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ICD-10: What is it? How do I prepare for it?

Understand the structure and changes in ICD-10-CM coding system for better healthcare documentation. Learn about expanded specificity and new coding examples. Prepare efficiently with insights from an expert trainer.

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ICD-10: What is it? How do I prepare for it?

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  1. ICD-10: What is it? How do I prepare for it? Angela R Campbell, RHIA AHIMA Approved ICD-10-CM/PCS Trainer Eastern Illinois University

  2. Differences are in the organization of ICD-10-CM • ICD-10-CM has the same hierarchical structure as ICD-9-CM. • First three characters of the code and all codes within the same category have similar traits. Organization & Structure

  3. ICD-10-CM offers the addition of information relative to ambulatory and managed care encounters. • Conditions that are new or that were not uniquely identified in ICD-9-CM have been assigned code numbers in ICD-10-CM. • In ICD-10-CM, some three-character categories are not used in order to allow for revisions and future expansion. Overview of Changes & Improvements

  4. ICD-10-CM codes are alphanumeric and include all letters except "U”. • ICD-9-CM’s V and E codes are incorporated into the main classification in ICD-10-CM. • The length of codes in ICD-10-CM can be a maximum of seven characters. • Injuries grouped by site of the injury, then type. • New treatment protocol, new discoveries, new etiologies listed in a more appropriate chapter. Overview continued

  5. Grouping of codes • More complete descriptions • Fifth and sixth characters • Laterality • Many categories • Excludes notes • Use of extensions • Combination codes • Terminology used • Postprocedural conditions • Trimester specificity • New codes Major Changes in ICD-10-CM

  6. Coding Examples Laterality Coding Examples Combination Codes M05.271 Rheumatoid vasculitis with rheumatoid arthritis of right ankle and foot C50.512 Malignant neoplasm of lower-outer quadrant of left female breast K50.812 Crohn’s disease of both small and large intestine with intestinal obstruction K71.51 Toxic liver disease with chronic active hepatitis with ascites Coding Examples: Laterality & Combination

  7. Visual Changes & Additions

  8. ICD-9-CM Format ICD-10-CM Format X Extension Etiology, manifestation, site Category Etiology, Severity, site ICD-10-CM Example a S 5 2 . 1 3 1 Displaced fracture of neck of right radius, initial encounter for closed fracture Let’s Compare Old to New

  9. ICD-9-CM ICD-10-CM Musculoskeletal System and Connective Tissue M00 – M99

  10. Category 274, Gout in ICD-9-CM Chapter 3, Endocrine, Nutritional and Metabolic Diseases and Immunity Disorders • M10, Gout, ICD-10-CM Chapter 13. • Code 268.2, Osteomalacia, unspecified in ICD-9-CM Chapter 3 • M83, Adult osteomalacia in ICD-10-CM Chapter 13. • Code 524.4 Malocclusion, unspecified in ICD-9-CM Chapter 9, Diseases of the Digestive System • M26.4, Malocclusion, unspecified in ICD-10-CM Chapter 13. • Code 526 Diseases of the jaw in ICD-9-CM Chapter 9 • Moved to Chapter 13 Codes moved in ICD-10

  11. Inflammatory Polyarthropathies (M05 – M14) This section includes subcategories for: • Rheumatoid lung disease with rheumatoid arthritis (M05.1) • Rheumatoid vasculitis with rheumatoid arthritis (M05.2) • Rheumatoid heart disease with rheumatoid arthritis (M05.3) • Rheumatoid myopathy with rheumatoid arthritis (M05.4) • Rheumatoid polyneuropathy with rheumatoid arthritis (M05.5) • Rheumatoid arthritis with involvement of other organs and systems (M05.6) • Rheumatoid arthritis with rheumatoid factor without organ or systems involvement (M05.7) • Other rheumatoid arthritis with rheumatoid factor (M05.8) • Rheumatoid arthritis with rheumatoid factor, unspecified (M05.9) Expanded specificity

  12. A initial encounter for fracture • B subsequent encounter for fracture with routine healing • G subsequent encounter for fracture with delayed healing • K subsequent encounter for fracture with nonunion • P subsequent encounter for fracture with malunion • S sequelae 7th Character Extensions

  13. The following must also be coded in addition to the type of fracture: • Place of occurrence code • Activity code • Displaced vs. non-displaced • Type of fracture • Site of fracture • Laterality Fracture Coding

