10/16/2014. Disclaimer. APMA Coding Resource Center. The Wonders of ICD-10 [anyone have an aspirin?]

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1 The Wonders of ICD-10 [anyone have an aspirin?] 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 the American Podiatric i Medicine i Association or PICA for any demonstrated insensitivity, poor judgment, unfunny jokes, puns that aren t punny, or lack of taste. APMA Coding Resource Center 1

2 The ICD-10 Why Question ICD-9 has been used by the US for 35 years ICD-9 has outgrown its intended level of specificity ICD-9 cannot reasonably accommodate new codes HIPAA regulations mandate the move to ICD-10 CMS announced it will no longer support ICD-9 The rest of the world is moving toward ICD-11 The Why Question is no longer important Timing Less than 1 year away (again) 2

3 Transitioning 1. Designate someone in the office/group to be the ICD-10 project manager 2. Contact your vendors to check how ready they are 3. Check your major payers about signing up for ICD-10 testing Transitioning 4. Staff and doctors should schedule to attend ICD-10 learning sessions 5. Crosswalk existing ICD-9 codes used by the practice to ICD Integrate those ICD-10 codes into your software, new forms, future charge tickets, etc. Crosswalking ICD-9 to ICD-10 3

4 Crosswalking ICD-9 to ICD-10 #1 Crosswalking ICD-9 to ICD-10 Crosswalking ICD-9 to ICD-10 4

5 Crosswalking ICD-9 to ICD-10 Crosswalking ICD-9 to ICD-10 Abrasion ankle, left What s the main term? Crosswalking ICD-9 to ICD-10 Abrasion ankle, left What s the main term? 5

6 Crosswalking ICD-9 to ICD Go to the ICD-10 Index to Diseases & Injuries 2. Look under A for Abrasion Crosswalking ICD-9 to ICD Search for Abrasion Crosswalking ICD-9 to ICD-10 6

7 Crosswalking ICD-9 to ICD-10 Crosswalking ICD-9 to ICD-10 The Hyphen (or Dash) Educational Moment A hyphen at the end of an ICD-10 indicates that additional characters are required You will only see the hyphen on a code in the You will only see the hyphen on a code in the alphabetic index 7

8 Crosswalking ICD-9 to ICD-10 S90.51 Crosswalking ICD-9 to ICD-10 In the Tabular List: S S codes are located in Chapter 19 ( Injury, Poisoning and Certain Other Consequences of External Causes ) Crosswalking ICD-9 to ICD-10 In the Tabular List: S S codes are located in Chapter 19 ( Injury, Poisoning and Certain Other Consequences of External Causes ) 2. S90 is the category dedicated to superficial injury of ankle, foot and toes 8

9 Crosswalking ICD-9 to ICD-10 In the Tabular List: S S codes are located in Chapter 19 ( Injury, Poisoning and Certain Other Consequences of External Causes ) 2. S90 is the category dedicated to superficial injury of ankle, foot and toes 3. S90.5 is the subcategory dedicated to other superficial injuries of ankle Crosswalking ICD-9 to ICD-10 In the Tabular List: S S codes are located in Chapter 19 ( Injury, Poisoning and Certain Other Consequences of External Causes ) 2. S90 is the category dedicated to superficial injury of ankle, foot and toes 3. S90.5 is the subcategory dedicated to other superficial injuries of ankle 4. Find S90.51 Crosswalking ICD-9 to ICD-10 S

10 Crosswalking ICD-9 to ICD-10 category S90.51 subcategory subcategory subcategory Let the abrasion be on the right ankle Crosswalking ICD-9 to ICD The additional character indicator box located in front of a code is a hint that you need one or more additional characters at the end to get to the code of highest specificity Crosswalking ICD-9 to ICD-10 S Let the abrasion be on the right ankle 10

11 Crosswalking ICD-9 to ICD-10 S Let the abrasion be on the right ankle Crosswalking ICD-9 to ICD-10 S Scroll u up Let the abrasion be on the right ankle Crosswalking ICD-9 to ICD-10 S

