CCA/CPC Review

Medical Group Business ServicesBrown Bag Series

April 12, 2007

CCA/CPC Review

UCSF Clinical Enterprise Compliance Program

CECP Education SeriesWanda T. Ziemba MFA RHIT

CHCC CHCO CPC

Associate Compliance Officer & CECP Educator

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ICD-10-CM

“Catching Up With The Rest of The World”

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The National Library of Medicine (NLM) has begun a project to develop, review and test mappings between SNOMED CT, ICD-9-CM and HIPAA standards. This is one of the priority efforts for HHS to align clinical vocabulary and messaging standards in order to move forward with the national electronic health record.

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While the final decision regarding the replacement of the ICD-9-CM coding system with ICD-10 is eminent, preparatory planning now is advised. While there are some similarities between the coding systems, the differences are more striking. The ICD-10 codes will have up to 6 alpha numeric characters with 3 to the right of the decimal point. Codes will be expanded to include underlying and combination conditions, laterality, timeframes, causes and complications.

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The ICD-10 is copyrighted by the World Health Organization (WHO), which owns and publishes the classification. WHO has authorized the development of an adaptation of ICD-10 for use in the United States for U.S. government purposes. As agreed, all modifications to the ICD-10 must conform to WHO conventions for the ICD. Except in rare instances, no modifications have been made to existing three-digit categories and four-digit codes, with the exception of title changes that did not change the meaning of the category or code.

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ICD-10-CM was developed following a thorough evaluation by a Technical Advisory Panel and extensive additional consultation with physician groups, clinical coders, and others to assure clinical accuracy and utility. We believe the clinical modification represents a significant improvement over ICD-9-CM and ICD-10. The current draft of ICD-10-CM contains a significant increase in codes over ICD-10 and ICD-9-CM.

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ICD-10-CM

ICD-10-CM scheduled to replace ICD-9-CM

Target implementation date 2010

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Anticipated timeline for adoption of ICD-10-CM was originally 2008.

Canada and Australia have converted to ICD-10 already (Note: both countries have single payor systems)

ICD-10 has been implemented in the U.S. for the coding of death certificates since January 1999

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Benefits of ICD-10-CM

More accurate payment for new procedures – flexibility in nomenclature will improve support of medical innovations

Fewer miscoded, rejected and improper claims – expanded coding schema reinforces structured and complete physician documentation

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Better understanding of the value of new procedures

Improved disease management – consistency with coding conventions will support world-wide research

Better understanding of healthcare outcomes

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Improvements in ICD-10-CM

More relevant ambulatory and managed care encounter codes

Expanded injury codes Combination diagnosis/symptom codes Six digits, maximum

(Cont’d…)

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Improvements

(…Cont’d)

More fourth and fifth digits added Updated diabetes codes Greater overall specificity

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ICD-10-CM Structure

21 Chapters V and E codes incorporated Addition of chapters for

– Eye and Adnexa– Ear and Mastoid Process

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Crosswalk

ICD-9-CM code cross-walked to new ICD-10-CM code

Figure: 15.7Figure: 15.7

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Index

Main terms and subterms

Figure: 15.8Figure: 15.8

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Tabular

Each section begins with unique letter and codes arranged in numerical order

Figure: 15.9Figure: 15.9

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ICD-10-PCS

Will replace Volume 3, Procedures of ICD-9-CM

Currently being piloted

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Advanced Planning

Mitigate impact to Accounts Receivable Secure training and additional coding

resources Demonstrate organization commitment

to coder retention with commitment to training and support needed

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Implementation Requirements

Higher level of expertise in anatomy and physiology than for current ICD-9-CM coding

Database and information processing systems must be able to accommodate a 7 character field for alphanumeric codes (compared to 5 character field size for

ICD-9-CM

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Training Requirements

NCVHS Field Testing projects conclude that a minimum of 16 hours of introductory training is needed for each experienced coder

3-6 weeks required for experienced coders to become comfortable with the ICD-10-CM schema

it takes 6 months until the productivity level reaches current ICD-9-CM levels

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Concerns

Coding schema is significantly different with a combination of numeric digits 0-9 and alphabetic characters A-H, J-N, P-Z

26% of current coders surveyed indicated personal plans to retire or change careers before ICD-10-CM is implemented

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Organization impact is widespread: HIMS/inpatient coding, IT, Patient Billing Services, Physicians/Providers, Quality Management, Decision Support, Department Management, Medical Research, etc.

