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Preparing for ICD-10 for Hospitals May 2011 Copyright 2011 Medtronic Notices These coding suggestions and coverage guidelines do not replace seeking coding advice from the payer and/or your coding staff. The ultimate responsibility for correct coding lies with the provider of services. Please contact your local payer for interpretation of the appropriate codes to use for specific procedures. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other third party payers as to the correct form of billing or the amount that will be paid to providers of service. See NCD 20.8 for Medicare covered indications for pacemakers and NCD 20.4 for Medicare covered indications for defibrillators. Copyright 2011 Medtronic 2 CEUs for Coders A survey will be sent out to all registered participants a few days after the session. The CEU certificates will be included in the survey as attachments for those who listened to the entire session. AAPC This program has the prior approval of the American Academy of Professional Coders (AAPC) for 2 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor. AAPC Index# MTI0329110337A. AHIMA This program has been approved for 2 continuing education units for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Copyright 2011 Medtronic 3 Topics Preparing for ICD-10 An Introduction to ICD-10 for Cardiovascular Background ICD-10-CM Diagnosis Codes ICD-10-PCS Procedure Codes DRGs under ICD-10 Appendix Copyright 2011 Medtronic 4 Background Copyright 2011 Medtronic 5 Components of ICD-10 ICD-10 has two main components: ICD-10-CM is for diagnosis codes and includes a tabular list, an index, and tables for drugs and neoplasms. ICD-10-PCS is for procedure codes and includes code tables and an index. There are other materials that are also officially part of the classification system, including: GEMs Body Part Key Device Key Copyright 2011 Medtronic Official Guidelines for Coding and Reporting ICD-10-PCS Reference Manual 6 This Is Going to Happen ICD-10 was adopted as the national standard under HIPAA (Federal Register, January 16, 2009, pp.3328-3362) and its use is mandatory The effective date for implementation is October 1, 2013 Which components of ICD-10 must be used depends on the type of provider: Provider Setting Diagnoses Procedures Hospitals Inpatient ICD-10-CM ICD-10-PCS Hospitals Outpatient ICD-10-CM CPT® ASCs Outpatient ICD-10-CM CPT® Physicians Facility/Office ICD-10-CM CPT® Copyright 2011 Medtronic 7 ICD-10 Freeze Starting October 1, 2011, all codes in ICD-10 will be frozen for 3 years. The ICD-10 Coordination and Maintenance Committee announced the freeze to allow a period of stability for programming, publishing, and training for implementation of ICD-10. Limited updates may take place on October 1, 2012 and October 1, 2013 for new technologies and new diseases The deadline for submitting change requests prior to the freeze has already passed The C&M Committee will continue to meet during the freeze Regular annual updates will resume on October 1, 2014 Copyright 2011 Medtronic 8 GEMS The General Equivalence Mappings are a very useful tool for translating between ICD-9-CM and ICD-10. The “forward” GEM converts current ICD-9-CM codes to their equivalent ICD-10 codes The “backward” GEM converts ICD-10 codes back to ICD-9-CM codes While very handy, GEMS are not a substitute for learning ICD-10. They’re intended for use in converting large databases, not for coding individual cases. Copyright 2011 Medtronic 9 Limits of GEMS Particularly for procedure codes, many ICD-9-CM codes convert to far more than one ICD-10 code. ICD-9-CM ICD-10-PCS 3795 02H63ME 3795 02H73ME Example: 37.95, implantation of ICD lead(s) 3795 02HK3ME 3795 02HL3ME There are other limits in GEMs conversion of ICD-9-CM codes to ICD-10: 3795 02HN0ME 3795 02HN4ME Some conversions