12 Crosswalking ICD-9 to ICD-10 S Don t think encounter Think episode of care or active treatment or phase of treatment A Initial Encounter S90.511A Used while the patient is receiving active treatment for a condition. Examples of active treatment are: surgical treatment, emergency department encounter, & evaluation and treatment by a new physician. A Initial Encounter S90.511A Used while the patient is receiving active treatment for a condition. Examples of active treatment are: surgical treatment, emergency department encounter, & evaluation and continued treatment by the same or a different physician. 12

13 A Initial Encounter Used while the patient is receiving active treatment for a condition. How do you define active treatment? A Initial Encounter There can only be one initial episode of care per doctor per condition However, in a hospital, from admission to discharge is considered one episode of care A Initial Encounter More than one provider may code A during an episode of care If the emergency department physician sees the If the emergency department physician sees the patient and orders x-rays, requests a consult from both an infectious disease specialist and a foot and ankle specialist, how many physicians get A s? at least 4 13

14 D Subsequent Encounter S90.511D D Subsequent Encounter Used after the patient has received active treatment for the condition during the healing or recovery phase. When does active treatment end? How do you define healing phase? D Subsequent Encounter S90.511D Examples of subsequent care are: cast change or removal, an x-ray to check healing status of fracture, removal of external or internal fixation device, medication adjustment, other aftercare and follow-up visits following treatment of the injury. 14

15 A & D A Fly in the Ointment Disclaimer Best Current Interpretation 1. If you see a patient in the ED for the first time, it s an A 2. If the patient is admitted and you round 3 times during the admission, it s an A each time 3. If the patient is discharged from the hospital to your care and you see them in the office, it s a D 4. If you reappoint and see the patient for follow-up care, it s a D A & D A Fly in the Ointment Disclaimer Best Current Interpretation 5. If the patient was seen by a primary care physician in their office for an injury and then refers them to you for follow-up, the 1 st time you see that patient for that t condition, it s an A 6. If there is no referral, but instead a patient calls your office and tells you they just twisted their ankle, and you see them in your office for the 1 st time for that condition, it s an A 7. When the patient returns for follow-up care, it s a D A & D A Fly in the Ointment Unanswered Questions 1. The initial encounter description is definite for physician, what about NPs, PAs, PTs, OTs, etc.? 2. If you belong to a podiatry supergroup (7 docs), and one of your partner s patients with an established condition sees you because you are available, is that an A or D for you? 3. What if you happened to be a podiatrist in a small orthopedic group (65 docs), same scenario, is that an A or D for you? 4. Why did CDC/CMS make this so confusing? 15

16 S Sequela Sequela LATER Crosswalking ICD-9 to ICD-10 S90.511A (initial encounter) 16

17 Crosswalking ICD-9 to ICD-10 #2 Crosswalking ICD-9 to ICD-10 Crosswalking ICD-9 to ICD-10 17

18 Crosswalking ICD-9 to ICD-10 Crosswalking ICD-9 to ICD-10 Crosswalking ICD-9 to ICD-10 18

19 Crosswalking ICD-9 to ICD-10 Crosswalking ICD-9 to ICD-10 Tada 19

20 Crosswalking ICD-9 to ICD-10 Crosswalking ICD-9 to ICD-10 #3 Crosswalking ICD-9 to ICD-10 20

21 Crosswalking ICD-9 to ICD-10 Crosswalking ICD-9 to ICD-10 Crosswalking ICD-9 to ICD-10 21

22 Crosswalking ICD-9 to ICD-10 Tada Crosswalk Finished 22

23 Whew Back to Transitioning 7. Prepare yourself and your office it s gonna cost you something to implement ICD-10 Bottom Line Preparation Costs? 23

24 Bottom Line Preparation Costs? AAPC Survey of 220 Members (vendor costs, education, consultants but not including staff time training/education) Small practices (fewer than 10 providers) = $750 per provider Medium practices (10 49 providers) = $575 per provider Large practices (50 or more providers) = $3,500 per provider PMNews ICD-10 Poll ( ) Back to Transitioning 6. Get to know the ICD-10 guidelines and conventions now, not later 24