Comparative trends with historical data not feasible for many codes due to combining nomenclature

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Example Chapter-Infectious & Parasitic Diseases

A00-A09 Intestinal infectious diseases A15-A19 Tuberculosis A20-A28 Certain zoonotic bacterial diseases

A30-A49 Other bacterial diseases A50-A64 Infections with a predominantly

sexual mode of transmission A65-A69 Other spirochetal diseases

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A70-A74 Other diseases caused by chlamydiae

A75-A79 Rickettsioses A80-A89 Viral infections of the central

nervous system A90-A99Arthropod-borne viral fevers

and viral hemorrhagic fevers

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B00-B09 Viral infections characterized by skin and mucous membrane lesions

B15-B19 Viral hepatitis B20 Human immunodeficiency virus [HIV] disease

B25-B34 Other viral diseases

B35-B49 Mycoses

B50-B64 Protozoal diseases

B65-B83 Helminthiases

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B85-B89 Pediculosis, acariasis and other infestations

B90-B94 Sequelae of infectious and parasitic diseases

B95-B97 Bacterial, viral and other infectious agents

B99 Other infectious diseases Intestinal infectious diseases

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Example Alpha – Tuberculosis

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T Tabacism, tabacosis, tabagism - meaning dependence (without remission)

F17.200 - - with - - - disorder F17.299 - - - - remission F17.211 - - - - specified disorder NEC F17.298

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Tuberculosis, tubercular, tuberculous (calcification) (calcified) (caseous) (chromogenic acid-fast bacilli)

(degeneration) (fibrocaseous) (fistula) (interstitial) (isolated circumscribed lesions) (necrosis)

(parenchymatous) (ulcerative) A15.9 - with pneumoconiosis (any condition in J60-

J64) J65 - abdomen (lymph gland) A18.39

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- abscess (respiratory) A15.9 - - bone A18.03 - - - hip A18.02 - - - knee A18.02 - - - sacrum A18.01 - - - specified site NEC A18.03 - - - spinal A18.01 - - - vertebra A18.01 - - brain A17.81 - - breast A18.89 - - Cowper's gland A18.15 - - dura (mater) (cerebral) (spinal) A17.81 - - epidural (cerebral) (spinal) A17.81

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- - female pelvis A18.17 - - frontal sinus A15.8 - - genital organs NEC A18.10 - - genitourinary A18.10 - - gland (lymphatic) - see Tuberculosis,

lymph gland - - hip A18.02 - - intestine A18.32

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- - ischiorectal A18.32 - - joint NEC A18.02 - - - hip A18.02 - - - knee A18.02 - - - specified NEC A18.02 - - - vertebral A18.01 - - kidney A18.11 - - knee A18.02 - - lumbar (spine) A18.01 - - lung - see Tuberculosis, pulmonary - - meninges (cerebral) (spinal) A17.0

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- - muscle A18.09 - - perianal (fistula) A18.32 - - perinephritic A18.11 - - perirectal A18.32 - - rectum A18.32 - - retropharyngeal A15.8 - - sacrum A18.01 - - scrofulous A18.2 - - scrotum A18.15

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- - skin (primary) A18.4 - - spinal cord A17.81 - - spine or vertebra (column) A18.01 - - subdiaphragmatic A18.31 - - testis A18.15 - - urinary A18.13 - - uterus A18.17 - accessory sinus - see Tuberculosis, sinus - Addison's disease A18.7 - adenitis - see Tuberculosis, lymph gland

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- adenoids A15.8 - adenopathy - see Tuberculosis, lymph gland - adherent pericardium A18.84 - adnexa (uteri) A18.17 - adrenal (capsule) (gland) A18.7 - alimentary canal A18.32 - anemia A18.89

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- ankle (joint) (bone) A18.02 - anus A18.32 - apex, apical - see Tuberculosis, pulmonary - appendicitis, appendix A18.32 - arachnoid A17.0 - artery, arteritis A18.89 - - cerebral A18.89

