AHIMA-Approved ICD-10-CM/PCS Trainer Stacey Chevious, BA, CPC, AHI, CDIP August 13, 12 PM EST

Transcription

1 AHIMA-Approved ICD-10-CM/PCS Trainer Stacey Chevious, BA, CPC, AHI, CDIP August 13, 12 PM EST

2 Agenda Clarify new anatomical and physiological documentation requirements with detailed explanations of the specificity level Provide clear-cut anatomy lessons that make correct coding of operative reports and chart notes easier for protected payments Show you some selected examples from GI, Radiculopathy, Human Bone, Cerebral Emboli, Urology, Female Reproductive System, Sinus, etc. Teach you how to tackle the advanced specificity and the stronger clinical knowledge requirements that will be necessary for proper selection of ICD-10-CM code sets Arm you with ICD-10-CM examples that expand medical terminology and anatomy understanding for more accurate coding now and beyond Teach you the relationships between anatomy, physiology, and code capture in diagnosis coding 2

3 Biggest Change in Three Decades Where Do You Start? ICD-10 is the biggest change in medical coding in close to three decades - with diagnosis codes increasing from 14,000 to 69,000! The countdown to this system stands at just over a year, so now is a great time to zero in on the transition details you and your practice need to know. 3

4 ICD-10 Concerns ICD-10-CM will require much more detail to determine the correct diagnosis and condition of the patient. And ensuring proficiency in anatomy and physiology is the first step a coder or biller should take to prepare for the big switch! 4

5 What to Expect in 2014 Advanced Specificity Thorough understanding of anatomy and physiology ICD-10-CM requires much greater detail to determine proper diagnoses than ICD-9. A more thorough understanding of anatomy and physiology is required for this new code set. 5

6 Additional Anatomic Details You'll need additional anatomic details when you start using ICD-10. For instance, for the same Metatarsal Fracture, choosing the proper ICD-10 code will depend on: Whether the fracture is of first, second, third, fourth, fifth or unspecified metatarsal On RT or LT foot Whether first or subsequent encounter for this fracture with the physician Although that information didn t matter for ICD-9, ICD-10 will allow you to specify laterality. 6

7 The greater specificity of ICD-10-CM means that medical coders and billers will no longer be able to get away without a thorough understanding of human anatomy and physiology. Don t worry! That s why we are here today to help you prepare for ICD-10-CM specificity, stronger clinical terms, and documentation requirements! 7

8 Coder & Billers Need a Solid Foundation in Basic Human Anatomy & Physiology Now when we talk about anatomy and physiology, it is one of those subjects that everybody says why do I need to know about the veins and other things. But the truth is in ICD-10, as a coder and biller, you will need to have a good understanding of anatomy and pathophysiology because your physicians are going to describe things they do to these structures. Example: Teaching your provider to include one detail in his hip fracture documentation now can make the difference between a hard-to-get covered nonspecified ICD-10 code or a direct-pay specified ICD-10 code. 8

9 Drawings, MD Insight Improve Comprehension To capture proper pay for the services rendered, you ll need to know in-depth location information for: Wounds Nodes Ligaments Veins And More So sometimes looking at pictures and getting a little background information about what is going on with the body is actually extremely helpful to you as a coder when you are faced with difficult-to-comprehend situations. 9

10 That s What We re Going to Do Here Take some lessons on anatomy and physiology to tackle the advanced specificity and the stronger clinical knowledge requirements that will be necessary for proper selection from ICD-10-CM code sets! 10

11 Anatomy: 150.x-156.x Match to Gastrointestinal Anatomy Sites Stay alert for most appropriate code for overlapping sites. Having trouble distinguishing the cecum from the sigmoid colon or the duodenum from the descending colon? Take a moment to review the graphic in the following slide. To see how anatomy can compare to your coding options, check the table, which offers a sampling of codes related to primary neoplasm diagnoses. 11

12 Gastrointestinal Anatomy Sites 12

13 Caution: When choosing codes for your claims, always look at both the ICD-9 index and the tabular list to be sure you have the most appropriate code. This precaution is especially important when documentation indicates neoplasms of contiguous or overlapping sites. Notes in the tabular list will often instruct you to use an "other specified sites" code ending in.8 for these cases. For example, ICD-9 offers (Malignant neoplasm of stomach; other specified sites of stomach) with the note: "Malignant neoplasm of contiguous or overlapping sites of stomach whose point of origin cannot be determined." 13

14 ICD-10 Guidelines Read: A primary malignant neoplasm that overlaps two or more contiguous (next to each other) sites should be classified to the subcategory/code.8 ('overlapping lesion'), unless the combination is specifically indexed elsewhere. For multiple neoplasms of the same site that are not contiguous, such as tumors in different quadrants of the same breast, codes for each site should be assigned.

