Making The Transition from ICD-9 to ICD-10 Coding Are You Ready?

Transcription

1 Making The Transition from ICD-9 to ICD-10 Coding Are You Ready? Sherry Thomas, CCP, CCP-AS, CEO/Director of Education, Medical Staff SOS, Inc./PHIA, Louisville, KY

2 Top 4 Things to Know for CE 1. Make sure your BADGE IS SCANNED each time you enter a session to record your attendance. 2. Carry your Evaluation Packet with you to EVERY session. 3. Pharmacists, Pharmacy Technicians and Nurses need to track their hours on the Statement of Continuing Education Form as they go (the 2-page triplicate form, so press firmly!). 4. FOR CE: At your last session, total the hours and sign both pages of your Statement of Continuing Education Form. Keep the PINK copy for your records and place the YELLOW and WHITE copies in your CE Envelope. Make sure an Evaluation Form is in your CE Envelope for each session you attended (extra forms are available at the registration desk if you forgot to pick one up). Write your name and unique ID number (six digit number at the bottom of your name badge) in the designated area on the outside of the envelope, seal it, and place it in the drop box located near the 4/9/ registration area.

3 Sherry Thomas is CEO/Director of Education at Medical Staff SOS, Inc./PHIA. The conflict of interest was resolved by peer review of slide content. Clinical trials and off-label/investigational uses will not be discussed during this presentation. 4/9/2012 3

4 ICD-10-CM Implementation date October 1,

5 ICD-9-CM Codes 3 5 characters in length Numeric code 3 digit code = Category 5

6 ICD-10-CM Codes 3 7 characters in length Alpha-numeric code 1 st digit of 3 digit code = Alpha 2 nd and 3 rd digit = Number 4 th, 5 th, 6 th digit = Subcategory May be a Number or Alpha 7 th digit - Alpha 6

7 Default Codes 3 digit code = Heading of a Category Indicates this condition is the most commonly associated code with the main term or it s unspecified Take back to provider for more specific documentation Diagnosis codes are supposed to be used and reported at their highest number of digits available! 7

8 7 th digit - Alpha Applies to certain categories Required when noted in the tabular Must ALWAYS be the last character If code is NOT a full 6 digit code: Place-holder X must be used Place in the 5 th position within code 8

9 What does the 7 th character represent? A D S initial encounter subsequent encounter sequela 9

10 A = Initial encounter Use while patient is receiving active treatment for the injury Examples: Surgical treatment Emergency department encounter Evaluation and treatment by a new physician 10

11 D= Subsequent encounter Use after the patient has received active treatment of the injury and receiving routine care for the injury during the healing or recovery phase Examples: Cast change or removal Removal of external or internal fixation device Medication adjustment Other aftercare* and follow up visits following injury treatment 11

12 S = Sequela Use for complications or conditions that arise as a direct result of an injury Example: scar formation after a burn Use both the injury code (that precipitated the sequela) AND the code for the sequela S is ONLY added to the sequela code, NOT the injury code List the sequela code first AND the injury code second 12

13 X What does this represent? Filler or place holder character Use as 5 th digit for certain 6 character codes Allows for expansion of code in future T47.0x1 13

14 Appears directly under the category name Further defines, clarifies, or gives examples Inclusion terms listed: Includes Notes Indicates some of the condition that may be associated with that code NOT an all inclusive list 14

15 Excludes Notes 2 Types: Excludes 1 and 2 EXCLUDES 1: Considered a pure exclude NOT CODED HERE! Mutually exclusive codes: two codes that can NOT be coded together 15

16 EXCLUDES 2: NOT included here Indicates although the excluded condition is NOT part of the condition it is excluded from, a patient may have both conditions at the same time May be acceptable to use both the code AND the excluded code together (if documentation can support both). 16

