ICD-10 Wisconsin - Clean - WPMA Podiatrists

11/15/2013

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ICD-10-CM: No More Baby Steps

October 1, 2014 Tick-Tock, Tick-Tock

Presented by Harry Goldsmith, DPM

DisclaimerThis presentation is brought to you by Harry Goldsmith, DPM who is solely responsible for its content and delivery so don’t complain to or blame WSPM about any demonstrated insensitivity, poor judgment, unfunny jokes, puns that aren’t punny, or lack of taste.

The APMA Coding Resource Center

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Making Your Life Easier

ICD-9 to ICD-10Crosswalk


New low price: $249 per year

for APMA Members

www.apmacodingrc.org

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Codingline-APMA’s “Coding in Paradise” Seminar

Right after the APMA Hawaii Seminar (July 28-31)

www.codingline.com/events-hawaii.htm

Questions? [email protected]

ICD-10-CM: October 1, 2014

Believe it

ICD-10-CM WatchMedical Group Management Association’s (MGMA) survey found in mid-June that 4.8% of medical practices have made significant progress in their readiness of ICD-10.

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ICD-10-CM Watch2013 National Physician Practice ICD-10 Readiness Survey notes

• 62% of medical practices surveyed said they have no ICD-10 implementation plany p p

• More than 33% said they did not know any of their vendors’ ICD-10 plans or timelines

• 22.4% of medical practices said they do not expect to be ready by October 1, 2014

What’s the Worst that Can Happen?

No dough

ICD-10-CM ConcernsOther Issues

• ‘Same old, same old’ mentality• Coding complexity • Documentation details• Documentation details• 2014: The perfect storm

• Meaningful use, stage 2• PQRS • eRx• HIPAA – Security, privacy

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ICD-10-CM

What is the ICD-10-CM code for when the sky (or things from the sky) falls on you?

W21.220- Hockey puck T75.0- Lightning

Y36.22- Guided missileV95.41- Spacecraft

X39.8xxA Dorothy’s house falling on the witch

ICD-10-CMICD-10 will be implemented October 1, 2014. There is no grace period.

A sensible transition program can alleviate a scramble as the implementation date approaches;scramble as the implementation date approaches; and avoid costly mistakes.

ICD-10-CMTransition Preparation Timeline

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New Insurance Claim Form (02 12)

New Insurance Claim Form (02 12)


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What Is ICD-10-CM?It is an alphanumeric code used to translate words identifying diagnoses of diseases, circumstances, symptoms, other health problems, etc. into a universal, workable system that can be read by computer software, analyzed, “acted upon”, stored, and retrieved as needed.

So, why should we care?

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ICD-10-CM Q/As• WHO owns ICD-10-CM?• Why not skip ICD-10-CM and go to ICD-11-CM

way, way down the road?

ICD-10-CM Q/As• What does the “CM” stand for in ICD-10-CM?• Come October 1, 2014, will I only be dealing

with ICD-10?• What will be the biggest problem/issueWhat will be the biggest problem/issue

association with ICD-10-CM implementation?

Comparing ICD-9 to ICD-10

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Comparing ICD-9 to ICD-10ICD-9

• Numeric characters(with exception of some codes beginning with V, E, M)

ICD-10• Alphanumeric

characters(always begin with an alpha [except U] character

Alphanumeric Character Issue

Alphanumeric Character Issue

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Comparing ICD-9 to ICD-10ICD-9

• Numeric characters(with exception of some codes beginning with V, E, M)

ICD-10• Alphanumeric

characters(always begin with an alpha

• 3-5 characters in length

• About 13,000 codes

[except U] character

• 3-7 characters in length

• About 68,000 codes

Comparing ICD-9 to ICD-10

ICD-9 Formatting ICD-10

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ICD-9 Structure - Format3-5 character examples