15 ICD-10: You'll Need Specific Region Details to Accurately Report Radiculopathy Get ready for multiple diagnosis choices. Choosing your diagnosis code for radiculopathy will get site-specific in ICD-10. Start educating your providers now to document which of the spinal regions was treated to ensure that you re ready for expanded code options. 15

16 Remember Your Spinal Regions The spine is divided into five regions, with a total of 33 vertebrae The vertebrae in the two lower regions (sacral and coccygeal) are fused together, but vertebrae in the rest are each separated by intervertebral spaces Many different conditions can cause spinal nerves to become inflamed, compressed, or suffer a compromise in blood supply. This leads to a type of neuropathy in one or more spinal segments known as radiculopathy 16

17 Get Specific Documentation for Code Switches ICD-9 includes two codes for spinal radiculopathy: (Brachial neuritis or radiculitis), which you report for cervical radiculopathy (Thoracic or lumbosacral neuritis or radiculitis, unspecified), which you report for thoracic, lumbar, or sacral radiculopathy Having only two diagnosis choices means that providers currently might not specify many anatomic-specific details in their documentation. That will change with ICD-10, when each of the two current codes will expand to multiple options. 17

18 Cervical Changes: Instead of having a single diagnosis code for cervical radiculopathy, you ll have: One code specifically for C0-C1 and C1-C2 - M54.11 One code for cervical - M54.12 One for cervicothoracic - M54.13 If your physician documents cervical disc disorder (such as intervertebral disc displacement, degeneration, or disease) with radiculopathy, you ll have even more choices: M50.10 Cervical disc disorder with radiculopathy, unspecified cervical region M50.11 occipito-atlanto-axial region M50.12 mid-cervical region M50.13 cervicothoracic region. 18

19 Thoracic/Lumbar/Sacral changes: Diagnosis gets more specific under ICD-10 with individual codes for spinal regions. Your basic code choices will be: M54.14 Radiculopathy, thoracic region M54.15 thoracolumbar region M54.16 lumbar region M54.17 lumbosacral region M sacral and sacrococcygeal region. Additional choices for intervertebral disc disorders with radiculopathy, distinguished by anatomic site: M51.14 Intervertebral disc disorders with radiculopathy, thoracic region M51.15 thoracolumbar region M51.16 lumbar region M51.17 lumbosacral region. 19

20 Respiratory Other Anomalies Code Expands to More Specific Other Codes If you use for all your 'other' congenital abnormalities of the trachea and bronchi for conditions not otherwise specified in ICD-9, then you should be prepared to encounter more specific 'other' codes in ICD-10. Most of them focus on the anatomical areas. Right now, if a patient suffers from any of the conditions previously enumerated, the ENT would likely diagnose her with "other congenital anomalies of larynx trachea and bronchus" and you would report with (Other congenital anomalies of larynx trachea and bronchus) 20

21 ICD-10 Expands into Five More Specific Diagnosis Codes Q Congenital subglottic stenosis Q Laryngocele Q Other congenital malformations of larynx Q Other congenital malformations of trachea Q Other congenital malformations of bronchus. The expansion of is an example of why coders need to brush up on their anatomy and pathophysiology. 21

22 Documentation & Coder Tips Documentation: Code only the confirmed diagnoses Do not code "suspected," "rule out" or "probable" diagnoses You may report codes that describe signs and symptoms, as opposed to diagnoses, when the ENT has not established a related definitive diagnosis Coder tips: Two of the commonly used CPT codes that an ENT would link to Q31.1, Q31.3, Q31.8, Q32.1, or Q32.4 are: (Bronchoplasty; graft repair) (Bronchoplasty; excision stenosis and anastomosis). A bronchoplasty is performed with either graft repair or excision of a stenosis with anastomosis. 22

23 Let s Look at the Human Bone Bone comprises a rigid structure, which is based on dense connective tissue. A normal human bone is made up of the following essential macro and micro elements: Periosteum Medullary Membrane Marrow Blood Vessels and Nerves of Bone Haversian Canals (Canals of Havers) Lamellae Lacunae Canaliculi Perichondrium Osteoblasts Osteoclasts Medullary spaces Epiphysis Diaphysis Metaphysis 23

