Kay Potter, RHIT, CPC, CPC-I, PCS
*Guidelines Most Significantly Affected Under ICD-10-CM
*Tips And Resources
*ICD – 10*Keep Calm
*And
*Code On!
Official ICD 10 Guidelines
*Objectives:
*In this section you will learnReview the basic structure of ICD-10-CM
and differences/similarities to ICD-9-CM.
Describe updates to the ICD-10-CM system
Analyze changes to ICD-10-CM Official Guidelines for Coding and Reporting
*Key Point
*NCHS is responsible for developing the diagnostic portion of the ICD-10 coding system, ICD-10-CM.
*CMS is responsible for developing the procedure portion of the ICD-10 coding system, ICD-10-PCS.
*Who is NCHS? National Center for Health Statistics compiles statistical information used to guide actions and policies to improve the public health U.S. citizens.
*
*ICD-10 Code Set Draft Format
*Implementation date October 1, 2014
*Partial Code Freeze
*October 1, 2011 – Last regular update to ICD-9-CM
*October 1, 2012 – 2013 – Limited updates to both ICD-(-CM and ICD-10-CM
*October 1, 2014 – Limited updates to ICD-10-CM, ICD-9-CM no longer used.
*October 1, 2015 – Regular Updates to ICD-10-CM/PCS.
*ICD-10-CM Diagnosis Codes
*To be used in all settings*Hospital inpatients
*Hospital outpatients
*Physicians offices
*Emergency offices
*Home Health
*Long Term Care
*Rehabilitation Facilities
*For ANY diagnosis anywhere
*Advantages of ICD-10
*As additional detail is to be reported with ICD-10-CM, more detail will be required in the medical records from which the data for coding are extracted.
*For payers, the clarity afforded by the ICD-10-CM coding system is likely to greatly enhance and assist in supporting medical necessity.
*With ICD-10-CM, the diagnosis comes significantly closer to being “married” to the procedure; further, it intrinsically gives a more complex description of the condition, thereby leaving less room for denials.
*A Review of the Basics
*21 chapters and expanded codesSome chapters reorganized, some conditions put in to
different chaptersAlphanumeric – first character is always a letterAddition of up to 7 characters7th character code extensions in some cases
InjuriesInitial encounterSubsequent encounterSequela
Obstetrics Glaucoma
*Why so Many More Codes?
*Laterality
*__ Example: Acute angle closure glaucoma* ICD-9-CM 365.22
* ICD-10-CM H40.211 Right eyeH40.212 Left eye
H40.213 Bilateral
H40.214 Unspecified eye
Increased Specificity External Cause Codes
*What is Different in ICD-10-CM
• Alphanumeric
• Alpha characters are not case sensitive
• I and O are used but only as the 1st character
• U is not used – saved for the International version
• Restructured chapters E.g. injuries by site and then by type
• Increased specificity and detail E.g. laterality – as described
• Combination codes E.g. – Diabetes, Angina, and CAD
* The Good News – What is the SAME in ICD-10-CM
Many of the guidelines are exactly the same between ICD-9-CM and ICD-10-CM
Conventions Format of the Index and Tabular List
Abbreviations and Punctuation NEC, NOS, brackets, and colons etc.
Steps in assigning codes
Includes notes
General coding guidelines
* Some Differences – Conventions and General Guidelines
Conventions, general coding guidelines and chapter specific guidelines
X as a placeholder
7th character
Excludes Notes
-- Excludes 1 – not coded
-- Excludes 2 – not included here
General Coding Guidelines
Late Effects is now a Sequela
Laterality
*Documentation Needs
*The diagnosis coding system (ICD-10-CM) will affect both hospital and physician providers .
*In creating the clinical modification for ICD-10 in this country, the National Center for Hospital Statistics has made significant changes.
*The number of diagnostic codes available for use in the ICD-10-CM coding system is larger than the number available in ICD-9-CM by thousands.
*Documentation Needs
*The documentation principles and concepts, may apply to documentation considerations created by the impact of both systems.
*ICD-10-CM will pose certain significant challenges to coders in both physician and facility settings.
*As additional detail is to be reported with ICD-10-CM, more detail will be required in the medical records from which the data for coding are extracted.
*Coding Tip
*Never code strictly from the alphabetical index, always confirm your code choice in the tabular list to insure the most appropriate code choice selection.
*ICD 10 has 21 Chapters
*Alphabetic Index
*The alphabetic Index is divided into sections and is organized by main terms
*Index of Diseases and Injury
*Index of External Causes of Injury
*Table of Neoplasms
*Table o Drugs and Chemicals
*Terms
*Data Granularity
*Degree or detail contained in data; the fineness in which data fields are subdivided.
*The increased granularity, or in other words, the greater level of detail afforded by ICD-10 provides the quality data needed to support the medical necessity of rendering patient care, improving clinical outcomes, and improve cost-effective disease management.
*Terms
*Combination Code – The term represents a single code used to classify: two diagnoses, either a diagnosis with an associated sign or symptom or a diagnosis with an associated complication.
* IMPORTANT—Multiple codes should not be used when the classification provides a combination code that clearly identifies all of the elements documented in the diagnosis.
*Terms
*Granularity – The term refers to the level of hierarchy and the amount of information the increased hierarchy provides to the diagnostic description
*Laterality – ICD-10 code description include right or left designation.
* The right side is usually character 1,
* Left side character 2.
* Bilateral character is usually 3.
* Unspecified side is either a character 0 or 9, depending on whether it is a fifth or sixth character.
*New – placeholder “X” if the code only has 4 or 5 characters, but needs a 7th character (e.g., initial/subsequent/sequela to injury), use an “X” in the blank spaces
*Different – Exclude 1 (never code it here) and Exclude 2 (not included, if he has that code it separately
*New – Laterality
*New – Coding pregnancy trimesters
*New – Glasgow coma scale
*New – Functional quadriplegia
*What you can
do
*Be detailed in your diagnostic documentation:
*Identify laterality
*Identify specific site, anatomical location.
*ICD-10-CM Specific Guidelines for Selected
Chapters
*Thank you for Supporting
*AHIMA!