25 ICD-10 Educational Moment New Terms: Excludes1 Excludes2 Excludes1 Not coded here - mutually exclusive; can never occur at the same site along with the primary condition Excludes1 Not coded here - mutually exclusive; can never occur at the same site along with the primary condition 25

26 Excludes2 Degenerative joint disease 1 st metatarsalphalangeal joint Not included here the excluded condition is not part of the condition represented in the primary code. An Excludes2 code can be coded with the primary code as long as it is occurring elsewhere. ICD-10 Educational Moment SEQUELA S Sequela Encounter Sequela a late effect a residual condition Sequela a late effect a residual condition (unplanned; complication) that remains or occurs after the acute phase of an injury or illness. 26

27 S Sequela Encounter Acute phase of an injury or illness defined as the immediate post-injury healing processes; typically the first hours after an injury S Sequela Encounter Sequela (a late effect ) a residual condition (unplanned; complication) that remains or occurs any time after hours post-injury or illness. S Sequela Encounter Examples of Sequela Keloid post laceration Joint contracture post fracture near joint Scarring post burn Traumatic arthritis due to old fracture 27

28 S Sequela Encounter Not a Sequela Surgical complications are not sequela S Sequela Encounter Sequela Hint: Documentation Phrases Late Old Due to previous injury or illness Following previous injury or illness How Do You Code a Sequela? You need 2 codes in a specific order: 1. Code the problem the patient is now presenting that resulted from an old injury or illness (the consequence due to ) 2. Code the old injury or illness with an S as the 7 th character 28

29 Sequela Example A patient was referred to you with pain in her right ankle. She has no history of recent trauma, but 4 years ago, she fractured her right ankle (non-displaced fracture lateral malleolus). X-rays reveal arthritic changes to the right ankle. Impression: arthritis, right ankle; pain Main term? Sequela Example A patient was referred to you with pain in her right ankle. She has no history of recent trauma, but 4 years ago, she fractured her right ankle (non-displaced fracture lateral malleolus). X-rays reveal arthritic changes to the right ankle. Impression: arthritis, right ankle; pain Main term? Arthritis, Post Trauma, Right 29

30 Arthritis, Post Trauma, Right Arthritis, Post Trauma, Right Arthritis, Post Trauma, Right 30

31 Arthritis, Post Trauma, Right Arthritis, Post Trauma, Right Arthritis, Post Trauma, Right 31

32 Arthritis, Post Trauma, Right Late Effect Current Problem M (post-traumatic osteoarthritis, right ankle and foot) would be coded first Arthritis, Post Trauma, Right Late Effect Current Problem M (post-traumatic osteoarthritis, right ankle and foot) would be coded first ICD-10 Educational Moment ICD-10 defines and as and or and/or 32

33 Arthritis, Post Trauma, Right Late Effect Current Problem M (post-traumatic osteoarthritis, right ankle) would be coded first Next code the injury that caused the late effect The Cause of the Chief Complaint The reason the patient is being see is due to. A patient was referred to you with pain in her right ankle. She has no history of recent trauma, but 4 years ago, she fractured her right ankle (non-displaced fracture lateral malleolus). X-rays reveal arthritic changes to the right ankle. Impression: arthritis, right ankle; pain Main term? The Cause of the Chief Complaint The reason the patient is being see is due to. A patient was referred to you with pain in her right ankle. She has no history of recent trauma, but 4 years ago, she fractured her right ankle (non-displaced fracture lateral malleolus). X-rays reveal arthritic changes to the right ankle. Impression: arthritis, right ankle; pain Main term? 33

34 Sequela: Fracture, lateral malleolus, right Sequela: Fracture, lateral malleolus, right Sequela: Fracture, lateral malleolus, right 34

35 Sequela: Fracture, lateral malleolus, right Sequela: Fracture, lateral malleolus, right Sequela: Fracture, lateral malleolus, right 35

36 Sequela: Fracture, lateral malleolus, right S82.64 Sequela: Fracture, lateral malleolus, right S th 7 th The 6 th Character S th 36

