Overview of ICD-10-CM & ICD-10-PCS

Transcription

1 Overview f ICD-10-CM & ICD-10-PCS Presented By: Stacey Chevius, BA, AHI, CPC, CDIP AHIMA Apprved ICD-10-CM/PCS Trainer and Ambassadr May 2013

2 Why ICD-10? ICD-10 cde sets allw prviders t drill dwn int manifestatins f diseases and cnditins fr apprpriate treatment plans Prvide linkage between genetic risk factrs (pre-dispsitin) and pre-existing cnditins n chrnic illnesses and diseases Supprt clinical trial prtcls

3 Why ICD-10? (cnt.) ICD-10-CM cdes prvide greater specificity, accuracy and laterality when assigning diagnsis cdes that can imprve quality measures and utcmes ICD-10-PCS cdes allw fr expansin and emerging technlgy in prcedures

4 Glbal Cmpetitin

5 Areas t be Impacted by ICD-10 HIM Educatin (Staff/physicians) Finance Budget preparatins Reallcatin f staff (resurces) Clinical Care Dcumentatin EMR/EHR ICD-10 IT HIM Finance Payers Clinical Care

6 Areas t be Impacted by ICD-10 (cnt.) Payers IT Payment delays Incrrect payments System recnfiguratin and sftware upgrades System interfacing upgrades IT HIM ICD-10 Finance Payers Clinical Care

7 ICD-9-CM vs. ICD-10- CM/PCS Number f ICD cdes as f 2009 Diagnsis Cdes ICD-9-CM: 13,000 ICD-10-CM: 68,000 Prcedure Cdes ICD-9-CM: 3,800 ICD-10-PCS: 72,000 ICD-9 (Ttal, bth Diagnsis and Prcedures): 16,800 ICD-10 (Ttal, bth CM and PCS): 140,000+

8 ICD-9-CM vs ICD-10- CM/PCS Frmat

9 ICD-9-CM vs ICD-10- CM/PCS Frmat ICD-9-CM ICD-10-CM/PCS 3-5 alphanumeric characters Seven (7) alphanumeric characters Cntains bth diagnsis and prcedure cdes Lacks detail Limited space fr expansin f new cdes Generic terms used fr anatmical sites 1st character numeric-all letters except U in CM Cntains specificity (e.g., trimester, laterality) Flexibility fr adding new cdes Specific terms fr anatmic sites (e.g. gallbladder, appendix)

10 ICD-9-CM vs. ICD-10-CM Frmat ICD-9-CM Frmat X Categry Etilgy, anatmical site, manifestatin ICD-10-CM Frmat x x Categry Etilgy, anatmical site, and severity Extensin

11 Seventh Characters and Placehlders Sme ICD-10-CM categries have seven (7) characters If the seventh character is required, there are instructin ntes in the Tabular List If a cde requires seven characters and there are six characters, a placehlder f x must be used t fill in the space

12 Seventh Characters and Placehlders (cnt.) If a placehlder f X is used, the seventh character may be used t indicate encunter fr care. A-Initial encunter D-Subsequent encunter S- Sequela

13 Seventh Characters and Placehlders Example An 75-year ld female is discharged hme fllwing hip replacement surgery. After returning hme, she develped a superficial wund infectin at the incisin site. Hme health care has been rdered t assist with care f the wund. The physician rdered wund care three times per week alng with gait training t assist with restratin f the gait abnrmality.

14 Seventh Characters and Placehlders Example (cnt.) Cde Assigned: T81.4XXA Infectin fllwing a prcedure initial episde. The apprpriate 7th character is t be added t each cde frm categry T81. 7th T81.4 A-Initial encunter D-Subsequent encunter S- Sequela

15 Dummy Placehlders ICD-10-CM cdes that use XX as multiple placehlder characters, 5th and 6th allws fr future expansin f that cde Example: -O33.5 Maternal care fr disprprtin due t unusually large fetus If the fetus affected is number 2 Cde assigned: O33.5XX2

16 Dummy Placehlders (cnt.) O th character 0 is fr single gestatins and multiple gestatins where the fetus is unspecified. 7 th characters 1 thrugh 9 are fr cases f multiple gestatins t identify the fetus fr which the cde applies. The apprpriate cde frm categry O38, Multiple gestatins, must als be assigned when assigning cde O33.6 with a 7 th character f 1 thrugh 9. 0 nt applicable r unspecified 4 fetus 4 1 fetus 1 5 fetus 5 2 fetus 2 9 ther fetus 3 fetus 3

17 ICD-10 Omissins and Deletins Hypertensin Table has been mitted in ICD-10-CM; hypertensin cdes have been included in the Alpha and Tabular Indexes External causes f Injury cdes (E cdes) are n lnger prefixed with an E. External cdes are nw called External Causes f Mrbidity and are prefixed with a V

18 ICD-10 Omissins and Deletins (cnt.) V cdes (Status cdes) are nw Z cdes and called Factrs Influencing Health Status and Cntact with Health Services Table f Chemicals and Drugs nw part f index- Injury, Pisning and Certain Other Cnsequences f External Causes