are theoretically possible but unlikely Some codes convert to a “cluster” rather than one-for-one Some codes don’t convert directly to ICD-10 at all In making the transition to ICD-10, the best way to use the GEMs is either as a starting place or for confirmation. Copyright 2011 Medtronic 10 ICD-10-CM Diagnosis Codes Copyright 2011 Medtronic 11 Format of ICD-10-CM Diagnosis Codes The format of ICD-10-CM has several new features: Codes can be from 3 to 7 characters long The first digit is always a letter (only “U” is not used) The second and third digits are always numbers The fourth to seventh digits can be letters or numbers A decimal is placed after the third digit Examples I11.0 Hypertensive heart disease with heart failure R55 Syncope T82.120A Displacement of cardiac electrode, initial encounter Copyright 2011 Medtronic 12 Greater Specificity ICD-10-CM has far more diagnosis codes than ICD-9-CM. System # Diagnosis Codes ICD-9-CM 14,025 ICD-10-CM 68,069 The majority of new codes involve: Greater specificity for injuries, including site, type, and encounter Laterality (left, right, bilateral) Specificity for device complications, including encounter Copyright 2011 Medtronic 13 Heart Block The heart block codes in ICD-10-CM are quite similar to those in ICD-9-CM. Complete heart block retains a distinct code, which remains a CC ICD-10-CM doesn’t make a distinction between Mobitz and other second degree blocks Copyright 2011 Medtronic I44 Atrioventricular and left bundle-branch block I44.0 Atrioventricular block, first degree I44.1 Atrioventricular block, second degree Atrioventricular block, type I and II Mobitz block, type I and II Second degree block, type I and II Wenckebach's block I44.2 Atrioventricular block, complete Complete heart block NOS Third degree block ……………………………………… 14 Other Conduction Disorders Other codes for pacemaker and defibrillator indications related to conduction are located in I45. Codes for bifascicular and trifascicular blocks were actually simplified; the codes reflect pacemaker indications and also remain CCs I45 Other conduction disorders Long QT syndrome retains a distinct code, as needed to reflect the defibrillator indication Copyright 2011 Medtronic I45.2 Bifascicular block I45.3 Trifascicular block I45.6 Pre-excitation syndrome Lown-Ganong-Levine syndrome Wolff-Parkinson-White syndrome ……………………………………… I45.8 Other specified conduction disorders I45.81 Long QT syndrome I45.89 Other specified conduction disorders Atrioventricular dissociation Interference dissociation Nonparoxysmal AV nodal tachycardia 15 Paroxysmal Tachycardia VT is an indication for defibrillators and remains a CC Re-entry ventricular arrhythmia has its own code I47 Paroxysmal tachycardia I47.0 Re-entry ventricular arrhythmia I47.1 Supraventricular tachycardia Atrial paroxysmal tachycardia Atrioventricular paroxysmal tachycardia Junctional paroxysmal tachycardia Nodal paroxysmal tachycardia I47.2 Ventricular tachycardia Note that I47.0 and I47.9 I47.1 are not assigned for AVNRT (atrioventricular nodal reentrant tachycardia) Paroxysmal tachycardia unspecified Note: As in ICD-9-CM, tachycardia not otherwise specified is assigned to a symptom code. Copyright 2011 Medtronic 16 Atrial Fibrillation and Flutter Like ICD-9-CM, the current version of ICD-10-CM has just two codes for atrial fibrillation and flutter. I48 Atrial fibrillation and flutter I48.0 Atrial fibrillation I48.1 Atrial flutter However, it is likely that this will be expanded on October 1, 2011 to capture more detail. WHO is updating the international version of ICD-10 for these codes and the US must maintain compatibility. A proposal was recently presented before the C&M Committee to create specific codes within I48 for atrial fibrillation documented as: Persistent Permanent First episode Paroxysmal http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm March 9-10, 2011 proposals, pages 48-50 Copyright 2011 Medtronic 17 Other Cardiac Arrhythmias VF is a defibrillator indication and remains an MCC SSS retains a distinct code, as needed to reflect the pacemaker indication The depolarization codes are new According to the index, AVNRT is assigned to I49.8 Copyright 2011 Medtronic I49 Ventricular fibrillation and flutter I49.0 Ventricular fibrillation and flutter I49.01 I49.02 Ventricular fibrillation Ventricular flutter I49.1 Atrial premature beats I49.2 Junctional premature depolarization I49.3 Ventricular premature depolarization …………………………………… I49.5 Sick sinus syndrome Tachycardia-bradycardia syndrome I49.8 Other specified cardiac arrhythmias I49.9 Cardiac arrhythmia unspecified 18 Heart Failure ICD-10-CM codes for heart failure are essentially the same as the ICD-9-CM codes. This is actually by intent. The main differences are: ICD-10-CM has no code for “congestive heart failure” per se; it is included in I50.9 for unspecified heart failure “Congestive” is a non-essential term for heart failure When any form of pulmonary edema (acute, chronic, unspecified) is present with heart failure, L50.1 for left ventricular failure is assigned In addition to being a CC or MCC, heart failure is a major indication for defibrillators and bi-ventricular devices. Copyright 2011 Medtronic 19 Heart Failure Code Structure CCs and MCCs remain the same Because it is coded to I50.1, pulmonary edema is a CC rather than an MCC I50 Heart failure I50.1 Left ventricular failure I50.2 Systolic (congestive) heart failure I50.20 I50.21 I50.22 I50.23 Unspecified systolic (congestive) heart failure Acute systolic (congestive) heart failure Chronic systolic (congestive) heart failure Acute on chronic systolic (congestive) heart failure I50.3 Diastolic (congestive) heart failure I50.30 I50.31 I50.32 I50.33 Unspecified diastolic (congestive) heart failure Acute diastolic (congestive) heart failure Chronic diastolic (congestive) heart failure Acute on chronic diastolic (congestive) heart failure I50.4 Combined systolic (congestive) and diastolic (congestive) heart failure I50.40 I50.41 I50.42 I50.43 Unspecified combined (congestive) heart failure Acute combined (congestive) heart failure Chronic combined (congestive) heart failure Acute on chronic combined (congestive) heart failure I50.9 Heart failure, unspecified Copyright 2011 Medtronic 20 Heart Failure Due to Hypertension ICD-10-CM maintains the current coding practices for heart failure due to hypertension. An additional code is used from I50 to show the type of heart failure ICD-10-CM does not differentiate between benign, malignant, and unspecified hypertensive disease I11 Hypertensive heart disease I11.0 Hypertensive heart disease with heart failure Hypertensive heart failure Use additional code to identify type of heart failure (I50.-) I11.9 Hypertensive heart disease without heart failure ICD-10-CM has similar codes for hypertensive heart and chronic kidney disease. Copyright 2011 Medtronic 21 Chest Pain Chest pain codes are both reorganized and expanded. ICD-10-CM more clearly differentiates anterior chest wall pain from types of respiratoryrelated pain R07 Pain in throat and chest R07.0 Pain in throat R07.1 Chest pain on breathing Painful respiration R07.2 Precordial pain R07.8 Other chest pain According to the index, code R07.89 also classifies chest pressure, tightness, and discomfort Copyright 2011 Medtronic R07.81 Pleurodynia R07.82 Intercostal pain R07.89 Other chest pain Anterior chest wall pain R07.9 Chest pain unspecified 22 Coronary Artery Disease There are over 35 codes for CAD, reflecting different types of vessels as well as combination codes for CAD with angina. Category I25.1 is for CAD of native coronary vessels Category I25.7 is CAD of other coronary vessels with angina Subcategory Vessel Type