37 The Dummy x Placeholder When the highest level of coding specificity requires a certain number of characters, the code s 4 th, 5 th, and/or the 6 th character positions are empty, you use the letter x to serve as a placeholder to fill in the blank for a not yet assigned (future expansion) character. For example, S th 7 th The Dummy x Placeholder When the highest level of coding specificity requires a certain number of characters, the code s 4 th, 5 th, and/or the 6 th character positions are empty, you use the letter x to serve as a placeholder to fill in the blank for a not yet assigned (future expansion) character. For example, S82.64x _ 6 th 7 th The Dummy x Placeholder 37

38 The 7 th Character S82.64x _ 7 th The 7 th Character The 7 th Character S82.64xS 38

39 Back to our ankle arthritis (late effect) and previous fracture coding Late Effect Current Problem M (post-traumatic osteoarthritis, right ankle) would be coded first The Original Cause S82.64xS (non-displaced fracture, lateral malleolus, right fibula) would be coded second Tada 39

40 Back to Transitioning 8. Practice, practice, practice ICD-10: Clinical Examples ICD-10 Coding Ms. Johnson presented to the office complaining of a painful bunion on the left foot. The exam revealed normal motion in the 1 st metatarsal-phalangeal joint with pain reported on palpation and with shoewear. X-rays confirm a bunion presence, hallux abductovalgus, and metatarsus primus adductus. 40

41 ICD-10 Coding Ms. Johnson presented to the office complaining of a painful bunion on the left foot. The exam revealed normal motion in the 1 st metatarsal-phalangeal joint with pain reported on palpation and with shoewear. X-rays confirm a bunion presence, hallux abductovalgus, and metatarsus primus adductus. Diagnoses/Symptoms 1. hallux valgus, acquired, left 2. bunion, acquired, left 3. metatarsus primus adductus, left 4. pain, left Diagnoses/Symptoms 1. hallux valgus, acquired, left 2. bunion, acquired, left 3. metatarsus primus adductus, left 4. pain, left 41

42 ICD-10 Coding ICD-10 Coding ICD-10 Coding 42

43 ICD-10 Coding ICD-10 Coding ICD-10 Coding hallux valgus, acquired, left 43

44 Diagnoses/Symptoms 1. M20.12 (hallux valgus, acquired, left) 2. bunion, acquired, left 3. metatarsus primus adductus, left 4. pain, left ICD-10 Coding ICD-10 Coding 44

45 ICD-10 Coding ICD-10 Coding ICD-10 Coding 45

46 ICD-10 Coding ICD-10 Coding bunion, acquired, left Diagnoses/Symptoms 1. M20.12 (hallux valgus, acquired, left) 2. bunion, acquired, left 3. metatarsus primus adductus, left 4. pain, left 46

47 ICD-10 Coding ICD-10 Coding ICD-10 Coding 47

48 ICD-10 Coding ICD-10 Coding ICD-10 Coding 48

49 Diagnoses/Symptoms 1. M20.12 (hallux valgus, acquired, left) 2. Q66.2 (metatarsus primus adductus, left) 3. pain, left ICD-10 Coding ICD-10 Coding 49

50 ICD-10 Coding ICD-10 Coding ICD-10 Coding 50

51 ICD-10 Coding pain in foot, left Diagnoses/Symptoms 1. M20.12 (hallux valgus, acquired, left) 2. Q66.2 (metatarsus primus adductus, left) 3. M (pain in foot, left) Tada 51

52 Let s Do Some Coding Diabetic Foot Ulcer Ms. Green presents to the office with an ulcer, nondraining, sub2nd metatarsal right foot. The subcutaneous tissue is exposed. She is a type 2 diabetic with bilateral partial numbness of both feet. Diagnoses/Symptoms 1. Diabetes, type 2 2. Diabetic foot ulcer, right 3. Diabetic neuropathy bilateral 52

