ICD-10-CM Recertification Prep: Proper Prepping Isn t as Bad as You Think

Transcription

1 ICD-10-CM Recertification Prep: Proper Prepping Isn t as Bad as You Think Julie Orton Van, CPC, CPC-P, CEMC Product Manager Coding Solutions 2015 AAPC HEALTHCON, Las Vegas NV

2 Publisher s Notice: Although we have tried to include accurate and comprehensive information in this presentation, please remember it is not intended as legal or other professional advice. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 2

3 Focus and agenda ICD-10-CM recertification Use and application of ICD-10-CM What to prep What do you need Tips and tricks to test-taking Bonus content Extra study materials Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 3

4 ICD-10-CM recertification Credentialing and certifying organizations Verify knowledge is current Assess ICD-10-CM knowledge and ability to apply correctly Requirements vary by organization AHIMA CEUs Up to 18 CEUs required AAPC Proficiency Assessment Timed 75-question Unlimited time, 150-question with prerequisite AAPC approved training See other organization websites for specific information Employe-required verification of knowledge May use established testing or their own Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 4

5 Use and application of ICD-10-CM Complete ICD-10-CM training from a credible source

6 Use and application of ICD-10-CM Conventions for ICD-10-CM ICD-10-CM Official Guidelines for Coding and Reporting Section 1.A. Three to seven characters Placeholder character: X NEC vs NOS NEC other specified NOS equivalent of unspecified And and or or With associated with or due to Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 6

7 Use and application of ICD-10-CM (continued) Pull out the ICD-10-CM Guidelines Get the most recent version Get out your highlighter Look at ALL the sections You need to know the guidelines for all specialties, not just your own Let s review a few critical guidelines Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 7

8 Use and application of ICD-10-CM (continued) Includes Notes Gives examples of included content Inclusion Terms Synonyms Other specified terms Conditions assigned to that code Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 8

9 Use and application of ICD-10-CM (continued) Excludes Notes Excludes 1 NOT CODED HERE Two conditions cannot occur together Congenital and acquired Excludes 2 Not included here Not part of the condition represented by the code May be appropriate to report together when both exist Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 9

10 Use and application of ICD-10-CM (continued) Etiology and manifestation Code first Use additional code Underlying condition is sequenced first followed by the manifestation Etiology states use additional code Manifestation states code first Use these guidelines even if the code description does not state in diseases classified elsewhere In the index, manifestation codes are listed with etiology codes in brackets Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 10

11 Use and application of ICD-10-CM (continued) Etiology and manifestation In the index, manifestation codes are listed with etiology codes in brackets Always use the Code first and Use additional code guidelines Used to identify other conditions that require multiple codes Code if applicable Sequela, complication, obstetrics Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 11

12 Use and application of ICD-10-CM (continued) Code also This instruction is separate from code first and use additional code Two codes may be required There is no sequencing direction Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 12

13 Use and application of ICD-10-CM (continued) Default codes A code listed next to a main term Condition that is most commonly associated with the main term Unspecified code for that condition If condition is documented without additional information use the default code Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 13

14 Use and application of ICD-10-CM (continued) Signs and symptoms Appropriate when a definitive diagnosis has not be established Use specific diagnosis when supported by documentation If definitive diagnosis is not established by end of encounter Unspecified codes Use when sufficient information isn t known or available Use when they reflect what is known about the patient s condition Do not select a more specific code if the information is not in the documentation Additional testing to determine type of bacteria Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 14

15 Use and application of ICD-10-CM (continued) Conditions integral part of disease process Signs and symptoms that are associated with a disease process are not separately coded Code sign and symptom only if instructed in the classification Conditions NOT integral part of disease process Additional signs and symptoms not associated with disease are coded when present J30.2 Other seasonal allergic rhinitis R06.2 Wheezing Excludes1 asthma (J45.-) Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 15

16 Use and application of ICD-10-CM (continued) Acute and Chronic Must be listed in diagnostic statement Can report both if there are separate entries and both documented Must be at same indentation level Sequence acute (subacute) first Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 16

17 Use and application of ICD-10-CM (continued) Combination code A combination code is a single code To report two diagnosis Diagnosis with associated secondary process or manifestation Diagnosis with associated complication Report only the combination code Fully identifies diagnostic condition Alphabetic Index direction Use additional code only if the combination code lack needed specificity Manifestation Complication Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 17

