ICD-10-CM Foundation Training 1
Objectives What is ICD-10? Benefits of ICD-10 ICD-10 Impacts Important Facts about ICD-10 Where to Get More Information Codebook Structure Conventions Overview Code Structure 2
ICD Overview International Classification of Diseases (ICD) ICD-9-CM CM: Clinical Modification (diagnoses & procedures) The US has been utilizing ICD-9-CM since 1979 ICD-10-CM/PCS CM: Clinical Modification (diagnoses) PCS: Procedural Coding System (procedures) Go-Live Date October 1, 2015 Everyone will be impacted by this transition. 3
How are ICD Codes Used? To track public health conditions To code and classify data for epidemiological research To measure outcomes and care provided to patients To determine risks & changes needed To make clinical decisions To enable payment systems/processing claims 4
Benefits of ICD-10 Positive impact for patients Robust clinical documentation explicitly defining patient s clinical status Enhanced organizational performance monitoring Enhanced ability to identify and resolve problems and differentiate payment based on performance Increased tracking and reporting capabilities Improved disease and outbreak tracking can lead to better outcomes for whole populations Reference: HiMMS Ten Reasons Why ICD-10 Implementation Cannot be Further Delayed 5
Benefits of ICD-10, cont More accurate payment structures Over time there will be greater claim accuracy, fewer denials and the ability to differentiate reimbursement based on the patient s complexity and outcomes Potential reduction in costs for information requests Once highly specific codes are submitted there should be a reduction in claims attachments required by payers Reference: HiMMS Ten Reasons Why ICD-10 Implementation Cannot be Further Delayed 6
Additional Reasons for Change ICD-9 is more than 35 years old ICD-9 lacks the capacity for continued growth of diagnosis and procedure codes ICD-9 lacks the specificity required to adequately document today s diagnoses and procedures Government mandated transition date of October 1, 2015 7
Where is ICD-10? Canada United States Iceland Norway Sweden Finland Denmark Poland Ireland Germany UK Czech Republic The Netherlands Austria France Switzerland Japan China Costa Rica Venezuela Thailand Colombia Brazil Singapore Argentina Implementation Date Comparison United Kingdom 1995 France 1997 Australia 1998 Germany 2000 Canada 2001 USA - 2015 Australia New Zealand The United States is the last industrialized nation to make the transition Reference: 3M 8
ICD-9 to ICD-10 Code Differences Diagnosis Code Structural Change X X X X X Category ICD-9.. Etiology, anatomic site, manifestation ICD-10 X X X X X X X Category Etiology, anatomic site, manifestation Extension Reference: CMS Procedure Code Structural Change ICD-9. X X X X Body System or Site Purpose or Technique ICD-10 X X X X X X X Section Body Root System Operation Body Part Approach Device Qualifier ICD-9-CM (Dx) ICD-10-CM 14,025 codes 69,823 codes ICD-9-CM (Px) ICD-10-PCS 3,882 codes 72,769 codes 9
ICD-10 Myths & Facts Myth: ICD-10 will cause excessive delays in patient care workflow. Fact: With advanced preparation efforts, including rolebased education and tools, enhanced workflows will be minimally impacted. Myth: ICD-10 is going to add to the list of already competing priorities and regulatory demands. Fact: Balancing of priorities related to the ICD-10 conversion along with all other IU Health and governmental initiatives is being addressed to ensure all initiatives can be completed successfully. 10
ICD-10 Myths & Facts, cont Myth: ICD-10 will require more accurate and complete clinical documentation. Fact: Regardless of the coding system, the need for accurate and complete clinical documentation remains a requirement. Clinical training surrounding these documentation requirements is already underway. Myth: ICD-10 will have a negative impact to cash flow. Fact: IU Health is proactively testing and collaborating with payers to determine potential risk areas and to provide feedback to clinicians. 11
ICD-10-CM Codebook Overview Codebook Structure, Conventions Overview, and Code Structure 12
ICD-10-CM Codebook Structure 13
ICD-10-CM Codebook Structure Alphabetic Index List of terms and their corresponding code (or code category) Contains 4 Sections Index of Disease and Injury Neoplasm Table Table of Drugs and Chemicals Index of External Causes Tabular List Arranged in Alpha/Numeric order Chapters are divided into body systems or conditions 14
Tabular Comparison: ICD-9 to ICD-10-CM # of Chapters Chapter Structure 5 th Digit Sub-Classification Guidance Included in Tabular Index ICD-9 19 ICD-10 21 New Chapters Created & Codes Reorganized Verbiage Included with Actual Code & Displayed in Full 15
ICD-10-CM Chapter/Code Classifications Code Range A00-B99 C00-D49 D50-D89 E00-E89 F01-F99 G00-G99 H00-H59 H60-H95 I00-I99 J00-J99 K00-K95 Chapter Title Certain Infectious and Parasitic Diseases Neoplasms Diseases of Blood and Blood-Forming Organs and Certain Disorders involving the Immune Mechanism Endocrine, Nutritional and Metabolic Disorders Mental and Behavioral Disorders Diseases of the Nervous System Diseases of the Eye and Adnexa (*New Chapter) Diseases of the Ear and Mastoid Process (*New Chapter) Diseases of the Circulatory System Diseases of the Respiratory System Diseases of the Digestive System 16