53 Diabetic Foot Ulcer Diabetic Foot Ulcer Diabetic Foot Ulcer 53

54 Diagnoses/Symptoms 1. E (diabetes, type 2, diabetic foot ulcer) 2. Diabetic foot ulcer, right 3. Diabetic neuropathy bilateral Combination Code E combines Diabetes Diabetes, type 2 Diabetic foot ulcer into one code Diagnoses/Symptoms 1. E (diabetes, type 2, diabetic foot ulcer) 2. Diabetic foot ulcer, right 3. Diabetic neuropathy bilateral 54

55 Diabetic Foot Ulcer sub2nd metatarsal right foot. The subcutaneous tissue is exposed Diabetic Foot Ulcer Diabetic Foot Ulcer 55

56 Diabetic Foot Ulcer Diagnoses/Symptoms 1. E (diabetes, type 2, diabetic foot ulcer) 2. L (foot ulcer, subcutaneous tissue exposed, right non-decubitus) 3. Diabetic neuropathy bilateral Diagnoses/Symptoms 1. E (diabetes, type 2, diabetic foot ulcer) 2. L (foot ulcer, subcutaneous tissue exposed, right non-decubitus) 3. Diabetic neuropathy bilateral 56

57 Diabetic Foot Ulcer Diabetic Foot Ulcer Diabetic Foot Ulcer 57

58 ICD-10 Coding ICD-10 Coding Diagnoses/Symptoms 1. E (diabetes, type 2, diabetic foot ulcer) 2. L (foot ulcer, subcutaneous tissue exposed, right non-decubitus) 3. E11.42 (diabetic neuropathy bilateral) 58

59 Tada Let s Do Some Coding Decubitus Ulcer Mr. Smith had not been seen in 8 months. He had been released from the hospital with a decubitus ulcer of the left heel. E i ti fi d t 3 d bit l f Examination confirmed a stage 3 decubitus ulcer of the left heel. 59

60 Decubitus Ulcer Stage 3 Decubitus Ulcer, Left Heel What is the main term? Decubitus Ulcer Stage 3 Decubitus Ulcer, Left Heel What is the main term? Decubitus Ulcer, Left Heel 60

61 Decubitus Ulcer, Left Heel Decubitus Ulcer, Left Heel Decubitus Ulcer, Left Heel 61

62 ICD-10 Educational Moment Defining Unspecified & Other Unspecified Unspecified means that there is not enough information in the medical record to assign a more specific ICD-10 code Example: You forgot to note which ankle was sprained in your medical record Other Other means the medical record details a condition, illness, diagnosis, or a place of occurrence that doesn t have an existing ICD-9 or 10 code Example: What did CMS crosswalk sesamoiditis to? osteomyelitis Correct code? M77.8 Other enthesopathies, not elsewhere classified 62

63 Decubitus Ulcer, Left Heel Decubitus Ulcer, Left Heel, Stage 3 Diagnoses/Symptoms 1. L (pressure ulcer of left heel, stage 3) 63

64 Tada Let s Do Some Coding Infected Ingrown Nail My toe is swollen and painful. 64

65 Infected Ingrown Nail History of Present Illness: The patient who is an 18 year old male presents to the office with a swollen right great toe along the medial nail fold. There is a drainage present coming from the end of the toe. The patient says the site is painful (7/10, 10 being worse). The swelling has been present for 6 days; the drainage for about 2 days. The patient attempted to self-treat using nail clippers, but thinks he made it worse. He has been soaking, occasionally, the foot in warm water. He is unable to wear enclosed shoes because of the swelling and pain. Infected Ingrown Nail Examination: Dermatology - a swollen right great toe along the medial aspect of the nail fold; there is redness not just around the nail fold but extending 2-3 cm proximal to the metatarsal-phalangeal joint area; there is a puslike drainage present subungual distal medial nail; the nail appears severely incurvated distally and somewhat loose at its distal, medial portion. Infected Ingrown Nail Examination: Dermatology - a swollen right great toe along the medial aspect of the nail fold; there is redness not just around the nail fold but extending 2-3 cm proximal to the metatarsal-phalangeal joint area; there is a puslike drainage present subungual distal medial nail; the nail appears severely incurvated distally and somewhat loose at its distal, medial portion. 65

