Disclaimer 11/15/2013. ICD-10-CM: No More Baby Steps. The APMA Coding Resource Center

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1 ICD-10-CM: No More Baby Steps October 1, 2014 Tick-Tock, Tick-Tock Presented by Harry Goldsmith, DPM Disclaimer This presentation is brought to you by Harry Goldsmith, DPM who is solely responsible for its content and delivery so don t complain to or blame WSPM about any demonstrated insensitivity, poor judgment, unfunny jokes, puns that aren t punny, or lack of taste. The APMA Coding Resource Center 1

2 The APMA Coding Resource Center Making Your Life Easier ICD-9 to ICD-10 Crosswalk The APMA Coding Resource Center New low price: $249 per year for APMA Members 2

3 Codingline-APMA s Coding in Paradise Seminar Right after the APMA Hawaii Seminar (July 28-31) Questions? hgoldsmith@codingline.com ICD-10-CM: October 1, 2014 Believe it ICD-10-CM Watch Medical Group Management Association s (MGMA) survey found in mid-june that 4.8% of medical practices have made significant progress in their readiness of ICD-10. 3

4 ICD-10-CM Watch 2013 National Physician Practice ICD-10 Readiness Survey notes 62% of medical practices surveyed said they have no ICD-10 implementation plan More than 33% said they did not know any of their vendors ICD-10 plans or timelines 22.4% of medical practices said they do not expect to be ready by October 1, 2014 What s the Worst that Can Happen? No dough ICD-10-CM Concerns Other Issues Same old, same old mentality Coding complexity Documentation details 2014: The perfect storm Meaningful use, stage 2 PQRS erx HIPAA Security, privacy 4

5 ICD-10-CM What is the ICD-10-CM code for when the sky (or things from the sky) falls on you? W Hockey puck T75.0- Lightning Y Guided missile V Spacecraft X39.8xxA Dorothy s house falling on the witch ICD-10-CM ICD-10 will be implemented October 1, There is no grace period. A sensible transition program can alleviate a scramble as the implementation date approaches; and avoid costly mistakes. ICD-10-CM Transition Preparation Timeline Wake up & realize ICD D-10 is happening Designate an office ICD D-10 person Contact vendors, clear ringhouse, payers Begin doctor/staff ICD- -10 education Identity everything you have ICD-9 on Identify your top ICD-9 codes Actively seek out ICD-1 10 lectures Review ICD-10 guideli nes Buy the APMA Coding Resource Center Convert your top ICD-9 9 codes to ICD-10 5

6 ICD-10-CM Transition Preparation Timeline Wake up & realize ICD D-10 is happening Designate an office ICD D-10 person Contact vendors, clear ringhouse, payers Begin doctor/staff ICD- -10 education Identify everything you have ICD-9 on Identify your top ICD-9 codes Actively seek out ICD-1 10 lectures Review ICD-10 guideli nes Buy the APMA Coding Resource Center Convert your top ICD-9 9 codes to ICD-10 ICD-10-CM Transition Preparation Timeline Wake up & realize ICD D-10 is happening Designate an office ICD D-10 person Contact vendors, clear ringhouse, payers Begin doctor/staff ICD- -10 education Identify everything you have ICD-9 on Identify your top ICD-9 codes Actively seek out ICD-1 10 lectures Review ICD-10 guideli nes Buy the APMA Coding Resource Center Convert your top ICD-9 9 codes to ICD-10 ICD-10-CM Transition Preparation Timeline Wake up & realize ICD D-10 is happening Designate an office ICD D-10 person Contact vendors, clear ringhouse, payers Begin doctor/staff ICD- -10 education Identify everything you have ICD-9 on Identify your top ICD-9 codes Actively seek out ICD-1 10 lectures Review ICD-10 guideli nes Buy the APMA Coding Resource Center Convert your top ICD-9 9 codes to ICD-10 6

7 New Insurance Claim Form (02 12) New Insurance Claim Form (02 12) ICD-10-CM Transition Preparation Timeline Wake up & realize ICD D-10 is happening Designate an office ICD D-10 person Contact vendors, clear ringhouse, payers Begin doctor/staff ICD- -10 education Identify everything you have ICD-9 on Identify your top ICD-9 codes Actively seek out ICD-1 10 lectures Review ICD-10 guideli nes Buy the APMA Coding Resource Center Convert your top ICD-9 9 codes to ICD-10 7