ICD-10-CM Chapter/Code Classifications, cont. Code Range L00-L99 M00-M99 N00-N99 O00-O9A P00-P96 Q00-Q99 R00-R99 S00-T88 V01-Y99 Z00-Z99 Chapter Title Diseases of the Skin and Subcutaneous Tissue Diseases of the Musculoskeletal System & Connective Tissue Diseases of the Genitourinary System Pregnancy, Childbirth and the Pueperium Certain Conditions Originating in the Perinatal Period Congenital Malformations, Deformations, and Chromosomal Abnormalities Symptoms, Signs and Abnormal Clinical Lab Findings not elsewhere classified Injury, Poisoning and Certain Other Consequences of External Causes External Causes of Morbidity Factors Influencing Health Status and Contact with Health Services 17
ICD-10-CM Codebook Conventions Overview 18
Official Coding Conventions Format Punctuation Abbreviations Typeface General Notes 19
Punctuation: Brackets [ ] Alphabetic Index Identify Manifestation Codes Tabular List Utilize to Enclose Synonyms, Alternative Wording or Explanatory Phrases 20
Punctuation: Parentheses ( ) Enclosed nonessential modifiers Supplementary words, that may be present or absent in the statement of a disease, without affecting the code to which it is assigned. Alphabetic Index Tabular List 21
Abbreviations Other Other Specified (NEC) Unspecified (NOS) 22
Instructional Notes Code First/Use Additional Code Code Also See See Also Excludes1 Excludes2 23
Instructional Note: Code First/Use Additional Code Some conditions have an underlying etiology and multiple body system manifestations In some circumstances, the underlying condition may be sequenced before the manifestation code(s). Instructional notes in ICD-10-CM indicate when this is appropriate. 24
Instructional Note: Code Also Some codes have an instructional note in the Tabular List indicating two codes may be required to fully describe a condition. 25
Instructional Note: See & See Also Instructions follow the main term in the Alphabetic Index indicating another term: Should be referenced May be referenced that provides additional useful Alphabetic Index entries. 26
Excludes Notes Excludes1 Pure excludes note indicates disease process is not coded here. For Example: congenital and acquired conditions Excludes2 Code is not included here. For Example: acute and chronic conditions 27
ICD-10-CM Code Structure 28
ICD-9 to ICD-10-CM Comparison Diagnosis Code Structural Change ICD-9-CM (Dx) X X X X X.. ICD-10-CM X X X X X X X Reference: CMS Category Etiology, anatomic site, manifestation Category Etiology, anatomic site, manifestation Extension ICD-9 Codes ICD-10-CM Codes Length: 3-5 characters First Character: Alpha or Numeric Value (only letters E or V are utilized) Characters 2-5: Numeric Value Length: 3-7 characters First Character: ALWAYS Alpha (All Letters Used Except U) Character 2: ALWAYS Numeric Value Character 3-7: Alpha or Numeric ICD-9-CM (Dx) ICD-10-CM 14,025 codes 69,823 codes 29
Code Structure Comparison: Characters 1 3 ICD-9-CM Category 523: Gingival & periodontal diseases Category 250: Diabetes Mellitus Category 410: Acute myocardial infarction ICD-10-CM Category K05: Gingivitis & periodontal diseases Category E11: Type 2 Diabetes Mellitus Category I21: ST elevation (STEMI) & non-st elevation (NSTEMI) myocardial infarction All ICD-10-CM diagnosis codes will begin with an alpha character 30
ICD-10-CM Code Structure: Characters 4 6 Etiology, anatomic sites and manifestations 4 th Character 5 th Character 6 th Character 31
ICD-10-CM Code Structure: Character 7 Extension 32
ICD-10-CM Code Structure: Placeholder Character Placeholder 33
What s New Some timeframes on particular codes have changed Laterality Description ICD-9 ICD-10 Acute MI 8 weeks 4 weeks Abortion vs Fetal Death 22 weeks 20 weeks Early vs late vomiting in pregnancy 22 weeks 20 weeks 34
What s New, cont. Expansion of some code categories for additional specificity E08 Diabetes mellitus due to underlying condition E09 Drug or chemical induced diabetes mellitus E10 Type I Diabetes mellitus E11 Type II Diabetes mellitus E13 Other specified diabetes mellitus New combinations codes are available in ICD-10 35
Code Expansions Injuries Injury codes impacted by significant expansion Impact to fracture codes Open vs Closed Displaced vs Non-displaced Laterality Encounter Status of healing 36
Code Expansions Drug Dependence Alcohol and substance abuse codes Tobacco codes 37
Code Expansions Obstetrics Trimesters 7 th character classification Weeks gestation 38
Medical Terminology Updates Osteoporosis Age related replaces senile Diabetes Mellitus No longer controlled or uncontrolled Uncontrolled is now, diabetes, by type, with hyperglycemia Cardiovascular Unstable angina replaces intermediate coronary syndrome 39
Questions For additional training, questions, concerns E-mail ICD10@iuhealth.org 40