I25.70 Coronary artery bypass graft(s), unspecified type I25.71 Coronary artery bypass graft(s), autologous vein I25.72 Coronary artery bypass graft(s), autologous artery I25.73 Coronary artery bypass graft(s), nonautologous biological I25.75 Coronary artery, native, transplanted heart I25.76 Coronary artery bypass graft(s), transplanted heart I25.79 Coronary artery bypass graft(s), other type Category I25.8 is CAD of other coronary vessels without angina Copyright 2011 Medtronic 23 CAD of Native Coronary Arteries Subcategory I25.11 shows the basic structure for the combination codes for CAD with angina. I25.1 Atherosclerotic heart disease of native coronary artery Coronary artery disease I25.10 ASHD of native coronary artery without angina pectoris I25.11 ASHD of native coronary artery with angina pectoris I25.110 ASHD of native coronary artery with unstable angina pectoris I25.111 ASHD of native coronary artery with angina pectoris with documented spasm I25.112 ASHD of native coronary artery with other forms of angina pectoris I25.119 ASHD of native coronary artery with unspecified angina pectoris ICD-10-CM assumes a causal relationship between angina and atherosclerosis. Copyright 2011 Medtronic 24 Acute Myocardial Infarction The ICD-10-CM AMI codes have several key differences from the AMI codes in ICD-9-CM. ICD-10-CM differentiates primarily between anterior wall and inferior wall, then by the coronary artery involved ICD-10-CM does not differentiate by episode of care Rather than 8 weeks, acute MI is defined as a duration of 4 weeks (28 days) or less from onset ICD-10-CM has distinct categories for the initial MI and for subsequent re-infarction Copyright 2011 Medtronic 25 Subsequent Infarction Codes in I22 are used for a repeat infarction within 4 weeks (28 days) of a previous AMI, regardless of site. I22 Subsequent STEMI and NSTEMI myocardial infarction I22.0 Subsequent STEMI of anterior wall I22.1 Subsequent STEMI of inferior wall I22.2 Subsequent NSTEMI I22.8 Subsequent STEMI of other sites I22.9 Subsequent STEMI of unspecified site Codes in I22 are never used alone; they are always used with a code from I21 The I22 code is sequenced first if the repeat AMI leads to a second admission, or after the I21 code if it occurs during the same admission as the initial AMI Copyright 2011 Medtronic 27 Cardiomyopathy Cardiomyopathy, an indication for defibrillators, has expanded codes for greater specificity. Ischemic cardiomyopathy has its own code, distinct from other forms of chronic ischemic heart disease Congestive, restrictive and non-obstructive hypertrophic cardiomyopathy have their own codes, all CCs Copyright 2011 Medtronic I25.5 Ischemic cardiomyopathy I42 Cardiomyopathy I42.0 Dilated cardiomyopathy Congestive cardiomyopathy I42.1 Obstructive hypertrophic cardiomyopathy I42.2 Other hypertrophic cardiomyopathy Non-obstructive …………………………………… I42.5 Other restrictive cardiomyopathy …………………………………… I42.8 Other cardiomyopathies I42.9 Cardiomyopathy unspecified 28 Non-Rheumatic Valve Disorders In ICD-10-CM, each valve has its own code category. Within each category, there are distinct codes for each specific type of valve disorder I35 Non-rheumatic aortic valve disorders Category Valve I34 Mitral I35.0 Non-rheumatic aortic (valve) stenosis I35 Aortic I36 Tricuspid I37 Pulmonary I35.1 Non-rheumatic aortic (valve) insufficiency Non-rheumatic aortic (valve) incompetence Non-rheumatic aortic (valve) regurgitation I35.2 Non-rheumatic aortic (valve) stenosis with insufficiency I35.8 Other non-rheumatic aortic valve disorders I35.9 Non-rheumatic aortic valve disorder unspecified Copyright 2011 Medtronic 29 Historical Conditions As with ICD-9-CM, historical conditions which are indications for defibrillators are distinctly identified in ICD-10-CM. Old Myocardial Infarction This has its own code in chronic ischemic