Disclaimer. Course Overview. Preparing for the ICD 10 Code Transition An Update

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1 Coding and Reimbursement Series: Preparing for the ICD 10 Code Transition An Kyle C. Dennis, PhD Audiology and Speech Pathology Service Department of Veterans Affairs Debra Abel, AuD Senior Education Specialist, Practice Management American Academy of Audiology Disclaimer The opinions expressed herein are those of the author and do not necessarily reflect the opinions or official positions of the Department of Veterans Affairs or the U.S. Government. 2 Course Overview This program will provide: Brief overview of ICD 10 CM Focused presentation of audiology codes Practical examples of codes audiologists will commonly use, with exercises After attending this session, you will be able to: Describe basic principles of ICD 10 CM coding Give at least two examples of major changes in audiology coding Identify ICD 10 CM codes for common audiology diagnoses 3 1

2 What is ICD 10 CM? International Statistical Classification of Diseases and Related Health Problems, also known as ICD 10 Used in many countries for disease classification Used in the U.S. to classify mortality data (death certificates) since January 1999 ICD 10 CM is the U.S. version of ICD 10 ICD 10 CM is maintained by the National Center for Health Statistics (NCHS), part of CDC 4 Description of ICD 10 CM Over 68,000 disease codes compared to 14,000 codes in ICD 9 CM Expands available characters to seven Substantially increased specificity and expandability Incorporates advances in medicine and technology Codes more detail on socioeconomic and family factors, problems related to lifestyle, and outcomes of screening Added detail on etiology, anatomy, severity, laterality, and postprocedural disorders 5 Overview of ICD 10 CM Organized in 21 chapters. Each chapter is uniquely identified by letter. Letter does not indicate content 1 st digit always alphabetic 2 nd and 3 rd digits always numeric 4 th, 5 th, and 6 th digits may be letters or numbers, or may be a placeholder (x) There is always a decimal after the first three digits. First 3 digits define the code category Second three digits etiology, anatomical site, or severity Seventh digit extension describes the encounter type (initial, subsequent, sequela) for certain conditions such as TBI 6 2

3 Coding Conventions in ICD 10 CM Conventions Other codes (NEC, not elsewhere classified). Codes titled other or other specified are for use when the information in the medical record provides detail for which a specific code does not exist. Alphabetic Index entries with NEC in the line designate other codes in the Tabular List. These Alphabetic Index entries represent specific disease entities for which no specific code exists so the term is included within an other code. Unspecified codes (NOS, not otherwise specified). Codes titled unspecified are for use when the information in the medical record is insufficient to assign a more specific code. For those categories for which an unspecified code is not provided, the other specified code may represent both other and unspecified. 8 Conventions Inclusion terms synonyms or in some cases examples of conditions. Not an exhaustive list. Exclusion terms two type of exclusion terms: Excludes1 = NOT CODED HERE. Codes cannot occur together Excludes2 = NOT INCLUDED HERE. Indicates that the condition is not part of the coded condition, but the patient may have both conditions at the same time Code first Many conditions specify the underlying etiology and its manifestations. Indicates proper sequencing of codes. Placeholder character X used as a 5th character placeholder in certain 6 digit codes to allow for future expansion. Must be used to be considered a valid code. 3

4 Caveats Material is presented as examples for illustration only. Use official code sets, guidance, and maps for reference. Notes on coding: Dash ( ) indicates additional specificity in the 5 th and 6 th digit position (e.g. H91.0 ) x indicates a placeholder (e.g. H83.3x) 10 Coding Laterality For bilateral conditions, the final character indicates laterality. 1 = RIGHT, 2 = LEFT, 3 = BILATERAL. Unspecified is coded as 0 or 9 There are exceptions: Bilateral conductive HL: H90.0 Unilateral conductive HL: H90.11 or H90.12 Bilateral SNHL: H90.3 Unilateral SNHL: H90.41 or H90.42 Bilateral mixed HL: H90.6 Unilateral mixed HL: H90.71 or H90.72 For all other ear conditions, final character 1 =right, 2 = left, 3 =bilateral, and unspecified is 0 or 9 11 Hearing Loss and Ear Disease Coding in ICD 10 CM 4

