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Basic ICD-10-CM/PCS Coding 2013 Edition

Basic ICD-10-CM/PCS Coding 2013 Edition. Introduction to ICD-10-CM. Objectives and Key Terms. Review the objectives of the chapter Look for the key terms through the chapter. What is Coding. Coding is the transformation of verbal descriptions into numbers

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Basic ICD-10-CM/PCS Coding 2013 Edition

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  1. Basic ICD-10-CM/PCS Coding2013 Edition Introduction to ICD-10-CM

  2. Objectives and Key Terms • Review the objectives of the chapter • Look for the key terms through the chapter

  3. What is Coding • Coding is the transformation of verbal descriptions into numbers • Specific codes describe diseases, injuries, and procedures • Detailed thought process • Knowledge of medical terminology, anatomy, and pathophysiology

  4. What is Coding • A diagnosis is a word or a phrase used by a physician to identify a disease from which a individual suffers. • A diagnosis may also be a condition for which the patient needs, seeks, or receives medical care. • A surgical or therapeutic procedure is a single, separate, systematic process upon or within the body that can be complete in itself.

  5. How Are Codes Assigned and What Systems Are Used • ICD-10-CM disease classification system • Maintained by National Center for Health Statistics (NCHS) • ICD-10-PCS procedures • Maintained by the Centers for Medicare and Medicaid Services (CMS)

  6. History of Coding • Notion of classification originated at the time of ancient Greece • 17th century English statistician John Graunt • London Bills of Mortality—first documentation of the proportion of children who died before age six

  7. History of Coding • 1838 — William Farr, registrar general of England, developed a system to classify deaths • 1893 —Jacques Bertillon, French physician, introduced the Bertillon Classification of Causes of Death at the International Statistical Institute in Chicago

  8. History of Coding • 1898 —American Public Health Association (APHA) recommended the registrars of Canada, Mexico, and the United States adopt the Bertillon System • APHA recommended the system be revised every ten years to remain current with medical practice

  9. History of Coding • 1900—the first international conference to revise the International Classification of Causes of Death; subsequent revisions occurred every 10 years • One book with Alphabetic Index and Tabular List

  10. History of Coding • Sixth revision expanded classification into two volumes and included morbidity and mortality conditions • Name change: Manual of International Statistical Classification of Diseases, Injuries and Causes of Death (ICD)

  11. History of Coding • Prior to sixth edition, responsibility for ICD revisions fell to the Mixed Commission, a group composed of representatives from the International Statistical Institute and the Health Organization of the League of Nations • 1948—The World Health Organization (WHO) in Geneva Switzerland assumed responsibility for revising ICD every 10 years • Seventh edition—1957 • Eighth edition—1968

  12. History of Coding • Today, WHO is the United Nations specialized agency responsible for ensuring the attainment of the highest possible levels of health for all people • Headquarters in Geneva, Switzerland

  13. History of Coding • WHO is responsible for a number of international classificiations • International Classification of Diseases and Related Health Problems (ICD) • International Classification of Functioning, Disability, and Health (ICF)

  14. History of Coding • ICD is most widely used statistical classification in the world. • Some countries found ICD sufficient for hospital indexing purposes • Other countries develop their own adaptation for use in their country • Original revisions of ICD did not provide for classification of procedures

  15. History of Coding • 1959—The US Public Health Services published The International Classification of Diseases, Adapted for Indexing of Health Records and Operation Classification (ICDA) • Considered the 7th revision of ICD

  16. History of Coding • The US Public Health Service published the Eighth Revision, International Classification of Diseases, Adapted for Use in the United States • Commonly referred to as ICDA-8 • Used to code diagnostic and operative procedural data for official morbidity and mortality statistics in the United States

  17. History of Coding • WHO published the ninth revision of ICD or ICD-9 in 1978 • The US Public Health Service modified ICD-9 to meet the needs of American hospitals and called it the International Classification of Diseases, Ninth Edition, Clinical Modifications (ICD-9-CM) • 9th revision expanded to 3 volumes and introduced a fifth-digit subclassification

  18. Background on ICD-10-CM and ICD-10-PCS • 1990—WHO published the 10th revision of ICD • 1999—USA adopted the international version of ICD-10 for death certificate coding • 1994—National Center for Health Statistics (NCHS) initiated the US clinical modification of the ICD-10

