Title: ICD-10-CM – A Piece of Cake

1. Title: ICD-10-CM – A Piece of Cake ICD-10-CM (International Classification of Diseases – 10th Revision – Clinical Modifications) Session: T-5-1330

2. Pre-Quiz Quiz – jot down your answers • ICD-10-CM is: • ICD-9-CM where they replaced the three digit categories with three digit alpha-numeric categories to have more space • Pretty much volumes 1 and 2 of ICD-9-CM (volume 3 is now ICD-10-PCS) • Mapped to ICD-9-CM with about 95% of the codes being a one-to-one mapping • All of the above

3. Pre-Quiz • When you think “Personal History of” you think: • V10 – Personal History of malignant neoplasm, through V15 Other Personal History Presenting Hazard to Health • V86 Estrogen Receptor Status • V87 Other specified personal exposures and history presenting hazards to health • V88 Acquired absence of other organs and tissue • Both a and c even though they are not in the same place – this just makes coding more challenging!

4. Pre-Quiz • The coding guidelines for ICD-10-CM (e.g., assign all the digits available) are: • Are pretty much the same as for ICD-9-CM • Are pretty much the same as for ICD-8-A • Are pretty much the same as for ICD-7 • Are pretty much the same as for ICD-6 • All of the above

5. Pre-Quiz • The ICD-9-CM codes are being “frozen” (will not change, no additions/deletions) in 2012 because: • There is so much automation and all those programs need to have all the code numbers for the various conditions changed, tested, fixed, tested… • To give coders an entire year to goof off claiming they were studying VERY hard to understand the ICD-10-CM • Because the cost of gasoline had gone up to $3/gallon and those of us driving up from Washington to Baltimore for the Coordination and Maintenance Meetings wanted a break for an entire year • Because we knew Congress was looking to cut funding so long as it was not their pet project, so we coders squirreled away the funding somewhere else and said the codes were “frozen” so they would not take the money to maintain the code set

6. Pre-Quiz • The General Equivalency Mappings (GEMs) don’t have a one-for-one mapping because • Some few medical concepts have changed so the ICD-10-CM reflects the thought process of the current medical understanding • ICD-10-CM has expanded some concepts so it may have five codes while ICD-9-CM only has one code • If there was a one-for-one mapping to ICD-9-CM from ICD-10-CM, and a one-for-one mapping to 10 from 9, why bother with ICD-10? • All of the above • None of the above

7. Pre-Quiz • I plan to get ready for the new codes: • On 1 Oct 2013 and not a second before • When I take the Oct 2013 AHIMA CCS-P quiz I will borrow a book and hope for the best • I’d be willing to attend tele-classes for a few weeks prior so long as they let me do it from work • What – you silly goose, who actually believes the MHS will be ready on 1 Oct 2013, they can’t even get the new codes out until Jan/Feb/Mar on a normal year – I’m sticking with the MHS and plan never to have to learn the new codes • Other:

8. Objectives Know that ICD-10-CM transition will be easy for coders Understand the General Equivalency Mappings Know the coding guidelines for ICD-10-CM

9. ICD-10-CM • Why • How – Direct Care • Issue: CAPER diagnosis field is only 7 characters • Issue: SIDR diagnosis field is only 8 characters • Issue: AHLTA • Issue: CCE • Issue: All the other direct and purchased care MHS systems/programs using ICD codes • Training Proposal Development • Coders • Providers • Data Analysts

10. Difference Between ICD-10-CM, ICD-10-PCS and ICD-9-CM • International Classification of Diseases – 9th Revision – Clinical Modifications (ICD-9-CM) • Developed in USA in 1970s based on the World Health Organization’s ICD-9 • Based on ICD-8 and ICD-8a • Clinical Modifications (CM) is the United States’ version • Added to WHO ICD-9: • External Causes of Injury • Factors Influencing Health • Volume 3, Institutional Procedure Coding

11. ICD-10-CM • ICD-10-Clinical Modifications is for use in the United States • Other countries use modifications specific to their country, such as ICD-10-CA for Canada and ICD-10-AM for Australia • ONLY: • Diagnoses, • Factors Influencing Health, and • External Causes of Injury • Does not include procedures as did ICD-9-CM • No third volume • See ICD-10-Procedure Classification System • Currently used for cause of death reporting in the United States

12. ICD-10-CM • Available for download from: • http://www.cdc.gov/nchs/icd/icd10cm.htm#10update • At the bottom of the page • A bit easier and less expensive than going to Ingenix and buying it on disc for $119.00 • Would recommend buying one book every other year until 2013 as books are much easier to work with if that is what you are used to • The downloads are nice for a quick word search