heart disease I25.2 Old myocardial infarction History of SCD Family and personal history are separately identified Z82.41 Family history of sudden cardiac death Z86.74 Personal history of sudden cardiac arrest Personal history of sudden cardiac death successfully resuscitated Copyright 2011 Medtronic 30 Attention to Cardiac Device Like ICD-9-CM, ICD-10-CM has specific codes for use when the encounter focuses on attention to a device rather than the underlying condition, as in: Routine device replacement, eg. end-of-battery life Encounter for device interrogation or programming Z45.0 Encounter for adjustment and management of cardiac device Z45.01 Encounter for adjustment/management of cardiac pacemaker Z45.010 Encounter for checking and testing pacemaker pulse generator Encounter for replacing cardiac pacemaker pulse generator [battery] Z45.018 Encounter for adj/mgt of other part of cardiac pacemaker Z45.02 Encounter for adj/mgt of automatic implantable cardiac defibrillator Z45.09 Encounter for adj/mgt of other cardiac device Copyright 2011 Medtronic 31 Device Complications ICD-10-CM continues to classify device complications as mechanical, infection, and other (non-mechanical). Definitions are the same as ICD-9-CM for mechanical (eg. breakdown) and other non-mechanical (eg. pain) Mechanical complication codes are defined as electrode vs generator, rather than by the type of device The nature of the mechanical complication is more specific, eg. breakdown, displacement or other complication The nature of the non-mechanical complication is also more specific, eg. embolism, hemorrhage Copyright 2011 Medtronic 32 Device Complication Code Structure T82.1 Mechanical complication of cardiac electronic device All codes require a 7th T82.11 Breakdown (mechanical) of cardiac electronic device T82.110 Breakdown of cardiac electrode digit for T82.111 Breakdown of cardiac pulse generator episode of care T82.118 Breakdown of other cardiac electronic device A initial encounter D subsequent encounter S sequela T82.12 Displacement of cardiac electronic device T82.120 Displacement of cardiac electrode T82.121 Displacement of cardiac pulse generator T82.128 Displacement of other cardiac electronic device ………………………………………………… T82.7 Infection/inflammatory reaction to other cardiac devices …………………………………………………. All codes are T82.8 Other specified complications of cardiac/vascular devices CCs but only T82.84 Pain from cardiac and vascular devices for the initial T82.847 Pain from cardiac devices, implants and grafts T82.848 Pain from vascular devices, implants and grafts episode of care ………………………………………………….. Copyright 2011 Medtronic 33 ICD-10-CM Coding Guidelines Codes aren’t complete without uniform guidelines on usage. As with ICD-9-CM, there is a set of “ICD-10-CM Official Guidelines for Coding and Reporting” Use of the Official Guidelines is mandatory under HIPAA The Official Guidelines are still in draft form but will be finalized prior to October 1, 2013 The quarterly journal Coding Clinic® will also continue Coding Clinic® will begin addressing ICD-10 guidance in advance of the 2013 implementation date Copyright 2011 Medtronic 34 ICD-10-PCS Procedure Codes Copyright 2011 Medtronic 35 A New Concept ICD-10-PCS is completely unlike ICD-9-CM, or any other coding system for that matter. Key characteristics are: Codes are not assigned, they are built character-by-character from tables of values Within a section, each character represents a standard element All terms, particularly root operations, have standard definitions There are very few defaults Copyright 2011 Medtronic 36 Format of ICD-10-PCS Codes The format of ICD-10-PCS is a complete departure from the past. All codes are 7 characters long, without exception All codes are alphanumeric (letters “I” and “O” are not used) There are no decimal points Examples 027034Z Dilation