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International Classification of Disease, 10 th Revision, Clinical Module (ICD-10-CM)

International Classification of Disease, 10 th Revision, Clinical Module (ICD-10-CM). Steven M. Verno , CMBS, CMSCS, CEMCS, CPM-MCS. Disclaimer.

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International Classification of Disease, 10 th Revision, Clinical Module (ICD-10-CM)

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  1. International Classification of Disease, 10th Revision, Clinical Module (ICD-10-CM) Steven M. Verno, CMBS, CMSCS, CEMCS, CPM-MCS

  2. Disclaimer • I am not a Lawyer. I am a practice manager, medical coder and medical biller. I do not provide any legal advice. This presentation contains no legal advice. The contents are provided for training purposes only!

  3. It’s true!! • There is No Longer any Rumor! • ICD-10-CM BECOMES OUR CURRENT DIAGNOSIS CODE SET AS OF OCTOBER 1, 2013

  4. What I won’t be Discussing! • I will not be discussing ICD-10-PCS

  5. When is ICD-10-CM Effective? • October 1, 2013!

  6. What Changes with ICD-10-CM? The disease remains the same: • Chicken Pox is still chicken pox • Measles is still measles • Chest pain is still chest pain. The numbers change!

  7. Comparing ICD-9 to ICD-10 Codes Chicken Pox: ICD-9-CM: • V05.4 Varicella • Chicken pox ICD-10-CM B01.9 - Varicella without complication

  8. Comparing ICD-9 to ICD-10 Codes Measles ICD-9-CM: • 055 Measles • 056 Rubella ICD-10-CM B05.9 - Measles without complication B06.9 - Rubella without complication

  9. Comparing ICD-9 to ICD-10 Codes Chest pain ICD-9-CM: • 786.50 Chest pain, unspecified ICD-10-CM R07.9 - Chest pain, unspecified

  10. What doesn’t change? Coding Conventions don’t change: ICD-9-CM • 370.2 Superficial keratitis without conjunctivitis • Excludes: dendritic [herpes simplex] keratitis (054.42) • 370.20 Superficial keratitis, unspecified ICD-10 • H10 Conjunctivitis • Excludes: keratoconjunctivitis ( H16.2 ) • H10.0 Mucopurulent conjunctivitis • H10.3 Acute conjunctivitis, unspecified • Excludes: ophthalmia neonatorum • NOS ( P39.1 )

  11. What doesn’t change? NEC “Not elsewhere classifiable” • This abbreviation in the Index represents “other specified”. When a specific code is not available for a condition, the Index directs the coder to the “other specified” code in the Tabular. NOS “Not otherwise specified” • This abbreviation is the equivalent of unspecified.

  12. What doesn’t change? • [ ] Brackets are used in the tabular list to enclose synonyms, alternative wording or explanatory phrases. Brackets are used in the Index to identify manifestation codes. • ( ) Parentheses are used in both the Index and Tabular to enclose supplementary words that may be present or absent in the statement of a disease or procedure without affecting the code number to which it is assigned. The terms within the parentheses are referred to as nonessential modifiers. • : Colons are used in the Tabular List after an incomplete term which needs one or more of the modifiers following the colon to make it assignable to a given category.

  13. “Unspecified” codes • Codes (usually a code with a 4th digit 9 or 5th digit 0 for diagnosis codes) titled “unspecified” are for use when the information in the medical record is insufficient to assign a more specific code. For those categories for which an unspecified code is not provided, the “other specified” code may represent both other and unspecified. Includes Notes • This note appears immediately under a three-digit code title to further define, or give examples of, the content of the category.

  14. Inclusion terms • List of terms is included under some codes. These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of “other specified” codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Index may also be assigned to a code. Excludes Notes • ICD-10-CM has two types of excludes notes. Each type of note has a different definition for use but they are all similar in that they indicate that codes excluded from each other are independent of each other.

  15. Many Guidelines remain the same ICD-9 • Signs and symptoms • Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the physician. Chapter 16 of ICD-9-CM, Symptoms, Signs, and Ill-defined conditions (codes 780.0 -799.9) contain many, but not all codes for symptoms. ICD-10 • Codes for symptoms, signs, and ill-defined conditions • Codes for symptoms, signs, and ill-defined conditions from Chapter 18 are not to be used as principal diagnosis when a related definitive diagnosis has been established.

  16. ICD-9 • Conditions that are an integral part of a disease process • Signs and symptoms that are integral to the disease process should not be assigned as additional codes. ICD-10 • Conditions that are an integral part of a disease process • Signs and symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.