66 Infected Ingrown Nail, Right Hallux Diagnosis: 1. Infection, hallux right 2. Abscess, hallux right 3. Cellulitis, hallux right 4. Ingrown nail, hallux right 5. Pain, hallux right Infected Ingrown Nail, Right Hallux Treatment: 1. Partial nail avulsion 2. Incision & drainage of abscess 3. Culture 4. Instructions of home self-care 5. Return to office in 4 days CPT Coding CPT 1. CPT 9920x (E/M service; new patient)* 2. CPT T5 For non-medicare payers, add a -25 modifier on the E/M code 66

67 Infected Ingrown Nail, Right Hallux Diagnosis: 1. Infection, hallux right 2. Abscess, hallux right 3. Cellulitis, hallux right 4. Ingrown nail, hallux right 5. Pain, hallux right Infected Ingrown Nail, Right Hallux Diagnosis: 1. Infection, hallux right 2. Abscess, hallux right 3. Cellulitis, hallux right 4. Ingrown nail, hallux right 5. Pain, hallux right Infection, Right Hallux 67

68 Infection, Right Hallux Infection, Right Hallux Infection, Right Hallux 68

69 Infected Ingrown Nail, Right Hallux Diagnosis: 1. L08.89 (infection) 2. Abscess, hallux right 3. Cellulitis, hallux right 4. Ingrown nail, hallux right 5. Pain, hallux right Abscess, Right Hallux Diagnosis: 1. L08.89 (infection) 2. Abscess, cellulitis, hallux right 3. Ingrown nail, hallux right 4. Pain, hallux right Abscess, Right Hallux 69

70 Abscess, Right Hallux Abscess, Right Hallux Abscess, Right Hallux 70

71 Abscess, Right Hallux Diagnosis: 1. L08.89 (infection) 2. L (abscess, right foot) 3. Cellulitis, hallux right 4. Ingrown nail, hallux right 5. Pain, hallux right Abscess, Right Hallux Diagnosis: 1. L08.89 (infection) 2. L (abscess, hallux right) 3. Cellulitis, hallux right 4. Ingrown nail, hallux right 5. Pain, hallux right Cellulitis, Right Hallux 71

72 Cellulitis, Right Hallux Cellulitis, Right Hallux Cellulitis, Right Hallux 72

73 Cellulitis, Right Hallux Cellulitis, Right Hallux Diagnosis: 1. L08.89 (infection) 2. L (abscess, right foot) 3. L (cellulitis, right toe) 4. Ingrown nail, hallux right 5. Pain, hallux right Cellulitis, Right Hallux Diagnosis: 1. L08.89 (infection) 2. L (abscess, right foot) ( g ) 3. L (cellulitis, right toe) 4. Ingrown nail, hallux right 5. Pain, hallux right 73

74 Ingrown Nail, Right Hallux Ingrown Nail, Right Hallux Ingrown Nail, Right Hallux 74

75 Ingrown Nail, Right Hallux Infected Ingrown Nail, Right Hallux Diagnosis: 1. L08.89 (infection) 2. L (abscess, right foot) 3. L (cellulitis, right toe) 4. L60.0 (ingrown nail) 5. Pain, hallux right Infected Ingrown Nail, Right Hallux Diagnosis: 1. L08.89 (infection) 2. L (abscess, right foot) ( g ) 3. L (cellulitis, right toe) 4. L60.0 (ingrown nail) 5. Pain, hallux right 75

76 Infected Ingrown Nail, Right Hallux Diagnosis Coding: 1. L08.89 (infection) 2. L (abscess, right foot) 3. L (cellulitis, right toe) 4. L60.0 (ingrown nail) Tada Let s Do Some Coding 76

