Mapping ICD 9 CM to ICD 10: Lessons Learned Gail I. Smith, MA, RHIA, CCS P Gail I. Smith Consulting 1
Topics Process for Decision Making Mapping and Decision Trees Documentation for Coding Decisions Root Operations = Key Component Examples, Illustrations, Tips. 2
The Challenge What is different? What is the same? What skill set would be needed? 3
The Plan Formal Education Official guidelines, resources Review Code Sets Educational Plan Assign codes Review documentation Actual Cases 4
The Action two projects Mapping Project Health Record Review/Case Study Analysis 5
Overview of the Mapping Project GEMS General Equivalence Maps Mapping is Tool Comprehensive lists of codes 6
GEM Structure Exact match Approximate match One Many No match 7
Exact Match ICD 9 CM ICD 10 CM 585.1 chronic kidney disease, stage 1 N18.1 Chronic kidney disease, stage 1 ICD 9 PCS ICD 10 PCS 45.23 Colonoscopy 0DJD8ZZ Colonoscopy (Inspection) 8
Approximate Match Diagnosis: Closed stress fracture of the right ankle 9
Approximate Match ICD 9 CM ICD 10 CM 733.93 Stress fracture of tibia or fibula M84.36 Stress fracture, tibia and fibula (6 th digit and 7 th digit needed) Example: M84.363A Stress fracture, right fibula, initial encounter 733.95 Stress fracture of other bone M84.37 Stress fracture, ankle, foot and toes Example: M84.371A Stress fracture, right ankle, initial encounter 10
Approximate Match Malignant neoplasm of mastoid antrum ICD 9 CM 160.1 Malignant neoplasm of nasal cavities, middle ear and accessory sinuses ICD 10 CM C30.1 Malignant neoplasm of middle ear 11
Mapping Project Lessons Learned Expansion of codes Obstetrics different axis Injuries and Poisonings 7 th character for encounter Underdosing 12
Obstetrics different axis ICD 9 CM 641.11 Hemorrhage from placenta previa, with delivery (with or without mention of antepartum condition) ICD 10 CM O44.13 Placenta previa with hemorrhage, third trimester 13
ICD 9 CM Injuries and Poisonings Displaced, comminuted fracture of the shaft of the right ulna ICD 10 CM 813.22 Fracture, ulna, shaft S52.251A Comminuted fracture of shaft of ulna (right arm), initial encounter for closed fracture 14
To understand specificity rules, your ICD 10 tool or Book should show all chapter and section instructions clearly! 15
Diabetes Mellitus ICD 9 CM 250.41 Diabetes with renal manifestations, type I [juvenile type] (not stated as uncontrolled) 583.81 Diabetic nephropathy ICD 10 CM E10.21 Diabetes mellitus, Type 1 with diabetic nephropathy What about uncontrolled? 16
Visualizing the Differences Decision Trees 17
Diabetes Mellitus ICD 9 CM 18
Diabetes Mellitus ICD 10 CM 19
Myocardial Infarction ICD 9 CM 410.01 Acute myocardial infarction, of anterolateral wall (initial episode of care) ICD 10 CM I21.09 ST (STEMI) myocardial infarction involving other coronary artery of anterior wall ICD 9 CM 410.02 Acute myocardial infarction, of anterolateral wall (subsequent episode of care) ICD 10 CM I21.09 ST (STEMI) myocardial infarction involving other coronary artery of anterior wall 20
Myocardial Infarction ICD 9 CM 410.71 Subendocardial infarction (Non ST elevation) (initial episode of care) ICD 10 CM I22.2 Subsequent non ST elevation myocardial infarction ICD 9 CM 410.02 Acute myocardial infarction, of anterolateral wall (subsequent episode of care) ICD 10 CM I21.09 ST (STEMI) myocardial infarction involving other coronary artery of anterior wall 21
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Acute Myocardial Infarction Index 23
No Map ICD 10 CM Code R40.2 T36 Y70 Y82 Y90. Z67. Description Coma Scale Underdosing Medical devices associated with adverse incidents in diagnostic and therapeutic use Blood alcohol level Type blood, Rh (negative or positive) 24
Part II of Action Plan Case Studies 25
The Approach Using Medi Regs Mapping tool Review of Documentation Outcomes to share 26
ICD 10 CM Story 27
Case Study #1 Patient admitted due to being less responsive over the past couple of days, suspect stroke. Physician documents CT scan shows massive right middle artery territory infarct. Final Diagnosis: CVA, patient expired 28
Mapping Case #1 ICD 9 CM 434.91 Cerebral artery occlusion, unspecified ICD 10 CM I63.50 Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebral artery I63.511 Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery 29
Mapping Case #2 Patient is a 64 year old female who comes in with syncopal event. Final Diagnosis: 1.Paroxysmal ventricular tachycardia 2.Anxiety disorder she was admitted in extreme anxiety. Patient ran out of her Xanax and didn t refill due to lack of money. This condition improved with use of Xanax in the hospital. 30
Case #2 Coding ICD 9 CM ICD 10 CM 427.1 Paroxysmal ventricular tachycardia I47.2 Ventricular tachycardia 300.00 Anxiety F41.9 Anxiety disorder, unspecified E939.4 Adverse Effect benzodiazepines T42.4x6A Underdosing of benzodiazepines Z91.120 Patient s intentional underdosing of medication regimen due to financial hardship 31
Case Study #3 Mapping ICD 9 CM 998.2 Accidental puncture or laceration during a procedure. ICD 10 CM Numerous. 32
Case #3 Mapping Complications I97.5 Accidental puncture and laceration of a circulatory system organ or structure during a procedure I97.51 Accidental puncture and laceration of a circulatory system organ or structure during a circulatory system procedure I97.52 Accidental puncture and laceration of a circulatory system organ or structure during other procedure 33
Lessons Learned ICD 10 CM 34
Focus on ICD 10 PCS 35
Case Study Review General medical/surgical facility Inpatient procedures 36
Case Study #1 Surgical Procedure: Laminectomy During the operative episode, we sustained a small tear in the iliac vein, and this was repaired using 4 0 Prolene. Procedure: Repair of left common iliac vein tear 37
Repair of Iliac Vein ICD 9 CM Procedure Code ICD 10 PCS 39.32 Suture of vein Numerous 02Q..05Q..06Q. 38
Repair of Left Common Iliac Vein Repair Vein Common Iliac Left 06QD 39
06QD0ZZ Repair left common iliac vein 40
3 Research Approaches Map from ICD 9 or use index to get to general area and proper terms. Key word search in the E CodeBook. Key word search in ICD 10 Explorer. 41
Case #2 Hysterectomy This 44 year old patient had an exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo oophorectomy and lysis of adhesions. Resection Release 42
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Case #3 Patient admitted with sepsis and a pressure ulcer (Stage III) of the buttocks. Physician performed an excisional debridement of ulcer of the left buttocks. 46
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What about non excisional debridement? 50
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Case #4 The physician inserted a PICC line (peripherally inserted central catheter). 52
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In Summary. 54
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