17 4 th T81 Complications of procedures, not elsewhere classified Excludes 2: Complications following immunization (T88.0-T88.1) Complications following infusion, transfusion and therapeutic injection (T80-) Complications of transplanted organs and tissue (T86-) Specified complications classified elsewhere, such as: adverse effect, poisoning and toxic effects of drugs and chemicals (T36-T65) complication of prosthetic devices, implants and grafts (T82-T85) dermatitis due to drugs and medicaments (L23.3, L24.4, L25.1, L27.0-L27.1) endosseous dental implant failure (M27.6-) floppy iris syndrome (IFIS) (intraoperative) H21.81 intraoperative and postprocedural complications of specific body system (D78-, E36-, E89-, G97.3-, G97.4, H59.3-, H59-, H95.2-, H95.3, I97.4-, J95, K91-, L76-, M96-, N99-) ostomy complications (95.0-, K94-, N99.5-) plateau iris syndrome (post-iridectomy) (postprocedural) H21.82 The appropriate 7 th character is to be added to each code from category T81 A initial encounter D subsequent encounter S sequela 17

18 x7 th T81.4 Infection following a procedure Intra-abdominal abscess following a procedure Postprocedural infection, not elsewhere classified Sepsis following a procedure Stitch abscess following a procedure Subphrenic abscess following a procedure Wound abscess following a procedure Use additional code to identify infection Use additional code (R65.2) to identify severe sepsis, if applicable Excludes 1: obstetric surgical wound infection (O86.0) postprocedural fever NOS (R50.82) postprocedural retroperitoneal abscess (K68.11) Excludes 2: bleb associated endophthalmitis (H59.34) infection due to infusion, transfusion and therapeutic injection (T80.2) infection due to prosthetic devices, implants and grafts (T82.6-T82.7, T83.5-T83.6, T84.5-T84.7, T85.7) 18

19 Coding for bilateral sites Final character of code indicates side Unspecified side codes available Take back to provider for additional information If there is NO bilateral code available Assign separate codes for both the left and right 2012 PHIA/Medical Staff SOS, Inc

20 Etiology/Manifestation Codes Manifestation codes include the phrase: in diseases classified elsewhere Indicates this is a manifestation code NEVER billed as primary diagnosis Use in conjunction with the underlying condition 20

21 21

22 ICD-9 to ICD-10 Comparisons 22

23 Infections of the skin and subcutaneous tissue (L00=L08) Use additional code (B95-B97) to identify infectious agent Excludes 2: hordeolum (H00.0) infective dermatitis (L30.3) local infections of skin classified in Chapter 1 lupus panniculitis (L93.2) panniculitis NOS (M79.3) panniculitis of neck and back (M54.0) Perle che due to candidiasis (B37.0) Perle che due to riboflavin deficiency (E53.0) pyogenic granuloma (L98.0) relapsing panniculitis [Weber-Christian] (M35.6) viral warts (B07-) zoster (B02-) 23

24 5 th L03.1 Cellulitis and acute lymphangitis of other parts of limb 6 th L03.11 Cellulitis of other parts of limb Excludes 2: cellulitis of fingers (L03.01-) cellulitis of toes (L03.03-) groin (L03.314) L Cellulitis of right axilla L Cellulitis of left axilla L Cellulitis of right upper limb L Cellulitis of left upper limb L Cellulitis of right lower limb L Cellulitis of left lower limb L Cellulitis of unspecified part of limb 24

25 Infections of the skin and subcutaneous tissue (L00=L08) Use additional code (B95-B97) to identify infectious agent Bacterial and viral infectious agents (B95 B97) 4 th B95 Streptococcus, Staphylococcus, and Enterococcus as the cause of diseases classified elsewhere 4 th B96 Other bacterial agents as the cause of diseases classified elsewhere 5 th B96.8 Other specified bacterial agents as the cause of diseases classified elsewhere 4 th B97 Viral agents as the cause of diseases classified elsewhere 25