77 Follow-Up Ingrown Nail Back to our patient Office Visit Follow-Up (Day 4) Chief Complaint: Toe is infected History of Present Illness: Doing much better; no more drainage; swelling better, able to wear shoes. Right hallux color improved. Pain 0-1/10, occasionally present Patient taking antibiotics and keeping a Band-Aid on the toe. Culture returned: staph aureus (methicillin susceptible) Office Visit Follow-Up (Day 4) Chief Complaint: Toe is infected History of Present Illness: Doing much better; no more drainage; swelling better, able to wear shoes. Right hallux color improved. Pain 0-1/10, occasionally present Patient taking antibiotics and keeping a Band-Aid on the toe. Culture returned: staph aureus (methicillin susceptible) 77

78 Office Visit Follow-Up (Day 4) Treatment: 1. Continue antibiotics 2. Instructions of home self-care 3. Call office if not continuing to improve; RA prn Office Visit Follow-Up (Day 4) Diagnosis Coding: 1. Infection, nail, toe 2. Staph aureus Office Visit Follow-Up (Day 4) Diagnosis Coding: 1. L08.89 (infection) 2. Staph aureus 78

79 Office Visit Follow-Up (Day 4) Diagnosis Coding: 1. L08.89 (infection) 2. Staph aureus Infection, Right Hallux Follow-Up Ingrown Nail 79

80 Office Visit Follow-Up (Day 4) Diagnosis Coding: 1. L08.89 (infection) 2. B95.61 (staph aureus) Office Visit Follow-Up (Day 4) Diagnosis Coding: 1. L08.89 (infection) 2. B95.61 (staph aureus) Tada 80

81 Let s Do Some Coding ICD-10: Give Me a Break Mr. Jones, weekend athlete, hit one through the gap. Rounding 1 st base, he picked up speed knowing the play was going to be close at second. Out of the corner of his eye he saw the right fielder release the ball. Mr. Jones slid into the bag with his right foot. Good news: He was safe. Bad news: He heard a crack and now has a limp and a painful foot and ankle ICD-10: Give Me a Break Mr. Jones was diagnosed with 1. Closed fracture, non-displaced, base of the 5 th metatarsal right foot 2. Ankle sprain, anterior talofibular ligament, right 81

82 Closed fracture, non-displaced, base of the 5 th metatarsal right foot What is the main term? Closed fracture, non-displaced, base of the 5 th metatarsal right foot What is the main term? Closed fracture, non-displaced, base of the 5 th metatarsal right foot 82

83 Closed fracture, non-displaced, base of the 5 th metatarsal right foot Closed fracture, non-displaced, base of the 5 th metatarsal right foot Closed fracture, non-displaced, base of the 5 th metatarsal right foot 83

84 Closed fracture, non-displaced, base of the 5 th metatarsal right foot Closed fracture, non-displaced, base of the 5 th metatarsal right foot S92.354A ICD-10: Give Me a Break Mr. Jones was diagnosed with 1. Closed fracture, non-displaced, base of the 5 th metatarsal right foot 2. Ankle sprain, anterior talofibular ligament, right 84

85 Ankle sprain, anterior talofibular ligament, right What is the main term? Ankle sprain, anterior talofibular ligament, right What is the main term? Ankle sprain, anterior talofibular ligament, right 85

86 Ankle sprain, anterior talofibular ligament, right Ankle sprain, anterior talofibular ligament, right Ankle sprain, anterior talofibular ligament, right 86

87 Ankle sprain, anterior talofibular ligament, right ICD-10: Give Me a Break Diagnoses 1. S92.354A nondisplaced fracture of the 5 th metatarsal base, right foot, closed 2. S93.491A sprain of other ligament, right ankle So, are you done? Almost Fracture, 5 th metatarsal and ankle sprain, right Oh, yeah, the injury occurred on a baseball field, didn t it? S Baseball field as the place of occurrence of the external cause 87

88 Fracture, 5 th metatarsal and ankle sprain, right Place of occurrence codes (Y92-) are 1) Billed only once at the initial encounter for treatment 2) Billed with an event or activity code (Y93-) e.g., clothing caught fire while burning household trash in backyard of home, causing burn W03.0xxA + X06.2xxA + Y Y93.E9 + Y99.8 ICD-10 Coding Thank you. 88