ICD-10 Physician Education General Surgery 1
Training Objectives ICD-9 to ICD-10 Comparison Documentation Tips Additional Educational Opportunities Questions 2
ICD-9 to ICD-10 Comparison Code Structure Diagnosis Code Volume What Will Change Up to 7 characters Alpha-numeric codes 14,025 to 69,823 What Remains the Same DRGs CPT, HCPCS, E&M Codes Reimbursement methodology (awaiting finalization) Coders can only assign codes based on provider documentation Diagnosis Code Structural Change ICD-9 X X X X X Category.. Etiology, anatomic site, manifestation ICD-10-CM X X X X X X X Category Etiology, anatomic site, manifestation Extension Reference: CMS 3
Neoplasms Type Malignant, benign Detailed location(s) Overlapping sites vs different, distinct locations Laterality (when applicable) Primary Still active primary site Previously removed/treated Metastatic Location Symptomatic Current treatment course Manifestations Mucositis Anemia Link to etiology (neoplasm, chemotherapy) 4
Endocrine and Nutritional Diseases Diabetes Type (1, 2, drug induced, other) Documentation concept of controlled and uncontrolled is no longer applicable in ICD-10 Link manifestations/ complications with due to Neurology Ophthalmology Nephrology Long term use of insulin Insulin pump status Gestational (clearly state condition is gestational or predates the pregnancy) Overweight, obesity, morbid obesity Specify BMI Malnutrition Type BMI 5
Mental & Behavioral Disorders Anxiety Specify type Depression Major depressive disorder Single vs recurrent episode Type Remission Smoking Use or dependence Specify product new concept 6
Nervous System Mononeuritis of unspecified site expansion Link if a manifestation to diabetes or other etiology E11.41 Type 2 diabetes mellitus with diabetic mononeuropathy Polyneuropathy in diabetes expansion Link to the diabetes (with type specified) E09.40 Type 2 diabetes mellitus with diabetic mononeuropathy 7
Circulatory System Atherosclerosis Artery or vein Native vs graft Angina Pectoris (when applicable) expansion Documented spasm Other type Atrial Fibrillation expansion Paroxysmal Chronic Unspecified Peripheral Vascular Disease Hypertension concept change Documentation no longer needs to state benign or malignant Link manifestations to hypertension or other underlying disease process 8
Respiratory System Asthma Intermittent vs persistent Mild, moderate or severe new concept COPD Identify underlying condition(s) Exacerbation/decompensation Identify acute infections Respiratory Failure Acute, chronic or both Hypoxic vs hypercapnic new concept 9
Digestive System GERD Appendicitis Acute or chronic Peritonitis Hernia Inguinal, umbilical, diaphragmatic Unilateral vs bilateral Obstruction or gangrene present Polyps expansion Crohn s Disease expansion Diverticulosis expansion Gallbladder Calculous Cholecystitis Link complications to disease Bleeding, perforation, fistula, abscess, obstruction, gangrene 10
Skin & Subcutaneous Tissue Cellulitis/Abscess Location Laterality Acute vs chronic Manifestation Due to infection Pressure ulcer Detailed site(s) Laterality Stage Non-pressure chronic ulcer Etiology (atherosclerosis, diabetes, venous) Site Laterality Severity (skin breakdown, fat layer exposed, necrosis of muscle and/or bone) 11
Signs and Symptoms Site/Laterality/Quadrant Abdominal tenderness Abdominal/pelvic swelling, mass, lump Abdominal rigidity Abdominal pain Edema expansion Generalized Localized Unspecified Enlargement of lymph nodes expansion Generalized Localized Unspecified
Injuries and Trauma Type of trauma Laceration Open wound Puncture Other Site & Anatomic specificity Open or Closed Laterality new concept Foreign body present Episode of Care (from the patient s perspective) new concept Initial (presentation) Subsequent (routine or delayed healing) Sequela (late effect after initial injury/event has healed) S81.832A Puncture wound without foreign body, left lower leg, initial encounter
Z Codes (Formerly V Codes) Personal history of: Venous thrombosis and embolism Allergy to penicillin Tobacco use Family history of malignant neoplasm of gastrointestinal tract Long term use of medications Specify medication Encounter for: Preprocedural laboratory examination Other preprocedural examination Acquired absence of organ(s) Post-procedural status Specify procedure 14
Code Examples 611.72 Breast lump N63 Unspecified lump in breast 174.9 Malignant neoplasm of breast (female) unspecified C50.911 Malignant neoplasm of unspecified site of right female breast C50.912 Malignant neoplasm of unspecified site of left female breast C50.919 Malignant neoplasm of unspecified site of unspecified female breast 568.0 Peritoneal adhesions (postoperative)(postinfection) K66.0 Peritoneal adhesions (postprocedural) (postinfection) K99.4 Postprocedural pelvic peritoneal adhesions 15
Code Examples, cont 540.9 Acute appendicitis without mention of peritonitis K35.89 Other acute appendicitis K35.80 Unspecified acute appendicitis 540.1 Acute appendicitis with peritoneal abscess K35.3 Acute appendicitis with localized peritonitis 540.0 Acute appendicitis with generalized peritonitis K35.2 Acute appendicitis with generalized peritonitis 162.9 Malignant neoplasm of bronchus and lung, unspecified C34.90 Malignant neoplasm of unspecified part of unspecified bronchus or lung C34.91 Malignant neoplasm of unspecified part of right bronchus or lung C34.92 Malignant neoplasm of unspecified part of left bronchus or lung 16
Code Examples, cont 455.2 Internal hemorrhoids with other complication K64.0 First degree hemorrhoids K64.1 Second degree hemorrhoids K64.2 Third degree hemorrhoids K64.3 Fourth degree hemorrhoids K64.8 Other hemorrhoids 550.90 Inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified K40.90 Unilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent 17
Code Examples, cont 575.0 Acute cholecystitis N81.0 Acute cholecystitis 575.11 Chronic cholecystitis N81.1 Chronic cholecystitis 575.12 Acute and chronic cholecystitis N81.2 Acute cholecystitis with chronic cholecystitis 575.10 Cholecystitis, unspecified N81.9 Cholecystitis, unspecified 18
Code Examples, cont 562.11 Diverticulitis of colon (without mention of hemorrhage) K57.20 Diverticulitis of large intestine with perforation and abscess without bleeding K57.32 Diverticulitis of large intestine without perforation or abscess without bleeding K57.40 Diverticulitis of both small and large intestine with perforation and abscess without bleeding K57.52 Diverticulitis of both small and large intestine without perforation or abscess without bleeding K57.80 Diverticulitis of intestine, part unspecified, with perforation and abscess without bleeding K57.92 Diverticulitis of intestine, part unspecified, without perforation or abscess without bleeding 19
Additional Educational Opportunities Physician/Provider Foundation training Specialty/Service Line meetings ICD-10 Website http://iuhicd10.iuhisclinicaleducation.org/ 20
Questions ICD10@iuhealth.org