5 ICD 10 CM is Not as Scary as it Seems 13 Diseases of Ear and Mastoid Process Chapter 8 in ICD 10 CM Every code starts with an H Organization: Diseases of external ear (H60 H62) Disorders of middle ear and mastoid (H65 H75) Diseases of inner ear (H80 H83) Other disorders of the ear (H90 H95) Hearing loss is organized under Other Disorders of the Ear (H90 H95) 14 What is Not in Chapter 8 Conditions are not part of the codes in Chapter 8, but the patient may have both conditions at the same time. Certain conditions originating in the perinatal period (P04 P96) Certain infectious and parasitic diseases (A00 B99) Complications of pregnancy, childbirth and the puerperium (O00 O99) Congenital malformations, deformations and chromosomal abnormalities (Q00 Q99) Endocrine, nutritional and metabolic diseases (E00 E88) Injury, poisoning and certain other consequences of external causes (S00 T88) Neoplasms (C00 D49) Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00 R94) 15 5

6 The Good News Laterality (right, left, bilateral) New codes for unilateral and bilateral temporary threshold shift (H93.24 ) New codes for ototoxic hearing loss (H91.0 ) New codes for intra operative and postprocedural complications (H95) 16 The Not So Good News Different types of hearing loss in each ear cannot be coded accurately All forms of tinnitus (objective and subjective) are coded as tinnitus (H93.1 ) Specific forms of conductive hearing loss (e.g. conductive hearing loss, middle ear) are lost. All conductive hearing losses are coded as H90.0x Specific codes for sensory and neural hearing loss are lost. Coded as sensorineural hearing loss (H90.3). 17 More Not So Good News Impairment of auditory discrimination (388.43) is lost. Coded as other abnormal auditory perceptions (H93.29) Developmental CAPD (315.32) moves under Other Abnormal Auditory Perceptions (H93.25), but acquired CAPD (388.45) losses its identity under other abnormal auditory perceptions (H93.29) Detail in otalgia (388.7 ) such as otogenic pain or referred pain is lost. All otalgia is coded as H92.0 Detail in otorrhea (388.6 ) such as CSF otorrhea is lost. All otorrhea is coded as H

7 How Do I Code Sensorineural Hearing Loss? There is no separate classification for sensory and neural hearing loss in ICD 10 CM Bilateral sensory loss (389.11) coded as bilateral SNHL (H90.3) Unilateral sensory loss (389.17) coded as unilateral SNHL (H90.41 or H90.42) Bilateral neural loss (389.12) coded as bilateral SNHL (H90.3) Unilateral neural loss (389.13) coded as unilateral SNHL (H90.41 or H90.42) Asymmetric hearing loss (386.16) has no representation in ICD 10 CM. Coded as H90.5 (unspecified SNHL) 19 Specific Forms of SNHL Bilateral SNHL (389.18) coded as H90.3 SNHL, bilateral Unilateral SNHL (389.15) coded as H90.4 SNHL unilateral with unrestricted hearing on opposite side H90.41 SNHL, right ear H90.42 SNHL, left ear H90.5 Unspecified SNHL includes: Central hearing loss (389.14) Congenital deafness Neural hearing loss (389.12, ) Sensory hearing loss (389.11, ) Asymmetric hearing loss (389.16) 20 Polling Question The code for unilateral sensorineural hearing loss, right ear is: A. H90.41 B. H90.42 C. H90.3 D

8 What is Not Included Under SNHL Deaf nonspeaking NEC (H91.3) Deafness NOS (H91.9 ) Hearing loss NOS (H91.9 ) Noise induced hearing loss (H83.3 ) Ototoxic hearing loss (H91.0 ) Sudden (idiopathic) hearing loss (H91.2 ) 22 How Do I Code Conductive Hearing Loss? Bilateral conductive hearing loss (389.06) is coded as H90.0 conductive hearing loss, bilateral Unilateral conductive hearing loss (389.05) coded as H90.0 conductive hearing loss unilateral with unrestricted hearing on opposite side H90.11 Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side H90.12 Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side H90.2 Conductive hearing loss, unspecified 23 How Do I Code Mixed Hearing Loss? Bilateral mixed hearing loss (389.22) is coded as H90.6 Mixed conductive and sensorineural hearing loss, bilateral Unilateral mixed hearing loss (389.21) is coded as H90.7 Mixed conductive and sensorineural hearing loss, unilateral with unrestricted hearing on the contralateral side H90.71 Mixed conductive and sensorineural hearing loss, unilateral, right ear with unrestricted hearing on the contralateral side H90.72 Mixed conductive and sensorineural hearing loss, unilateral, left ear with unrestricted hearing on the contralateral side 24 8

