ICD-10-CM Are You Prepared?

Rebecca H. Wartman OD January 2014

With contributions from Doug Morrow OD & Harvey Richman OD

Overview This webinar will provide an

introduction to ICD-10-CM coding changes and begin your preparation

There will be more information coming in the next few months to further prepare you for the change to ICD-10-CM

Are You Well Connected?? Notice: To hear the audio portion of this webinar- Connect through your computer with a headset or through your telephone

If you cannot get connected, you may contact Erin Nichols AOA TPC staff member, for assistance:

EMNichols@AOA.org

1.All information was current at time it was prepared 2.Drawn from national policies, with links included in

the presentation for your use 3.Prepared as a tool to assist doctors and staff and is

not intended to grant rights or impose obligations 4.Prepared and presented carefully to ensure the

information is accurate, current and relevant 5.No conflicts of interest exist for the presenter-

financial or otherwise

Disclaimers for Presentation

Disclaimers for Presentation

6. Of course the ultimate responsibility for the correct submission of claims and compliance with provider contracts lies with the provider of services

7. AOA, AOA-TPC, its presenters, agents, and staff make no representation, warranty, or guarantee that this presentation and/or its contents are error-free and will bear no responsibility or liability for the results or consequences of the information contained herein

Recording and Handouts for this Course

Recorded presentation and webinar course handouts will be available at: http://www.aoa.org/coding

Click ICD-10 on the right hand column and it will

take you to all the available resources for ICD-10 Other helpful resources will soon be available as well

Q&A and After the Webinar • AT THE END OF THE PRESENTATION: Questions will be answered at the end of the

presentation, as time permits To ask a question: Click on the red arrow to maximize the webinar

control panel and expand the ‘Questions’ section. Type inquiries in the dialog box and press ‘Send

• AFTER THE WEBINAR Please send questions to…

AskTheCodingExperts@aoa.org

AOA Third Party Center Coding Experts

Rebecca H. Wartman, O.D Douglas C. Morrrow, O.D Harvey B. Richman, O.D

• ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification /Procedure Coding System)

• Two parts:

– ICD-10-CM for diagnosis coding – ICD-10-PCS for inpatient procedure coding

(Hospitals only)

• Implementation of ICD-10-CM DOES NOT CHANGE our use of CPT® Coding set

What is ICD-10-CM/PCS

10-1-2014 adoption date

Guaranteed implementation date No sign of CMS changing deadline again But…who knows!!

ICD-10-CM

ICD-9-CM is 30 years old • Produces limited data about medical conditions • Uses outdated terms • Is inconsistent with current medical practice • Structure limits number of new codes • Many ICD-9 categories are full

ICD-10-CM used world-wide since 1994 (except the US and Italy) Published by World Health Organization (WHO)

WHY ICD-10-CM?

• Harmonizes with other classifications – DSM-IV - mental health disorders – ICDO-2 – cancer registries – Nursing

• Removes relationships with procedure codes • Revises diabetes codes - consistent with ADA

ICD-10-CM Improvements

68,000 codes (5 times more than ICD-9-CM)

Information on diseases and conditions and causes grouped as follows:

• Communicable diseases • General diseases that affect the whole body • Local diseases arranged by site • Developmental diseases • Injuries • External causes

ICD-10-CM

ICD-9-CM • 3 -5 characters(at least 3) • Character 1=numeric or

alpha (E or V only) • Characters 2-5=numeric • Decimal after 3 characters

ICD-10-CM • 3 -7 characters • Character 1= alpha (except U) • Character 2 = numeric • Characters 3-7=alpha or

numeric • Decimal after 3 characters • Dummy placeholder “x” • Alpha characters not case-

sensitive

ICD-10-CM Structure

Three volumes:

• Volume 1 – The Tabular List (British spelling) – Alpha-numeric listing of diseases, disease groups and health

related problems with inclusion & exclusion notes and some coding rules

• Volume 2 – The Instruction Manual – introduction to classification – instructions on use of classification to code death

certificates, hospital medical records and other forms of health information

• Volume 3 – The Alphabetical Index (Amer Spelling) – alphabetical list of codes from the Tabular List

ICD-10-CM

“Golden Rules” 1. Volumes 1 and 3 must be used together to

correctly find codes for each case • Check Index for code→ confirm choice in Tabular List

2. Special disease categories take priority over the body system categories

3. Never use asterisk code (*) alone if code uses dagger (ϯ) & asterisk (*) convention

(this will make sense later) 4. Cautious of spelling: Tabular List uses British spelling Alphabetical Index uses American spelling with cross-

references in the Index

ICD-10-CM

• Determine conditions to be coded from medical documentation following the ICD rules