  17. ICD-9 Level of Detail in Coding • Diagnosis and procedure codes are to be used at their highest number of digits available. • ICD-9-CM diagnosis codes are composed of codes with either 3, 4, or 5 digits. Codes with three digits are included in ICD-9-CM as the heading of a category of codes that may be further subdivided by the use of fourth and/or fifth digits, which provide greater detail. • A three-digit code is to be used only if it is not further subdivided. Where fourth-digit subcategories and/or fifth-digit subclassifications are provided, they must be assigned. A code is invalid if it has not been coded to the full number of digits required for that code. For example, Acute myocardial infarction, code 410, has fourth digits that describe the location of the infarction (e.g., 410.2, Of inferolateral wall), and fifth digits that identify the episode of care. It would be incorrect to report a code in category 410 without a fourth and fifth digit. • ICD-9-CM Volume 3 procedure codes are composed of codes with either 3 or 4 digits. Codes with two digits are included in ICD-9-CM as the heading of a category of codes that may be further subdivided by the use of third and/or fourth digits, which provide greater detail. ICD-10 Level of Detail in Coding • Diagnosis codes are to be used and reported at their highest number of digits available. • ICD-10-CM diagnosis codes are composed of codes with 3, 4, 5, 6 or 7 digits. Codes with three digits are included in ICD-10-CM as the heading of a category of codes that may be further subdivided by the use of fourth and/or fifth digits, which provide greater detail. • A three-digit code is to be used only if it is not further subdivided. A code is invalid if it has not been coded to the full number of characters required for that code, including the 7th character, if applicable.

  18. Some guidelines changed or do not exist in ICD-10 ICD-9 15. Admissions/Encounters for Rehabilitation • When the purpose for the admission/encounter is rehabilitation, sequence the appropriate V code from category V57, Care involving use of rehabilitation procedures, as the principal/first-listed diagnosis. The code for the condition for which the service is being performed should be reported as an additional diagnosis. • Only one code from category V57 is required. Code V57.89, Other specified rehabilitation procedures, should be assigned if more than one type of rehabilitation is performed during a single encounter. A procedure code should be reported to identify each type of rehabilitation therapy actually performed. ICD-10 Does not exist in ICD-10

  19. How do I look up a code? ICD-9-CM: 1. Use of Both Alphabetic Index and Tabular List • Use both the Alphabetic Index and the Tabular List when locating and assigning a code. Reliance on only the Alphabetic Index or the Tabular List leads to errors in code assignments and less specificity in code selection. 2. Locate each term in the Alphabetic Index • Locate each term in the Alphabetic Index and verify the code selected in the Tabular List. Read and be guided by instructional notations that appear in both the Alphabetic Index and the Tabular List. Locating a code in the ICD-10-CM • It is essential to use both the Index and Tabular List when locating and assigning a code. The Index does not always provide the full code. Selection of the full code, including laterality and any applicable 7th character can only be done in the Tabular list. A dash (-) at the end of an Index entry indicates that additional characters are required. Even if a dash is not included at the Index entry, it is necessary to refer to the Tabular list to verify that no 7th character is required.

  20. ICD-9 Table of Drugs and Biologicals

  21. ICD-10 Table of Drugs and Biologicals Substance Poisoning Poisoning Acicidental Intentional Poisoning Poisoning Adverse Underdosing Unintentional Self harm Assault undetermined effect 1-propanol T51.3x1 T51.3x2 T51.3x3 T51.3x4 -- -- 2-propanol T51.2x1 T51.2x2 T51.2x3 T51.2x4 -- -- 2,4-D (dichlorophen-oxyacetic acid) T60.3x1 T60.3x2 T60.3x3 T60.3x4 -- -- 2,4-toluene diisocyanate T65.0x1 T65.0x2 T65.0x3 T65.0x4 -- -- 2,4,5-T (trichloro-phenoxyacetic acid) T60.1x1 T60.1x2 T60.1x3 T60.1x4 -- -- 14-hydroxydihydro-morphinone T40.2x1 T40.2x2 T40.2x3 T40.2x4 T40.2x5 T40.2x6 ABOB T37.5x1 T37.5x2 T37.5x3 T37.5x4 T37.5x5 T37.5x6 Abrine T62.2x1 T62.2x2 T62.2x3 T62.2x4 -- -- Abrus (seed) T62.2x1 T62.2x2 T62.2x3 T62.2x4 -- -- Absinthe T51.0x1 T51.0x2 T51.0x3 T51.0x4 -- -- - beverage T51.0x1 T51.0x2 T51.0x3 T51.0x4 -- -- Under ICD-9, Accidental poisoning by Absinthe would be 980.0 . Under ICD-10, this code would be T51.0x1 When looking at T51.0, you find this: T51.0 Toxic effect of ethanol Toxic effect of ethyl alcohol Excludes2: acute alcohol intoxication or "hangover" effects drunkenness pathological alcohol intoxication T51.0x Toxic effect of ethanol T51.0x1 Toxic effect of ethanol, accidental (unintentional) Toxic effect of ethanol NOS

  22. Getting Ready for ICD-10-CM

  23. Documentation ICD-10 takes a disease down to the Nth degree, due to the availability of more codes to select. Therefore, the provider must be exact with the medical condition of the patient. Not being as detailed as possible with the documentation can delay the coding of the claim as well as the possible selection of an incomplete or incorrect code.