19 Neplasms Neplasms nw include laterality (C00- D49) C50.0-Malginant neplasm f nipple and arela C Malignant neplasm f nipple and arela, right female breast C Malignant neplasm f nipple and arela, left female breast C Malignant neplasm f nipple and arela, unsp. female breast

20 Neplasms (cnt.) C Malignant neplasm f nipple and arela, unsp. female breast C Malignant neplasm f nipple and arela, right male breast C Malignant neplasm f nipple and arela, left male breast C Malignant neplasm f nipple and arela, unsp. male breast

21 Neplasms-Behavirs Neplasms behavirs nw included in cde D29- Benign neplasm f male genital rgans D29.0 Benign neplasm f penis D29.1 Benign neplasm f prstate D29.2 Benign neplasm f testis D29.20 Benign neplasm f unspecified testis D29.21 Benign neplasm f right testis D29.22 Benign neplasm f left testis Certain benign neplasms may be fund in the specific bdy system chapters

22 Diabetes Mellitus Diabetes mellitus cdes are all cmbinatin cdes in ICD-10-CM. There are mre than 200 cdes fr Diabetes mellitus. Diabetes cdes n lnger classified as cntrlled r uncntrlled. Instead ICD- 10-CM Diabetes mellitus cdes are classified as inadequately cntrlled, ut f cntrl, and prly cntrlled diabetes mellitus by type with hyperglycemia.

23 Diabetes Mellitus (cnt.) T accurately cde Diabetes mellitus, the physician dcumentatin must include the fllwing: Type f diabetes Bdy system affected Use f Insulin Any cmplicatins Any manifestatins Reasn(s) fr secndary diabetes mellitus

24 New Diabetes Categries (E08.00-E13.9) E08, Diabetes mellitus due t underlying cnditin E09, Drug r chemical induced diabetes mellitus E10, Type I diabetes mellitus E11, Type II diabetes mellitus E13, Other specified diabetes mellitus

25 Diabetes Mellitus Case Example 1 A 48-year ld male, a type I diabetic with stage 3 chrnic kidney disease is being treated t regulate his insulin dsage. He has an abscessed right incisr, which has been determined t be respnsible fr his elevated bld sugar. Assign cde(s): E10.22; N18.3; K04.7 E10.22 Diabetes mellitus, type I with CKD N18.3 CKD, stage 3 K04.7 Abscess, tth, teeth (rt)

26 Diabetes Mellitus Case Example 2 A 40-year ld female is being treated fr nging management f sterid-induced diabetes mellitus frm prlnged use f crticsterids, which have nw been discntinued. The patient s diabetes is being managed with insulin that she has been taking fr the past tw years. Assign cde(s): E09.9; T38.0X5S; Z79.4

27 Diabetes Mellitus Case Example 2 (cnt.) E09.9: Diabetes due t drug r chemical T38.0X5S: Adverse effect, crticsterids, Sequela Z79.4: Lng-term (current) (prphylactic) drug therapy (use f), insulin

28 Nervus System Case Example 1 A 74-year ld male has been experiencing increasing dementia and frgetfulness. He has been wandering ff and leaving his daughter s hme and frgetting where he is r where he is ging. The diagnsis f dementia due t earlynset Alzheimer s has been established. Assign cde(s): G30.0; F02.81; Z91.83

29 Nervus System Case Example 1 (cnt.) G30.0: Alzheimer s Disease, early nset with behavir disturbance F02.81: Dementia, in Alzheimer s Disease Z91.83: Wandering, in diseases classified elsewhere

30 Nervus System Case Example 2 A 16-year ld male is being seen t manage his juvenile myclnic epilepsy. He has nt respnded t treatment and was diagnsed with an intractable seizure. Assign cde(s): G40.B19 G40.B19 Epilepsy, epileptic, epilepsia (attack) (cerebral) (cnvulsin) (fit) (seizure), juvenile myclnic, intractable

31 Factrs Influencing Health Services (Z00-Z99) Factrs Influencing Health Status & Cntact with Health Services (Z00-Z99) These cdes replaced V cdes as reasns fr encunters. Z00 5th- Encunter fr general examinatin withut cmplaint, suspected r reprted diagnsis Z00.0-Encunter fr general adult medical exam Z Encunter fr general adult medical exam withut abnrmal findings Z00.01-Encunter fr general adult medical exam with abnrmal findings

32 Factrs Influencing Health Services (Z00-Z99) (cnt.) Z75 4th Prblems related t medical facilities and ther health care Z75.0-Medical services nt available in hme Z75.1-Persns awaiting admissin t adequate facility elsewhere Z75.2-Other awaiting perid fr investigatin and treatment

33 Factrs Influencing Health Services (Z00-Z99) (cnt.) Z75 4th Prblems related t medical facilities and ther health care (cnt.) Z75.3-Unavailability and inaccessibility f ther helping agencies Z75.5-Hliday relief care Z75.8-Other prblems related t medical facilities and ther health care Z75.9-Unspecified prblem related t medical facilities and ther health care

34 AAPC CEU CEU Cde: 31530LNL

35 Overview f ICD-10-PCS

36 Rad t ICD-10-PCS st Draft f ICD-10 was cmpleted Training prgrams were develped Frmal testing was cnducted and Final draft was cmpleted 1998-Present ICD-10-PCS updated annually

37 ICD-10-PCS Frmat Sectin Rt Operatin Apprach Qualifier Bdy Sectin Bdy Part Device There are seven (7) characters in each ICD-10- PCS (Prcedural Cding System) cde. Each character has a slightly different meaning related t that particular sectin. I and O are nt used in PCS.