8 ICD-10-CM Transition Preparation Timeline Wake up & realize ICD D-10 is happening Designate an office ICD D-10 person Contact vendors, clear ringhouse, payers Begin doctor/staff ICD- -10 education Identify everything you have ICD-9 on Identify your top ICD-9 codes Actively seek out ICD-1 10 lectures Review ICD-10 guideli nes Buy the APMA Coding Resource Center Convert your top ICD-9 9 codes to ICD-10 ICD-10-CM Transition Preparation Timeline Wake up & realize ICD D-10 is happening Designate an office ICD D-10 person Contact vendors, clear ringhouse, payers Begin doctor/staff ICD- -10 education Identify everything you have ICD-9 on Identify your top ICD-9 codes Actively seek out ICD-1 10 lectures Review ICD-10 guideli nes Buy the APMA Coding Resource Center Convert your top ICD-9 9 codes to ICD-10 ICD-10-CM Transition Preparation Timeline Wake up & realize ICD D-10 is happening Designate an office ICD D-10 person Contact vendors, clear ringhouse, payers Begin doctor/staff ICD- -10 education Identify everything you have ICD-9 on Identify your top ICD-9 codes Actively seek out ICD-1 10 lectures Review ICD-10 guideli nes Buy the APMA Coding Resource Center Convert your top ICD-9 9 codes to ICD-10 8

9 ICD-10-CM Transition Preparation Timeline Wake up & realize ICD D-10 is happening Designate an office ICD D-10 person Contact vendors, clear ringhouse, payers Begin doctor/staff ICD- -10 education Identify everything you have ICD-9 on Identify your top ICD-9 codes Actively seek out ICD-1 10 lectures Review ICD-10 guideli nes Buy the APMA Coding Resource Center Convert your top ICD-9 9 codes to ICD-10 ICD-10-CM Transition Preparation Timeline Wake up & realize ICD D-10 is happening Designate an office ICD D-10 person Contact vendors, clear ringhouse, payers Begin doctor/staff ICD- -10 education Identify everything you have ICD-9 on Identify your top ICD-9 codes Actively seek out ICD-1 10 lectures Review ICD-10 guideli nes Buy the APMA Coding Resource Center Convert your top ICD-9 9 codes to ICD-10 ICD-10-CM Transition Preparation Timeline Wake up & realize ICD D-10 is happening Designate an office ICD D-10 person Contact vendors, clear ringhouse, payers Begin doctor/staff ICD- -10 education Identify everything you have ICD-9 on Identify your top ICD-9 codes Actively seek out ICD-1 10 lectures Review ICD-10 guideli nes Buy the APMA Coding Resource Center Convert your top ICD-9 9 codes to ICD-10 9

10 ICD-10-CM Transition Preparation Timeline Wake up & realize ICD D-10 is happening Designate an office ICD D-10 person Contact vendors, clear ringhouse, payers Begin doctor/staff ICD- -10 education Identify everything you have ICD-9 on Identify your top ICD-9 codes Actively seek out ICD-1 10 lectures Review ICD-10 guideli y away reserve operations fund nes Start putting money Buy the APMA Coding Resource Center Convert your top ICD-9 9 codes to ICD-10 ICD-10-CM Transition Preparation Timeline 9 codes to ICD-10 Convert your top ICD-9 What Is ICD-10-CM? It is an alphanumeric code used to translate words identifying diagnoses of diseases, circumstances, symptoms, other health problems, etc. into a universal, workable system that can be read by computer software, analyzed, acted upon, stored, and retrieved as needed. So, why should we care? 10

11 ICD-10-CM Q/As WHO owns ICD-10-CM? Why not skip ICD-10-CM and go to ICD-11-CM way, way down the road? ICD-10-CM Q/As What does the CM stand for in ICD-10-CM? Come October 1, 2014, will I only be dealing with ICD-10? What will be the biggest problem/issue association with ICD-10-CM implementation? Comparing ICD-9 to ICD-10 11

12 Comparing ICD-9 to ICD-10 ICD-9 Numeric characters (with exception of some codes beginning with V, E, M) ICD-10 Alphanumeric characters (always begin with an alpha [except U] character Alphanumeric Character Issue Alphanumeric Character Issue 12

13 Comparing ICD-9 to ICD-10 ICD-9 Numeric characters (with exception of some codes beginning with V, E, M) ICD-10 Alphanumeric characters (always begin with an alpha [except U] character 3-5 characters in length About 13,000 codes 3-7 characters in length About 68,000 codes Comparing ICD-9 to ICD-10 ICD-9 Formatting ICD-10 13

14 ICD-9 Structure - Format 3-5 character examples 700 Corn and callosities Hallux valgus (acquired) Nonunion of fracture V49.71 Lower limb amputation status, great toe ICD-10 Structure - Format 3-7 character examples L84 Corn and callosities B95.5 Staphylococcus aureus as the cause of diseases classified elsewhere M20.11 Hallux valgus (acquired), right foot S98.111A Complete traumatic amputation of right great toe (initial encounter) ICD-10 to ICD-9 Differences 14