700 Corn and callosities735.0 Hallux valgus (acquired)733.82 Nonunion of fractureV49.71 Lower limb amputation status, great

toe

ICD-10 Structure - Format3-7 character examples

L84 Corn and callositiesB95.5 Staphylococcus aureus as the cause

of diseases classified elsewhereM20.11 Hallux valgus (acquired), right foot S98.111A Complete traumatic amputation of

right great toe (initial encounter)

ICD-10 to ICD-9 Differences

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ICD-10 to ICD-9 DifferencesLaterality (side of the body affected – right/left) has been added to relevant codes

Expanded use of combination codes– Certain conditions and associated commonCertain conditions and associated common

symptoms or manifestations

Combination Code ExamplesE11.52 Type 2 diabetes mellitus with diabetic

peripheral angiopathy with gangreneE11.621 Type 2 diabetes mellitus with foot ulcerI69.144 Monoplegia of lower limb followingI69.144 Monoplegia of lower limb following

nontraumatic intracerebral hemorrhage affecting left non-dominant side

I70.235 Atherosclerosis of native arteries of right leg with ulceration of other part of foot

Other ICD-10 to ICD-9 Differences

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It’s In the Details

ICD-9 ICD-10V49.71 - Lower limb

amputation status,great toe

Z89 – Acquired absence of limb

Z89.4 – Acquired absence of toe(s), foot, &

klankleZ89.41 – Acquired

absence of great toe

Z89.411 - Acquiredabsence of right greattoe

Other ICD-10 to ICD-9 Differences

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Meet the7th Character

(when required)

ICD-10: The 7th CharacterExample: Fracture codes The fracture codes require a 7th character:

A - Initial encounter for closed fracture B - Initial encounter for open fracture D - Subsequent encounter for fracture with routineD - Subsequent encounter for fracture with routine

healing G - Subsequent encounter for fracture with delayed

healing K - Subsequent encounter for fracture with nonunion P - Subsequent encounter for fracture with malunionS - Sequelae

ICD-10: The 7th CharacterAnother example…

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How Are ICD-10 & ICD-9 Similar?

ICD-9 & ICD-10 SimilaritiesBoth ICD-9 and ICD-10 Alphabetic Indexes include

• The Index of Diseases and Injury• The Index of External Causes of InjuryThe Index of External Causes of Injury• The Tables of Neoplasm; and• The Table of Drugs and Chemicals

ICD-9 & ICD-10 SimilaritiesBoth ICD-9 and ICD-10 use an indented format

Hallux 735.9rigidus (acquired) 735 2rigidus (acquired) 735.2

congenital 755.66

The main term is listed in bold font with subordinate terms are listed beneath the main term in an indented format.

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ICD-9 & ICD-10 SimilaritiesMany of the terms along with their

• Definitions/applications• Symbols• Guidelines and• Guidelines, and • Conventions

are the same in both ICD-9 and ICD-10.

ICD-10 HoweverDoes have several new conventions that we will discuss today through examples.

ICD-10 HoweverProvides greater specificity through the expansion of the 3-5 ICD-9 code to a 3-7 ICD-10 codes.

Which has resulted inA d ti i i th b f• A dramatic increase in the number of available codes

• A need for more accurate, detailed medical records

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Any questions before I move on?

ICD-10 Clue

The Game of ClueA man has been murdered in a large mansion by one of six guests. It is up to the game players to find out which of the six guests, i.e., suspects, did the deed, which of the six weapons was used, and in which of nine possible rooms it was done.

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The ICD-10 Clue Game

The suspect is…


Alyssa Stephenson, DPM


Her weapon…

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Revolver

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X93


The ICD-10 Clue GameSummary

You are given a 3 character codeX93

That requires a 7th characterThat requires a 7 character A – initial encounterD – subsequent encounterS - sequela

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The ICD-10 Clue GameWe have the first 3 characters and a 7 character (A), and nothing in between.

X93._ _ _A

The “x” PlaceholderBecause no specific character(s) exist in the 4th, 5th, and 6th position, the letter “x” serves as a placeholder filling in character ‘holes’ in the code when, in this case, it requires a 7th character.

