 th digit 9

12 Other and Unspecified The 4 th character 8, when placed a`er a decimal point, is used to indicate some other specified category The 4 th character 9, when placed a`er a decimal point, is used to indicate and unspecified condi'on This helps give numbers to represent the difference between (NEC) (not elsewhere classified) and (NOS) (not otherwise specified). In ICD-10-CM, the other specified and unspecified each have their own code The abbrevia'on NOS (Not Otherwise Specified) in the Tabular List is equal to unspecified A04.9 Bacterial intes'nal infec'on, unspecified Bacterial enteri's NOS K52.89, Other specified noninfec've gastroenteri's and coli's K52.9, Non-infec've gastroenteri's and coli's, unspecified

13 With vs. Without When with and without are the choices for the final character of an ICD-10-CM code, the default is always without When there is a 5 character code, a 0 as the fi`h character represents without and 1 represents with When there is a 6 character code, a 1 as the sixth character represents with and a 9 represents without G Epilep'c seizures related to external causes, not intractable, with status epilep.cus G Epilep'c seizures related to external causes, not intractable, without status epilep.cus

14 Parentheses ( ) Punctua.on - ( ) Parentheses are used to enclose supplemental words that may or may not be documented and does not affect code selec'on. Terms in the parentheses are called nonessen'al modifiers Anemia (essen'al) (general) (hemoglobin deficiency) (infan'le) (primary) (profound) Diabetes, diabe'c (mellitus) (sugar) Hemophilia (classical) (familial) (hereditary) H44.611, Retained (old) magne'c foreign body in anterior chamber, right eye I10 Essen'al (primary) hypertension K51.011, Ulcera've (chronic) pancoli's with rectal bleeding

15 Brackets [ ] Punctua.on - [ ] Brackets enclose synonyms, alterna've wordings, or explanatory phrases in the tabular list and iden'fy manifesta'on codes in the alphabe'cal index Index: Disease, Alzheimer s G30.9 [F02.80] Nephrosis, in amyloidosis E85.4 [N08] Tabular: B06, Rubella [German Measles] J00, Acute nasopharyngi's [common cold]

16 Colons : Punctua.on - : Colons are used in the tabular a`er an incomplete term which needs one or more of the modifiers following the colon to make the code complete. The colon is used with both includes and excludes notes, in which the words that precede the colon are not considered complete terms and must be appended by one of the modifiers indented under the statement before the condi'on can be assigned the correct code G73.7 Myopathy in disease classified elsewhere Excludes1: myopathy in: rheumatoid arthri's (M05.32) sarcoidosis (D86.87) scleroderma (M34.82) sicca syndrome [Sjögren] (M35.03) systemic lupus erythematosus (M32.19)

17 Combina.on Code Only u'lize a combina'on code when the code fully describes the condi'ons documented or when ICD-10-CM directs their use. Whenever any combina'on code lacks any required elements or specificity, an addi'onal code should be used as a secondary code A combina'on code is a single code used to describe: Two diagnoses, or A diagnosis with an associated secondary process (manifesta'on), or A diagnosis with an associated complica'on

18 Combina.on Code Guidelines state that mul'ple codes should not be used when you clearly have a combina'on code that iden'fies all of the elements in the diagnosis When you suspect that a combina'on code may be applicable, but suppor'ng documenta'on is lacking query the physician

19 ICD-10-CM Conven.ons Instruc.onal Notes: Various forms of instruc'onal notes are used in ICD-10-CM such as code first, use addi'onal code, and cross reference notes Includes: It is important to remember that the list of inclusions terms is not exhaus've and may include diagnoses not listed in the inclusion note. The word Includes will appear at the beginning of a chapter, sec'on or category, however it will not appear in a list of terms found under the code in the tabular

20 ICD-10-CM Conven.ons Includes examples: K25 Gastric Ulcer Includes: erosion (acute) of stomach pylorus ulcer (pep'c) stomach ulcer (pep'c) K31.5 Obstruc.on of duodenum Constric.on of duodenum Duodenal ileus (chronic) Stenosis of duodenum Stricture of duodenum Volvulus of duodenum