  14. Other changes to this chapter include: • Postoperative complications have been moved to procedure-specific body system chapters. • Pyogenic arthritis is now classified by organism, specific site, and laterality. • Rheumatoid arthritis has 191 code options by type, manifestation, and laterality. • Osteomyelitis is now classified by type, acuity, specific site, and laterality. • Osteoarthritis is now classified by type, specific site, and laterality. • Systemic Lupus Erythematosus (SLE) is now classified by etiology or manifestation. • Scoliosis is classified by type and anatomical region of spine. • Pain in the limb, which had only one code option in ICD-9-CM, now has 31 code options based on specific site and laterality. Other changes

  15. ICD-10-CM groups injuries • first by specific site (e.g., head, arm, leg), • then by type of injury (e.g., fracture, open wound). Injury

  16. Greater level of specificity in code selection • Coders need detailed progress notes • Detailed notes equal less inquires • Reduction in A/R and claims turnaround Need for Physician Documentation

  17. E codes now Y or V categories • V codes were replaced by Z codes • Represent reasons for encounters other than disease • BMI located in this section Z68 • Pediatric and adult codes Where Did the E and V Codes Go?

  18. ICD-10-CM and ICD-10-PCS • October 1, 2014 • Date of discharge for inpatient claims • Date of service for outpatient claims • HHS had stated the date will not be extended. Compliance Date

  19. Coding errors • Backlog of claims • Change in documentation requirements • Superbills – expansion to accommodate increased codes, may require alternative • Confusion and possible slow claims transactions with claims administrators What Impact Will This Have on Practices

  20. Coding professionals • Physicians • Other healthcare professional • Nonphysician clinicians/ancillary department personnel • Utilization management personnel • Software vendors • Information systems personnel • Billing/accounting personnel • Compliance officers • Fraud investigators • Government agency personnel Who will need Training?

  21. Staff • Professional Organizations • World Health Organization • Software Vendors • EMR, Encoders/Coding solutions • Industry specific organizations • Journals/Magazines • Universities/Community Colleges • Consultants Training Resources

  22. World Health Organization (WHO) • http://www.who.int/classifications/icd/en/ • Centers for Medicare and Medicaid Services (CMS) (2 free modules, CME credit) • http://www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/icd10 • Centers for Disease Control and Prevention (CDC) • http://www.cdc.gov/nchs/icd/icd10.htm • U.S. Department of Health and Human Services • http://www.hrsa.gov/healthit/toolbox/webinars/pdfs/icd10.pdf Reference Websites

  23. American Health Information Management Association (AHIMA) • http://www.ahima.org/icd10/ • AAPC • http://www.aapc.com/icd-10/ • For the Record Magazine • http://www.fortherecordmag.com • Health Data Management • http://www.healthdatamanagement.com/ • Healthcare IT News • http://www.healthcareitnews.com/

  24. HIMSS • http://www.himss.org/library/icd-10/playbook • ICD10Monitor • http://ICD10Monitor.com • ICD-10 Education (Free webinars, readiness assessments) • http://www.icd10-education.com/ • ICD 10 Watch • http://www.icd10watch.com/

  25. Step 1 – Impact Analysis: 3 – 6 months • Step 2 – Contact your Vendors: 2 – 3 months • Step 3 – Contact your Payers, Billing Service and Clearinghouse: 2 – 3 months • Step 4 – Installation of Vendor Upgrades: 3 – 6 months • Step 5 – Internal Testing: 2 – 3 months AMA Implementation Timeline

  26. Step 6 – Update Internal Processes: 2 – 3 months • Step 7 – Conduct Staff Training: 2 – 3 months • Step 8 – External Testing with Clearinghouses, Billing Service, and Payers: 6 – 9 months • Step 9 – Make the Switch to ICD-10: October 1, 2014 • After October 1, 2014

  27. General Equivalence Mappings • Developed for specific, limited short-term need • Reference mappings • Not a substitute for using/learning ICD-9-CM and ICD-10-CM/PCS • Links concepts without consideration of context or encounter information • Two GEM files available allowing for bidirectional mappings. • ICD-9-CM to ICD-10-CM • ICD-10-CM to ICD-9-CM GEM’s

  28. Basic conventions are the same • All letters used in alphabet with exception of U • Be careful in writing a zero vs. and “o”, or an “I” vs. one. • Read, read, read, notes at the beginning of each chapter – the only way to become familiar with guideline changes • ICD-10-CM will allow comparison of mortality and morbidity data • Incorporates much greater specificity and clinical information Summary

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