15 ICD-10 to ICD-9 Differences Laterality (side of the body affected right/left) has been added to relevant codes Expanded use of combination codes Certain conditions and associated common symptoms or manifestations Combination Code Examples E11.52 Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene E Type 2 diabetes mellitus with foot ulcer I Monoplegia of lower limb following nontraumatic intracerebral hemorrhage affecting left non-dominant side I Atherosclerosis of native arteries of right leg with ulceration of other part of foot Other ICD-10 to ICD-9 Differences 15

16 It s In the Details ICD-9 V Lower limb amputation status, great toe ICD-10 Z89 Acquired absence of limb Z89.4 Acquired absence of toe(s), foot, & ankle Z89.41 Acquired absence of great toe Z Acquired absence of right great toe Other ICD-10 to ICD-9 Differences 16

17 Meet the 7 th Character (when required) ICD-10: The 7th Character Example: Fracture codes The fracture codes require a 7 th character: A - Initial encounter for closed fracture B - Initial encounter for open fracture D - Subsequent encounter for fracture with routine healing G - Subsequent encounter for fracture with delayed healing K - Subsequent encounter for fracture with nonunion P - Subsequent encounter for fracture with malunion S - Sequelae ICD-10: The 7th Character Another example 17

18 How Are ICD-10 & ICD-9 Similar? ICD-9 & ICD-10 Similarities Both ICD-9 and ICD-10 Alphabetic Indexes include The Index of Diseases and Injury The Index of External Causes of Injury The Tables of Neoplasm; and The Table of Drugs and Chemicals ICD-9 & ICD-10 Similarities Both ICD-9 and ICD-10 use an indented format Hallux rigidus (acquired) congenital The main term is listed in bold font with subordinate terms are listed beneath the main term in an indented format. 18

19 ICD-9 & ICD-10 Similarities Many of the terms along with their Definitions/applications Symbols Guidelines and Guidelines, and Conventions are the same in both ICD-9 and ICD-10. ICD-10 However Does have several new conventions that we will discuss today through examples. ICD-10 However Provides greater specificity through the expansion of the 3-5 ICD-9 code to a 3-7 ICD-10 codes. Which has resulted in A dramatic increase in the number of available codes A need for more accurate, detailed medical records 19

20 Any questions before I move on? ICD-10 Clue The Game of Clue A man has been murdered in a large mansion by one of six guests. It is up to the game players to find out which of the six guests, i.e., suspects, did the deed, which of the six weapons was used, and in which of nine possible rooms it was done. 20

21 The Game of Clue A man has been murdered in a large mansion by one of six guests. It is up to the game players to find out which of the six guests, i.e., suspects, did the deed, which of the six weapons was used, and in which of nine possible rooms it was done. The Game of Clue A man has been murdered in a large mansion by one of six guests. It is up to the game players to find out which of the six guests, i.e., suspects, did the deed, which of the six weapons was used, and in which of nine possible rooms it was done. The Game of Clue A man has been murdered in a large mansion by one of six guests. It is up to the game players to find out which of the six guests, i.e., suspects, did the deed, which of the six weapons was used, and in which of nine possible rooms it was done. 21

22 The ICD-10 Clue Game The suspect is The ICD-10 Clue Game Alyssa Stephenson, DPM The ICD-10 Clue Game Her weapon 22

23 The ICD-10 Clue Game Revolver 23

24 The ICD-10 Clue Game X93 The ICD-10 Clue Game The ICD-10 Clue Game Summary You are given a 3 character code X93 That requires a 7 th character A initial encounter D subsequent encounter S - sequela 24

25 The ICD-10 Clue Game We have the first 3 characters and a 7 character (A), and nothing in between. X93. _A The x Placeholder Because no specific character(s) exist in the 4 th, 5 th, and 6 th position, the letter x serves as a placeholder filling in character holes in the code when, in this case, it requires a 7 th character. X93.xxxA Assault (murder) by revolver, initial encounter The x Placeholder The x placeholder also allows for future code expansion. In those cases, you may see a single x within a code. 25

26 The x Placeholder Another example: When placeholder character applies, it must be used in order for the code to be considered valid. By the Way, X is NOT an x Placeholder The ICD-10 Clue Game Back to the game 26

27 The ICD-10 Clue Game The ICD-10 Clue Game EXCLUDES1 - Very Pistol EXCLUDES1 Indicates mutually exclusive codes - two conditions that cannot be reported together. Excludes1 note indicates that the code is excluded from the main code, and should never be used at the same time as the code above it. Example: A congenital condition and an acquired condition 27