13. ICD-10-CM Is Better Due To: • Addition of information relevant to ambulatory and managed care encounters • Expanded injury codes • Creation of combination diagnosis/symptom codes to reduce the number of codes needed to fully describe a condition • Addition of a sixth and seventh character for some codes • Laterality; and • Greater specificity in code assignment for many codes • The new structure will allow further expansion than was possible with ICD-9-CM

14. ICD-10-CM • “Piece of Cake” for anyone who can code using ICD-9-CM • Same basic guidelines • Same basic layout/organization • Same basic index • Same basic tabular • Some codes are more detailed • Some codes indicate initial or subsequent encounter • Format: alpha + 2 numerics + decimal point + numeric + 3 alphanumerics • H66.9 Otitis media, unspecified • Otitis media NOS • Acute otitis media NOS • Chronic otitis media NOS • H66.90 Otitis media, unspecified, unspecified ear • H66.91 Otitis media, unspecified. right ear • H66.92 Otitis media, unspecified, left ear • H66.93 Otitis media, unspecified, bilateral

15. Review of Existing Code Formats • ICD-9-CM diagnoses (look for the decimal point) • 3-5 numeric characters with decimal point after the 3rd • External cause of injury Exxx.x • Factors influencing health Vxx.xx • ICD-9-CM procedure (look for the decimal point) • Numeric xx.xx • CPT – 5 numeric, or 4 numeric with terminal F or T (no decimal point) • HCPCS – alpha with 4 numeric (no decimal point) – does not currently use F or T

16. ICD-9-CM Comparison to ICD-10-CM ICD-9-CM ICD-10-CM Chapt Title Category Chapter Title Category er Range Range I Infectious and parasitic diseases 001-139 I Certain infectious and parasitic diseases A00-B99 II Neoplasms 140-239 II Neoplasms C00-D48 III Endocrine, nutritional and metabolic 240-279 III Diseases of the blood and blood-forming D50-D89 diseases and immunity disorders organs and certain disorders involving the immune mechanism IV Diseases of blood and blood-forming 280-289 IV Endocrine, nutritional and metabolic E00-E90 organs diseases V Mental disorders 290-319 V Mental and behavioral disorders F00-F99 VI Diseases of the nervous system and 320-389 VI Diseases of the nervous system G00-G99 sense organs VII Diseases of the circulatory system 390-459 VII Diseases of the eye and adnexa H00-H59 VIII Diseases of the respiratory system 460-519 VIII Diseases of the ear and mastoid process H60-H95 IX Diseases of the digestive system 520-579 IX Diseases of the circulatory system I00-I99 X Diseases of the genitourinary 580-629 X Diseases of the respiratory system J00-J99 system XI Complications of pregnancy, 630-676 XI Diseases of the digestive system K00-K99 childbirth and the puerperium XII Diseases of the skin and 680-709 XII Diseases of the skin and subcutaneous L00-L99 subcutaneous tissue tissue

17. ICD-9-CM Comparison to ICD-10-CM

18. Sample of Downloaded Index

19. The Tabulars • ICD-9-CM • 001 Cholera • 001.0 Due to Vibriocholerae • 001.1 Due to Vibriocholerae el tor • 001.9 Cholera, unspecified • 002 Typhoid and paratyphoid fevers • ICD-10-CM • A00 Cholera • A00.0 Cholera due to Vibriocholerae 01, biovarcholerae (classical cholera) • A00.1 Cholera due to Vibriocholerae 01, biovareltor (cholera eltor) • A00.9 Cholera, unspecified • A01 Typhoid and paratyphoid fevers

20. The Tabular – Example J00 (currently 460) Excludes1 = NOT CODED HERE (both conditions cannot occur at same time) Excludes2 = Not included in this diagnosis; if it is there, code them both

21. ICD-9-CM vs. ICD-10-CM Tabular ICD-9-CM 8. Diseases of the Respiratory System (460-591) Acute Respiratory Infections (460-466) 460 Acute nasopharyngitis [common cold] ICD-10-CM Chapter X – Diseases of the Respiratory System (J00-J99) Acute Upper Respiratory Infections (J00-J06) J00 Acute nasopharyngitis [common cold]

22. ICD-10-CM • Morbidity classification • Includes potentially fatal conditions • Treatable • For use in • Hospitals: acute short-term, long-term • Provider office • Other outpatient settings