• Use Alphabetical Index (Vol 3) to locate the condition and allocate the code

• Use Tabular List (Vol 1) to review all coding instructions related to code (e.g. inclusion, exclusion, etc)

• Use Instruction Manual (Vol 2) for any rules regarding the selection for reporting mortality or morbidity data

ICD-10-CM

• Shortest chapter- YEAH!! • Diseases of eye • Disease of adnexa

– structures which surround the eye • lacrimal (tear) glands and ducts • extraocular muscles • eyelids

• Also several asterisk categories – number of diseases coded in other chapters have

manifestations that occur in the eye • associated with infectious diseases (Chapter I) • diabetes (Chapter IV)

Volume 1 Chapter VII Diseases of Eye and Adnexa

H00-H06→Disorders of eyelid, lacrimal system, orbit H10-H13→Disorders of conjunctiva H15-H22→Disorders of sclera, cornea, iris, ciliary body H25-H28→Disorders of lens H30-H36→Disorders of choroid and retina H40-H42→Glaucoma H43-H45→Disorders of vitreous body and globe H46-H48→Disorders of optic nerve & visual pathways H49-H52→Disorders of ocular muscles, binocular

movement, accommodation and refraction H53-H54→Visual disturbances and blindness H55-H59→Other disorders of eye and adnexa

Volume 1 Chapter VII

H03* Disorders of eyelid… H06* Disorders of lacrimal system and orbit… H13* Disorders of conjunctiva… H19* Disorders of sclera and cornea… H22* Disorders of iris and ciliary body… H28* Cataract and other disorders of lens… H32* Chorioretinal disorders… H36* Retinal disorders… H42* Glaucoma… H45* Disorders of vitreous body and globe… H48* Disorders of optic [2nd] nerve and visual pathways… H58* Other disorders of eye and adnexa…

Volume 1 Chapter VII Asterisk categories –in diseases classified elsewhere

• Certain conditions originating in perinatal period (P00-P96) • Certain infectious and parasitic diseases (A00-B99) • Complications of pregnancy, childbirth and puerperium

(O00-O99) • Congenital malformations, deformations and Chromosomal

abnormalities (Q00-Q99) • Endocrine, nutritional and metabolic diseases (E00-E90) • Injury, poisoning and certain other consequences of

external causes (S00-T98) • Neoplasms (C00-D48) • Symptoms, signs and abnormal clinical and laboratory

findings, not elsewhere classified (R00-R99)

Volume 1 Chapter VII Exclusions

Planning Jan-Feb 2013 – Identify resources - Create project team - Assess effects – Create project plan - Secure budget

Communications – Inform staff – Contact vendors-Contact payers Jan-Feb 2013 – Monitor vendor prep March-Dec 2013 – Monitor payer prep March 2013 – June 2014

Testing – High-level training for test team March-Dec 2013 – Level 1: internal April- Dec 2013 – Level 2: external Oct 2103 – Sept 2014

Comprehensive Training – Documentation Jan-Dec 2014 and beyond – Coding Jan-Dec 2014 and beyond

Timeline for Change Preparation

Timeline for Change Preparation

Medicare Carrier Testing Week March 3 through March 7, 2014 The opportunity for providers and suppliers to

submit test claims through the Common Electronic Data Interchange (CEDI) during this designated testing week

• Developing Your ICD-9-CM List of current uses – Develop list of places in office where use ICD-9-CM codes – Determine how switch to ICD-10-CM will impact daily work

• Reviewing Your Current ICD-9-CM List Uses Accounting for: 1. Authorizations/pre-certifications 2. Physician orders 3. Medical records 4. Superbills/Encounter forms 5. Practice management and billing systems 6. Coding manuals 7. Public health reporting

Review your use of ICD-9-CM

• Review documentation for most often used codes in your practice

• Determine if documentation is specific and detailed

enough to select ICD-10-CM codes • ICD-10-CM will not affect the way you provide care

but gives more specific diagnosis choices

Improve Clinical Documentation

• Site: cornea, conjunctiva, retina, etc • Laterality: right or left eye • Location: central, peripheral, macular etc If Injury: • External cause – Document cause of the injury- How? • Place of occurrence – Document where pt was when

injured - home, work, in car, etc • Activity code – Describe activity when injured

– playing a sport, using tool, etc • External cause status – Indicate if injury was work or

military related etc

Specific Documentation

• Improve documentation of systemic disease, too • Diabetes Mellitus:

– Type of diabetes – Body system affected – Complication or manifestation – If type 2 diabetes, long-term insulin use

Specific Documentation

• B02.3 Zoster Ocular Disease – B02.30 Zoster ocular disease, unspecified – B02.31 Zoster Conjunctivitis – B02.33 Zoster iridocyclitis – B02.34 Zoster keratitis – B02.39 Other herpes zoster eye disease

• B02.7 Disseminated Zoster • B02.8 Zoster with other complication BUT THESE CODES ARE NOT SPECIFIC ENOUGH!!