28 EXCLUDES1 Example: EXCLUDES2 Indicates the excluded condition is not part of or defined by the condition it is excluded from, but both conditions can be present at the same time in the patient. When an Excludes2 note appears below a code, it is okay to use both that code and the Excludes2 code at the same time. Example: EXCLUDES2 28

29 The ICD-10 Clue Game Back to the game again The ICD-10 Clue Game What if it wasn t murder, but an accident? The ICD-10 Clue Game W Accidental handgun discharge W Accidental handgun malfunction Both codes require the appropriate 7 th character: A D S initial encounter subsequent encounter sequela 29

30 The ICD-10 Clue Game W Accidental handgun discharge W Accidental handgun malfunction Example: W32.0xxA The ICD-10 Clue Game What if the murder was done with one of the other weapons? Y00.xxxA Y00.xxxA Y00.xxxA T71.193A X99.1xxA 30

31 The ICD-10 Clue Game What if the victim was pecked by a bird? Pecked or bitten by a W61.01 parrot W61.11 macaw W61.21 cockatoo W61.33 chicken W61.43 turkey W61.51 goose W61.61 duck W61.91 all other birds * All need a 7 th character Brief Interlude History of Present Illness: The patient was waterskiing on Lake Meade at a company outing. The temperature was in the low 100s. Suddenly, without warning, her skis burst in flames and she sustained 1 st and d2 nd degree burns on her lower legs How does this happen? How do you code this? 31

32 Brief Interlude V91.07xA burn due to water skis on fire The real question is Is this work related? The ICD-10 Clue Game Back to the game The ICD-10 Clue Game Where did the murder occur? 32

33 The ICD-10 Clue Game Kitchen The ICD-10 Clue Game Y Kitchen of single-family house Excludes: mobile home The ICD-10 Clue Game What if it was done in a different room? 33

34 The ICD-10 Clue Game Y Other place in single-family house as the place of occurrence of the external cause Y Unspecified place in single-family house as the place of occurrence of external cause Other & Unspecified Y Other place in single-family house as the place of occurrence of the external cause Y Unspecified place in single-family house as the place of occurrence of external cause Other Other means the medical record details a condition or, in this case, place of occurrence that doesn t have an existing ICD-9 or 10 code 34

35 Unspecified Unspecified means there is not enough information in the medical record to assign a more specific code Would You Like to Play Again? No. Back to ICD-9 and ICD-10 Similarities 35

36 Searching for a Code With both ICD-9 and ICD-10, you begin your code search in the alphabetic index, then verify the code in the tabular list ICD-10 Example Alphabetic Index hallux valgus (acquired), left foot M20.1- ICD-10 Coding Format M20.1 code ending in a hyphen An ICD-10 code ending in a hyphen means the code is not detailed enough to bill. When a hyphen-ending code is seen in the alphabetic index of ICD-10, you must go to the tabular coding listing to look for a more specific description/more specific code. 36

37 Tabular List M20.1 Hallux valgus (acquired), left foot Tabular List M20.1 Hallux valgus (acquired), left foot Another Example? Your turn 37

38 Ready? Go! Stage III Decubitus Ulcer of Left Heel How do you begin? 38

39 Stage III Decubitus Ulcer of Left Heel You look up the main term Stage III Decubitus Ulcer of Left Heel Stage III Decubitus Ulcer of Left Heel Go to the Alphabetic Index Ulcer, ulcerated, ulcerating, ulceration See ulcer by site lower limb (atrophic) )(chronic)(neurogenic) (perforating) (pyogenic) (trophic) (topical) pressure/decubitus (pressure area) L89- heel L

40 Stage III Decubitus Ulcer of Left Heel Decubitus ulcer heel L89.6- Time to go to the Tabular Listing Stage III Decubitus Ulcer of Left Heel In the Tabular: L89- Stage III Decubitus Ulcer of Left Heel Look for a 4 character code beginning with L89 L89.6 Pressure ulcer of heel L89.62 Pressure ulcer of left heel L Pressure ulcer of left heel, stage III 40

41 Stage III Decubitus Ulcer of Left Heel L Stop! Eight Hours, Not Bad 41

42 Another Example Patient is seen with a painful bunion on the left foot. The exam reveals reduced ROM with pain reported with movement of MTPJ. X-rays confirm degenerative changes in MTPJ. ICD-9 diagnoses: ICD bunion ICD hallux limitus ICD osteoarthritis, localized, primary, foot ICD pain in limb (or ICD pain in joint, foot) Ready? 42

43 Go! ICD-10 Coding Steps Bunion (left foot) 1) Go to ICD-10 Index to Diseases & Injuries 2) Under B, find bunion Bunion see Deformity, toe, hallux valgus 43