of Coronary Artery, One Site, with Drug-Eluting Intraluminal Device, Percutaneous Approach 0JH60P5 Insertion of CRT-D Pulse Generator into Subcutaneous Tissue/Fascia, Chest, Open Approach Copyright 2011 Medtronic 37 Character Counts! In section “0”, Medical and Surgical procedures, the character meanings are: 1 section 2 3 4 5 root operation approach body system body part 6 7 qualifier device Body system, eg. urinary, GI, respiratory, upper arteries Root operation, eg. bypass, dilation, destruction Body part, eg. left external iliac artery, duodenum, sacrum Approach, eg. open, endoscopic via natural opening Device, eg. infusion device, cardiac lead, tissue expander Copyright 2011 Medtronic 38 Coding Character by Character 027034Z Dilation of Coronary Artery, One Site, with Drug-Eluting Intraluminal Device, Percutaneous Approach 1 Section 0 Medical & Surgical 2 Body system 2 Heart & Great Vessels 3 Root operation 7 Dilation 4 Body part 0 Coronary Artery, One Site 5 Approach 3 Percutaneous 6 Device 4 Drug-Eluting Intraluminal Device 7 Qualifier Z No Qualifier Copyright 2011 Medtronic 39 Code Table Example: PTCA and Stent PTCA with drug-eluting stent 027034Z Dilation of Coronary Artery, One Site, with Drug-Eluting Intraluminal Device, Percutaneous Approach PTCA with non-drug-eluting (bare metal) stent 02703DZ Copyright 2011 Medtronic Dilation of Coronary Artery, One Site, with Intraluminal Device, Percutaneous Approach 40 Insertion of CRDM Generators Pacemaker: 0JH60P2 Defibrillator: 0JH60P4 Copyright 2011 Medtronic CRT-P (BiV): 0JH60P3 CRT-D (BiV): 0JH60P5 41 Insertion of CRDM Leads Pacemaker leads, RA and RV, transvenous: 02H63MA, 02HK3MA CRT-P leads, RA and RV, transvenous: 02H63MA, 02HK3MA Defibrillator leads, RV, epicardial placement: 02HN0ME CRT-D leads, RA, RV, and LV via the CS, transvenous: 02H63ME, 02HK3ME, 02H43ME Copyright 2011 Medtronic 42 Codes for CRDM Systems Unlike ICD-9-CM, ICD-10-PCS does not have codes for implantation of an entire device system. Instead, components are coded individually. Implantation of dual chamber pacemaker with transvenous RA and RV leads Generator 0JH60P2 RA lead 02H63MA RV lead 02H6KMA Copyright 2011 Medtronic Implantation of CRT-D with transvenous RA and RV leads, and transvenous LV lead via the coronary sinus Generator RA lead RV lead LV (CS) lead 44 0JH60P5 02H63ME 02HK3ME 02H43ME Replacement of Device Root operation R-Replacement is not used to code replacement of devices. It’s used for replacing a native body part with a device, eg. valve replacement. Root operation W-Revision is also not used to code replacement of devices. It’s for correcting an existing device, eg. repositioning a lead. Instead, device replacement in ICD-10-PCS takes two codes: Insertion of the new device, Removal of the old device, using operation H-Insertion using operation P-Removal Removal codes contain less detail than Insertion codes. Copyright 2011 Medtronic 45 Removal of CRDM Generators Pacemaker Defibrillator CRT-P (BiV) CRT-D (BiV) Copyright 2011 Medtronic 0JPT0PZ 46 Removal of CRDM Leads Pacemaker Defibrillator CRT-P (BiV) CRT-D (BiV) Copyright 2011 Medtronic Any chamber or location 47 02PA3MZ Replacement of Rhythm Devices When a device is replaced, eg. end-of-battery life, complication, or upgrade, Insertion and Removal codes are used together. Replacement of defibrillator generator due to end-of-life Insertion of new generator 0JH60P4 Removal of old generator 0JPT0PZ Upgrade of pacemaker to CRT-D (replacement of generator, new LV lead via coronary sinus, retention of existing RA and RV leads) Insertion of new CRT-D generator 0JH60P5 Replacement of broken CRT-D RV lead, transvenous Removal of old pacer generator 0JPT0PZ Insertion of new lead 02HK3ME Removal of old lead 02PA3MZ Insertion of LV lead via CS 02H43ME Copyright 2011 Medtronic 48 Diagnostic EPS Diagnostic EPS : 4A023FZ The