  24. Start your personnel training early • You don’t want to wait until the last minute to train your staff on the new changes. • Be cautious of “fly-by-night” offers to provide your staff with ICD-10 training. Obtain your training guidance from a reputable organization. • The certifying agencies are working now to update their certification tests to change from ICD-9-CM to ICD-10-CM.

  25. New Manuals • You will be left in the dust and not using current coding manuals could be very costly to your business, the provider and the patient. • There are some websites that currently allow you to look up ICD-9-CM codes for free. Whether these sites are changed or will be open is unknown at this time. • DO NOT Rely on any association or coding forum to do your coding for you. Your coders should be highly trained, Certified and ready to use the new codes the minute they are effective.

  26. Contact Your Billing Software Vendor • Your billing software may have to be upgraded to hold both ICD-9 and ICD-10 because the claims you submit on September 30, 2013 will need the ICD-9 Codes for all claims prior to October 1, 2011. You can expect and plan on delays in payments while insurance companies work out the bugs with their systems as they too will need to keep the ICD-9 codes in their system for all pre October 1, 2013 claims. You may have to perform claims testing with your upgraded software so that it does not send claims after October 1, 2013 with ICD-9-CM codes.

  27. HIPAA ANSI 5010 http://www3.cms.gov/ICD10/03_ICD-10andVersion5010ComplianceTimelines.asp#TopOfPage

  28. Contact the Insurance Companies • Find out their coding policies as it relates to ICD-10 and benefit restrictions based on diagnoses. • Double check your current provider contracts regarding coding requirements. If your provider agreed to the carrier coding policies, you want to ensure that the carrier and your provider are on the same sheet of music. • Check with them to see when they are ready to accept claims using the ICD-10. Find out what delays may be expected with claims and payment. This could have an affect on your current provider contract with detailed payment timeframes.

  29. Update your Compliance Plans • Many Compliance Plans address ICD-9 coding issues. Make sure yours is changed to reflect the ICD-10 and any problems that may come with it. What will you do if 90% of the charts contain insufficient information to select the proper code out of 25 different codes for the condition. How will you resolve these problems? How often will you conduct internal coding audits? How many claims are being denied for coding issues and how will you address this? These should be part of your compliance plan.

  30. Update your appeals • Go through your appeals that relate to any coding issues, specifically diagnosis coding. • Make sure they are changed to reflect the new ICD-10-CM codes. • Proofread any appeals you send to make sure the appeal does not reference ICD-9-CM if an ICD-10 code was used.

  31. Updated Superbills • Some superbills may contain a checklist of ICD-9 codes. Make sure you convert the ICD-9 code to the appropriate ICD-10 code(s). • This may be a project that may take many days to accomplish. Once completed, have the superbill proof read by a trained certified coding staff member who has been trained in ICD-10. • Don’t forget to include the provider and staff in your updated training. • www.donself.com (superbill examples)

  32. Fight Fraud and Abuse • Just because there is a huge change coming in the future, you should be on your toes to watch out for intentional or unintentional upcoding or downcoding using the new ICD-10 codes. You do not want to be the subject of an audit by Medicare, Medicaid, the OIG or any other insurance audit. If you do what is right, you aren't afraid of any audits.

  33. What does this mean for you?? • New Coding Books ICD-10-CM • Updated Training • Updating Billing Software • Test Claims • Updating Superbills • Keeping an eye on claims denials or claims review • Keeping your provider’s AR to keep it down • Staying in close contact with the insurance companies • Possible updating of provider contracts to include clauses to prevent coding problems. • More Out of Pocket Expenses to get ready

  34. ICD-9-CM 1600 Pennsylvania Avenue

  35. ICD-10-CM W01.9 Pennsylvania Avenue

  36. ICD-10-CM is NOT scary

  37. ICD-10 is friendly to a trained coder

  38. Helpful Websites • Don Self: www.donself.com • AAPC: www.aapc.com • PAHCS: www.pahcs.org • POMAA: www.pomaa.net • MAB Forum: http://medicalassociationofbillers.yuku.com/ • BC Advantage: http://www.billing-coding.com/forum/ • CDC: www.cdc.gov/nchs/icd9.htm • www.cdc.gov/nchs/about/ • major/dvs/mortdata.htm • www.cdc.gov/nchs

  39. Questions? steve_verno@yahoo.com

  40. Thank You!

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