X93.xxxAAssault (murder) by revolver, initial encounter

The “x” PlaceholderThe “x” placeholder also allows for future code expansion. In those cases, you may see a single “x” within a code.

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The “x” PlaceholderAnother example:

When placeholder character applies, it must be used in order for the code to be considered valid.

By the Way, “X” is NOT an “x” Placeholder


Back to the game…

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EXCLUDES1 - Very Pistol

EXCLUDES1Indicates mutually exclusive codes - two conditions that cannot be reported together.

Excludes1 note indicates that the code is excluded from the main code and should never beexcluded from the main code, and should never be used at the same time as the code above it.

Example:A congenital condition and an acquired condition

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EXCLUDES1Example:

EXCLUDES2Indicates the excluded condition is not part of or defined by the condition it is excluded from, butboth conditions can be present at the same time in the patient.

When an Excludes2 note appears below a code, it is okay to use both that code and the Excludes2 code at the same time.

EXCLUDES2Example:

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Back to the game…again


What if it wasn’t murder, but an accident?

The ICD-10 Clue GameW32.0 - Accidental handgun discharge

W32.1 - Accidental handgun malfunction

Both codes require the appropriate 7th character:

A initial encounterD subsequent encounterS sequela

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The ICD-10 Clue GameW32.0 - Accidental handgun discharge

W32.1 - Accidental handgun malfunction

E l W32 0 AExample: W32.0xxA


What if the murder was done with one of the other

‘ ’?‘weapons’?

Y00.xxxA

Y00.xxxA

Y00.xxxA

T71.193AX99.1xxA

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What if the victim was pecked by a bird?

Pecked or bitten by a…W61.01 – parrotW61.11 – macaw

W61.21 – cockatooW61.33 – chickenW61.43 – turkeyW61.51 – gooseW61.61 – duck

W61.91 – all other birds* All need a 7th character

Brief InterludeHistory of Present Illness: The patient was waterskiing on Lake Meade at a company outing. The temperature was in the low 100s. Suddenly, without warning, her skis burst in flames and she

t i d 1st d 2nd d b h lsustained 1st and 2nd degree burns on her lower legs…

How does this happen?How do you code this?

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Brief Interlude

V91.07xA“burn due to water skis on fire”

The real question is…

Is this work related?


Back to the game…


Where did the murder occur?occur?

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Kitchen

The ICD-10 Clue GameY92.010 - Kitchen of single-family house

Excludes: mobile home


What if it was done in a different room?different room?

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The ICD-10 Clue GameY92.018 - Other place in single-family house as

the place of occurrence of the externalcause

Y92.019 - Unspecified place in single-family house as the place of occurrence of external cause

Other & UnspecifiedY92.018 - Other place in single-family house as

the place of occurrence of the externalcause

Y92.019 - Unspecified place in single-family house as the place of occurrence of external cause

OtherOther means the medical record details a condition

or, in this case, place of occurrence that doesn’t have an existing ICD-9 or 10 code

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UnspecifiedUnspecified means there is not enough information

in the medical record to assign a more specificcode

Would You Like to Play Again?

No.

Back to ICD-9 and ICD-10 Similarities

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Searching for a Code

With both ICD-9 and ICD-10, you begin your code search in the alphabetic index, then verify the code in the tabular list

ICD-10 ExampleAlphabetic Index

hallux valgus (acquired), left foot

M20.1-

ICD-10 Coding FormatM20.1–

“code ending in a hyphen”An ICD-10 code ending in a hyphen means the code is not detailed enough to bill.

When a hyphen-ending code is seen in the alphabetic index of ICD-10, you must go to the tabular coding listing to look for a more specific description/more specific code.

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Tabular ListM20.1 Hallux valgus (acquired), left foot

Tabular ListM20.1 Hallux valgus (acquired), left foot

Another Example?Your turn…

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Ready?

