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Introduction to ICD-10-CM

Introduction to ICD-10-CM. ICD-10 Final Rule. CMS-0013-F Published on January 16, 2009 October 1, 2013 – Compliance date for implemention of ICD-10-Clinical Modification (CM) and ICD-10- Procedure Coding System (PCS) http://edocket.access.gpo.gov/2009/pdf/E9-743.pdf. ICD-10 Implementation.

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Introduction to ICD-10-CM

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  1. IntroductiontoICD-10-CM

  2. ICD-10 Final Rule CMS-0013-F • Published on January 16, 2009 • October 1, 2013 – Compliance date for implemention of ICD-10-Clinical Modification (CM) and ICD-10- Procedure Coding System (PCS) http://edocket.access.gpo.gov/2009/pdf/E9-743.pdf

  3. ICD-10 Implementation • Single implementation date for everyone • Date of service for physicians and ambulatory patients • Date of discharge of inpatients • ICD-9-CM will not be accepted after October 1, 2013 • ICD-9-CM claims with dates of service prior to implementation date will be allowed, but cut-off date not yet determined • NO GRACE PERIOD

  4. Benefits of ICD-10-CM • Up-to-date classification system will provide much better data for: • Measuring the quality, safety and efficacy of care • Designing payment systems and claims processing systems for reimbursement • Conducting research and clinical trials • Setting health policies • Operational and strategic planning and design of healthcare delivery systems • Monitoring resource utilization • Improving clinical, financial, and administrative performance • Preventing and detecting fraud and abuse • Tracking public health and risks

  5. ICD-10-CM Structure ICD-9-CM ICD-10-CM 3 – 7 characters Character 1 is alpha (all letters used except “U” Character 2 is numeric Characters 3 – 7 are either alpha or numeric Use of decimal after 3 characters Use of dummy placeholder “x” Alpha characters are not case sensitive • 3 – 5 characters • First character is numeric or alpha (E or V) • Characters 2-5 are numeric • Always at least 3 characters • Use of decimal after 3 characters

  6. ICD-9-CM Structure - Format 3 – 5 characters 700 110.1 726.73 V58.69 • Codes longer than 3 characters always have a decimal point after first 3 characters • First character numeric or alpha • Second through fifth characters are numeric

  7. ICD-10-CM Structure - Format 3 – 7 characters L84 Corn and callosities B95.5 Staphylococcus aureus as the cause of diseases classified elsewhere M20.11 Hallux valgus (acquired), right foot T78.01D Anaphylactic shock due to peanuts (subsequent encounter) S98.111A Complete traumatic amputation of right great toe (initial encounter) • Codes longer than 3 characters always have decimal point after third character • First character is alpha • Second through seventh characters are numeric or alpha • Seventh character used in certain chapters: musculoskeletal, injuries and external causes of injury

  8. ICD-10-CM: Similarities to ICD-9-CM • Format • Tabular List and Index • Chapters in Tabular structure similar to ICD-9-CM with minor exceptions • A few chapters have been restructured • Sense organs (eye and ear) separated from Nervous system chapter and move to their own chapters • Index structure same as ICD-9-CM • Alphabetic index of Diseases and Illnesses • Alphabetic index of External Causes • Table of Neoplasms • Table of Drugs and Chemicals

  9. ICD-10-CM: Similarities to ICD-9-CM • Divided into Alphabetic Index and Tabular List • Structure and format are the same • Index is alphabetic list of terms and their corresponding codes • Alphabetic index lists main terms in alphabetical order with indented subterms under main terms • Index is divided into two main parts: Index to Diseases and Injuries and Index to External Causes

  10. ICD-10-CM: Similarities to ICD-9-CM • Tabular List is a chronological list of codes divided into chapters based on body system or condition • Tabular list is presented in code order number • Same hierarchical structure • Codes are invalid if they are missing an applicable character • Codes are looked up the same way • Look up diagnostic term in alphabetic index • Then verify code in tabular index

  11. ICD-10-CM: Similarities to ICD-9-CM • Many conventions have the same meaning • Abbreviations, punctuations, symbols, notes such as “code first” and “use additional code” • Nonspecific codes (“unspecified” or “not otherwise specified”) are available to use when detailed documentation to support more specific code is not available

  12. ICD-10-CM: Similarities to ICD-9-CM • ICD-10-CM Official Guidelines for Coding and Reporting accompany and complement ICD-10-CM conventions and instructions • Adherence to the official coding guidelines in all healthcare is required under the Health Insurance Portability and Accountability Act