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- arthritis (chronic) (synovial) A18.02 - - spine or vertebra (column) A18.01 - articular - see Tuberculosis, joint - ascites A18.31 - asthma - see Tuberculosis, pulmonary - axilla, axillary (gland) A18.2 - bilateral - see Tuberculosis, pulmonary - bladder A18.12

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- bone A18.03 - - hip A18.02 - - knee A18.02 - - limb NEC A18.03 - - sacrum A18.01 - - spine or vertebral column A18.01 - bowel (miliary) A18.32 - brain A17.81 - breast A18.89 - broad ligament A18.17

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- bronchi, bronchial, bronchus A15.5 - - ectasia, ectasis (bronchiectasis) - see

Tuberculosis, pulmonary - - fistula A15.5 - - - primary (progressive) A15.7 - - gland or node A15.4 - - - primary (progressive) A15.7 - - lymph gland or node A15.4 - - - primary (progressive) A15.7

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- bronchiectasis - see Tuberculosis, pulmonary

- bronchitis A15.5 - bronchopleural A15.6 - bronchopneumonia, bronchopneumonic -

see Tuberculosis, pulmonary - bronchorrhagia A15.5 - bronchotracheal A15.5 - bronze disease A18.7

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- buccal cavity A18.83 - bulbourethral gland A18.15 - bursa A18.09 - cachexia A15.9 - cardiomyopathy A18.84 - caries - see Tuberculosis, bone - cartilage A18.02 - - intervertebral A18.01 - catarrhal - see Tuberculosis, respiratory

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- cecum A18.32 - cellulitis (primary) A18.4 - cerebellum A17.81 - cerebral, cerebrum A17.81 - cerebrospinal A17.81 - - meninges A17.0 - cervical (lymph gland or node) A18.2 - cervicitis, cervix (uteri) A18.16 - chest - see Tuberculosis, respiratory - chorioretinitis A18.53 - choroid, choroiditis A18.53 - ciliary body A18.54

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Example Tabular - Tuberculosis

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Tuberculosis

Tuberculosis (A15-A19) Includes: infections due to Mycobacterium tuberculosis and Mycobacterium bovis Excludes1:congenital tuberculosis (P37.0) pneumoconiosis associated with tuberculosis (J65) sequelae of tuberculosis (B90.-) silicotuberculosis

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Respiratory Tuberculosis

A15.0 Tuberculosis of lung Tuberculous bronchiectasis Tuberculous fibrosis of lung Tuberculous pneumonia Tuberculous pneumothorax

A15.4 Tuberculosis of intrathoracic lymph nodes Tuberculosis of hilar lymph nodes Tuberculosis of mediastinal lymph nodes Tuberculosis of tracheobronchial lymph nodes Excludes1:tuberculosis specified as primary (A15.7)

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A15.5 Tuberculosis of larynx, trachea and bronchus Tuberculosis of bronchus Tuberculosis of glottis Tuberculosis of larynx Tuberculosis of trachea

A15.6 Tuberculous pleurisy Tuberculosis of pleura Tuberculous empyema Excludes1:primary respiratory tuberculosis (A15.7)

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A15.7 Primary respiratory tuberculosis

A15.8 Other respiratory tuberculosis Mediastinal tuberculosis Nasopharyngeal tuberculosis Tuberculosis of nose Tuberculosis of sinus [any nasal]

A15.9 Respiratory tuberculosis unspecified

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Tuberculosis of the Nervous System

A17.0 Tuberculous meningitis Tuberculosis of meninges (cerebral)(spinal) Tuberculous leptomeningitis Excludes1:tuberculous meningoencephalitis (A17.82)

A17.1 Meningeal tuberculoma Tuberculoma of meninges (cerebral) (spinal) Excludes2:tuberculoma of brain and spinal cord (A17.81)

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A17.8 Other tuberculosis of nervous system A17.81 Tuberculoma of brain and spinal cord

Tuberculous abscess of brain and spinal cord A17.82 Tuberculous meningoencephalitis

Tuberculous myelitis A17.83 Tuberculous neuritis Tuberculous

mononeuropathy A17.89 Other tuberculosis of nervous system

Tuberculous polyneuropathy A17.9 Tuberculosis of nervous system,

unspecified

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Tuberculosis of Other Organs