21 New Feature: 2 Excludes Notes 2 types of Excludes notes to differen'ate between when two codes MAY be used together if they are both present vs. when two codes can NEVER be used together because it would be clinically impossible. Excludes1 note indicates not coded here. The code being excluded can never be used with the code above being chosen because it would be clinically impossible. [Ex. B06, Rubella (German measles) has an exclusion1 of congenital rubella (P35.0).] There was a guidance update that you may code both if they are unrelated. Excludes 1 = There can only be one Excludes2 note indicates not included here. The code with this exclusion is not already being represented by the code above being chosen and it is acceptable to use both codes if they are both true for the pa'ent. [ex. J04.0, Acute laryngi's has an Excludes2 of Chronic laryngi's (J37.0).] Excludes 2 = Means there can be two

22 The Rubric or Family Code The first 3 characters of any ICD code are called the rubric or you can think of them as a code family. This is highly important, especially in ICD-10-CM, as when reviewing codes, one may be several pages away from the root family code. There are important includes and excludes notes that are some'mes found directly under your code, but also some'mes found under the family, rubric, root code. Always go back to the root/rubric.

23 2017 ICD-10 Changes & Updates

24 2017 Changes & Updates A. Conven.ons for the ICD-10-CM 12. Excludes Notes a. Excludes1 A type 1 Excludes note is a pure excludes note. It means NOT CODED HERE An Excludes1 note indicates that the code excluded should never be used at the same 'me as the code above the Excludes1 note. An Excludes1 is used when two condi'ons cannot occur together such as a congenital form versus an acquired form of the same condi'on. An excep.on to the Excludes1 defini.on is the circumstance when the two condi.ons are unrelated to each other. If it is not clear whether the two condi.ons involved in an Excludes1 note are related or not, query the provider.

25 2017 Changes & Updates A. Conven.ons for the ICD-10-CM 14. Documenta.on for BMI, Depth of Non-pressure ulcers, Pressure Ulcer Stages, Coma Scale, and NIH Stroke Scale For the Body Mass Index (BMI), depth of non-pressure chronic ulcers, pressure ulcer stage, coma scale, and NIH stroke scale (NIHSS) codes, code assignment may be based on medical record documenta'on from clinicians who are not the pa'ent s provider (i.e. physician or other qualified healthcare prac''oner legally accountable for establishing the pa'ent s diagnosis), since this informa'on is typically documented by other clinicians involved in the care of the pa'ent (e.g., a die'cian o`en documents the BMI, a nurse o`en documents the pressure ulcer stages, and an emergency medical technician omen documents the coma scale). However, the associated diagnosis (such as overweight, obesity, acute stroke, or pressure ulcer) must be documented by the pa'ent s provider. If there is conflic'ng medical record documenta'on, either from the same clinician or different clinicians, the pa'ent's arending provider should be queried for clarifica'on. The BMI, coma scale, and NIHSS codes should only be reported as secondary diagnoses.

26 2017 Changes & Updates A. Conven.ons for the ICD-10-CM 15. With The word with should be interpreted to mean associated with or due to when it appears in a code 'tle, the Alphabe'c Index, or an instruc'onal note in the Tabular List. The classifica.on presumes a causal rela.onship between the two condi.ons linked by these terms in the Alphabe.cal Index or Tabular List. These condi.ons should be coded as related even in the absence of provider documenta.on explicitly linking them, unless the documenta.on clearly states that the condi.ons are unrelated. For condi.ons not specifically linked by these rela.onal terms in the classifica.on, provider documenta.on must link the condi.ons in order to code them as related.

27 2017 Changes & Updates A. Conven.ons for the ICD-10-CM 19. Code Assignment and Clinical Criteria The assignment of a diagnosis code is based on the provider s diagnos.c statement that the condi.on exists. The provider s statement that the pa.ent has a par.cular condi.on is sufficient. Code assignment is not based on clinical criteria used by the provider to establish the diagnosis.

28 2017 Changes & Updates B. General Coding Guidelines 13. Laterality When a pa.ent has a bilateral condi.on and each side is treated during separate encounters, assign the bilateral code (as the condi.on s.ll exists on both sides), including for the encounter to treat the first side. For the second encounter for treatment amer one side has previously been treated and the condi.on no longer exists on that side, assign the appropriate unilateral code for the side where the condi.ons s.ll exists (e.g., cataract surgery performed on each eye in separate encounters). The bilateral code would not be assigned for the subsequent encounter, as the pa.ent no longer has the condi.on in the previously treated site. If the treatment on the first side did not completely resolve the condi.on, then the bilateral code would s.ll be appropriate.