  13. ICD-10-CM: Differences from ICD-9-CM • All codes are alphanumeric • 1st character is always an alpha and alpha characters may appear elsewhere in the code as well • Codes can be up to 7 characters in length • Codes are more specific • Code titles are more complete (no need to refer back to a category, subcategory, or subclassification level to determine complete meaning of code

  14. ICD-10-CM: Differences from ICD-9-CM • Laterality (side of the body affected) has been added to relevant codes • Expanded use of combination codes • Certain conditions and associated common symptoms or manifestations • Poisonings and associated external causes • Injuries grouped by anatomic site rather than type of injury • Codes reflect modern medicine and updated medical terminology

  15. Combination Codes • E11.52 Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene • E11.621 Type 2 diabetes mellitus with foot ulcer • I69.144 Monoplegia of lower limb following nontraumatic intracerebral hemorrhage affecting left non-dominant side • I70.235 Atherosclerosis of native arteries of right leg with ulceration of other part of foot

  16. ICD-10-CM: Injury Changes • ICD-9-CM • Fractures (800-829) • Dislocations (830-839) • Sprains and strains (840-848) • ICD-10-CM • Injuries of muscle, fascia and tendon of lower leg (S86) • Fracture of foot and toe (S92) • Dislocation and sprain of joints and ligaments at ankle, foot and toe level (S93)

  17. ICD-10-CM: Differences from ICD-9-CM • Addition of 7th character • Used in certain chapters to provide information about the characteristic of the encounter • Must always be in the 7th character position • If a code has a 7th character, the code must be reported with an appropriate 7th character value in order to be valid

  18. ICD-10-CM: 7th Character for Injuries and External Causes A Initial encounter D Subsequent encounter S Sequella Note: For aftercare of an injury, assign acute injury code with 7th character “D”

  19. ICD-10-CM: 7th Character for Fractures A Initial encounter for closed fracture B Initial encounter for open fracture D Subsequent encounter for fracture with routine healing G Subsequent encounter for fracture with delayed healing K Subsequent encounter for fracture with non-union P Subsequent encounter for fracture with malunion S Sequella

  20. ICD-10-CM: Placeholder “X” • Addition of a dummy placeholder “X” is used in certain codes to: • Allow for future expansion • Fill out empty characters when a code contains fewer than 6 characters and a 7th character is applies • When a placeholder character applies, it must be used in order for the code to be consider valid

  21. ICD-10-CM: Excludes Notes • Excludes 1 Note • Indicates that a code identified in a note and code where the note appears cannot be reported together because the two conditions cannot occur together Example: E10 Type 1 diabetes mellitus Excludes 1: diabetes mellitus due to underlying condition (E08.-) drug or chemical inducted diabetes mellitus (E09.-) gestational diabetes (O24.4-) type 2 diabetes mellitus (E11.-) hyperglycemia NOS (R73.9) neonatal diabetes mellitus (P70.2) type 2 diabetes mellitus(E11.-)

  22. ICD-10-CM: Excludes Notes • Excludes 1 Note • Additional examples M21 Other acquired deformities of limbs Excludes 1: acquired absence of limb (Z89.-) congenital absence of limbs (Q71 – Q73)

  23. ICD-10-CM: Excludes Notes • Excludes2 Note • Indicates that a condition identified in the note is not part of the condition represented by the code where the note appears, so both codes may be reported together if the patient has both conditions Example L89 Pressure ulcer Excludes2: diabetic ulcers (E08.621, E08.622, E09.621, E09.622, E10.621, E10.622, E11.621, E11.622, E13.621, E13.622) non-pressure chronic ulcer of skin (L97.-) skin infections (L00 – L08) varicose ulcer (I83.0, I83.2)

  24. ICD-10-CM: Excludes Notes • Excludes2 Note • Additional example I70.2 Atherosclerosis of native arteries of extremity Excludes2: atherosclerosis of bypass graft of extremities (I70.30 – I70.79)

  25. ICD-10-CM: Specificity Examples • Increased specificity S91.121A Laceration with foreign body of right great toe without damage to nail (initial encounter) M89.672 Osteopathy after poliomyelitis left ankle and foot Z47.81 Encounter for orthopedic aftercare following surgical amputation Z87.81 Personal history of sex reassignment Z86.31 Personal history of diabetic foot ulcer Excludes 2 : current diabetic foot ulcer (E09.640, E10.640, E11.640, E13.640)

  26. ICD-10-CM Laterality Examples • Laterality M14.672 Charcot’s joint, left ankle and foot M21.31 Hallux varus (acquired), right foot M20.5x2 Other deformities of toe(s) (acquired), left foot M66.371 Spontaneous rupture of flexor tendons, right ankle and foot M71.072 Abscess of bursa, left ankle and foot