9 Proposed Coding Different Hearing Loss in Each Ear ICD 10 CM allows only coding for unilateral hearing loss with unrestricted hearing on the opposite side Audiologists were the first to notice that ICD 10 CM contained a serious flaw that prevents coding of different types of hearing loss in each ear (e.g. conductive hearing loss in one ear and SNHL in the other ear). A consortium of audiology and ENT organizations presented a proposal to the ICD 9 Coordination & Maintenance Committee. American Academy of Audiology Academy of Rehabilitative Audiology American Speech Language Hearing Association Academy of Doctors of Audiology American Academy of Otolaryngology Head and Neck Surgery. 25 How Do I Code Different Hearing Loss in Each Ear? Proposed new subcategory: H90.A Conductive and sensorineural hearing loss with restricted hearing on the contralateral side Proposed new note: Use two codes to show different type of hearing loss on the contralateral side. H90.A1 Conductive hearing loss, unilateral, with restricted hearing on the contralateral side H90.A11 Conductive hearing loss, unilateral, right ear with restricted hearing on the contralateral side H90.A12 Conductive hearing loss, unilateral, left ear with restricted hearing on the contralateral side 26 How Do I Code Different Hearing Loss in Each Ear? H90.A2 Sensorineural hearing loss, unilateral, with restricted hearing on the contralateral side H90.A21 Sensorineural hearing loss, unilateral, right ear, with restricted hearing on the contralateral side H90.A22 Sensorineural hearing loss, unilateral, left ear, with restricted hearing on the contralateral side H90.A3 Mixed conductive and sensorineural hearing loss, unilateral with restricted hearing on the contralateral side H90.A31 Mixed conductive and sensorineural hearing loss, unilateral, right ear with restricted hearing on the contralateral side H90.A32 Mixed conductive and sensorineural hearing loss, unilateral, left ear with restricted hearing 27on the contralateral side 9

10 Polling Question The code for sensorineural hearing loss, right ear, and mixed hearing loss, left ear is: A. H90.41 B. H90.42 C. H90.41 and H90.72 D. None of the above 28 Other Hearing Loss Other specified hearing loss H91.8x Note placeholder x in the 5 th character position Unspecified hearing loss H91.9 Final character: 1 =right, 2 =left, 3 =bilateral, 0 or 9 = unspecified 29 How Do I Code Balance Disorders? H81.0 Ménière's disease H81.1 Benign paroxysmal vertigo H81.2 Vestibular neuronitis H81.31 Aural vertigo H81.39 Other peripheral vertigo H81.4 Central vertigo H81.8x Other disorders of vestibular function H82 Vertiginous syndromes classified elsewhere H83.0 Labyrinthitis H83.1 Labyrinthine fistula H83.2x Labyrinthine dysfunction Final character: 1 =right, 2 =left, 3 =bilateral, 0 or 9 = unspecified 30 10

11 Coding Other Auditory Conditions H61.2 Impacted Cerumen H91.1 Presbycusis H91.2 Sudden idiopathic hearing loss H93.1 Tinnitus H93.2 Other abnormal auditory perceptions H93.21 Auditory recruitment H93.22 Diplacusis H93.23 Hyperacusis H93.25 Developmental auditory processing disorder H93.29 Other abnormal auditory perceptions Includes acquired auditory processing disorder Final character: 1 =right, 2 =left, 3 =bilateral, 0 or 9 = unspecified 31 Polling Question ICD 10 CM does not differentiate subjective and objective tinnitus. True False 32 Coding the 7 th Character A, initial encounter is used while the patient is receiving active treatment for the condition. Examples: surgical treatment, emergency department encounter, and evaluation and treatment by a new physician. D subsequent encounter is used for encounters after the patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase. Examples: rehabilitation, aftercare and follow up visits following treatment of the injury or condition. S, sequela is for use for complications or conditions that arise as a direct result of a condition not currently treated. Code both the injury code that precipitated the sequela and the code for the sequela itself. The S is added only to the injury code, not the sequela code. The 7th character S identifies the injury responsible for the sequela. The specific type of sequela (e.g. scar) is sequenced first, followed by the injury code

