Steve Simoneaux Children s Healthcare of Atlanta Emory University

Transcription

1 Steve Simoneaux Children s Healthcare of Atlanta Emory University

2 None

3 International Classification of Diseases Sponsored by World Health Organization Standard diagnostic tool for: Epidemiology track causes of death worldwide Health Management Clinical purposes 10-year review to keep current

4 Origins in 1893 by French physician Bertillon Classification of Causes of Death 179 groups Adopted in US in 1898 Recommended 10-year review Became ICD with 6 th revision (1949) First with diseases, not just death causes ICD-7 first by WHO (1955)

5 Published in 1978; replaced 1965 ICD-8 Added 4 th and 5 th level codes ICD-9-CM (Vol 1. and 2) US adaptation by National Center for Health Statistics 1988 mandatory for all Medicare/Medicaid claims ICD-9 Volume 3 Procedural codes for inpatient billing

6 10-year cycle delayed; started in 1983 WHO adopted in 1990 with first use in ,000 codes (diagnoses and procedures) Compared to 18,000 in ICD-9 No easy conversion between 9 and 10 Used mainly to compare mortality rates between countries

7 US only industrialized country not using it Replaces outdated terminology from ICD-9 Incorporates new technology and procedures First change since 1978

8 Why Change? Reflects current medical practice Structure accommodates addition of new codes No capacity in ICD-9 Expanded data capture Quality measurement Reduce coding errors Better analysis of disease patterns Track and respond to public health outbreaks More efficient claim submission Identify fraud and abuse

9 Two parts ICD-10-Clinical Modification (CM) for diagnosis coding in all health settings* ICD-10-Procedure Coding System (PCS) For inpatient procedure coding in hospital settings Does not replace CPT for physician procedure coding *HIPAA-covered entities

10 Copyrighted publication of AMA Annual update Currently CPT 2013 HCPCS level 1 codes Used as standard Medicare code since 1996 In conjunction with HIPAA Tells payers what professional service was performed Provides common definition for professional work HCPCS level 2 codes: non-md services Ambulance, prostheses Supplies

11 68,000 ICD-10-CM codes 14,000 in 9 87,000 ICD-10-PCS codes 4,000 in 9 CMS has created General Equivalence Mapping (GEM) to assist with conversion

12 Slow adoption in US 1999 mortality reporting with ICD-10 began 2008 rule required use of ICD-10-CM by Oct 2013 In 2012, delayed till October 1, 2014 WHO already working on ICD-11 Will be endorsed in 2015

13 Inpatient procedure reporting Does not replace CPT for MD and OP procedures 72,000 codes; 7 characters 16 sections: Med/Surg, OB, Admin, Chiro, Imaging, NM, etc. In Med/Surg (62,000) 1 st character = Section 0 2 nd = Body system (30 or so; CNS, muscle, urinary) 3 rd = Root operation (30+; bypass, repair, transplant) 4 th = Body part (up to 34/system) 5 th = Approach (7; open, percutaneous, natural opening) 6 th = Device (lots; drain, skin graft, luminal, synthetic) 7 th = Qualifier (additional attribute)

14 Imaging (2900) 1 st = Section (B) 2 nd = Body system 3 rd = Root type (XR, FL, CT, MRI, US) 4 th = Body part (includes laterality) 5 th = Contrast (0 high osm, 1 low osm, Y other) 6 th = Qualifier (without and with contrast) 7 th = Qualifier (not used) UGI: BD15ZZZ CXR: BW03ZZZ MRI abdomen w/o and w: BW30Y0Z NM, IR separate

15 Document standard that acts as common interface Used by CMS Allows faster and cheaper claims submissions New HIPAA standard electronic form Version 5010 (June 2012) Supports ICD-10 Paper claims may still be submitted CMS 1500 UB-04

16 ICD-9-CM ICD-10-CM 3-5 characters 3-7 characters 17,000 codes 68,000 codes No space for new codes Lots of room to grow General Very Specific Lacks laterality Left/right included

17 Characters 1-3 Category Characters 4-6 Etiology, anatomic site, severity or other clinical detail Character 7 Extension

18 J45 Asthma J45.2 Mild Intermittent asthma, J45.20 uncomplicated J45.21 with (acute) exacerbation J45.22 with status asthmaticus J45.3 Mild persistent asthma J45.30 uncomplicated J45.31 with (acute) exacerbation J45.32 with status asthmaticus J45.4 Moderate persistent asthma J45.40 uncomplicated J45.41 with (acute) exacerbation J45.42 with status asthmaticus J45.5 Severe persistent asthma J45.50 uncomplicated J45.51 with (acute) exacerbation J45.52 with status asthmaticus J45.9 Other and unspecified asthma J45.90 Unspecified asthma J with (acute) exacerbation J with status asthmaticus J uncomplicated J45.99 J Exercise-induced bronchospasm J Cough variant asthma J Other asthma

19 Seven main fracture extensions A Initial encounter for closed fracture B Initial encounter for open fracture D Subsequent encounter for fx w/ routine healing G Subsequent encounter for fx w/ delayed healing K Subsequent encounter for fx w/ non-union P Subsequent encounter for fx with malunion S Sequelae Some fractures subtype open fractures (Gustilo) Forearm fxs (except torus and greenstick) 16 extensions

20 Documentation should include: Laterality Open/closed (closed if not mentioned) Displacement (displaced if not mentioned) Location: sternal end, shaft, lateral end, unspecified 7 th digit extender: A, B, D, G, K, P, S Example: Displaced fx of sternal end of right clavicle initial encounter open fracture S42.011B ICD-9 only one code; ICD choices

21 S52 Fracture of forearm S52.5 Fracture of lower end of radius S52.52 Torus fracture of lower end of radius S Torus fracture of lower end of right radius S52.521A Torus fracture of lower end of right radius, initial encounter for closed fracture S59.2 Physeal fracture lower end of forearm

22 ICD-10 has 50 codes for complications of foreign body accidently left in body after procedure One code in ICD-9 Examples: T Perf due to FB after heart cath T Perf due to FB left after surg operation T Obstruction due to FB left after endoscopic procedure T Adhesions due to FB left after aspiration, puncture, or other catheterization

23 Does have signs and symptom codes like ICD-9 Similar choices Cough ICD-10-CM R05 ICD-9-CM Coders use diagnosis, if given If not specific, then signs/symptoms

24 External cause codes Not required by CMS Some states could require Examples: 3.1 V01 Pedestrian injured with pedal cycle 3.1 V02 Pedestrian injured with 2, 3 wheeled vehicle 11.1 V80 Animal rider injured in transport accident W09 Fall from playground equipment 18.9 W58 Contact with alligator or crocodile Y07 Perpetrator of assault, maltreatment or neglect Y07.14 Adoptive mother as perp of assault 36 Child abuse codes (confirmed and suspected)

25 Mandatory conversion Oct. 1, 2014 After that date, ICD-9 codes cannot be transmitted More specific reports may be needed Depends of Local and National Coverage Determinations of reasonable and necessary Medicare policies Not completed A lot of work for coders