1 / 57

Real World Experiences with ICD-10:Trips, Traps, and Shifts

Real World Experiences with ICD-10:Trips, Traps, and Shifts. Eva M. Gregorek, RHIT, CCS Senior Consultant AHIMA Approved ICD-10-CM/PCS Trainer Jzanus Consulting, Inc. Overview of ICD-10 Shift Examples Tools. ICD-10 Shift Project. DRG Shift Project.

ethan-bentley
Download Presentation

Real World Experiences with ICD-10:Trips, Traps, and Shifts

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Real World Experiences with ICD-10:Trips, Traps, and Shifts Eva M. Gregorek, RHIT, CCS Senior Consultant AHIMA Approved ICD-10-CM/PCS Trainer Jzanus Consulting, Inc Jzanus Consulting Inc.

  2. Overview of ICD-10 Shift • Examples • Tools Jzanus Consulting Inc.

  3. ICD-10 Shift Project Jzanus Consulting Inc.

  4. DRG Shift Project • A DRG change due to ICD-10-CM/PCS implementation • Findings are used to evaluate • Financial/case mix impact • Coding education need • Physician documentation gaps • Coders will experience this when doing dual coding Jzanus Consulting Inc.

  5. My Reaction to the First ICD-10 Shift Project Jzanus Consulting Inc.

  6. Day 1 Jzanus Consulting Inc.

  7. Day Two Jzanus Consulting Inc.

  8. Day Three Jzanus Consulting Inc.

  9. Eventually Jzanus Consulting Inc.

  10. DRG Shifts • Identify why the shift happened • Procedure mapping • Diagnosis mapping • PCS change • Coding Guideline Change • Incorrect ICD-9 DRG • Not really a shift Jzanus Consulting Inc.

  11. DRG ShiftExamples Jzanus Consulting Inc.

  12. ICD-9 Decompressive Laminectomy • Spinal Fusion Jzanus Consulting Inc.

  13. ICD-10 Decompressive Laminectomy Jzanus Consulting Inc.

  14. ICD-10 Spinal Decompression Guidance • Spinal Decompression • Coding Clinic, Fourth Quarter 2013 Page: 116 • New codes contained in this issue effective with discharges October1, 2013. Other coding advice or code assignments contained in this issue effective with discharges October 21, 2013. • Question: • What is the appropriate code assignment for a spinal decompression? • Answer: • Spinal decompression is the removal of pressure from the spinal cord. Assign a code for the surgery that is performed to relieve the pressure. For example, if a laminectomy is performed to remove pressure from the spinal cord, assign a code from table 0QB or 0PB based on the Index to Procedures: • Laminectomy • see Excision, Lower Bones 0QB- • see Excision, Upper Bones 0PB- Jzanus Consulting Inc.

