Transition to ICD-10 for Coding Professionals

1. Transition to ICD-10 for Coding Professionals Kathy Pride, RHIT, CPC, CCS-P Barbara Oviatt, CPC, CCS-P

2. Who Are We? • Complete Practice Resources, LLC was formed specifically to assist providers in addressing the ICD-10 transition. • We are dedicated to improving healthcare delivery by providing innovative healthcare information technology and services. • From clinical and patient access management, to revenue cycle and health information management, Complete Practice Resources delivers real-world solutions that assist healthcare professionals in delivering outstanding patient care with optimum efficiency.

3. Purpose of this Workshop To understand the differences between the ICD-9 and ICD-10 guidelines and data elements, and how to kick start your transition by performing a gap analysis of your current documentation.

4. Part I - Course Objectives • Understand the coding guideline variations between ICD-9 and ICD-10 • Understand how to crosswalk your ICD-9 codes using GEMs and other tools • Understand the documentation impact for ICD-10 by comparing documentation elements between ICD-9 and ICD-10

5. Part II Course Objectives • Know how to formulate a strategy for conducting chart reviews • Become comfortable evaluating documentation for ICD-10 coding • Develop strategies for implementing ICD-10 documentation education

6. Regulatory Background • 1996 – HIPAA - Regulations for privacy, security, unique identifiers and electronic transactions and code sets. • 2000 – HHS final rule names standard transactions to be used by covered entities Covered entities are providers, payers and clearinghouses who conduct specific administrative transactions electronically

7. Regulatory Background, cont. • January 16, 2009 HHS Final Rule • Replace inflexible, ambiguous version 4010 electronic format with version 5010 with mandatory use by January 1, 2012 • Adopt ICD-10 as the new code set to replace ICD-9- CM with mandatory use by October 1, 2013 • August 24, 2012 HHS announces October 1, 2013 deadline will be pushed back to October 1, 2014

8. New Deadline:Oct. 1, 2014 • Re-adjust your implementation timelines • This is not a time to relax, it is a time to catch up

9. Kick Start Your Transition • Awareness training for you and your staff • Familiarize yourself with the new structure • Documentation Improvement Program • Perform gap analysis • Provide feedback to providers

11. Overall Coding process is the same! • Capture the required encounter documentation • Choose the correct code • Alphabetic Index • Tabular List • Read instructional notations

12. Differences between ICD-9-CM and ICD-10-CM

13. ICD-10-CM Code Structure ICD-10-CM Code Format Unspecified asthma with acute exacerbation ICD-10J45.901 ICD-9-CM Code Format Asthma, unspecified type with acute exacerbation ICD-9   493.92

14. ICD-10 Structural Changes ICD – 9 – CM ICD – 10 – CM 21 Chapters Z codes V, W, X and Y codes Addition of 6th and 7th characters Addition of “placeholder” • 17 Chapters • V codes • E codes • Maximum 5 character codes

15. New Features of ICD-10-CM • Combination codes for conditions and common symptoms or manifestations E20.21 Type I diabetes mellitus with diabetic nephropathy I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris K50.112 Crohn’s disease of large intestine with intestinal obstruction Examples:

16. New Features in ICD-10-CM • Combination codes for poisonings and external causes T36.0x1A Poisoning by penicillin, accidental (unintentional), initial encounter T42.4x5A Adverse effect of benzodiazepines, initial encounter Examples: 5th digit is a place holder 6th digit indicates external cause 7th digit indicates episode of care

17. New Features in ICD-10-CM • Added laterality H60.332 Swimmer’s ear, left ear S63.411A Sprain of carpal joint of right wrist, initial encounter H65.06 Acute serous otitis media, recurrent, bilateral Examples:

18. Changes to General Coding Guidelines • Laterality • Use a bilateral code if available • Assign separate codes for a bilateral condition when no bilateral code is available

19. New Features in ICD-10-CM • Added 7th character extensions for episode of care M80.08A Age related osteoporosis with current pathological fracture, vertebra(e), initial encounter S61.421D Laceration with foreign body of right hand, subsequent encounter T21.31xS Burn of third degree of chest, sequela Examples:

20. Placeholder Character • Dummy placeholder is always the letter “x” • Used as the 5th character for certain 6 character codes to provide future expansion • When a code has <6 characters and a 7th character extension is needed – “x” is assigned for all characters less than 7 to meet the number of characters need to add the 7th character extension

21. Changes to General Coding Guidelines • Initial encounter • First visit to provider • Subsequent encounter • Under active treatment • Sequela • New name for Late Effects, same rules • No time limit • Not under active treatment for acute condition

22. Episode of Care - Fracture • A - initial encounter for closed fracture • B - initial encounter for open fracture • D - subsequent encounter for fracture with routine healing • G - subsequent encounter for fracture with delayed healing • K - subsequent encounter for fracture with nonunion • S - sequela

23. Episode of Care - Open Fracture A - initial encounter for closed fracture B - initial encounter for open fracture type I or II and initial encounter for open fracture NOS C - initial encounter for open fracture type IIIA, IIIB, or IIIC D - subsequent encounter for closed fracture with routine healing E - subsequent encounter for open fracture type I or II with routine healing F - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing

24. Episode of Care - Open Fracture, Cont. G - subsequent encounter for closed fracture with delayed healing H - subsequent encounter for open fracture type I or II with delayed healing J - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing K - subsequent encounter for closed fracture with nonunion M - subsequent encounter for open fracture type I or II with nonunion N - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion

25. Episode of Care - Open Fracture, Cont P - subsequent encounter for closed fracture with malunion Q - subsequent encounter for open fracture type I or II with malunion R - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion S - sequela

26. 7th Character for Obstetrics • 0 - not applicable or unspecified • 1 - fetus 1 • 2 - fetus 2 • 3 - fetus 3 • 4 - fetus 4 • 5 - fetus 5 • 9 - other fetus

27. New Features in ICD-10-CM • Inclusion of trimesters in obstetrics codes and elimination of 5th digits for episode of care O10.012 Pre-existing essential hypertension complicating pregnancy, second trimester O99.013 Anemia complicating pregnancy, third trimester Examples: Remember the first digit is the letter “O” not the number zero

28. Classification Changes • Certain diseases have been reclassified to a more appropriate chapter – Example gout was reclassified from endocrine to musculoskeletal • Postoperative complications have been moved to procedure–specific body system chapters • Eyes and ears have their own chapters

29. Injury, Poisoning, and Certain Other Consequences of External Causes • Added “ Certain Other Consequences of External Causes” • Significant modifications made • Arranged by body region beginning with the head and concluding with ankle/foot vs. arranged by injury in ICD-9 • Includes codes that begin with S and T

30. Classification Changes • Injuries classified by site and then by injury Example: • Head • Scalp • Eyelid • Nose • Ear • Cheek • Lip • Other • Injury Type • Fracture • Dislocation/Sprain • Nerve injury • Contusion • Superficial Injury • Laceration/wound • Traumatic

31. Injury, Poisoning, and Certain Other Consequences of External Causes • Injuries including lacerations, fractures, sprains, foreign body, etc. • Burns and corrosions • Frost bite • Poisoning • Toxic effects of nonmedicinal substances • Certain early complications of trauma • Complications of surgical and medical care

32. Classification Changes Chapter 5 – Mental and Behavioral Disorders This chapter contains more subchapters, categories, subcategories, and codes than ID-9-CM. Consequently when comparing ICD-10-CM to ICD-9-CM some disorders are classified differently with greater clinical detail.

33. Mental and Behavioral Disorders • F10.10 – Alcohol abuse, uncomplicated • F10.120 – Alcohol abuse with intoxication, uncomplicated (305.00 – 305.03) • F10.121 – Alcohol abuse with intoxication delirium (291.0) • F10.129 – Alcohol abuse with intoxication, unspecified (305.00 – 305.03)

34. External Causes of Morbidity • Formerly E-Codes, located in a supplemental classification • Capture the cause of the injury or health condition, the intent, the place, activity, and the person’s status (civilian or military) • V, W, X, Y codes in ICD-10 • More detailed than the E-Codes in ICD-9

35. W56.02XA Struck by a Dolphin, Initial Encounter

36. W56.02XD Struck by a Dolphin, Subsequent Encounter

37. W56.02XS Struck by a Dolphin, Sequela with F32.8 Depressive Episode

38. Coding Conventions • Most coding conventions remain the same • Abbreviations • NEC, NOS • Punctuation • ( ) Parentheses, : Colon, [] Bracket • “Includes” instructional notes