  19. Background on ICD-10-CM and ICD-10-PCS • 1998 – The International Classification of Diseases, 10th Revision, Clinical Modification released by NCHS and updated several times since the initial version • ICD-10-CM is planned to be used for reporting of diseases and condition in all health care settings in the US effective October 1, 2014

  20. Background on ICD-10-CM and ICD-10-PCS • ICD-10-CM—disease classification • More specific and contains significantly more codes than ICD-10-CM • Codes are alpha-numeric with all letters except U • Codes can extend up to 7 characters

  21. Background on ICD-10-CM and ICD-10-PCS • 2013 version of ICD-10-CM is available on the NCHS website at the Classifications of Diseases, Functioning, and Disability homepage • Implementation established in the Final Rule of the HIPAA Administrative Simplification Modifications to the Medical Data Code Set Standards published January 16, 2009

  22. Background on ICD-10-CM and ICD-10-PCS • The 2009 Final Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Administrative Simplification with Modifications to the medical data code sets • Established standard that ICD-10-CM would be used for diagnosis coding • Established standard that ICD-10-PCS would be used for the inpatient hospital procedure coding • October 2013 was original implementation date

  23. Background on ICD-10-CM and ICD-10-PCS • Health Insurance Portability and Accountability Act of 1996 (HIPAA) • Federal legislation to provide continuing health coverage, control fraud and abuse in healthcare, reduce healthcare costs, and guarantee the security and privacy of health information

  24. Background on ICD-10-CM and ICD-10-PCS • On April 17, 2012, the Secretary of HHS issued a proposed rule to change the implementation date for ICD-10-CM and ICD-10-PCS from October 1, 2013 to October 1, 2014. • On September 5, 2012, the Final Rule was published in the Federal Register to set the implementation date of October 1, 2014.

  25. Background on ICD-10-CM and ICD-10-PCS • The Final Rule modifies the standard medical data code sets for coding diagnoses by concurrently adopting the ICD-10-CM for diagnosis codes including the Official ICD-10-CM Guidelines for Coding and Reporting, as maintained by the National Center for Health Statistics.

  26. Background on ICD-10-CM and ICD-10-PCS • The Final Rule also modifies the standard medical data code sets for coding inpatient hospital procedures by concurrently adopting the ICD-10-PCS for inpatient hospital procedures including the Official ICD-10-PCS Guidelines for Coding and Reporting, as maintained by HHS.

  27. ICD-10-CM and ICD-10-PCS • ICD-10-CM and ICD-10-PCS replaces ICD-10-CM, Volumes 1, 2 and 3, including the Official Guidelines for Coding and Reporting • ICD-10-PCS was developed by 3M Health Information Systems under contract with the Centers for Medicare and Medicaid Services (CMS).

  28. ICD-10-CM Official Guidelines for Coding and Reporting • Required component of the ICD-10-CM code set in the final rule for electronic transactions and coding standards • Guidelines have been approved by the Cooperating Parties for the ICD-10-CM • AHA, AHIMA, CMS, and NCHS

  29. ICD-10-CM Official Guidelines for Coding and Reporting • Guidelines are a set of coding rules that accompany and complement the official conventions and instructions within ICD-10-CM • Instructions and conventions in ICD-10-CM take precedence over the guidelines. • Guidelines provide additional instruction and are based on the coding and sequencing instructions in the Tabular List and Alphabetic Index

  30. ICD-10-CM Official Guidelines for Coding and Reporting • Adherence to the ICD-10-CM guidelines are a requirement for compliance with the HIPAA rule • Guidelines were developed to identify the diagnoses and procedures that are to be reported based on complete documentation in the record

  31. ICD-10-CM Official Guidelines for Coding and Reporting • The conventions, guidelines, and chapter specific ICD-10-CM guidelines are applicable to all healthcare settings unless otherwise specified • The guidelines for the principal and additional diagnoses are only applicable to inpatient settings

  32. Medicare Prescription Drug, Improvement and Modernization Act of 2003 • Signed into law December 8, 2003 • Section 503 of the Act includes the possibility that code changes could occur two times a year: • April 1 and October 1 • Since the law took effect codes have only been updated on October 1st of each year

  33. Official Addendum to ICD-10-CM • The Official Addendum contains the codes that were added, revised or deleted in ICD-10-CM effective April 1st or October 1st each year • NCHS is responsible for maintaining the diagnosis classification. • CMS is responsible for maintaining the procedure classification