26 4 th C18 Malignant neoplasm of colon Excludes 1 malignant carcinoid tumors of the colon (C7a.02-) C18.0 Malignant neoplasm of cecum Malignant neoplasm of ileocecal valve C18.1 Malignant neoplasm of appendix C18.2 Malignant neoplasm of ascending colon C18.3 Malignant neoplasm of hepatic flexure C18.4 Malignant neoplasm of transverse colon C18.5 Malignant neoplasm of splenic flexure C18.6 Malignant neoplasm of descending colon C18.7 Malignant neoplasm of sigmoid colon Malignant neoplasm of sigmoid (flexure) Excludes 1 malignant neoplasm of rectosigmoid junction (C19) C18.8 Malignant neoplasm of overlapping sites of colon C18.9 Malignant neoplasm of colon, unspecified Malignant neoplasm of large intestine NOS 26

27 Failure to thrive 5 th R62.51 Child over 28 days Excludes 1 HIV disease resulting in failure to thrive (B20) Physical retardation due to malnutrition (E45) Failure to thrive in child 28 days old (P92.6) R62.7 Adult F52.22 Female P92.6 Newborn (child under 28 days) Excludes 1 Failure to thrive in child 28 days old (R62.51) 27

28 Demyelinating diseases of the central nervous system (G35-G37) Multiple sclerosis G35 Disseminated multiple sclerosis Generalized multiple sclerosis Multiple sclerosis NOS Multiple sclerosis of brain stem Multiple sclerosis of cord 28

29 Osteoarthritis ICD-10 Listed by exact site Further broken down to: Unilateral, bilateral, primary, post traumatic, other & unspecified 2012 PHIA/Medical Staff SOS, Inc

30 Knee and Hip Osteoarthritis ICD-9 = approx. 12 codes site specific generalized localized (idiopathic, primary, secondary) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ICD-10 = approx. 63 codes site specific generalized (erosive, primary, specified) post traumatic (primary, secondary) 2012 PHIA/Medical Staff SOS, Inc

31 Osteoarthritis of knee 4 th M17 Osteoarthritis of knee M17.0 Bilateral primary osteoarthritis of knee 5 th M17.1 Unilateral primary osteoarthritis of knee Primary osteoarthritis of knee NOS M17.10 Unilateral primary osteoarthritis, unspecified knee M17.11 Unilateral primary osteoarthritis, right knee M17.12 Unilateral primary osteoarthritis, left knee M17.2 Bilateral post-traumatic osteoarthritis of knee 5 th M17.3 Unilateral post-traumatic osteoarthritis of knee Post-traumatic osteoarthritis of knee NOS M17.30 Unilateral post-traumatic OA, unspec.knee M17.31 Unilateral post-traumatic osteoarthritis, right knee M17.32 Unilateral post-traumatic osteoarthritis, left knee M17.4 Other bilateral secondary osteoarthritis of knee M17.5 Other unilateral secondary osteoarthritis of knee Secondary osteoarthritis of knee NOS M17.9 Osteoarthritis of knee, unspecified 2012 PHIA/Medical Staff SOS, Inc

32 A41.9 Sepsis, unspecified Septicemia NOS With, due to, during, following Condition specific Numerous codes! 32

33 Sepsis: due to device, implant or graft T85.79 arterial graft NEC T82.7 breast (implant) G85.79 catheter NEC T85.79 dialysis (renal) T82.7 intraperitoneal T85.71 infusion NEC T82.7 spinal (epidural)(subdural) T85.79 urinary (indwelling) T

34 Sepsis: due to device, implant or graft T85.79 catheter NEC T85.79 infusion NEC T th T82.7 Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts ~ use additional code to identify infection ~ The appropriate 7 th character is to be added to each code from category T82 A initial encounter D subsequent encounter S sequela 34

35 Sepsis: due to device, implant or graft T85.79 catheter NEC T85.79 infusion NEC T82.7 spinal (epidural)(subdural) T th T85.79 Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts ~ use additional code to identify infection ~ The appropriate 7 th character is to be added to each code from category T85 A initial encounter D subsequent encounter S sequela 35

36 N39 Other disorders of urinary system Excludes 2: hematuria NOS (R31-) recurrent or persistent hematuria (N02-) recurrent or persistent hematuria with specified morphological lesion (N02-) proteinuria NOS (R80-) N39.0 Urinary tract infection, site not specified ~ use additional code (B95-B97),to identify infectious agent ~ Excludes 1: Candidiasis of urinary tract (B37.4) Neonatal urinary tract infection (P39.3) Urinary tract infection of specified site, such as: cystitis (30-) urethritis (N34-) 36