24 Human Bone - Anatomy 24

25 Now Apply This to Your Diagnosis Coding Example: Suppose your physician documents that a patient has a nontraumatic acute slipped upper femoral epiphysis of the right hip. (Note: The epiphysis means the articular end of a long bone, which is surrounded by cartilage.) How should you report this? You should report M (Acute slipped upper femoral epiphysis [nontraumatic], right hip). Documentation note: Encourage your physician to specify the location and the affected hip to get to a more detailed code. 25

26 ICD-10 Gets More Specific For Anatomical Location Of Cerebral Emboli You ll have to be more specific to report cerebral embolism diagnosis codes You ll need to ensure your clinician clearly documents which territory in the central circulation was affected by embolism 26

27 Look For Embolism Site When There Is No Infarction In ICD-9, there is only one code that you can report for cerebral embolism without cerebral infarction. You report (Cerebral embolism without cerebral infarction) for embolism in all territories of cerebral blood supply. In ICD-10, your coding options expand to a choice of four codes depending upon the specific anatomical location of the embolism: I66.09 (Occlusion and stenosis of unspecified middle cerebral artery) I66.19 (Occlusion and stenosis of unspecified anterior cerebral artery) I66.29 (Occlusion and stenosis of unspecified posterior cerebral artery) I66.9 (Occlusion and stenosis of unspecified cerebral artery) The last code I66.9 applies when either your physician does not mention the site affected by the embolism or the same cannot be construed appropriately in the imaging and other diagnostic studies. 27

28 Anatomical Site, Laterality, Infarctions Guide You to Correct Code ICD-10 is further specific for laterality. For example, look at the codes below for occlusion or stenosis of the middle cerebral artery. I66.01 (Occlusion and stenosis of right middle cerebral artery) I66.02 (Occlusion and stenosis of left middle cerebral artery) I66.03 (Occlusion and stenosis of bilateral middle cerebral arteries) The codes are specific for right, left, and bilateral involvement. This is the true specificity provided by ICD-10 and providers may need guidance in improving their documentation to include these details so they can be accurately reported. These codes map to ICD-9 codes (Cerebral thrombosis without cerebral infarction), (Cerebral embolism without cerebral infarction), and (Cerebral artery occlusion unspecified without cerebral infarction). 28

29 How to Select a Code Know the anatomy of cerebral circulation to spot the right code for cerebral embolism in ICD-10. Look at the diagram in next slide to see the cerebral circulation. The three main arteries on both sides, i.e. the anterior, middle, and posterior cerebral arteries, form a circle that gives off numerous other communicating branches to supply the brain. When reporting a cerebral embolism in any of these major arteries in the cerebral circulation, you will read through the suggestive symptoms that your clinician captures in the clinical notes and then look at the confirmatory imaging studies like CT or MRI he uses to come to a definitive diagnosis. 29

30 Cerebral Embolism 30

31 Examples Show You How Since regions in the brain control specific actions, your clinician can narrow down to the diagnosis of cerebral embolism and the potential site of obstruction. You may start to recognize that certain signs and symptoms connect to specific diagnoses. But don't make assumptions. Code choice should reflect the clinician's documentation. Here re a couple of examples providing cues for selecting the right coding, depending upon how your clinician approached the patient based on the presenting symptoms and signs in the patient. 31

32 Example 1: If your clinician documents that the patient presented with complaints of Repeatedly bumping into objects Hitting obstacles on the roadside Not being able to see half the printed page when reading You confirm further down in the clinical notes that the site of occlusion is the posterior cerebral artery and report code I The symptoms and signs of posterior cerebral artery strokes are numerous and diverse, but may include acute loss of vision, confusion, posterior cranial headache, and dizziness.

33 Example 2 If your clinician documents that the patient presented with hemiplegia and fixation of the eyes and head turned to the opposite side, he will also investigate to confirm that the patient has had a middle cerebral artery occlusion. You report this condition with ICD-10 code I66.09.

34 N80.2, N83.0 and More: Match the Code to the Female Reproductive Site Give your coding a boost by tying code digits to actual structures. When your physician interprets imaging of the female reproductive system, your ability to identify the body part involved will sharpen your coding. Use the anatomic illustration on the next slide to locate the site described, and then match that site to the sampling of applicable ICD-9-CM and ICD-10-CM codes in the table. (The table shows only sample codes. You should choose a code for your particular case based on the documentation and the most specific code available in the manual) 34