23. Benefit to the MHS • Ability to • Collect more detailed information • Compare morbidity data to mortality data • Compare to international data • Collect some laboratory results (e.g., blood alcohol levels and ABO blood types)

24. Benefit to the MHS • Ability to collect concepts such as • “Do Not Resuscitate” • Initial versus subsequent encounters • Right, left, bilateral • First, second, third trimester • Identification of fetus in multiple gestations • Classifications of fractures • Burns separated based on heat or chemical • Cesarean delivery without medical indication

25. Benefit to the MHS • Better data on which to base decisions • Easier to pull records with criteria needed for a specific study • Expandable, more space for new conditions • More detailed external causes of injury • e.g., Y93.5B Cellular telephone usage in work-related activity

26. Example of Expanded Code Set ICD-9-CM 303.00 Acute alcoholic intoxication, unspecified use 303.01 Acute alcoholic intoxication, continuous use 303.02 Acute alcoholic intoxication, episodic use 303.03 Acute alcoholic intoxication, in remission 303.90 Other and unspecified alcohol dependence, unspecified use 303.91 Other and unspecified alcohol dependence, continuous use 303.92 Other and unspecified alcohol dependence, episodic use 303.93 Other and unspecified alcohol dependence, in remission 8 codes • F10.2 Alcohol dependence • Excludes1: alcohol abuse (F10.1-) ;alcohol use, unspecified (F10.9-) • Excludes2: toxic effect of alcohol (T51.0-) • F10.20 Alcohol dependence, uncomplicated • F10.21 Alcohol dependence, in remission • F10.22 Alcohol dependence with intoxication • Acute drunkenness (in alcoholism) • Excludes1: alcohol dependence with withdrawal (F10.23-) • F10.220 Alcohol dependence with intoxication, uncomplicated • F10.221 Alcohol dependence with intoxication delirium • F10.229 Alcohol dependence with intoxication, unspecified • F10.23 Alcohol dependence with withdrawal • Excludes1: Alcohol dependence with intoxication (F10.22-) • F10.230 Alcohol dependence with withdrawal, uncomplicated • F10.231 Alcohol dependence with withdrawal delirium • F10.232 Alcohol dependence with withdrawal with perceptual disturbance • F10.239 Alcohol dependence with withdrawal, unspecified • F10.24 Alcohol dependence with alcohol-induced mood disorder • F10.25 Alcohol dependence with alcohol-induced psychotic disorder • F10.250 Alcohol dependence w/alcohol-induced psychotic disorder w/delusions • F10.251 Alcohol dependence with alcohol-induced psychotic disorder with hallucinations • F10.259 Alcohol dependence w/alcohol-induced psychotic disorder, unspecified • F10.26 Alcohol dependence with alcohol-induced persisting amnestic disorder • F10.27 Alcohol dependence with alcohol-induced persisting dementia • F10.28 Alcohol dependence with other alcohol-induced disorders • F10.280 Alcohol dependence with alcohol-induced anxiety disorder • F10.281 Alcohol dependence with alcohol-induced sexual dysfunction • F10.282 Alcohol dependence with alcohol-induced sleep disorder • F10.288 Alcohol dependence with other alcohol-induced disorder • F10.29 Alcohol dependence with unspecified alcohol-induced disorder

27. Example of New Code Set • O35 Maternal care for known or suspected fetal abnormality and damage • Includes: the listed conditions in the fetus as a reason for hospitalization or other obstetric care to the mother, or for termination of pregnancy • Code also any associated maternal condition • Excludes1: encounter for suspected maternal and fetal conditions ruled out (Z03.7-) • One of the following 7th characters is to be assigned to each code under category O35. 7th character 0 is for single gestations and multiple gestations where the fetus is unspecified. 7th characters 1 through 9 are for cases of multiple gestations to identify the fetus for which the code applies. The appropriate code from category O30, Multiple gestation, must also be • ICD-10-CM Tabular Page 1025 2010 • assigned when assigning a code from category O35 that has a 7th character of 1 through 9. • 0 not applicable or unspecified • 1 fetus 1 • 2 fetus 2 • 3 fetus 3 • 4 fetus 4 • 5 fetus 5 • 9 other fetus • O35.0 Maternal care for (suspected) central nervous system malformation in fetus • O35.1 Maternal care for (suspected) chromosomal abnormality in fetus • O35.2 Maternal care for (suspected) hereditary disease in fetus • O35.3 Maternal care for (suspected) damage to fetus from viral disease in mother • O35.4 Maternal care for (suspected) damage to fetus from alcohol • O35.5 Maternal care for (suspected) damage to fetus by drugs • O35.6 Maternal care for (suspected) damage to fetus by radiation • O35.7 Maternal care for (suspected) damage to fetus by other medical procedures • O35.8 Maternal care for other (suspected) fetal abnormality and damage • O35.9 Maternal care for (suspected) fetal abnormality and damage, unspecified