Herpes Zoster Example

• H16 Keratitis →H16.0 Corneal Ulcer

– H16.00 Unspecified corneal ulcer – H16.001 Unspecified corneal ulcer, right eye – H16.002 Unspecified corneal ulcer. left eye – H16.003 Unspecified corneal ulcer, bilateral – H16.009 Unspecified corneal ulcer, unspecified eye

Corneal Ulcer Example

• Hordeolum, ext- right upper lid 379.11 →→ H00.011 • Hordeolum, ext-right lower lid 379.11→→ H00.012 • Chalazion, right upper lid 373.2 →→ H00.11 • Chalazion, right lower lid 373.2 →→ H00.12

More Specific Examples

Key:

• H00 = Hordeolum/chalazion • H00.01 = hordeolum, external • H00.02 = hordeolum, internal • H00.03 = abscess of eyelid (furuncle) • H00.1 = chalazion

Final Digit:

• 1 = right upper • 2 = right lower • 3 = unspecified • 4 = left upper • 5 = left lower

How do I know these codes are correct?

H42* Glaucoma in diseases classified elsewhere Code First underlying condition, such as: Glaucoma in: amyloidosis (E85.-ϯ) Lowe’s syndrome (E72.0ϯ)… (Code will indicate inclusion/ exclusions) (†) underlying cause or aetiology (note spelling!)

(*) current manifestation Always record the two codes in order dagger then

asterisk E85._____ and then H42______

Glaucoma Example

Corneal Abrasion-right eye-central-tree branch

Tabular Alpha Index-Volume 3- “C” cornea – see condition “A” abrasion – link to T14.8 T14.8 → cornea – link to S05.0 S05.0=Injury of conjunctiva and cornea abrasion

without foreign body- choose right eye = S05.01 S05.01→ Initial = S05.01XA Subsequent = S05.01XD Sequela = S05.01XS BUT STILL NOT DONE!!

But WAIT, there is more

Use secondary code(s) from Chapter 20- (External causes of morbidity) to indicate cause of

injury when code is S

Go to External Causes Index – but what “T”for tree- no “L” for limb- no “S” for scratched by – no or self inflected (not intentional)- no “B” for Blunt object – maybe? Y29.XXXA, Y29.XXXD, Y29.XXXS “S” for striking against object: W22.8→ striking against or struck by other object= W22.8XXA, W22.8XXD, W22.8XXS

ICD-10-CM Note

• S05.01XA and • W22.8XXA or Y29.XXXA Second code depends on whether you choose

Bumped by or Striking against OR is it? Contact with nonvenomous plant thorns and spines

and sharp leaves?? W60.XXXA, W60.XXXD, W60.XXXS

Ultimately coding

World Health http://apps.who.int/classifications/apps/icd/icd10training CMS ICD-10-CM information

https://www.cms.gov/Medicare/Coding/ICD10/index.html American Optometric Association EyeLearn Catalog, ICD-10: http://bit.ly/1eiYksI Medical Records and Coding Page: http://www.aoa.org/coding

Possible Resources

• Begin thinking about specifics of conditions • Begin documenting specifics • Ensure your ICD-9-CM is very specific • Begin thinking about differently about encounters

in terms of ICD-10-CM • Practice and invent different common encounters in

office and practice choosing ICD-10-CM code system

Take Home Message

• Begin review of office procedures • Begin discussions with vendors

–EHR, Clearinghouses, insurances • Begin education of self • Begin education of staff • Begin saving $$ in case payments are slow • Be careful with the ICD-9-CM to ICD-10-CM

conversion tables- not always as specific as necessary

Take Home Message

October 1, 2014 is

10 months away

Remember!!!

What is next? • More specific details on common coding scenarios for

typical optometric office encounters – Common eye diseases – Common eye infections – Common systemic diseases with ocular

manifestations – Common ocular injury coding – Suggested approaches to navigate ICD-10-CM – Common coding errors in ICD-10-CM

• Watch for webinars and articles coming out regularly from AOA

New Contact Email: askthecodingexperts@aoa.org

Thank you!!

Questions?