  27. ICD-10-CM Coding Examples Diabetes mellitus, type II with diabetic neuropathy Step 1 Look up in term Alphabetic Index Diabetes, diabetic (mellitus) (familial) (sugar) E11.9 type 2 E11.9 with neuropathy E11.40

  28. ICD-10-CM Coding Examples Type 2 diabetes mellitus with diabetic neuropathy (continued) Step 2 Verify code in Tabular: E11 Type 2 Diabetes mellitus E11.4 Type 2 Diabetes mellitus with neurologic complications E11.40 Type 2 Diabetes mellitus with diabetic neuropathy, unspecified E11.41 Type 2 Diabetes mellitus with diabetic mononeuropathy E11.42Type 2 Diabetes mellitus with diabetic polyneuropathy E11.43 Type 2 Diabetes mellitus with autonomic diabetic (poly)neuropathy E11.44 Type 2 Diabetes mellitus with amyotrophy E11.49 Type 2 Diabetes mellitus with other diabetic neurologic complication

  29. ICD-10-CM Coding Examples Stage III decubitus ulcer of left heel Step 1 Look up tern in Alphabetic Index Ulcer, ulcerated, ulcerating, ulceration See ulcer by site lower limb (atrophic) (chronic) (neurogenic) (perforating) (pyogenic) (trophic) (topical) - pressure (pressure area) L89.9- -- heel L89.6-

  30. ICD-10-CM Coding Examples Stage III decubitus ulcer of left heel (continued) Step 2 Verify in Tabular: L89.62 Pressure ulcer of left heel L89.623 Pressure ulcer of left heel, stage III

  31. AHIMA Resources • Practical guidance • Putting ICD-10-CM/PCS GEMs in Practice (free) • ICD-10 Checklist (free) • Role based implementation model (free) • Books • Pocket Guide of ICD-10-CM and ICD-10-PCS • ICD-10-CM and ICD-10-PCS Preview • Online courses • ICD-10-CM Overview: Deciphering the Code • E-newsletter (free) • Proficiency assessment (free) • Academy for ICD-10 Trainers (11-8/9-2010) • Articles • Webinars/Conferences

  32. CMS Resources • MS-DRG Conversion Report http://www.cms.hhs.gov/ICD10/Downloads/msdrgconversion.pdf • ICD-10 General Information http://www.cms.hhs.gov/ICD10

  33. Additional Resources • The following organizations offer providers and others ICD-10 resources • WEDI (Workgroup for Electronic Data Interchange http://www.wedi.org • HIMSS (Health Information and Management Systems Society) http://www.himss.org/ICD10

  34. APMA Time Line January 2011 – May 2011 • Software vendor and/or billing company: • Discussed their ICD-10 overall conversion process and can they comply prior to ICD-10 go-live date? • Will they be compliant with the Certification Commission for Health Information Technology (CCHIT) of Chicago; the Drummond Group of Austin; or InfoGard Laboratories, Inc., San Luis Obispo, California? • What will any new or additional costs entail? • Can they integrate an accounts receivable program into (from) your EHR/HIT program?

  35. APMA Time Line January 2011 – May 2011 • Staff training: • Attend introductory ICD-10 seminar • Discuss office program for ICD-10 conversion • Obtain ICD-10 training materials • Plan what your ongoing training needs will be (seminars, books, web material, etc.)

  36. APMA Time Line January 2011 – May 2011 • Budget • What costs are involved in hardware and software conversion to ICD-10? • Will a new certified EHR program need to be purchased? • If yes, what training costs are involved? If no, are there any costs involved training staff in changes with current program(s)? • What are the costs for purchase of other educational resources? • What are the costs for seminars (including all associated expenses)?

  37. APMA Time Line May to October 2011 • Doctors and staff participate in APMA ICD-10 education and training • Initiate internal practice training sessions to cover impacts on benefit coverage; payment policies; provider-patient relations; claims/claims processing; etc. • Develop an office implementation team and divide assignments

  38. APMA Time Line October 2011 to August 2012 • Doctors and staff participate in APMA ICD-10 education and training • Implementation team outlines specific tasks not yet completed and revises timeline and responsibilities • Make final decisions on changing software and/or billing vendors (if outstanding). Make sure they are 5010 compliant and all testing has been completed.

  39. APMA Time Line August 2012 to March 2013 • Doctors and staff participate in APMA ICD-10 education and training • Conduct doctors and staff training sessions (if outstanding) • Finalize installment and gain familiarity with EHR software • Review your contracts to update verbiage that will include ICD-10-CM for all diagnosis coding replacing ICD-9 by 10/1/2013

  40. Questions

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