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ICD-10Do I really have to?
Richard Lander, MD, FAAP
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ICD 10
Why spend all this money and time to implement ICD 10 when they are already planning ICD 11? (release 2019?)
ICD 10 is not new, is used by many countries and we, the USA have lagged behind for too long
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ICD 10
ICD 10 was developed back in the 1980’sGlobally began use in 1994Has been used in the United States since
1999 to help report mortality statistics
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ICD 10
Typically October 1 marks the beginning of new ICD codes, the deletion of certain codes and the modification of certain codes.
October 1, 2013 did not have any deleted or revised codes
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ICD 10
October 1, 2015- let the fun begin
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BASIC CODING
Coding is how we get paid CPT identifies the type of service
provided ICD provides the diagnosis HCPCS identifies supplies utilized
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BASIC CODING
International Statistical Class of Diseases and Related Health Problems
United States ICD-10-CM (clinical med)US ICD-10-PCS (Procedural Coding
System)
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ICD 10
You will have to utilize the ICD 10 codes after October 1, 2015 to be paid by the insurance companies as they will not honor the ICD 9 codes. Your HCFA 1500 claims will not be processed!
However both the payers and the providers will need to support ICD 9 codes for claims submitted prior to October 1, 2015
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ICD 10
July 2015 Medicare announced a grace period of one year to pay claims even if ICD 10 codes are not specific enough
Will the private insurers and Medicaid follow suit???
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ICD 10
The transition will not be this easyBe prepared to keep your systems for ICD
9 going until all of your claims are paid
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ICD 10
Practices should have close to a 90 day money reserve set aside in anticipation of claims not being paid or of delayed payments.
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ICD 10
Everyone needs to be taught ICD 10 Doctors, nursing staff, coding and billing
people, and the INSURERS
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ICD 10
Shouldn’t it be easy to simply “crosswalk” ICD 9 codes to ICD 10?
Can you put a round circle into a square hole?
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ICD 10
Wouldn’t you like some GEMS?
GENERAL EQUIVALENCE MAPPINGS helps to convert ICD 9 to ICD 10
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ICD 10
ICD 9 14,000 procedure codes 4,000 diagnosis codes
ICD 10 68,000 procedure codes 87,000 diagnosis codes
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ICD 10
The number of codes are so extensive because
they will now demonstrate: laterality (right vs left) specificity (thumb, pointer finger, etc) reasons or causes where did it happen (home, work) how (jumping-trampoline)
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ICD 10
What is one of the more common problems we see in our pediatric offices?
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ICD 10
Acute supporitive otitis media w/o rupture ICD 9 382.00 ICD 10 H66.001 asom w/o rupture R ear H66.002 asom w/o rupture L ear H66.003 asom w/o rupture bilat H66.004 asom w/o rupture recurrent R Etc. Etc. Etc.
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ICD 10
Want more?? ICD 9 382.9 unspecified otitis mediaICD 10 H66.90 om, unspecified, unspecified
ear H66.91 om, unspecified R ear H66.92 om, unspecified L ear H66.93 om, unspecified, bilat
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OH NO, MORE WORK NOW with the greater amount of specificity
involved with choosing the ICD 10 code there will have to be more detailed documentation to support the use of codes which should
GIVE BETTER PATIENT CARE
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ICD 10
The new codes have 3-7 characters the first is an alpha all the letters except for U the second is numeric the third to seventh is either X is sometimes used as a fifth character
placeholder to allow for future expansion
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ICD 10
Characters 1-3=categoryCharacters 4-6=etiology, site etcCharacter 7=extension
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ICD 10
.
category etiology, anatomic injuries site, severity external
cause
A 1 2 3 4 5 6
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ICD 10
The old E codes have been replaced with V W X Y followed by other characters describe where and how school, jumping on trampoline never primary, never reported alone
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ICD 10
V codes which we use for Well visits will be replaced by
Z codes are incredibly numerous as they will cover Well visits, other health visits, vaccines
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7th Character Examples
These will usually be found in certain ICD 10 categories such as:
Pregnancy and Childbirth-chapter 15 Injury, Poisoning and Certain Other
Consequences of External Causes-ch 19 during the initial encounter use A during the subsequent encounter use D a sequela of the issue would use S
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ICD 10
A initial encounter pt seen and admitted to hospital A used for everything
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ICD 10
D Subsequent after active phase of treatment and a
followup visit is needed
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ICD 10
S sequela laceration repair that then results in
a keloid formation
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ICD 10
How do I look something up?
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ICD 10
The book
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ICD 10
The ICD 10 book is divided into Index-an alphabetical list of terms Diseases and Injury External Causes of Injury Tabular-chronological list of codes whose
chapters are based on body system or condition
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AAP Principals of Ped ICD 10
Certain infectious and parasitic diseases A00-B99Neoplasms C00-D49Diseases of the blood and blood-forming
organs and disorders D50-89Endocrine, nutritional and metabolic
diseases E00-89Mental, behavioral, neurodevelopmentalDisorders F01-99
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AAP Principles of Ped ICD 10
Diseases of the nervous system G00-99Diseases of the eye and adnexa H00-59Diseases of the ear and mastoid H60-95Diseases of the Circulatory Sys I00-99Diseases of the Respiratory Sys J00-99Diseases of the Digestive Sys K00-95Diseases of the Skin, Subcu Sys L00-99
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AAP Principles of Ped ICD 10
Diseases of the Muscular sys and Connective tissue M00-99
Diseases of the GU sys N00-99Pregnancy, childbirth and the puerperium O0-09ACertain conditions originating in the
perinatal period P00-96Congenital malformations, deformations
and chrom. Abnormalities Q00-99
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AAP Principles of Ped ICD 10
Symptoms, signs and abnormal clinical and lab findings R00-99
Injury, poisoning and consequences of external causes S00-T88
External causes of morbidity V00-99Factors influencing hlth status and contact
with hlth services Z00-99
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ICD 10
First check the index for the condition, disease, symptom or sign
The first character is an alpha Then use the three digit numeric
characters to help you in the numbered Tabular section
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ICD 10
A dash (-) at the end of the Index entry means that more characters are needed
HINT if you don’t see the dash don’t assume
that a seventh character (numeric or alpha) is not needed-check the Tabular list
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ICD 10
Z00.110 “Health supervision under 8 days”
Z00.111 “Health supervision newborn 8 to 28 days old”How aboutZ00.129 “Routine child health check”Z00.121 “Routing child health check with
abnormal findings” plus what was found
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ICD 10
Sometimes ICD 10 replaces multiple ICD 9 codes
under ICD 9 there are 7 codes for TB 010.90-010.96 under ICD 10 there will be one code A15.7
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REFERENCES
Tabular index (1593 pages) Alphabetic Index of Codes (1263 pages)
These are free
www.cdc.gov/nchs/icd/icd10cm.htm#icd2014
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ICD 10
ARE YOU AS CONFUSED AS I AM?
SORRY
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ICD 10
Maybe these will help
www.cms.gov/medicare/coding/icd10/providerresources.html
www.ama-assn.org/go/icd-10
www.aap.org/en-us/professional-resources/practice-support/coding-at-the-aap/prages/icd-10.aspx
www.aapc.com/icd-10/codes/index.aspx
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THE SECRET OF GETTING AHEAD IS GETTING STARTED
MARK TWAIN
GET GOING!