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ICD-10
Getting There…..
Infectious Diseases
•
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
• The role of the provider is to accurately and specifically
document the nature of the patient’s condition and treatment.
• The role of the Clinical Documentation Specialist is to query
the provider for clarification, ensuring the documentation
accurately reflects the severity of illness and risk of mortality.
• The role of the coder is to ensure that coding is consistent with
the documentation.
• Good documentation….
•
•
•
•
•
•
Supports proper payment and reduces denials
Assures accurate measures of quality and efficiency
Captures the level of risk and severity
Supports clinical research
Enhances communication with hospital and other providers
It’s just good care!
The Importance of Good Documentation
Inadequate Documentation
Required ICD-10 Documentation
DIAGNOSES:
DIAGNOSES:
Shingles
Conjunctivitis
Blepharitis
Herpes zoster ophthalmicus right
eye with conjunctivitis & blepharitis
Inadequate vs. Adequate Documentation
Example 1: Herpes
Inadequate Documentation
Required ICD-10 Documentation
38-year-old male with pneumonia and
Kaposi’s sarcoma.
38-year-old male with P. carinii
pneumonia & biopsy proven papular
cutaneous Kaposi’s sarcoma both
secondary to AIDS. HIV positive for
1 year.
Inadequate vs. Adequate Documentation
Example 2: AIDS/HIV
Inadequate Documentation
Required ICD-10 Documentation
ASSESSMENT:
ASSESSMENT:
1.
2.
3.
4.
1.
2.
3.
4.
Influenza
Speech disturbance
Sinusitis
Otitis media with perforated
tympanic membrane
Influenza A
Laryngitis
Acute maxillary sinusitis
Left otitis media with left central
perforated tympanic membrane
Inadequate vs. Adequate Documentation
Example 3: Influenza
Inadequate Documentation
Required ICD-10 Documentation
Admit for left total knee replacement.
Pneumonia. Now septic. Blood
cultures positive.
Admit for left total knee replacement.
Post op day #6. Staph aureus
pneumonia. Now septic with shock.
Blood cultures positive for Staph
aureus.
Adult respiratory distress syndrome
requiring vent support with increased
PEEP.
B/P down to 73/45, Swan placed.
Adult respiratory distress syndrome
secondary to sepsis requiring vent
support with increased PEEP.
B/P down to 73/45, Swan placed.
Inadequate vs. Adequate Documentation
Example 4: Sepsis
Key Requirements for Documenting Infectious Diseases
• Indicate the status of the disease as
newly diagnosed, acute, or chronic
(e.g., HIV or AIDS).
• Describe the site of the infection or
infestation (e.g. TB of lung).
• Document any secondary disease
process related to the infection (e.g.,
whooping cough with pneumonia).
• Include the specific cause of the
infection or infestation, if known
(e.g., Shigellosis due to Shigella
boydii).
• Document the infectious agents in
other types of diseases (e.g.,
wound infection caused by
Streptococcus).
• Clarify the significance of positive
sputum and lab findings (e.g.,
Pseudomonas in sputum culture,
Strep pneumoniae in blood
culture).
With ICD-10, the need for specific and accurate
documentation is increased significantly.
• 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