44 ICD-10 Coding Steps Bunion see Deformity, toe, hallux valgus 1) Go to D 2) Look under Deformity 3) Find toe 4) Find hallux valgus ICD-10 Coding Steps Bunion see Deformity, toe, hallux rigidus 1) Look above hallux valgus and there is hallux rigidus M20.2- hallux rigidus ICD-10 Coding Steps We now have 2 of the 4 base codes we are looking for: M20.1- Hallux valgus, acquired M Hallux rigidus, id acquired 44

45 Moving to the Tabular Listing M20.1- and M20.2- ICD-10 Coding Steps M20.1 1) Go to ICD-10 Tabular List of Diseases & Injuries 2) In the list, look up M (Chapter 13 Diseases of the Musculoskeletal System and Connective Tissue) 3) Under M find M20.1 ICD-10 Coding Steps M20.1 Hallux valgus (acquired), left 45

46 ICD-10 Coding Steps M20.1 Hallux valgus (acquired), left ICD-10 Coding Steps M20.2 Hallux rigidus, left ICD-10 Coding Steps M Hallux rigidus, left 46

47 ICD-10 Coding Steps So far we have M20.12 Hallux valgus (acquired), left foot M Hallux rigidus, left foot That leaves two to go: Osteoarthritis Local pain ICD-10 Coding Steps Osteoarthritis, primary, foot 1) Go to ICD-10 Index to Diseases & Injuries 2) Under O, find osteoarthritis ICD-10 Coding Steps 47

48 ICD-10 Coding Steps Choices: M19.07-, M19.17-, or M ICD-10 Coding Steps Their common code root is M19 Moving to the Tabular Listing M19 48

49 ICD-10 Coding Steps M19 1) Go to ICD-10 Tabular List of Diseases & Injuries 2) In the list, look up M (Chapter 13 Diseases of the Musculoskeletal System and Connective Tissue) 3) Under M find M19 ICD-10 Coding Steps ICD-10 Coding Steps Our choices were: M M M

50 ICD-10 Coding Steps Osteoarthritis, foot, left ICD-10 Coding Steps Osteoarthritis, foot (primary), left foot ICD-10 Coding Steps So far we have M20.12 Hallux valgus (acquired), left foot M20.22 Hallux rigidus, left foot M Primary osteoarthritis, left foot That leaves one to go: Pain 50

51 ICD-10 Coding Steps Pain 1) Go to ICD-10 Index to Diseases & Injuries 2) Under P, find pain pain see Pain, lower limb ICD-10 Coding Steps Pain, limb, lower 1) Go to Pain, limb, lower 2) Find foot or toe M

52 Moving to the Tabular Listing M79.67 ICD-10 Coding Steps M ) Go to the ICD-10 Tabular List of Diseases & Injuries 2) In the list, look up M (Chapter 13 Diseases of the Musculoskeletal System and Connective Tissue) 3) Under M find M79.67 ICD-10 Coding Steps Pain, foot (or is pain in the toe?) 52

53 ICD-10 Coding Steps Finally ICD-10 M20.12 Hallux valgus (acquired), left foot ICD-10 M Hallux rigidus, left foot ICD-10 M Primary osteoarthritis, left foot and either ICD-10 M Pain, left foot or ICD-10 M Pain, left toe Stop! 53

54 Let s Play with ICD-10 Clinical Example: Plantar Spur Pre-Op Diagnosis: painful plantar fasciitis with heel spur, left foot Post-Op Diagnosis: same Procedure: endoscopic plantar fasciotomy, left ICD-10 Code(s)? Painful Plantar Fasciitis with Heel Spur, Left Foot Key term(s)? 54

55 Painful Plantar Fasciitis with Heel Spur, Left Foot Key term(s)? Fasciitis Painful Plantar Fasciitis with Heel Spur, Left Foot Key term(s)? Fasciitis Spur Painful Plantar Fasciitis with Heel Spur, Left Foot Begin by looking up fasciitis in the Alphabetic Index 55

56 Painful Plantar Fasciitis with Heel Spur, Left Foot 1) Go to ICD-10 Index to Diseases & Injuries 2) Under F find fasciitis 3) Under fasciitis find plantar Painful Plantar Fasciitis with Heel Spur, Left Foot Plantar fasciitis: M72.2 Moving to the Tabular Listing M

57 Painful Plantar Fasciitis with Heel Spur, Left Foot M72.2 Plantar fasciitis 1) In the Tabular List, look up M72.2 (Chapter 13 Diseases of Musculoskeletal System and Connective Tissue) Painful Plantar Fasciitis with Heel Spur, Left Foot M72.2 Plantar fasciitis Painful Plantar Fasciitis with Heel Spur, Left Foot M72.2 Plantar fasciitis 57

