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ICD-10 Getting There….. Radiology • Claims for ambulatory and physician services provided on or after 10/1/2015 must use ICD-10-CM diagnosis codes. • Hospital inpatient claims for discharges occurring on or after 10/1/2015 must use ICD-10-CM diagnosis codes. • CPT Codes will continue to be used for physician inpatient and outpatient services and for hospital outpatient procedures. • ICD-10-PCS – a NEW procedure coding classification system, must be used to code all inpatient procedures on Facility Claims for discharges on or after 10/1/15. • ICD-9-CM codes must continue to be used for all dates of services on or before 9/30/2015. • Further delays are not likely. What Physicians Need To Know ICD-9-CM Diagnosis Codes 3 to 5 digits Alpha “E” & “V” – 1st Character No place holder characters ICD-10-CM Diagnosis Codes 7 digits Alpha or numeric for any character Include place holder characters (“x”) Terminology Similar Index and Tabular Structure Similar Coding Guidelines Somewhat similar Approximately 14,000 codes Approximately 69,000 codes Severity parameters limited Extensive severity parameters Does not include laterality Common definition of laterality Combination codes limited Combination codes common ICD-9 vs ICD-10 Diagnosis Codes Clinical Area ICD-9 Codes ICD-10 Codes Fractures 747 17,099 Poisoning and Toxic Effects 244 4,662 1,104 2,155 292 574 Diabetes 69 239 Migraine 40 44 Bleeding Disorders 26 29 Mood Related Disorders 78 71 Hypertensive Disease 33 14 End Stage Renal Disease 11 5 7 4 Pregnancy Related Conditions Brain Injury Chronic Respiratory Failure Number of Codes by Clinical Area ICD-9-CM Code Choices ICD-10 Code Choices Cellulitis of upper arm and forearm. • • • • • Cellulitis of right axilla Cellulitis of left axilla Cellulitis of right upper limb Cellulitis of left upper limb Cellulitis of unspecified part of limb ICD-10-CM Enhancements Location and Laterality 250.61 Type I Diabetes with Neurological Manifestations 357.2 Diabetic Polyneuropathy E10.42 Type I Diabetes Mellitus with Diabetic Polyneuropathy ICD-10-CM Enhancements Combination Codes Acuity Type • Acute • Left Ventricular • Chronic • Systolic • Acute on Chronic • Diastolic • Combined Circumstances • Following Surgery • Due to Hypertension • Due to Chronic Kidney Disease ICD-10-CM Enhancements Acuity, Type and Circumstances Information Needed Required ICD-10 Documentation • • • • 32-year-old female S/P external fixation right displaced pilon fracture due to jumping from her second story bedroom window in a suicide attempt. Fracture shows nonunion four weeks post op. How did the injury occur? What type of injury was sustained? What activity was taking place? When did the injury occur in relation to this encounter? • Where was the patient when the injury occurred? • Why was the activity happening? Here for additional surgical intervention. ICD-10-CM Enhancements Circumstances Surrounding Injuries Anemia Cardiomyopathy Headache • • • • • Dilated/Congestive • Obstructive Non-obstructive • Endomyocardial fibrosis • • • • Nutritional Hemolytic Aplastic Blood Loss ICD-10-CM Enhancements Type Cluster Tension Post-traumatic Drug-induced DIABETES COPD • Skin Ulcers • Gout • Kidney Disease • PVD • Eye Problems • Malnutrition • Pneumonia • Musculoskeletal Changes • CHF CANCER • • • • Anemia Depression Malnutrition Thrombosis ARTHRITIS • • • • Lung Disease Heart Disease Skin Problems Sickle Cell Disease • Hypothyroidism ICD-10-CM Enhancements Underlying and Associated Conditions Major Changes in ICD-10-CM Acuity Circumstances Surrounding Injuries Combination Codes Identification Affected Fetus Laterality Site Trimester Type Underlying and associated Conditions ICD-10-CM Enhancements Specificity and Granularity • Sign/symptom and “unspecified” codes have acceptable, even necessary, uses. • If a definitive diagnosis has not been established by the end of the encounter, it is appropriate to report codes for signs and/or symptoms in lieu of a definitive diagnosis. • When sufficient clinical information is not known or available about a particular health condition, it is acceptable to report the appropriate “unspecified” code. • It is inappropriate to select a SPECIFIC code that is not supported by the medical record documentation. Using Sign/Symptom and Unspecified Codes Dates Method Content Nov 2014 – Jan 2015 Department Meetings Introduction/Overview Jan 2015 – Mar 2015 Web-based Overview Service Specific Documentation Future Order Entry Diagnosis Assistant Mar 2015 – Jun 2015 Classroom Documenting for ICD10 using the Electronic Health Record Jun 2015 – Sep 2015 Web-based Overview Documenting Operative and Procedure Notes for ICD-10-PCS Training for Physicians Demonstration Future Orders & Diagnosis Assistant