29 2017 Changes & Updates Chapter 9: Diseases of the Circulatory System (I00-I99) a. Hypertension The classifica.on presumes a causal rela.onship between hypertension and heart involvement and between hypertension and kidney involvement, as the two condi.ons are linked by the term with in the Alphabe.c Index. These condi.ons should be coded as related even in the absence of provider documenta.on explicitly linking them, unless the documenta.on clearly states the condi.ons are unrelated. For hypertension and condi.ons not specifically linked by rela.onal terms such as with, associated with, or due to in the classifica.on, provider documenta.on must link the condi.ons in order to code them as related.

30 2017 Changes & Updates Chapter 18: Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified i. NIHSS Stroke Scale The NIH stroke scale (NIHSS) codes (R29.7--) can be used in conjunc.on with acute stroke codes (I63) to iden.fy the pa.ent s neurological status and severity of the stroke. The stroke scale codes should be sequenced amer the acute stroke diagnosis code(s). At a minimum, report the ini.al score documented, If desired, a facility may choose to capture mul.ple stroke scale scores.

31 2017 Changes & Updates Chapter 19: Injury, poisoning, and certain other consequences of external causes a. Applica.on of 7 th Characters in Chapter th character A, ini'al encounter is used for each encounter where the pa'ent is receiving ac've treatment for the condi'on. 7th character D subsequent encounter is used for encounters a`er the pa'ent has completed ac've treatment of the condi'on and is receiving rou'ne care for the condi'on during the healing or recovery phase....

32 2017 Changes & Updates Sec.on IV. Diagnos.c Coding and Repor.ng Guidelines for Outpa.ent Services P. Encounters for medical examina.ons with abnormal findings An examina.on with abnormal findings refers to a condi.on/diagnosis that is newly iden.fied or a change in severity of a chronic condi.on (such as uncontrolled hypertension, or an acute exacerba.on of chronic obstruc.ve pulmonary disease) during a rou.ne physical examina.on.

33 Selected Combina.on Codes

34 Disseminated Candidiasis Candidal Sepsis B37.7 Disseminated candidiasis Systemic candidiasis q The B37 family is for Candidiasis. Use of the B37.7 code states both candidiasis along with related sepsis are present, note the inclusion of disseminated and systemic on the inclusive wording.

35 Combina.on codes that include MRSA Pneumonia due to MRSA J Do not code B95.62 with J Code first associated influenza, if applicable Code also associated abscess, if applicable

36 Sickle Cell Disease Sickle Cell Disease without crisis D57.1 Sickle Cell Anemia, Disease, or Disorder, NOS Hb-SS disease without crisis q Use of the D57.1 code is for sickle cell without crisis. Note there are other more specific codes for specific types of SS disease. Hb-SS Disease with crisis D57.0- D57.01 with acute chest syndrome D57.02 with splenic sequestra'on

37 DM w Ophthalmic Manifesta.ons DM with ophthalmic manifesta.ons includes the following codes: E E (Type I) E E (Type II) (non-prolifera've re'nopathy, with or without macular edema) DM with prolifera.ve re.nopathy, includes the following codes: E (E11.351) with macular edema E (E11.359) without macular edema

38 DM w Circulatory Complica.ons E10.5 (E11.5) DM with Circulatory Complica.ons E10.51 (E11.51) DM with diabe'c peripheral angiopathy without gangrene (default) E10.52 (E11.52) DM with diabe'c peripheral angiopathy with gangrene

39 Diabetes Coding Clinic 2016 The Coding Clinic issued guidance in Quarter 1 and Quarter 2 regarding the coding of diabetes and manifesta'ons. The word with may be understood as DM with a manifesta'on and providers do not need to state the cause and effect. These condi,ons should be coded as related even in the absence of provider documenta,on explicitly linking them, unless the documenta,on clearly states the condi,ons are unrelated and due to some other underlying cause besides diabetes.