58 Painful Plantar Fasciitis with Heel Spur, Left Foot M72.2 Plantar fasciitis Need next main term spur Painful Plantar Fasciitis with Heel Spur, Left Foot Go to Alphabetic Index and look up spur Painful Plantar Fasciitis with Heel Spur, Left Foot 1) Go to ICD-10 Index to Diseases & Injuries 2) Under S find spur 58

59 Painful Plantar Fasciitis with Heel Spur, Left Foot 1) Go to ICD-10 Index to Diseases & Injuries 2) Under S find spur 3) Under spur find heel What? No Heel? Painful Plantar Fasciitis with Heel Spur, Left Foot 1) Think calcaneal M

60 Painful Plantar Fasciitis with Heel Spur, Left Foot But look there s an instruction: see also Enthesopathy Let s follow that instruction and see where it takes us, shall we? Painful Plantar Fasciitis with Heel Spur, Left Foot 1) In the Index, under E find enthesopathy Painful Plantar Fasciitis with Heel Spur, Left Foot 1) Under enthesopathy find calcaneal spur 60

61 Painful Plantar Fasciitis with Heel Spur, Left Foot Instruction #1: M77.3- Spur, bone, calcaneal see also Enthesopathy Instruction #2: Enthesopathy, calcaneal spur see Spur, bone, calcaneal Back to Calaneal Spur Painful Plantar Fasciitis with Heel Spur, Left Foot 1) Going back to spur stick with calcaneal M

62 Moving to the Tabular Listing M77.3- Painful Plantar Fasciitis with Heel Spur, Left Foot M77.3- Bone Spur, calcaneal 1) In the Tabular List, look up M77.3 (Chapter 13 Diseases of Musculoskeletal System and Connective Tissue) Painful Plantar Fasciitis with Heel Spur, Left Foot M77.3- Calcaneal spur 62

63 Painful Plantar Fasciitis with Heel Spur, Left Foot M77.3- Calcaneal spur Painful Plantar Fasciitis with Heel Spur, Left Foot M77.32 Calcaneal spur, left foot Painful Plantar Fasciitis with Heel Spur, Left Foot M72.2 Plantar fasciitis M77.32 Calcaneal spur, left foot One term left pain, painful 63

64 Painful Plantar Fasciitis with Heel Spur, Left Foot Question: Do you need to add pain? Painful Plantar Fasciitis with Heel Spur, Left Foot Go to Alphabetic Index and look up pain Painful Plantar Fasciitis with Heel Spur, Left Foot 1) Go to ICD-10 Index to Diseases & Injuries 2) Under p find pain 64

65 Painful Plantar Fasciitis with Heel Spur, Left Foot 1) Go to ICD-10 Index to Diseases & Injuries 2) Under pain find foot Go to Pain, lower limb Painful Plantar Fasciitis with Heel Spur, Left Foot 65

66 Painful Plantar Fasciitis with Heel Spur, Left Foot Moving to the Tabular Listing M M Painful Plantar Fasciitis with Heel Spur, Left Foot M Pain, lower limb, foot 1) In the Tabular List, look up M79.67 (Chapter 13 Diseases of Musculoskeletal System and Connective Tissue) 66

67 Painful Plantar Fasciitis with Heel Spur, Left Foot M Pain, lower limb, foot Painful Plantar Fasciitis with Heel Spur, Left Foot M Pain, lower limb, foot Painful Plantar Fasciitis with Heel Spur, Left Foot M72.2 Plantar fasciitis M77.32 Calcaneal spur, left foot p, M Pain, lower limb, foot (optional) 67

68 Ta da Clinical Example: Skin Lesion Pre-Op Diagnosis: skin lesion, sub4th metatarsal head, right foot; plantar verruca, right foot Post-Op Diagnosis: same Procedure: excision and ablation of verruca, right foot with CO 2 laser; biopsy skin lesion, sub4th metatarsal, right foot ICD-10 Code(s)? Plantar Verruca, Right Foot and Skin Lesion, Right Foot Key term(s)? 68

69 Plantar Verruca, Right Foot and Skin Lesion, Right Foot Key term(s)? Verruca Plantar Verruca, Right Foot and Skin Lesion, Right Foot Key term(s)? Verruca Lesion Plantar Verruca, Right Foot and Skin Lesion, Right Foot Begin by looking up verruca in the Alphabetic Index 69

70 Plantar Verruca, Right Foot and Skin Lesion, Right Foot 1) Go to ICD-10 Index to Diseases & Injuries 2) Under V find verruca 3) Under verruca find plantar or plantaris Moving to the Tabular Listing B07.0 Plantar Verruca, Right Foot and Skin Lesion, Right Foot B07.0 Verruca plantaris 1) In the Tabular List, look up B07.0 (Chapter 1 Certain Infectious and Parasitic Diseases) 70

