ICD 10 CM. What does it mean to YOU? It s all about specificity

Transcription

1 ICD 10 CM What does it mean to YOU? It s all about specificity

2 ICD TIMELINE ICD-9 Published by WHO in 1978 ICD-10 Endorsed by WHO in 1990 ICD-10-CM draft released in 1995 ICD-10 Used for mortality in the USA since 1999 ICD-10 Initially slated for implementation October 2013, has been delayed twice.

3 SUMMARY OF ICD-10 Replacing current ICD-9 in October 2015 No impact to CPT or HCPCS coding Code set is increasing Code format is changing Electronic claim format has changed (5010) Financial impact is definite Everyone in the practice must contribute

4 MANY BENEFITS TO ICD-10 Better specificity Terminology and language that complements clinical practice Reveal more about the quality of care Integral part of Meaningful Use Help to support medical necessity (reduced rejections) The US remains the only industrialized nation that has not yet implemented ICD-10 for morbidity reporting

5 DIFFERENCES ICD-9 ICD-10 13,600 Codes 69,000 Codes Consists of 3-5 Characters Alpha/numeric format utilizing only letters E & V Shorter code descriptions-lack of specificity Consists of 3-7 Characters Alpha/numeric format utilizing all letters except U Longer code descriptions because of greater clinical detail and specificity and full code titles required

6 STRUCTURAL CHANGES ICD-9-CM 3-5 characters 3-7 characters ICD-10-CM A Category of code B Etiology, anatomical site, and manifestation A - Category of code B - Etiology, anatomical site, and/or severity C - Extension Example The following letters would be used to identify the encounter of an injury A - Initial encounter D - Subsequent encounter S - Sequela A B A B C

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14 SITE SPECIFICITY / LATERALITY ICD-9-CM Code ICD-10-CM Code M Pain in right arm M Pain in left arm M Pain in arm, unspecified Pain in limb M Pain in unspecified limb M Pain in right upper arm M Pain in left upper arm M Pain in unspecified upper arm M Pain in right forearm M Pain in left forearm M Pain in unspecified forearm M Pain in right hand M Pain in left hand M Pain in unspecified hand M Pain in right finger(s) M Pain in left finger(s) M Pain in unspecified finger(s)

15 USE OF 7 TH CHARACTER EXTENSION OB Denoting which fetus in multiple gestations (numeric) Glaucoma Denoting the stage of the glaucoma (numeric) Gout Denoting with or without tophus/tophi (numeric) Injuries / Poisonings Denoting episode of care (alpha) External Causes Denoting episode of care (alpha)

16 USE OF 7 TH CHARACTER EXTENSION INJURIES/POISONINGS/OTHER CAUSES Lacerations Puncture wound Open bite/insect bite Abrasions Foreign body Contusion Blister External constriction Fracture Traumatic amputation Dislocation Sprain/strain/tear Traumatic brain injury Concussion Traumatic hemorrhage Burn/corrosion Poisoning/overdose Adverse effects of heat/cold Asphyxiation

17 F R A C T U R E S Traumatic Fractures Location Laterality Which bone? Which part of the bone? Encounter Type Initial Subsequent For routine healing For delayed healing For non-union For malunion Sequela (such as bone shortening) Open OR Closed Classification/Cause Gustilo Classification Salter-Harris Classification Neer Classification Pathological Fractures Location Laterality Which bone? Which part of the bone? Encounter Type Initial Subsequent For routine healing For delayed healing For non-union For malunion Sequela Etiology Osteoporosis Neoplastic disease Other specified Fracture Pattern See illustration Alignment Displaced/Non-displaced

18 ENCOUNTER TYPES 7 TH CHARACTERS FOR FRACTURE CODES A = Initial Enc for Closed Fx B = Initial Enc for Open Fx D = Subsequent Enc for Fx with routine healing G = Subsequent Enc for Fx with delayed healing K = Subsequent Enc for Fx with nonunion P = Subsequent Enc for Fx with malunion S = Sequela or late effect

19 ADDITIONAL 7 TH CHARACTERS FOR OPEN FX OF LONG BONES OF LIMBS B = Initial Enc for Open Fx Type I or II, or Open Fx NOS C = Initial Enc for Open Fx Type IIIA, IIIB or IIIC E = Subsequent Enc for Open Fx Type I or II, Routine Healing F = Subsequent Enc for Open Fx Type IIIA, IIIB or IIIC, Routine Healing H = Subsequent Enc for Open Fx Type I or II, Delayed Healing J = Subsequent Enc for Open Fx Type IIIA, IIIB or IIIC, Delayed Healing M = Subsequent Enc for Open Fx Type I or II, with Nonunion N = Subsequent Enc for Open Fx Type IIIA, IIIB or IIIC, with Nonunion Q = Subsequent Enc for Open Fx Type I or II, with Malunion R = Subsequent Enc for Open Fx Type IIIA, IIIB or IIIC, with Malunion

20 CLOSED, DISPLACED SPIRAL FRACTURE SHAFT OF LEFT RADIUS EPISODE OF CARE ICD-9-CM ICD-10-CM Patent presents to ER, acute injury S52.342A 2 Days later first visit with Ortho V54.12 S52.342A 2 Weeks later follow up, delayed healing V54.12 S52.342G 2 Weeks later mal-union noted, no treatment V54.12, S52.342P 4 Days later surgery for mal-union V54.12, S52.342A 2 Weeks later follow up, routine healing V54.12 S52.342D 6 Months later, sequela - ongoing numbness 905.2, R20.0 S52.342S

21 CLOSED, DISPLACED SPIRAL FRACTURE SHAFT OF LEFT RADIUS EPISODE OF CARE ICD-9-CM ICD-10-CM Patent presents to ER, acute injury S52.342A 2 Days later first visit with Ortho V54.12 S52.342A 2 Weeks later follow up, delayed healing V54.12 S52.342G 2 Weeks later mal-union noted, no treatment V54.12, S52.342P 4 Days later surgery for mal-union V54.12, S52.342A 2 Weeks later follow up, routine healing V54.12 S52.342D 6 Months later, sequela - ongoing numbness 905.2, R20.0 S52.342S

22 ICD-9-CM ICD-10-CM September 2015 October 2015

23 ICD-9-CM ICD-10-CM September 2015 October 2015

24 DIFFERENCE IN DEFINITION AND CLASSIFICATIONS ICD-9-CM Abortion vs. Fetal Death Early fetal death before completion of 22 weeks Acute Myocardial Infarction With stated duration of 8 weeks or less Pregnancy (Episode of Care) Antepartum Postpartum Delivered or not ICD-10-CM Abortion vs. Fetal Death Early fetal death before completion of 20 weeks Acute Myocardial Infarction With stated duration of 4 weeks or less Pregnancy (Trimester) First Trimester Second Trimester Third Trimester

25 Tobacco Use If relevant, document whether patient has: Tobacco dependence (active or in remission) Non dependent tobacco use Past history of tobacco use (without current use) Exposure to second hand smoke Environmental Occupational Alcohol Use If relevant, document whether patient has: Alcohol dependence Alcohol abuse without dependence Alcohol use without abuse or dependence

26 QUESTIONS? Created by Mary K. Brown, CPC AHMA Approved ICD-10 Trainer Coding Coordinator, MIR