40 Hypertensive CKD & Heart Disease Hypertension Type ICD-9-CM ICD-10-CM HTN (primary, benign, essential, malignant) 401.x I10 with Heart Disease *Must Document Cause & Effect 402.xx I11.x with CKD [Cause & Effect are Assumed] 403.xx I12.x with Heart & Kidney Disease *Must Document Cause & Effect for Heart Disease 404.xx I13.x Hypertension, secondary 405.xx I15.x

41 Hypertensive Heart Disease I11.0 Hypertensive heart disease with heart failure (hypertensive heart failure) Includes condi,ons I51.4-I51.9 Use addi,onal code to iden,fy type of heart failure (I50.-) I11.9 Hypertensive heart disease without heart failure Includes condi,ons I51.4-I51.9 Hypertensive heart disease NOS

42 Hypertensive CKD I12.0 Hypertensive chronic kidney disease with Stage 5 CKD or ESRD Arteriosclerosis of kidney, Arteriosclero,c nephri,s, Hypertensive nephropathy, Nephrosclerosis Includes condi,ons N18 & N26 due to HTN Use addi,onal code to iden,fy stage of CKD (N18.5, N18.6) I12.9 Hypertensive chronic kidney disease with stage 1 stage 4 CKD, or unspecified CKD Hypertensive chronic kidney disease NOS Hypertensive renal disease NOS Use addi,onal code to iden,fy stage of CKD (N18.1-4, N18.9)

43 Hypertensive CKD & Heart Failure I13.0 Hypertensive heart & chronic kidney disease with heart failure & stage 1-4 CKD Any condi,on in I11.1- with any condi,on in I Cardiorenal disease, Cardiovascular renal disease Use addi,onal code to iden,fy type of heart failure (I50.-) Use addi,onal code to iden,fy stage of CKD (N18.1-4, N18.9) I13.2 Hypertensive heart & chronic kidney disease with heart failure & stage 5 CKD or ESRD Any condi,on in I11.1- with any condi,on in I Cardiorenal disease, Cardiovascular renal disease Use addi,onal code to iden,fy type of heart failure (I50.-) Use addi,onal code to iden,fy stage of CKD (N18.1-4, N18.9)

44 Hypertensive CKD w/o Heart Failure I13.10 Hypertensive heart & chronic kidney disease without heart failure & stage 1-4 CKD Any condi,on in I11.1- with any condi,on in I Cardiorenal disease, Cardiovascular renal disease Use addi,onal code to iden,fy type of heart failure (I50.-) Use addi,onal code to iden,fy stage of CKD (N18.1-4, N18.9) I13.11 Hypertensive heart & chronic kidney disease without heart failure & stage 5 CKD or ESRD Any condi,on in I11.1- with any condi,on in I Cardiorenal disease, Cardiovascular renal disease Use addi,onal code to iden,fy type of heart failure (I50.-) Use addi,onal code to iden,fy stage of CKD (N18.1-4, N18.9)

45 CAD w/ Angina I25.1 family is for Atherosclero.c heart disease of na.ve coronary artery (note we assume na.ve if no CABG in the DOS being reviewed) This also includes: Atherosclero.c cardiovascular disease, Coronary (artery) Atheroma, Coronary (artery) atherosclerosis, Coronary (artery) disease [AKA: CAD], Coronary artery sclerosis *Use addi,onal code to iden,fy... (smoking, exposure, calcified lesions, lipid rich plaque, etc.) I Atherosclero.c heart disease of na.ve coronary artery with angina pectoris I Atherosclero.c heart disease of na.ve coronary artery with unstable angina pectoris I Atherosclero.c heart disease of na.ve coronary artery with angina pectoris with documented spasm I Atherosclero.c heart disease of na.ve coronary artery with other forms of angina pectoris pectoris I Atherosclero.c heart disease of na.ve coronary artery with unspecified angina pectoris

46 Embolisms w Acute Cor Pulmonale I26.01 Sep.c pulmonary embolism with acute cor pulmonale Code first underlying infec'on I26.02 Saddle embolus of pulmonary artery with acute cor pulmonale I26.09 Other pulmonary embolism with acute cor pulmonale Acute cor pulmonale NOS q The I26.0 family is for Pulmonary embolism with acute cor pulmonale.