38 ICD-10-PCS Characters and Examples All f the ICD-10-PCS cdes have seven (7) characters with each representing a different aspect f the prcedure Character 1 Character 2 Character 3 Character 4 Sectin Bdy System Rt Operatin Medical/Surgical Obstetrics Placement Administratin Measurement and Mnitring Central Nervus System Respiratry System Gastrintestinal Hepatbiliary System & Pancreas Alteratin Bypass Change Destructin Change Detachment Fusin Replacement Resectin Bdy Part Appendix Gallbladder Upper Lip Lwer Lip Esphagus Jugular vein, left Jugular vein, right Inferir Parathyrid gland, left r right

39 ICD-10-PCS Characters and Examples (cnt.) Character 5 Character 6 Character 7 Apprach Device Qualifier Open Percutaneus Percutaneus Endscpic Via Natural r Artificial Opening Via Natural r Artificial Opening Endscpic External Grafts and Prstheses Implants Simple r Mechanical Appliances Electrnic Appliances Unique values fr individual prcedures. E.g., Identify destinatin site in a bypass.

40 ICD-9-CM vs.icd-10-pcs Cdes Cmparing ICD-9-CM Prcedure Cdes t ICD-10-PCS Cdes ICD-9 ICD-10

41 ICD-10-PCS Example 1 A physician perfrms a laparscpicassisted vaginal hysterectmy (LAVH). ICD-9-CM Cde: ICD-10-PCS Cde assigned: 0UT9FZZ Sectin Bdy System Rt Operatin Bdy Part Apprach Device Qualifier Med/Surg Female Reprductive System Resectin Uterus Via Natural r Artificial Opening with Percutaneus Endscpic Assistance Nne 0 U T 9 F Z Z Nne

42 ICD-10-PCS Example 2 A physician perfrms an pen chlecystectmy t remve gallstnes/calculi. ICD-9-CM Cde: ICD-10-PCS Cde assigned: 0FT40ZZ Sectin Bdy System Rt Operatin Bdy Part Apprach Device Qualifier Med/Surg Hepatbiliary System & Pancreas Resectin Gallbladder Open Nne Nne 0 F T 4 0 Z Z

43 ICD-10-PCS Example 3 A physician perfrms an pen appendectmy ICD-9-CM Cde : ICD-10-PCS Cde assigned: 0DTJ0ZZ Sectin Bdy System Rt Operatin Bdy Part Apprach Device Qualifier Med/Surg Gastrintestinal System Resectin Appendix Open Nne Nne 0 D T J 0 Z Z

44 ICD-10-PCS Example 4 A physician perfrms a laparscpic appendectmy ICD-9-CM Cde : ICD-10-PCS Cde assigned: 0DTJ4ZZ Sectin Bdy System Rt Operatin Bdy Part Apprach Device Qualifier Med/Surg Gastrintestinal System Resectin Appendix Percutaneus Endscpic Nne Nne 0 D T J 4 Z Z

45 ICD-10-CM & PCS Dcumentatin Challenges Transitin t ICD-10 will require physicians/prviders t capture additinal infrmatin ICD-10-CM cntains multiple cmbinatin cdes; therefre, the dcumentatin must be cmplete, accurate, and reflect the assciatin between manifestatins and cmrbid cnditins Dcumentatin must be cmprehensive t supprt ICD-10 specificity cde sets

46 ICD-10-CM & PCS Dcumentatin Challenges If it wasn t dcumented, it wasn t dne

47 ICD-10-CM & PCS Benefits Reduce ambiguity and redundancy Increased flexibility fr adding new cdes Imprve knwledge f medical terminlgy and anatmy Prvide transparency fr reimbursement and cmpliance

48 ICD-10-CM & PCS Benefits (cnt.) Alleviate wrries abut reductin in payments and claims denials fr additinal infrmatin requested by Payers Imprve data cllectin and tracking f new diseases and technlgies Imprve patient utcmes

49 ICD-10-CM & PCS Transitin CMS has set the date t transitin t ICD- 10 Octber 1, 2014

50 Questins

51 AAPC CEU CEU Cde: 31540KLB

52 Thank yu fr yur time. Please cntact TruBridge with any questins r fr mre infrmatin.

53 References ICD-10-CM: The Cmplete Official Draft Cde Set, 2013 Editin by Ingenix ICD-10-PCS: The Cmplete Official Draft Cde Set, 2013 Editin by Ingenix