71 Plantar Verruca, Right Foot and Skin Lesion, Right Foot B07.0 Verruca plantaris lantar Verruca, Right Foot and Skin Lesion, Right Foot B07.0 Verruca plantaris Need next main term lesion Plantar Verruca, Right Foot and Skin Lesion, Right Foot Go to the Alphabetic Index 71

72 Plantar Verruca, Right Foot and Skin Lesion, Right Foot 1) Go to ICD-10 Index to Diseases & Injuries 2) Under L find lesion 3) Under lesion find skin Moving to the Tabular Listing L98.9 Plantar Verruca, Right Foot and Skin Lesion, Right Foot L98.9 Lesion, skin 1) In the Tabular List, look up L98.9 (Chapter 12 Diseases of the Skin and Subcutaneous Tissue) 72

73 Plantar Verruca, Right Foot and Skin Lesion, Right Foot L98.9 Lesion, skin Plantar Verruca, Right Foot and Skin Lesion, Right Foot B07.0 Verruca plantaris L98.99 Lesion, skin Plantar Verruca, Right Foot and Skin Lesion, Right Foot B07.0 Verruca plantaris L98.99 Lesion, skin 73

74 Plantar Verruca and Skin Lesion B07.0 L98.99 Verruca plantaris Lesion, skin Ta da Educational Moment 74

75 NEOPLASMS OF UNCERTAIN BEHAVIOR NEOPLASMS OF UNCERTAIN BEHAVIOR What is a neoplasm of uncertain behavior? Certain histo-morphologically well-defined neoplasms, the subsequent behavior of which cannot be predicted from the present appearance. In English, please NEOPLASMS OF UNCERTAIN BEHAVIOR 1. The term "neoplasm of uncertain behavior" is a specific pathologic diagnosis. 2. This is a lesion whose behavior cannot be predicted. It's currently benign, but there's a chance that it could undergo malignant transformation over time. 3. It is not a lesion you are waiting for a pathology report or you are not willing to make a diagnosis on. 75

76 Next Clinical Example: Hammertoe Pre-Op Diagnosis: hammertoe, 2 nd toe, left; plantarflexed 2 nd met, right (congential) Post-Op Diagnosis: same Procedure: hammertoe correction 2 nd toe, left; osteotomy, 2 nd metatarsal, left ICD-10 Code(s)? Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left Key term(s)? 76

77 Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left Key term(s)? Hammertoe Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left Key term(s)? Hammertoe Metatarsal???? Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left Begin by looking up hammertoe in the Alphabetic Index 77

78 Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left 1) Go to ICD-10 Index to Diseases & Injuries 2) Under H find hammertoe 3) Is it acquired or congenital? Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left See also Deformity, toe, hammertoe 78

79 Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left 1) Go to ICD-10 Index to Diseases & Injuries 2) Under D find deformity Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left 1) Under deformity find toe 2) Under toe find hammertoe Moving to the Tabular Listing M20.4- M

80 Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left M20.4 Hammertoe 1) In the Tabular List, look up M20.4 (Chapter 13 Diseases of the Musculoskeletal System) Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left M20.4 Hammertoe Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left M20.4 Hammertoe 80

81 Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left M20.42 Hammertoe (acquired), left Need next main term metatarsal Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left Look up metatarsal in the Alphabetic Index Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left 1) Go to ICD-10 Index to Diseases & Injuries 2) Under M find metatarsal 3) What now? 81

82 Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left And what condition might that be? Plantarflexion? HINT: There ain t no plantarflexion listing Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left And what condition might that be? Plantarflexion? How about deformity, foot? Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left Look up deformity in the Alphabetic Index 82

83 Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left 1) Go to ICD-10 Index to Diseases & Injuries 2) Under D find deformity, then find foot Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left 1) Go to ICD-10 Index to Diseases & Injuries 2) Under D find deformity, then find foot Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left 1) Go to ICD-10 Index to Diseases & Injuries 2) Under D find deformity, then find foot 83

84 Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left 1) Go to ICD-10 Index to Diseases & Injuries 2) Under D find deformity, then find foot NOS & NEC NOS Not Otherwise Specified Equivalent to unspecified (not enough information in the medical record to assign a more specific code) NEC Not Elsewhere Classified Equivalent to other or other specified (the medical record details or condition have no ICD-9 or ICD-10 code that is specific for it) Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left 1) Go to ICD-10 Index to Diseases & Injuries 2) Under D find deformity, then find foot Q66.9 Q

85 Moving to the Tabular Listing Q66.9 and Q66.89 Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left Q66.9 and Q ) In the Tabular List, look up Q66 (Chapter 17 Congenital Malformations, Deformations and Chromosomal Abnormalities) Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left Q66.9 and Q