47 Atherosclerosis extremi.es w Ulcer Codes for atherosclerosis of extremi.es with ulcera.on are also combina.on codes Use addi'onal code to iden'fy severity of ulcer (L97.-) I Atherosclerosis of na.ve arteries of right leg with ulcera.on I Atherosclerosis of na.ve arteries of lem leg with ulcera.on I70.25 Atherosclerosis of na.ve arteries of other extremi.es with ulcera.on

48 Atherosclerosis bypass gram w Ulcer Codes for bypass gram of extremi.es with ulcera.on are also combina.on codes Examples found on next slide in table Use addi'onal code to iden'fy severity of ulcer (L97.-)

49 Atherosclerosis bypass gram w Ulcer Code Type Location I unspecified type of bypass graft(s) Right I unspecified type of bypass graft(s) Left I70.35 unspecified type of bypass graft(s) Other I autologous vein bypass graft(s) Right I autologous vein bypass graft(s) Left I70.45 autologous vein bypass graft(s) Other I nonautologous biological bypass graft(s) Right I nonautologous biological bypass graft(s) Left I70.55 nonautologous biological bypass graft(s) Other I nonbiological bypass graft(s) Right I nonbiological bypass graft(s) Left I70.65 nonbiological bypass graft(s) Other I Other type of bypass graft(s) Right I Other type of bypass graft(s) Left I70.75 Other type of bypass graft(s) Other

50 Crohn s disease w obstruc.on Codes for Crohn s disease (regional enteri.s) with obstruc.on are also combina.on codes Use addi'onal code to iden'fy manifesta'ons, such as: pyoderma gangrenosum (L88) K Crohn s disease of small intes.ne with intes.nal obstruc.on K Crohn s disease of large intes.ne with intes.nal obstruc.on K Crohn s disease of both small and large intes.ne with intes.nal obstruc.on K Crohn s disease, unspecified, with intes.nal obstruc.on

51 Ulcera.ve coli.s w obstruc.on Codes for ulcera.ve coli.s with obstruc.on are also combina.on codes Use addi'onal code to iden'fy manifesta'ons, such as: pyoderma gangrenosum (L88) K Ulcera.ve (chronic) pancoli.s with intes.nal obstruc.on K Ulcera.ve (chronic) proc..s with intes.nal obstruc.on K Ulcera.ve (chronic) rectosigmoidi.s with intes.nal obstruc.on K Inflammatory polyps of colon with intes.nal obstruc.on K LeM sided coli.s with intes.nal obstruc.on K Other ulcera.ve coli.s with intes.nal obstruc.on K Ulcera.ve coli.s, unspecified, with intes.nal obstruc.on

52 Rheumatoid arthri.s w polyneuropathy Note that in ICD-10 there is a differen.a.on between RA with rheumatoid factor (M05.-) and Rheumatoid arthri.s without rheumatoid factor (M06.-), and when in doubt our default is without. M05.5- Rheumatoid polyneuropathy with rheumatoid arthri.s

53 Systemic lupus erythematosus (SLE) Note that in ICD-10, SLE NOS = M32.9 This includes: systemic lupus erythematosus NOS, Systemic lupus erythematosus without organ involvement M32.13 Lung involvement in systemic lupus erythematosus

54 Dermatopolymyosi.s w lung involvement M33 Dermatopolymyosi.s: family of myosi's disorders that includes polymyosi's & dermatomyosi's M33.01 Juvenile dermatopolymyosi.s with respiratory involvement M33.11 Other dermatopolymyosi.s with respiratory involvement M33.21 Polymyosi.s with respiratory involvement M33.91 Dermatopolymyosi.s, unspecified with respiratory involvement

55 Scleroderma/ Sicca w lung involvement M34 Systemic sclerosis (scleroderma): Autoimmune disease with hardening of the skin. (can affect organs when severe) M35.0 Sicca syndrome (SjÖgren): Autoimmune disease that aracks exocrine glands, specifically saliva and tears. M Systemic sclerosis (scleroderma) with lung involvement M35.02 Sicca syndrome with lung involvement

56 Condi.ons due to drugs, medica.ons, and biological substances ICD -10-CM combina'on codes denote whether the pa'ent has experienced a poisoning, adverse effect, or under dosing as well as the specific substance responsible for the outcome. Pa'ent presents with accidental cocaine overdose T40.5X1-

57 Summary You should now be able to understand the following: Some of the basics ICD-10-CM guidelines Some of the combina'on codes found in ICD-10 How to maximize looking at base rubric/family codes The importance of reviewing includes and excludes for the code as well as the code family/rubric

58 Take Away Knowing that there is a combina'on code can be one of the most challenging aspects Scan all the chapters of the ICD-10 and highlight codes that you frequently report that were previously reported with 2 ICD-9 codes USE YOUR BOOK check the alphabe.c and tabular indices to look for any instruc.onal notes that may be applicable