  34. ICD-10-CM Coordination and Maintenance Committee • Chaired by representatives from NCHS and CMS • Responsible for maintaining the US clinical modification version of the ICD-10-CM/PCS code sets • Two open meetings each year—public forum for discussing proposed revisions to ICD-10-CM/PCS • Meeting announcement, proposals, and minutes can be found on NCHS and CMS websites

  35. A Point to Remember All ICD-10-CM coding books must be updated yearly with the ICD-10-CM revisions All coding software (encoders) must be updated yearly As a general rule, new ICD-10-CM codes are effective October 1 of each year

  36. Characteristics of ICD-10-CM • ICD-10-CM will be used for all diagnosis coding • System is more extensive and specific than ICD-9-CM but much of the hierarchical structure and conventions are used

  37. Characteristics of ICD-10-CM • Contains the Alphabetic Index which is an alphabetic listing of terms and codes • Contains the Tabular List which is a numerical list of the codes divided by chapters

  38. Conventions for ICD-10-CM • Conventions for ICD-10-CM address the structure and format of the coding system, including how to use the Alphabetic Index and the Tabular List • Rules and instructions the coder must follow

  39. Conventions for ICD-10-CM: Alphabetic Index • Alphabetic Index is divided into two parts • The Index to Diseases and Injury • Contains Neoplasm Table and Tables of Drugs and Chemicals • The Index to External Causes of Injury

  40. Conventions for ICD-10-CM: Alphabetic Index • Main terms in the Index are entries printed in boldface type and flush with the left margin of each column • Main terms represent diseases, conditions, nouns and adjectives • This is first place the coder uses to locate the ICD-10-CM code for the patient’s disease or condition

  41. Conventions for ICD-10-CM: Alphabetic Index • Beneath the main term are indented subterms or essential modifiers shown in their own alphabetic list • The indented subterm is always read in combination with the main term • The dash (-) at the end of an Index entry indicates that additional character is required

  42. Conventions for ICD-10-CM: Nonessential Modifiers • A nonessential modifier is a term or a series of terms that appear in parentheses ( ) following the main term or the subterm • The presence or absence of these parenthetical terms in the diagnosis statement has no effect on the selection of the codes listed for that main term or subterm

  43. Conventions for ICD-10-CM: “See” and “See Also” Instructions • “See” note is a cross reference term in the Alphabetic Index provides direction to look elsewhere in the Index before assigning a code • Mandatory instruction, points to an alternative term

  44. Conventions for ICD-10-CM: “See” and “See Also” Instructions • “See also” note provides direction to look elsewhere in the Index. • Requires the review of another term in the Index if all the needed information cannot be found under the first main term • However, it is not necessary to follow the “see also” note when the original main term provides the necessary code

  45. Conventions for ICD-10-CM: “Code Also” Note • “Code Also” note means that two codes may be required to fully describe a condition but this note does not provide sequencing direction • Alphabetic Index includes manifestation of disease code by including the manifestation codes as the second code, shown in brackets, directly after the underlying or etiology code, which should always be reported first

  46. Conventions for ICD-10-CM: Default Code • The default codes is the code listed next to a main term in the Alphabetic Index • Condition that is most commonly associated with the main term or is the unspecified code for the condition • The default code is used when the condition is documented in the record without any additional information

  47. Conventions for ICD-10-CM: Tabular List • Numerical listing of all the codes • Codes divided into 21 chapters • Chapters maybe based on body or organ systems • For example, diseases of circulatory or respiratory system • Other chapters group conditions by etiology or nature of the disease process • For example, infectious or parasitic diseases

  48. Conventions for ICD-10-CM: The 21 Chapters • Infectious and parasitic • Neoplasms • Blood and blood-forming • Endocrine, nutritional • Mental and behavioral • Nervous system • Eye and adnexa • Ear and mastoid • Circulatory system • Respiratory system • Digestive system • Skin and subcutaneous • Musculoskeletal and connective • Genitourinary system • Pregnancy • Perinatal period • Congenital & chromosomal • Symptoms and signs • Injury, poisoning and consequences • External causes • Factors influencing health status

  49. Conventions for ICD-10-CM: Code Format and Structure • ICD-10-CM contains • Chapters, categories, subcategories, and codes • Chapters are subdivided into • Subcategories or blocks of codes • Subcategories contain three character categories • Three character categories form the foundation for the codes

  50. Conventions for ICD-10-CM: Categories, Subcategories and Codes • Characters in categories, subcategories and codes may be letters or numbers • All categories are three characters • A three character code that has no further subdivisions is equivalent to a code • Most three-character categories are subdivided into four- and five-characters subcategories

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