ICD-10-PCS Reference Manual uses EPS as an example of root operation K-Map but the example is incomplete It is essential to use code 4A023FZ to obtain correct DRG assignment for EPS Copyright 2011 Medtronic 49 * See the Appendix for table 02K for mapping and table 025 for EP ablation Cardiac Catheterization RHC: 4A023N6 LHC: 4A023N7 R&L HC: 4A023N8 It’s essential to use code 4A023N~ to obtain correct DRG assignment, particularly when the cardiac cath is performed with other CRDM and cardiac procedures Additional codes are assigned from table B20 or B21 for angiography of the heart and coronary arteries Copyright 2011 Medtronic 50 * See the Appendix for table B21 as used for arteriography of the heart/coronary arteries PTCA : What is a Site? A “site” does not equal a single coronary artery Interventions at distinct sites within the same coronary artery are coded as multiple sites, but multiple stents in the same coronary artery may or may not be different sites Different interventions require separate codes Angioplasty of two distinct sites in the LAD each with a drug-eluting stent, LCx with a drug-eluting stent, and angioplasty of RCA without stent: 027234Z, 02703ZZ Copyright 2011 Medtronic 51 Atherectomy In ICD-9-CM, angioplasty and atherectomy use the same code but in ICD-10-PCS, they are separate codes Angioplasty is coded to root operation 7-Dilation but atherectomy is coded to root operation C-Extirpation No guidelines have been published yet but presumably, if both angioplasty and atherectomy take place within the same vessel, both are coded Copyright 2011 Medtronic 52 CABG Device refers to grafts obtained from patients (eg. SVG) or cadavers, or as products; no device is direct anastomosis The qualifier refers to the Aorta-coronary bypass, one site, with SVG: origin of the bypass, ie. 021009W source of the new blood flow Separate codes are assigned RIMA-coronary artery bypass, one site: for each bypass that uses 02100Z8 a different device or qualifier Copyright 2011 Medtronic 53 Valve Replacement This is a true replacement for coding purposes because the new valve physically takes over the place and the function of the native valve Replacement of aortic valve with porcine valve: 02RF08Z Replacement of mitral valve with mechanical valve: 02RG0JZ Copyright 2011 Medtronic 54 Greater Specificity ICD-10-PCS has far more procedure codes than ICD-9-CM. System # Procedure Codes ICD-9-CM 3,824 ICD-10-PCS 72,589 The sheer volume of codes can be daunting at first but some constructs are far less likely than others. The structure of ICD-10-PCS has key consequences in: ease of expansion for new procedures and technologies greater depth of clinical documentation and knowledge required to assign codes Copyright 2011 Medtronic 55 ICD-10-PCS Coding Guidelines The ICD-10-PCS Reference Manual contains an appendix with draft procedure coding guidelines Guideline use is mandatory under HIPAA The ICD-10-PCS Reference Manual also contains many helpful examples An ICD-10-PCS Body Part Key is available to help users choose the correct value for specific anatomic structures CMS is developing an ICD-10-PCS Device Key with trade names to help users choose the correct device value Coding Clinic® will address procedure code issues as well Copyright 2011 Medtronic 56 DRGs under ICD-10 Copyright 2011 Medtronic 57 MS-DRG Conversion CMS’s stated objective in the MS-DRG conversion is: “for data coded in ICD-10, the ICD-10 MS-DRGs would assign the same MS-DRG had the same case been (See the Appendix for the link) coded using ICD-9-CM codes” In other words, CMS is not taking advantage of the ICD-10 transition to make changes to MS-DRG assignments. DRG titles and concepts are unchanged. The conversion is strictly about the codes used, not about the MS-DRG structure itself. Copyright 2011 Medtronic 58 DRG Grouper Version CMS has gone through