18 Use and application of ICD-10-CM (continued) Reporting HIV HIV-related conditions Neoplasms Diabetes mellitus Type Insulin In pregnancy Nervous system Pain Transient Controlled/uncontrolled Hypertension Secondary hypertension Acute myocardial infarction COPD Chronic kidney disease Stages Obstetrics Trimesters Coma Scale Fractures Burns Z codes Bonus Content at end of slide deck Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 18

19 What to prep Read the section notes in the Official Guidelines Highlight what you think is critical or a little tricky Signs and symptoms Sequencing Look in the index Rule out Facility versus physician guidelines Combination codes vs. single code Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 19

20 What to prep (continued) Look at the combination of the codes Incomplete codes Look up the codes that are different Look at the sequencing Check laterality Look up terms Look it up in the index Terms are sometimes only listed in the index Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 20

21 What to prep (continued) Resources to use ICD-10-CM or PCS book Current guidelines for the year you are taking the test Don t use 2015 guidelines if you are taking the 2014 version Anatomy book Dictionary AHA Coding Clinic GEM mapping: be careful, as the mapping may not be exact Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 21

22 What to prep (continued) Tips for taking a multiple-choice test Read the full question Look for the little details all the words Think of the right answer before you look at the possible choices Look up the codes that are different and eliminate those that are not correct Your first choice is often correct Do not leave any questions blank If you get stuck on one, note it and come back at the end Well-prepared exams do not try to trick you with the question wording Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 22

23 What to prep (continued) Tips and tricks Same code more than once Look at the codes with only one character different Laterality Sequencing Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 23

24 What to prep (continued) Be rested Have the required time undisturbed Guidelines Coding conventions Coding scenarios Have snacks and beverages ready Plan a break if you need one Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 24

25 What is the AAPC ICD-10-CM Proficiency Assessment Assessment to verify your knowledge of ICD-10-CM coding This assessment covers the diagnostic code set (CM) only Does NOT include PCS Required to maintain AAPC credentials Only need to pass once regardless of number of credentials or certifications from AAPC Completion date is still listed as December 31, 2015 Not recognized by other credentialing or certifying organizations Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 25

26 Practice, practice, and more practice Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 26

27 Thank you. Contact information Julie Orton Van, CPC, CPC-P, CEMC, Product Manager Coding Solutions

28 BONUS CONTENT Extra study materials for ICD-10 Recertification Preparation

29 Use and Application of ICD-10-CM Reporting HIV Code only IF confirmed Encounter for HIV testing Screening Z11.4, Encounter for screening for human immunodeficiency virus [HIV] Testing with signs and symptoms report the symptoms Counseling pre and post-test Z71.7, Human immunodeficiency virus [HIV] counseling Inconclusive HIV serology - R75, Inconclusive laboratory evidence of human immunodeficiency virus [HIV] HIV-related conditions B20, Human immunodeficiency virus [HIV disease Additional codes for all reported HIV-related conditions Seen for unrelated condition Report code for unrelated condition Additional code B20 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 29

30 Use and Application of ICD-10-CM (continued) Neoplasms Encounter for treatment of malignancy Primary code is the malignancy Treatment of secondary site only Primary code is the secondary site Encounter for surgical treatment Primary code is malignancy Encounter for treatment Chemotherapy, immunotherapy, radiation with a code from Z51.- Dehydration Report first only if that is the only treatment at that encounter Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 30

31 Use and Application of ICD-10-CM (continued) Neoplasms Anemia malignancy Malignancy followed by anemia Anemia treatment (radiation, chemotherapy, immunotherapy) Treatment of anemia report anemia Secondary code is adverse effect for chemotherapy Secondary code is complication for radiation therapy Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 31

32 Use and Application of ICD-10-CM (continued) Neoplasms In pregnant patient Primary code is O9A.1- Current vs personal history Report malignancy Excised but additional treatment needed Current/active treatment Report history No further treatment No evidence of existing primary malignancy Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 32