59 Take Away Take your 'me and review the diagnos'c statement carefully, incorrect coding affects data quality and reimbursement could be at risk You need ongoing educa.on with respect to anatomy, physiology and the e'ology of diseases If the physician doesn t link two condi'ons you should be able to recognize that these are typically related and query the physician

60 Take Away Include your physicians in the educa'onal process whenever possible.

61 Fundamentals Quiz

62 Applying Concepts Quiz 1. Expanded Codes allow for more Complex condi'ons to be described in full. True or False

63 Applying Concepts Quiz 1. Answer: True Ra,onale: They capture more detail such as C50.511, malignant neoplasm of lower-outer quadrant of right female breast

64 Applying Concepts Quiz 2. Which statement is true about the 7 th Character: a) It is used to communicate injury b) If you are not sure what the episode of care is use X as your 7 th character c) Are used to communicate the episode of care for injuries and external causes of injuries

65 Applying Concepts Quiz 2. Answer: c) Are used to communicate the episode of care for injuries and external causes of injuries Ra,onale: X is used as a placeholder if the code is less than 7 characters.

66 3. () Parentheses are used to enclose words that must be documented: True or False Applying Concepts Quiz

67 Applying Concepts Quiz 3. Answer: False. Ra,onale: they are used to enclose supplemental words that may or may not be documented and does not affect code selec,on. They are called nonessen8al modifiers.

68 Applying Concepts Quiz 4. A Rubric is: a) A cube b) Not important it does not have all of the necessary characters c) May have important includes and excludes notes

69 Applying Concepts Quiz 4. Answer: c) May have important includes and excludes notes Ra,onale: The Rubric is the the first 3 characters of any ICD code. And some,mes have important includes and excludes notes directly under the family, rubric root code.

70 Applying Concepts Quiz 5. NOS is an abbrevia'on for: a) Not on site b) Never once seen c) Not Otherwise Specified

71 Applying Concepts Quiz 5. Answer: c) Not Otherwise Specified Ra,onale: NOS (Not Otherwise Specified) in the Tabular List is equal to unspecified

72 Applying Concepts Quiz 6. When a diagnosis code selec'on is either with or without. With is the default. True or False

73 Applying Concepts Quiz 6. Answer: False Ra,onale: The default is always without

74 Applying Concepts Quiz 7. You can use either mul'ple codes or a combina'on code, both accurately describe the diagnosis True or False

75 Applying Concepts Quiz 7. Answer: False Ra,onale: Guidelines state that when you clearly have a combina,on code that iden,fies all of the elements in the diagnosis you should use mul,ple codes.

76 Applying Concepts Quiz 8. Excludes 1 has a guidance update that you can code both if they are unrelated True or False

77 Applying Concepts Quiz 8. Answer: True Ra,onale: There was an update please be sure that the 2 diagnosis codes are unrelated.

78 Applying Concepts Quiz 9. What do you code when the diagnosis is bilateral but the code selec'on does not have an op'on for bilateral: a) Use both right and le` diagnosis codes b) Use the NOS op'on c) Only code either right or le`

79 Applying Concepts Quiz 9. Answer: a) Use both of the right and lem codes Ra,onale: Per Coding Guidelines

80 Applying Concepts Quiz 10. Signs and Symptoms that are associated rou'nely with a disease process should not be assigned as addi'onal codes, unless otherwise instructed by the classifica'on. True or False

81 Applying Concepts Quiz 10. Answer: True Ra,onale: Per coding guidelines

82 Coding Clinic To submit a ques'on to the coding clinic go to the site below. hrp:// For AHA Coding Clinic Webinars go to: hrp:// webinars.shtml

83 Ques.ons/Feedback

84 Disclaimer For Illustra.ve, Educa.onal and Discussion Purposes Only This program may contain references or links to statutes, regula'ons, or other policy materials. The informa'on provided is intended only to be a general summary. It is not intended to take the place of either the wriren law or regula'ons. We encourage readers to review the specific statutes, regula'ons and other interpre've materials for a full and accurate statement of their contents.

85 Thank You Thanks for your awen.on.

86 Contact Brian Boyce, BSHS, CPC, CPC-I, CRC, CTPRP CEO, Proprietor, and Managing Consultant 2112 W. Laburnum Ave. Suite 109 Richmond, VA Medical Record Audit and Review - Physician Prac'ce Op'miza'on - Leadership Mentoring Healthcare Educa'on and Networking for Pa'ents and Professionals - Risk Adjustment 88