two iterations of the MS-DRG Grouper using ICD-10 codes: V26 (FY 2009) was released for public comment in 2009 V28 (FY 2011) was released in February 2011 and comments are currently being taken Although ICD-10 codes will be final in October 2011, the MS-DRG Grouper for ICD-10 is still in draft form. V29 (FY 2012) is expected to be released in October 2011 The final version of the MS-DRG Grouper with ICD-10 codes is subject to the formal rule-making process Copyright 2011 Medtronic 59 CC/MCC Lists In keeping with the objective of assigning the same DRGs, all conditions that are CCs/MCCs in ICD-9-CM are also CCs/MCCs in ICD-10-CM. In some cases where ICD-10-CM codes reflect combined conditions, an automatic CC or MCC DRG is assigned Example: I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris In conflicts where an ICD-10-CM code could be either a CC or an MCC, designation was based on frequency data New codes were factored into the CC Exclusion List Example: I22.~, subsequent AMI, is excluded as an MCC when I21.~, initial AMI, is the principal diagnosis Copyright 2011 Medtronic 60 Qualifier Z for Lead Insertion Don’t default to qualifier Z! Pacemaker DRGs are assigned when qualifier Z is used Be sure to assign qualifier A for all pacemaker and CRT-P leads and qualifier E for all defibrillator and CRT-D leads Copyright 2011 Medtronic 64 Different DRGs? Be alert to unexpected DRGs. If the ICD-10 DRG assigned to a particular case is different from the ICD-9-CM DRG, either the codes are incorrect or the DRG structure is flawed. Check the ICD-10 codes assigned, with attention to the value for each character and the need for multiple codes Verify the DRG assignment manually Medtronic can assist in DRG verification and in notifying CMS about discrepant DRG logic. Copyright 2011 Medtronic 66 Appendix Copyright 2011 Medtronic 67 Key Websites The CDC and CMS have a wealth of educational materials and resources available on-line, both for implementation of ICD-10 and the MS-DRG conversion. ICD-10-CM Diagnosis Codes http://www.cdc.gov/nchs/icd/icd10cm.htm draft ICD-10-CM coding guidelines ICD-10-CM tabular and index diagnosis code GEMS Copyright 2011 Medtronic 68 Key Websites ICD-10-PCS Procedure Codes http://www.cms.gov/ICD10/11b_2011_ICD10PCS.asp#TopOfPage ICD-10-PCS tables and index ICD-10-PCS Reference Manual procedure code GEMS Copyright 2011 Medtronic 69 Key Websites DRGs http://www.cms.gov/ICD10/17_ICD10_MS_DRG_Conversion_Project. asp#TopOfPage Hospital payment impact analysis MS-DRG Grouper in ICD-10 (manual) MS-DRG Grouper in ICD-10 (pilot software) Copyright 2011 Medtronic 70 Table 02K: Mapping Table 02K is used for cardiac mapping, eg. 02K83ZZ This does not represent a full electrophysiologic study For EPS plus cardiac mapping, two codes must be used: one from table 4A0 for the electrophysiologic study one from table 02K for mapping Copyright 2011 Medtronic 71 Table 025: Electrophysiologic Ablation Endovascular EP ablation of arrhythmogenic focus in LA: 02573ZZ Copyright 2011 Medtronic Endovascular EP ablation of atrioventricular node: 02583ZZ 72 Table B21: Heart Angiography Arteriography of native coronary arteries with high osmolar contrast: B2110ZZ Left ventriculography with low osmolar contrast: B2150ZZ When performed with a cardiac catheterization, these codes are assigned separately Copyright 2011 Medtronic 73 Coding Hotlines You can contact Medtronic for assistance with coding and reimbursement issues. Cardiac Rhythm Disease Management (866) 877-4102, option 1 Vascular (877) 347-9662 Structural Heart (866) 616-8400 Copyright 2011 Medtronic 75 Question Time Copyright 2011 Medtronic 76 Thanks for Participating! We hope this was informative. If you have any comments or questions, please send us an email at: [email protected] Medtronic Inc. Minneapolis, MN www.medtronic.com Copyright 2011 Medtronic