  15. ICD-9 Embolization Jzanus Consulting Inc.

  16. ICD-10 Embolization Jzanus Consulting Inc.

  17. ICD-9 Embolization Jzanus Consulting Inc.

  18. ICD-10 Embolization Jzanus Consulting Inc.

  19. Spinal Tap ICD-9 Jzanus Consulting Inc.

  20. Spinal Tap – ICD-10 Jzanus Consulting Inc.

  21. Spinal Tap – ICD-9 Jzanus Consulting Inc.

  22. Spinal Tap – ICD-10 Jzanus Consulting Inc.

  23. Placement of Central Venous Catheter– ICD-9 Jzanus Consulting Inc.

  24. Placement of Central Venous Catheter– ICD-10 Jzanus Consulting Inc.

  25. Placement of Central Venous Catheter– ICD-9 Jzanus Consulting Inc.

  26. Placement of Central Venous Catheter– ICD-10 Jzanus Consulting Inc.

  27. Isolation –ICD-9 Jzanus Consulting Inc.

  28. Isolation –ICD-10 Jzanus Consulting Inc.

  29. Opioid Dependence –ICD-9 Jzanus Consulting Inc.

  30. Opioid Dependence –ICD-10 Jzanus Consulting Inc.

  31. Opioid Dependence –ICD-9 Jzanus Consulting Inc.

  32. Opioid Dependence –ICD-10 Jzanus Consulting Inc.

  33. Drainage of Retroperitoneal abscess–ICD-9 Jzanus Consulting Inc.

  34. Drainage of Retroperitoneal abscess–ICD-10 Jzanus Consulting Inc.

  35. Drainage of Retroperitoneal abscess–ICD-9 Jzanus Consulting Inc.

  36. Drainage of Retroperitoneal abscess–ICD-10 Jzanus Consulting Inc.

  37. Planning a Positive ICD-10 Experience Jzanus Consulting Inc.

  38. You might need a bigger boat Jzanus Consulting Inc.

  39. Education/Development • ICD-10-CM/PCS training program • Include payment methodology • Dual Coding/Review • Peer review • Independent review • Coding Roundtable • Group discussion about specific cases • Document decisions • Recognize that initial decisions may change • Send questions to Coding Clinic Jzanus Consulting Inc.

  40. Education/Development • Identify opportunities from shift analysis • Invite physicians to any/all of your educational activities. • The usual suspects in physician documentation • Laterality • Site • Depth of debridement • Specificity in general Jzanus Consulting Inc.

  41. Cerebral Infarction • ICD-9-CM • Etiology: • Embolism • Thrombosis • Unspecified occlusion/stenosis • ICD-10-CM • Etiology: Same as ICD-9-CM • Embolism • Thrombosis • Unspecified occlusion/stenosis • Site: • Cerebral artery • Anterior • Middle • Posterior • Cerebellar • Other specified cerebral artery • Unspecified cerebral artery • Laterality • Right • Left • Bilateral Jzanus Consulting Inc.

  42. Asthma ICD-9-CM Forms • Chronic obstructive • Cough variant • Exercise induced bronchospasm • Extrinsic • Intrinsic • Unspecified Complications • Acute exacerbation • Status asthmaticus • Unspecified ICD-10-CM Forms • Cough variant • Exercise induced bronchospasm • Extrinsic allergic • Idiosyncratic • Intrinsic nonallergic • Other • Unspecified Severity • Mild intermittent • Mild persistent • Moderate persistent • Severe persistent • Complications • Acute exacerbation • Status asthmaticus • Uncomplicated Jzanus Consulting Inc.

  43. Best Effort Jzanus Consulting Inc.

  44. Research • It is important to dig in with research. • Attend meetings • Network • Use resources • Coding Clinic • Regulatory • Professional Associations Jzanus Consulting Inc.

  45. Example • Removal of polydactyl • Multiple opinions • Detachment • Repair • Resection • Excision • Posted question on professional websites including AHIMA Engage Online Community • Sent to Coding Clinic Jzanus Consulting Inc.

  46. Jzanus Consulting Inc.

  47. Jzanus Consulting Inc.

  48. Follow-up • DRG shift was identified for a total hip revision that involved ICD-10-PCS codes 0SR9049 • Grouped to MS-DRG 464 - wound debridement and skin graft exc hand, for musculoskeletal connective tissue disease with CC. • MS-DRG 467 - revision of hip or knee replacement with CC as did the other PCS codes for hip replacement seemed more appropriate • Checked with various encoders and it to be appeared to be global in nature. Contacted Center for Medicaid and Medicare Services (CMS) ICD-10 Coordination Committee. Informed that it would be included on the next ICD-10 Coordination Committee agenda. • It wasn’t Jzanus Consulting Inc.

  49. Coder responsibilities • Identify how many hats coders are wearing. • Deficiency Analysis • Filing • Registry • Birth certificates • Charges/billing • Phone duty • Validate and take action. • Delegate to other staff or department • Eliminate the issue Jzanus Consulting Inc.

  50. Identification without validation or action Jzanus Consulting Inc.

More Related