12 Coding the 7 th Character The aftercare Z codes should not be used for aftercare for conditions such as injuries or drug effects, where 7th characters are provided to identify subsequent care. For example: aftercare of an injury, assign the acute injury code with the 7th character D (subsequent encounter). When coding an adverse effect of a drug that has been correctly prescribed and properly administered, assign the appropriate code for the nature of the adverse effect followed by the appropriate code for the adverse effect of the drug (T36 T50). The code for the drug should have a 5th or 6th character How Do I Code Ototoxic Hearing Loss? H91.0 Ototoxic Hearing Loss Example 1: Bilateral HL due to aminoglycoside ototoxicity Order of coding: H91.03 and T36.5x5D Example 2: Bilateral HL due to hemotherapeutic ototoxity Order of coding: H91.03 and T45.1x5D Note the placeholder (5 th digit) and the extension (7 th digit). D extension indicates this condition was being treated. Final character: 1 =right, 2 =left, 3 =bilateral, 9 = unspecified 35 Polling Question A patient suffers bilateral ototoxic hearing loss from aminoglycoside administration. The medication was properly prescribed and administered. The proper order of coding of treatment is: A. T36.5x5S and H91.03 B. H91.03 and T36.5x5D C. H91.03 and T36.5x5S D. H

13 How Do I Code Noise Effects? H83.3x Noise effects on inner ear Acoustic trauma of inner ear Noise induced hearing loss of inner ear Note: placeholder x in 5 th character position H93.24 Temporary auditory threshold shift Final character: 1 =right, 2 =left, 3 =bilateral, 9 = unspecified 37 Auditory Symptoms R42 Dizziness and giddiness Light headedness Vertigo NOS Excludes1: vertiginous syndromes (H81. ) R94.12 Abnormal results of function studies of ear and other special senses R Abnormal auditory function study R Abnormal vestibular function study R Abnormal results of other function studies of ear and other special senses 38 Post procedural Complications Code the complication code followed by the specific effect of the complication (e.g. hearing loss). H95.31 Accidental puncture and laceration of the ear and mastoid process during a procedure on the ear and mastoid process H95.41 Postprocedural hemorrhage and hematoma of ear and mastoid process following a procedure on the ear and mastoid process Example: Accidental TM perforation with hearing loss H95.31 H90.11 Conductive hearing loss, unilateral, right ear, with 39 unrestricted hearing on the contralateral side 13

14 Supplemental Codes Z codes represent reasons for encounters. A corresponding procedure code must accompany a Z code if a procedure is performed. Z codes are neither diagnoses or procedures. Used for circumstances other than a disease: When a person who may or may not be sick encounters the health services for some specific purpose, such as limited care or service for a current condition, to donate an organ or tissue, immunization, or to discuss a problem which is in itself not a disease or injury. When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury. 40 Status and History Codes Status codes indicate that a patient has the sequelae or residual of a past disease or condition. Includes such things as the presence of prosthetic or mechanical devices resulting from past treatment. Status may affect the course of treatment and its outcome. A status code is distinct from a history code. The history code indicates that the patient no longer has the condition. There are two types of history Z codes, personal and family. Personal history explains a patient s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring. Family history use when a patient has a family member(s) who has had a particular disease that causes the patient to be at higher risk of also contracting the disease. 41 Other Uses for Supplemental Codes Aftercare services: Code situations when the initial treatment of a disease has been performed and the patient requires continued care during the healing or recovery phase, or for rehabilitation. Routine and Administrative Exams: Describe encounters for routine or, examinations for administrative purposes. Not to be used if the examination is for diagnosis of a suspected condition or for treatment purposes. During a routine exam, should a diagnosis or condition be discovered, it should be coded as an additional code. Some of the codes for routine health examinations distinguish between with and without abnormal findings. When assigning a code for with abnormal findings, assign additional code(s) to identify the specific abnormal finding(s)