A18.0 Tuberculosis of bones and joints – A18.01 Tuberculosis of spine Pott's disease or

curvature of spine Tuberculous arthritis Tuberculous osteomyelitis of spine Tuberculous spondylitis

– A18.02 Tuberculous arthritis of other joints Tuberculosis of hip (joint) Tuberculosis of knee (joint)

– A18.03 Tuberculosis of other bones Tuberculous mastoiditis Tuberculous osteomyelitis

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– A18.09 Other musculoskeletal tuberculosis Tuberculous myositis Tuberculous synovitis Tuberculous tenosynovitis

– A18.1 Tuberculosis of genitourinary system– A18.10 Tuberculosis of genitourinary

system, unspecified – A18.11 Tuberculosis of kidney and ureter – A18.12 Tuberculosis of bladder

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– A18.13 Tuberculosis of other urinary organs Tuberculous urethritis

– A18.14 Tuberculosis of prostate – A18.15 Tuberculosis of other male genital

organs – A18.16 Tuberculosis of cervix

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– A18.17 Tuberculous female pelvic inflammatory disease Tuberculous endometritis Tuberculous oophoritis and salpingitis

– A18.18 Tuberculosis of other female genital organs Tuberculous ulceration of vulva

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A18.2 Tuberculous peripheral lymphadenopathy Tuberculous adenitis Excludes2:tuberculosis of bronchial and mediastinal lymph nodes (A15.4) tuberculosis of mesenteric and retroperitoneal lymph nodes (A18.39) tuberculous tracheobronchial adenopathy (A15.4)

A18.3 Tuberculosis of intestines, peritoneum and mesenteric glands – A18.31 Tuberculous peritonitis Tuberculous ascites – A18.32 Tuberculous enteritis Tuberculosis of anus and

rectum Tuberculosis of intestine (large) (small) – A18.39 Retroperitoneal tuberculosis Tuberculosis of

mesenteric glands Tuberculosis of retroperitoneal (lymph glands)

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A18.4 Tuberculosis of skin and subcutaneous tissue Erythema induratum, tuberculous Lupus excedens Lupus vulgaris NOS Lupus vulgaris of eyelid Scrofuloderma Excludes2:lupus erythematosus (L93.-) lupus NOS (M32.9) systemic (M32.-) A18.5 Tuberculosis of eye Excludes3:lupus vulgaris of eyelid (A18.4) – A18.50 Tuberculosis of eye, unspecified– A18.51 Tuberculous episcleritis – A18.52 Tuberculous keratitis Tuberculous interstitial keratitis

Tuberculous keratoconjunctivitis (interstitial) (phlyctenular) – A18.53 Tuberculous chorioretinitis – A18.54 Tuberculous iridocyclitis – A18.59 Other tuberculosis of eye Tuberculous conjunctivitis

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A18.6 Tuberculosis of ear Tuberculous otitis media Excludes2:tuberculous mastoiditis (A18.03)

A18.7 Tuberculosis of adrenal glands Tuberculous Addison's disease

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A18.8 Tuberculosis of other specified organs – A18.81 Tuberculosis of thyroid gland – A18.82 Tuberculosis of other endocrine glands

Tuberculosis of pituitary gland Tuberculosis of thymus gland

– A18.83 Tuberculosis of digestive tract organs, not elsewhere classified Excludes1: tuberculosis of intestine (A18.32)

– A18.84 Tuberculosis of heart Tuberculous cardiomyopathy Tuberculous endocarditis Tuberculous myocarditis Tuberculous pericarditis

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– A18.85 Tuberculosis of spleen – A18.89 Tuberculosis of other sites

Tuberculosis of muscle Tuberculous cerebral arteritis

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Other Tuberculosis

A19 Miliary tuberculosis Includes: disseminated tuberculosis generalized tuberculosis tuberculous polyserositis – A19.0 Acute miliary tuberculosis of a single

specified site – A19.1 Acute miliary tuberculosis of multiple sites– A19.2 Acute miliary tuberculosis, unspecified – A19.8 Other miliary tuberculosis – A19.9 Miliary tuberculosis, unspecified

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Recommendations

Emphasize the need for increased specificity in physician documentation

Understand the structure of ICD-10-C,/ICD-1o-PCS

Make sure coders have adequate knowledge and tools (particularly for anatomy and physiology.