28. Example of New Data Collection • R40.2 Coma • Coma NOS; Unconsciousness NOS • Codes first any associated: • coma in fracture of skull (S02.-) • coma in intracranial injury (S06.-) • The appropriate 7th character is to be added to each code from subcategory R40.21-, R40.22-, R40.23-: • 0 unspecified time • 1 in the field [EMT or ambulance] • 2 at arrival to emergency department • 3 at hospital admission • 4 24 hours or more after hospital admission • A code from each subcategory is required to complete the coma scale • Note: These codes are intended primarily for trauma registry and research use but may be utilized by all users of the classification who wish to collect this information • R40.20 Unspecified coma • R40.21 Coma scale, eyes open • R40.211 Coma scale, eyes open, never • R40.212 Coma scale, eyes open, to pain • R40.213 Coma scale, eyes open, to sound • R40.214 Coma scale, eyes open, spontaneous

29. Coma • R40.22 Coma scale, best verbal response • R40.221 Coma scale, best verbal response, none • R40.222 Coma scale, best verbal response, incomprehensible words • R40.223 Coma scale, best verbal response, inappropriate words • R40.224 Coma scale, best verbal response, confused conversation • R40.225 Coma scale, best verbal response, oriented • R40.23 Coma scale, best motor response • R40.231 Coma scale, best motor response, none • R40.232 Coma scale, best motor response, extension • R40.233 Coma scale, best motor response, abnormal • R40.234 Coma scale, best motor response, flexion withdrawal • R40.235 Coma scale, best motor response, localizes pain • R40.236 Coma scale, best motor response, obeys commands

30. Coding Guidelines Same – Look it up in the alphabetic, then check in the tabular Same – Abbreviations Same – Punctuation Same – use of “and,” “with,” “see,” “see also” Same – other and unspecified codes Same – includes notes and inclusion terms Same – etiology/manifestation (code first, use additional code, in disease classified elsewhere) Same – must use all available characters Same – conditions that are or are not an integral part of the disease process

31. Coding Guidelines Same – Acute and Chronic conditions Same – Late Effects (sequela) Same – Human Immunodeficiency Virus (HIV) coding Same – Treatment directed at malignancy Same – Treatment of secondary site of maligancy Same – Primary malignancy previously excised Same – Admission/Encounter for chemo Same – Hypertension Same – Acute myocardial infarction Same – Coding Pathologic Fractures…

32. Coding Guidelines New – placeholder “x” if the code only has 4 or 5 characters, but needs a 7th character (e.g., initial/subsequent/sequela to injury), use an “x” in the blank spaces Different – Exclude1 (never code it here) and Exclude2 (not included, if he has that, code it separately) New – Laterality New – Coding pregnancy trimesters New – Glasgow coma scale New – Functional quadriplegia

33. Coding Guidelines • Aftercare – Official Coding Guidelines • Section I, C, 21, c, 7) Aftercare • The aftercare Z codes should also not be used for aftercare for injuries. For aftercare of an injury, assign the acute injury code with the 7th character “D” (subsequent encounter). • Z51.89 – Encounter for other specified aftercare

34. Review ICD-10-CM Diagnoses, not procedures Very similar to ICD-9-CM diagnoses, volumes 1 and 2 (diagnosis index and tabular) Up to 7 alphanumeric characters BOTTOM LINE: If you can code with ICD-9-CM, you can easily transition to ICD-10-CM

35. Summary MHS is working on the transition The transition will be most difficult for the software programs ICD-10-CM is much better than ICD-9-CM Coders will not have a problem transitioning from ICD-9-CM to ICD-10-CM

36. Quiz Take the quiz again

37. Q&A • Questions? • Training • Who needs ICD-10-CM training? • When (e.g., 2 months prior)? • Intensity (e.g., 1 hour teleclass a day with 1 hour a day at work to do the assigned lessons)? • Format (e.g., train-the-trainer to come back to work to train you, teleclasses, one REALLY large class [400 students in an auditorium], good teacher sent to each site for a week)?