35 Anatomy and Physiology 35

36 Confused by Sinus Anatomy? This Diagram Highlights Billable Landmarks 36

37 ICD-10: When your diagnosis coding system changes in 2014, look for these equivalents: Code 470 becomes J34.2 (Deviated nasal septum) Code becomes J32.0 (Chronic maxillary sinusitis) Code becomes J32.1 (Chronic frontal sinusitis) Code becomes J32.2 (Chronic ethmoidal sinusitis) Code becomes J32.3 (Chronic sphenoidal sinusitis) Code becomes J34.3 (Hypertrophy of nasal turbinates) Code expands into three options: J34.0 (Abscess, furuncle and carbuncle of nose), J34.1 (Cyst and mucocele of nose and nasal sinus), and J34.89 (Other specified disorders of nose and nasal sinuses) 37

38 Picture Urologic Anatomy for Better Coding As a coder, you know that urologic radiology focuses on the urinary system. Major components include : Kidneys Ureters Urinary Bladder Urethra In normal anatomy, a patient has both a left kidney and a right kidney. Each kidney is connected to the urinary bladder by a ureter. The urethra then functions to carry urine from the bladder to the exterior of the body. Knowing which parts of that anatomy your urologist is focusing on will lead you to the proper radiology code for his services. 38

39 You Can Make Your Review and Comprehension of ICD-10-CM Specificity a Breeze with Some Targeted Resources from SuperCoder! 39

40 Tackling Advanced Specificity Doesn t Have to Be Difficult If You Have the Right Resource You can prepare for increased specificity and clinical terms using practical anatomical and pathophysiology resources from SuperCoder: ICD-10 SuperCoder Anatomy and Pathophysiology ICD-10 Coding Alert 40

41 ICD-10 SuperCoder Anatomy and Pathophysiology This online curriculum enhances your ICD-10 coding specificity by providing an in-depth understanding of the anatomy and physiology of the human body such as: Osteology (The Bony System or Skeleton) Syndesmology (The Articulations or Joints) Myology (The Muscular System) Angiology (The Vascular System) Lymphangiology (The Lymphatic System) Neurology (The Nervous System) The Organs of the Senses and the Common Integument Splanchnology (The Visceral System) 41

42 Benefits: Straightforward anatomy lessons in 8 chapters make correct coding of operative reports and chart notes easier for accurate payments ICD-10 examples expand medical terminology and anatomy understanding for more accurate coding now and beyond Term-to-code connections enhance ICD-10 code comprehension Thousands of physician-coder designed illustrations a Coding Institute exclusive bring anatomy to life Suggests documentation changes you can make now for easier ICD-10 transitioning later Includes: 1-year access for on-going reference and guidance Includes immediate class support from ICD-10 trainers via System quizzes improve knowledge retention 42

43 ICD-10 Coding Alert A monthly newsletter from The Coding Institute staff that covers step-bystep anatomical and pathophysiology guidance along with ICD-10 essentials to help you prepare for the challenges in 2014! Anatomy & pathophysiology lessons ICD-10 training and documentation strategies Specific examples to help you apply ICD-10 coding guidelines Advice on converting your ICD-9 superbills to ICD-10 superbills And more Every month, AHIMA-approved ICD-10 instructor Suzanne Leder, CPC, COBGC, provides expert insight to overcome your toughest ICD-10 coding, documentation, and reimbursement questions! 43

44 With ICD-10 Coding Alert you also get: Archived Library of Keyword and Code Searchable Articles on ICD-10 Reader Questions on Tough ICD-10 Scenarios Possible 24 AAPC and 5 AHIMA CEUs Free Bi-Weekly Newsletter SuperCoder Bolt 44

45 SuperCoder s ICD-10 Tools & E-Learning Cover Web-based solutions: Easily look up ICD-10 codes by code or keyword as well as by index or table Search for ICD-9 and ICD-10 codes at the same time Instant updates to ICD-10 codes and mappings mean your staff doesn't spend time on these tasks Become familiar with ICD-10 codes now by seeing corresponding codes on ICD-9 code pages Newsletter: Monthly tips and insight so you understand ICD-10 codeset specifics When combined with ICD-10 Coder, you can access articles tied to the ICD-10 code you re researching; so you get how-to advice for the code along with the code s descriptor, guidelines, and more 45

46 Tools & E-Learning E-Learning: Practical education avoids wasting time on boring generalities Reliable, easy-to-understand explanations from the original coding educators - The Coding Institute Staff Covers each of your specific ICD-10 needs Saves time & money by focusing on the elements you need Learn at your own pace Visit to check SuperCoder s ICD-10 Tools, Newsletter, and E-Learning. 46

47 To Download a PDF of the Presentation, Visit Get a CEU A few hours after the event, live attendees will be sent an with a link to download the CEU certificate. On-demand listeners who are SuperCoder.com subscribers can take a quiz available on to attain the AAPC 1 CEU certificate. CPT copyright 2012 American Medical Association. All rights reserved. 47