15 Supplemental Codes Z02 Encounter for administrative examination Z02.0 Encounter for examination for admission to educational institution Z02.1 Encounter for pre employment examination Z02.2 Encounter for examination for admission to residential institution Z02.3 Encounter for examination for recruitment to armed forces Z02.71 Encounter for disability determination Z03 Encounter for screening for other diseases and disorders Z13.5 Encounter for screening for eye and ear disorders Z Encounter for screening for traumatic brain injury 43 Supplemental Codes Encounter for other special examination without complaint, suspected or reported diagnosis Z01.10 Encounter for examination of ears and hearing without abnormal findings Z Encounter for hearing examination following failed hearing screening Z Encounter for examination of ears and hearing with other abnormal findings Use additional code to identify abnormal findings Z01.12 Encounter for hearing conservation and treatment 44 Supplemental Codes Z45 Encounter for adjustment and management of implanted device Z Encounter for adjustment and management of bone conduction device Z Encounter for adjustment and management of cochlear device Z Encounter for adjustment and management of other implanted hearing device Other Useful Codes Z46.1 Encounter for fitting and adjustment of hearing aid Z57.0 Occupational exposure to noise Z71.2 Person consulting for explanation of examination or test findings Z76.5 Malingerer (Person feigning illness with obvious motivation) Z Contact with and (suspected) exposure to noise 45 15

16 Supplemental Codes Z83.52 Family history of ear disorders Z86.69 Personal history of other diseases of the nervous system and sense organs Z96.20 Presence of otological and audiological implant, unspecified Z96.21 Cochlear implant status Z96.22 Myringotomy tube(s) status Z96.29 Presence of other otological and audiological implants Z97.4 Presence of external hearing aid 46 Coding Brain Injuries Concept of late effect disappears and is replaced by 7 th digit extensions. This change will affect coding of symptoms associated with intracranial injuries. Late effects are symptoms associated with TBI and are coded regardless of when the symptom is first observed. This is the only way that symptoms can be uniquely associated with TBI. Code both the injury code that precipitated the condition and the code for the condition itself. The extension is added only to the injury code. The specific condition is sequenced first, followed by the injury code. Coding example: Subsequent encounter (treatment) for abnormal auditory perception (acquired CAPD) associated with mild TBI H S06.0x1D Note the placeholder and the D extension 47 Practice Management and ICD 10 s 16

17 What To Do and When Perform a complete operational assessment of your practice 10 impactassessment tip sheet.pdf Establish a timeline stick to it _News.html 49 What To Do and When (cont.) Establish a budget Software upgrades May be included in an existing contract Software support Test date Claim submission for ICD 9 and ICD 10 codes Consult with your software and clearinghouse vendors to ensure their transition and compliance plans 50 What To Do and When (cont.) Create an internal steering committee with representatives from the areas that will be impacted; appoint a project manager Add in codes into computer systems Afew each month to reduce overwhelming factor Increase staff time to import codes 51 17

18 What To Do and When (cont.) Train staff on new codes 6 months prior to 10/1/14, beginning 4/1/14 Training needs Software support Anticipated productivity loss, at least initially 52 Basic Checklist Look for all locations where ICD 9 s are currently found Superbills, computer programs, patient insurance eligibility, quality measures, etc. Create superbill/encounter form(s) Academy will provide a template for common audiologic diagnosis codes 53 Documentation Documentation will be more critical Medical necessity must be met Chief complaint(s) detailed Reason(s) for the date of service Signs/symptoms reported for the date of service Test results and recommendations 54 18

19 What To Do and When (cont.) Long term improvements according to AHIMA: Fewer miscoded and rejected costs Increased productivity 55 Small to Medium Practices Centers for Medicare and Medicaid Services Timeline: /ICD10SmallMediumTimelineChart.pdf CMS Implementation Guide for Small and Medium Practices: ds/icd10smallandmediumpractices508.pdf 56 Large Practices CMS Implementation Guide for Large Practices: /ICD10_LargePractice_Handbook_060413%5B1%5D.pdf 57 19

20 American Health Information Management Association (AHIMA) Resources nts/ahima/bok1_ hcsp?ddocname=bok1_ nts/ahima/bok1_ pdf 58 More Resources 10 CM/Pages/default.aspx ml 59 After 10/1/14 Monitor claims for denials/rejections Staff should continue to meet to identify problem areas Implement correction plans May include changing documentation processes May need to include additional codes into systems Retrain current staff and train new staff 60 20

21 Questions To ask a question, please type your question into the chat box in the lower left corner of the screen and click on the Send button located right below the box. References 10 CM/Pages/default.aspx Thank you! 63 21