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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.

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

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  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.

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