37 Bacterial and viral infectious agents (B95 B97) 4 th B95 Streptococcus, Staphylococcus, and Enterococcus as the cause of diseases classified elsewhere 4 th B96 Other bacterial agents as the cause of diseases classified elsewhere 5 th B96.8 Other specified bacterial agents as the cause of diseases classified elsewhere 4 th B97 Viral agents as the cause of diseases classified elsewhere 37

38 5 th R78.8 Finding of other specified substances, not normally found in blood R78.81 Bacteremia Excludes 1: sepsis code to specified infection (A00-B99) 38

39 Osteomyelitis M86.9 (general, infective, localized, neonatal, purulent, septic, staphylococcal, streptococcal, suppurative, with periostitis) ICD-10 Listed by exact site Further broken down to: acute, sub-acute, chronic (or old), specific condition such as Garr s 2012 PHIA/Medical Staff SOS, Inc

40 Rheumatoid Arthritis ICD-9 approx.??? codes ICD-10..approx. the same as ICD-9 broken down to: due to, associated with, in, type, site *Osteoarthritis coded to different section 2012 PHIA/Medical Staff SOS, Inc

41 6 th M06.07 Rheumatoid arthritis without rheumatoid factor, ankle and foot M Rheumatoid arthritis without rheumatoid factor, right ankle and foot M Rheumatoid arthritis without rheumatoid factor, left ankle and foot M Rheumatoid arthritis without rheumatoid factor, unspecified ankle and foot 41

42 4 th E84 Cystic Fibrosis Includes mucoviscidosis E84.0 Cystic fibrosis with pulmonary manifestations Use additional code to identify any infectious organism present, such as: pseudomonas (B96.5) 5 th E84.1 Cystic fibrosis with intestinal manifestations E84.11 Meconium ileus in cystic fibrosis Excludes 1: meconium ileus not due to cystic fibrosis (P76.0) E84.19 Cystic fibrosis with other intestinal manifestations E84.8 Cystic fibrosis with other manifestations Distal intestinal obstruction syndrome E84.9 Cystic fibrosis, unspecified 42

43 J18.9 Pneumonia, unspecified organism Acute, Alpenstich, benign, bilateral, brain, cerebral, circumscribed, congestive, creeping, delayed resolution, double, epidemic, fever, flash, fulminant, fungoid, granulomatous, hemorrhagic, incipient, infantile, infectious, infiltration, insular, intermittent, latent, migratory, organized, overwhelming, primary, atypical, progressive, pseudolobar, purulent, resolved, secondary, senile, septic, suppurative, terminal, true, unresolved, vesicular 43

44 ICD-10 Further broken down to: with, due to, involving, congenital, specific condition such as viral, Q fever, etc PHIA/Medical Staff SOS, Inc

45 4 th J12 Viral pneumonia, not elsewhere classified Includes: bronchopneumonia due to viruses other than influenza viruses *(many EXCLUDES 1 conditions listed in book) Code first associated influenza, if applicable (J09.01-, J09.11-, J10.0-, J11.0-) Code also associated abscess, if applicable (J85.1) J12.1 Respiratory syncytial virus (RSV) pneumonia 45

46 4 th E86 Volume depletion Excludes 1: dehydration of newborn (P74.1) Hypovolemic shock NOS (R57.1) Postprocedural hypovolemic shock (T81.1) Traumatic hypovolemic shock (T79.4) E86.0 Dehydration E86.1 Hypovolemia Depletion of volume of plasma E86.9 Volume depletion, unspecified 46

47 Z16 Infection with drug resistant microorganisms (MRSA) NOTE: this category is intended for use as an additional code for infectious conditions classified elsewhere to indicate the presence of drug-resistance of the infectious organism Code first the infection! 47

48 Learning Assessment Questions & Answers Please refer to the 2012 NHIA Annual Conference & Exposition Onsite Program Guide for a brief post-test. Sherry@phia.com /9/