86 Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left Q66.9 and Q66.89 Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left Q66.9 and Q66.89 Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left Q

87 Hammertoe, 2 nd and Plantarflexed Metatarsal (Congenital), Left M20.42 Hammertoe (acquired), left Q66.89 Other specified congenital deformities of feet Ta da Clinical Example: RFC Diagnosis: long nails x10; corn 5 th bilateral; diabetes with peripheral vascular disease Procedure: palliative foot care ICD-10 Code(s)? 87

88 Nails and Corns and Diabetes with PVD, Oh My! What s wrong with this picture? 1) Nails, even long nails, is not a pathology 2) Is it type I or type II diabetes? 3) Specifically, what peripheral arterial disease does your patient have? Nailing It: Who yah Gonna Call? Nailing It ICD (other specified diseases of nail) crosswalks to ICD-10 L60.8 (other nail disorders) 88

89 Nails and Corns and Diabetes with PVD, Oh My! L60.8 Other nail disorders Next: Corns Nails and Corns and Diabetes with PVD, Oh My! 1) Go to ICD-10 Index to Diseases & Injuries 2) Under C find corn L84 infected? Moving to the Tabular Listing L84 89

90 Nails and Corns and Diabetes with PVD, Oh My! L84 1) In the Tabular List, look up L84 (Chapter 12 Diseases of the Skin and Subcutaneous Tissue) Nails and Corns and Diabetes with PVD, Oh My! L84 No mention of infected Nails and Corns and Diabetes with PVD, Oh My! L60.8 L84 Other nail disorders Corn Next: Diabetes with PVD 90

91 Nails and Corns and Diabetes with PVD, Oh My! 1) Go to ICD-10 Index to Diseases & Injuries 2) Under D find diabetes Nails and Corns and Diabetes with PVD, Oh My! 1) Go to ICD-10 Index to Diseases & Injuries 2) Under D find diabetes Then find the specific diabetic condition: With peripheral angiopathy (E11.51)? 1)? Due to an underlying condition: peripheral angiopathy (E08.51)? Specific type with peripheral angiopathy (E13.51)? Type I with peripheral angiopathy (E10.51)? Type II with peripheral angiopathy (E11.51)? Nails and Corns and Diabetes with PVD, Oh My! In our example, it will be Diabetes, type II, with peripheral angiopathy E

92 Moving to the Tabular Listing E11.51 Nails and Corns and Diabetes with PVD, Oh My! E ) In the Tabular List, look up E11.51 (Chapter 4 Endocrine, Nutritional and Metabolic Diseases) Nails and Corns and Diabetes with PVD, Oh My! Important to check at the beginning of the root code (E11) section for any instructions 92

93 Nails and Corns and Diabetes with PVD, Oh My! E11.51 Nails and Corns and Diabetes with PVD, Oh My! E11.51 Nails and Corns and Diabetes with PVD, Oh My! L60.8 Other nail disorders L84 Corn E11.51 Diabetes, type II, with peripheral angiopathy Issues? There is the Medicare Administrative Contractor s LCD billing instructions 93

94 Ta da Clinical Example: Fracture A 32 year old male was sliding into 2 nd base when he hit the bag. He felt a snap and instant pain in the outside of his right foot. X-rays revealed a non-displaced, slightly oblique 5 th metatarsal base fracture Diagnosis: closed 5 th metatarsal fracture, right ICD-10 Code(s)? Fracture 5 th Metatarsal, Closed, Right 1) Go to ICD-10 Index to Diseases & Injuries 2) Under F find fracture 3) Look by site : foot? 94

95 Fracture 5 th Metatarsal, Closed, Right See Fracture, metatarsal Fracture 5 th Metatarsal, Closed, Right 1) Go to Fracture, metatarsal 95

96 Fracture 5 th Metatarsal, Closed, Right 1) Go to Fracture, metatarsal Moving to the Tabular Listing Fracture 5 th Metatarsal, Closed, Right S S ) In the Tabular List, look up S92.35 (Chapter 19 Injury, Poisoning, and External Causes) 96

97 Fracture 5 th Metatarsal, Closed, Right Fracture 5 th Metatarsal, Closed, Right Fracture 5 th Metatarsal, Closed, Right S S S

98 Fracture 5 th Metatarsal, Closed, Right Fracture 5 th Metatarsal, Closed, Right S S Fracture 5 th Metatarsal, Closed, Right S92.354A 98

99 Fracture 5 th Metatarsal, Closed, Right S92.354A Non-placed fracture 5 th metatarsal, closed, right, initial visit Thank you, CMS Boy Scouts of America October 1, 2014 ICD-10: October 1,