39. New Features in ICD-10-CM • Two types of exclusion notes: • Excludes 1 – indicates not coded here - The code excluded is never used with the code • Excludes 2 – indicates not included here – The excluded condition is not part of the condition represented by the code and it is acceptable to use both codes together if the patient has both conditions

40. Changes to Coding Guidelines for Timeframes • Changes in timeframes specified in certain codes • Acute myocardial infarction – time period for classification of “acute” changed from 8 weeks to 4 weeks • Timeframe for abortion versus fetal death changed from 22 weeks to 20 weeks

41. Mental, Behavioral and Neurodevelopment disorders • Selection of codes for “in remission” for categories F10-F19 Mental and behavioral disorders requires the provider’s clinical judgment. • The appropriate codes for “in remission” are assigned only on the basis of provider documentation

42. Psychoactive Substance Use, Abuse And Dependence • When the provider documentation refers to use, abuse and dependence of the same substance, only one code should be assigned to identify the pattern of use based on the following hierarchy: • If both use and abuse are documented, assign only the code for abuse • If both abuse and dependence are documented, assign only the code for dependence • If use, abuse and dependence are all documented, assign only the code for dependence • If both use and dependence are documented, assign only the code for dependence.

43. Diseases of the Nervous System • Document - Dominant/Non-dominant in addition to Left or Right • If dominant side is not documented use the following default guidelines: • For ambidextrous patients, the default should be dominant. • If the left side is affected, the default is non-dominant. • If the right side is affected, the default is dominant.

44. Exposure to Tobacco Smoke NEW! • Z77.22 Contact with and exposure to environmental tobacco smoke • P96.81 Exposure to tobacco smoke in perinatal period • Z57.31 Occupational exposure to environmental tobacco smoke

45. Other Tobacco Use Codes • Z87.891 History of Tobacco Use • F17.xxx Tobacco Dependence • Z72.0 Tobacco Use (non-dependent) • O99.33- Smoking (tobacco) complicating pregnancy, childbirth, and the puerperium

46. Tobacco Use Disorder – Nicotine Dependence ICD-9-CM = 305.1 • Current smoker Additional documentation required ICD-10-CM = F17 • Terminology change to Nicotine dependence • Type of nicotine (cigarette, chewing tobacco, cigar, pipe, etc.) • Remission/Withdrawal/ Uncomplicated • Use Z87.891 for History of nicotine dependence • Use Z72.0 Tobacco Use (non-dependent)

47. Nicotine Dependence • Documentation for ICD-9: • Tobacco Use disorder vs. History of tobacco use disorder • Documentation elements for ICD-10: • Cigarettes, Chewing tobacco, Other tobacco • Uncomplicated, remission, withdrawal, or other nicotine-induced disorder • History of nicotine dependence

48. Using GEMs • Create awareness • Compile documentation requirements • Determine educational needs • Review frequently used diagnoses and create reference documents

49. Asthma, Unspecified ICD-9-CM = 493.90 • Extrinsic vs. intrinsic • Chronic obstructive asthma • With status asthmaticus • With exacerbation • Exercise induced bronchospasm • Cough variant asthma  Additional documentation required ICD-10-CM = J45.909 • Mild intermittent  • Mild persistent  • Moderate persistent  • Severe persistent  • With status asthmaticus • With exacerbation • Exercise induced bronchospasm • Cough variant asthma • Tobacco use or exposure (additional code required)  • Excludes chronic obstructive asthma

50. Diabetes with Complications ICD-9-CM = 250.20 – 250.90 • Type I or Type II • With coma • Controlled or Uncontrolled • Manifestation or Complication – Additional code required • Long term (current) insulin use – Additional code required  Additional documentation required ICD-10-CM = E11.8 • Type I or Type II • Manifestation or Complication – additional code no longer required – New Combination codes • Details of complication: • Arthropathy • Site of Ulcer • Severity of retinopathy  • With/without macular edema • Stage of CKD • Gangrene  • Hyperglycemia  • Long term (current) insulin use – Additional code required