33 Use and Application of ICD-10-CM (continued) Diabetes mellitus Type of diabetes Type 1 most type 1 diabetics develop the condition before reaching puberty Type 2 caused by the body's inability to respond to insulin that is produced, called insulin resistance The Coders Dictionary If the type of diabetes mellitus is not documented in the medical record the default is Ell.-, Type 2 diabetes mellitus. I.C.4.a.2 Insulin NOT the only indicator of type 1 Treatment with insulin without mention of type 1 is codes to E11 Long term use report Z79.4, Longterm (current) use of insulin Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 33

34 Use and Application of ICD-10-CM (continued) Diabetes Mellitus Secondary diabetes mellitus E08, Diabetes mellitus due to underlying condition E09, Drug or chemical induced diabetes mellitus E13, Other specified diabetes mellitus See tabular list for sequencing Diabetes Mellitus in pregnancy see Section I.C.15 Pre-existing diabetes report O21, Diabetes mellitus in pregnancy, childbirth, and the puerperium Appropriate diabetes codes (E08-E13) Gestational (pregnancy induced) diabetes report O O Abnormal glucose tolerance test in pregnancy O O Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 34

35 Use and Application of ICD-10-CM (continued) Nervous system For G81 Hemiplegia and hemiparesis For G83 Other paralytic syndromes Dominant/nondominant side Affected side document, not state dominant or nondominant Ambidextrous patient, default is dominant Left side, default is nondominant Right side, default is dominant Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 35

36 Use and Application of ICD-10-CM (continued) Pain Category G89 Do not use if definitive (underlying) diagnosis known May use if encounter is for pain control/management Treatment for underlying condition is reported Do not also code G89.- May be principal or first listed Pain control/management encounter Insertion of device for pain control Site specific pain Is Primary or first listed if treating definitive diagnosis G89 may be used to identify acute or chronic condition Chronic pain G89.2 No time use providers documentation Chronic pain syndrome G89.4 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 36

37 Use and Application of ICD-10-CM (continued) Hypertension I10 Hypertension with heart disease I11 with a heart condition classified to I50, I51.- Hypertensive chronic kidney disease I12 with a condition classifiable to N18 Hypertensive heart and chronic kidney disease I13 with both Hypertensive cerebrovascular disease Code first from category I60-I69 Hypertensive retinopathy H35.0 with I10-I15 Sequencing based upon reason for encounter Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 37

38 Use and Application of ICD-10-CM (continued) Secondary hypertension I15 Transient hypertension R03.0 elevated blood pressure only O13.- gestational hypertension O14.- Pre-eclampsia Controlled hypertension I10-I15 Uncontrolled hypertension I10-I15 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 38

39 Use and Application of ICD-10-CM (continued) Acute myocardial infarction (AMI) STEMI I21.0-I21.1 NSTEMI I21.4 Unspecified acute MI I21.3 Subsequent acute MI I22 Sequenced according to circumstance of encounter Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 39

40 Use and Application of ICD-10-CM (continued) COPD Uncomplicated or acute exacerbation (J44 and J45) Acute respiratory failure J96.- Sequencing dependent upon other comorbidities Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 40

41 Use and Application of ICD-10-CM (continued) Chronic kidney disease Based upon severity May have after kidney transplant use both N18.- Z94.0, Kidney transplant status Stage 1 Stage 2 mild Stage 3 moderate Stage 4 Severe Stage 5 End stage renal disease (ESRD) Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 41

42 Use and Application of ICD-10-CM (continued) Obstetrics Sequence first Exception is when pregnancy is incidental Use O codes only for mother Final character for the trimester Outcome of delivery use appropriate 7 th character Normal delivery without complication O80 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 42

43 Use and Application of ICD-10-CM (continued) Symptom codes used when definite diagnosis not established (confirmed) Report symptom with definitive diagnosis if not routinely associated Some combination codes include symptoms Coma Use appropriate 6 th and 7 th characters Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 43

44 Use and Application of ICD-10-CM (continued) Fractures Watch for the appropriate 7 th character May vary by specific three character code Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 44

45 Use and Application of ICD-10-CM (continued) Burns and corrosions Reported by depth Assign code for each site burned Sequence highest degree of burn first when multiple burns Use appropriate 7 th character Report T31 or T32 for body surface Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 45

46 Use and Application of ICD-10-CM (continued) Z codes May be used in any health care setting May be first listed or secondary code Identify history of Encounter for specific treatment or care Chemotherapy/radiation therapy Counseling Donors Screening Follow up Aftercare Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 46