Go!

Stage III Decubitus Ulcer of Left Heel

How do you begin?

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You look up the “main” term


Stage III Decubitus Ulcer of Left HeelGo to the Alphabetic Index

Ulcer, ulcerated, ulcerating, ulcerationSee ulcer by site

lower limb (atrophic) (chronic) (neurogenic) ( p ) ( ) ( g )(perforating) (pyogenic) (trophic) (topical)

pressure/decubitus (pressure area) L89-heel L89.6-

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Decubitus ulcer heelL89.6-

Time to go to the Tabular Listing

Stage III Decubitus Ulcer of Left HeelIn the Tabular: L89-

Stage III Decubitus Ulcer of Left HeelLook for a 4 character code beginning with L89

L89.6 Pressure ulcer of heel

L89.62 Pressure ulcer of left heel

L89.623 Pressure ulcer of left heel,stage III

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L89.623

Stop!

Eight Hours, Not Bad

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Another Example

Patient is seen with a painful bunion on the left foot. The exam reveals reduced ROM with pain reported with movement of MTPJ. X-rays confirm degenerative changes in MTPJ. ICD-9 diagnoses:

ICD-9 727.1 - bunionICD-9 735.8 - hallux limitusICD-9 715.17 - osteoarthritis, localized, primary, footICD-9 729.5 - pain in limb (or ICD-9 719.47 –

pain in joint, foot)

Ready?

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Go!

ICD-10 Coding StepsBunion (left foot)

1) Go to ICD-10 Index to Diseases & Injuries2) Under “B”, find

“bunion”bunion

Bunion – see Deformity, toe, hallux valgus

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ICD-10 Coding StepsBunion – see Deformity, toe, hallux valgus

1) Go to “D” 2) Look under “Deformity”3) Find “toe”3) Find toe4) Find “hallux valgus”

ICD-10 Coding StepsBunion – see Deformity, toe, hallux rigidus

1) Look above “hallux valgus”and there is “hallux rigidus”

M20.2- hallux rigidus

ICD-10 Coding StepsWe now have 2 of the 4 base codes we are looking for:

M20.1- Hallux valgus, acquiredM20 2 H ll i id i dM20.2- Hallux rigidus, acquired

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Moving to the Tabular Listing

M20.1- and M20.2-

ICD-10 Coding StepsM20.1

1) Go to ICD-10 Tabular List of Diseases & Injuries

2) In the list look up “M” (Chapter 13 – Diseases2) In the list, look up M (Chapter 13 Diseases of the Musculoskeletal System and Connective Tissue)

3) Under “M” find M20.1

ICD-10 Coding StepsM20.1 Hallux valgus (acquired), left

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ICD-10 Coding StepsM20.1 Hallux valgus (acquired), left

ICD-10 Coding StepsM20.2 Hallux rigidus, left

ICD-10 Coding StepsM20.2 - Hallux rigidus, left

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ICD-10 Coding Steps

So far we have…M20.12 – Hallux valgus (acquired), left foot

M20 22 Hallux rigidus left footM20.22 – Hallux rigidus, left foot

That leaves two to go: Osteoarthritis

Local pain

ICD-10 Coding StepsOsteoarthritis, primary, foot

1) Go to ICD-10 Index to Diseases & Injuries2) Under “O”, find

“osteoarthritis”osteoarthritis

ICD-10 Coding Steps

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ICD-10 Coding StepsChoices:

M19.07-, M19.17-, or M19.27-

ICD-10 Coding StepsTheir common code root is

M19


M19

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ICD-10 Coding StepsM19

1) Go to ICD-10 Tabular List of Diseases & Injuries2) In the list, look up “M” (Chapter 13 – Diseases of

the Musculoskeletal System and Connectivethe Musculoskeletal System and Connective Tissue)

3) Under “M” find M19

ICD-10 Coding Steps

ICD-10 Coding StepsOur choices were:

M19.07-M19.17-M19.27-

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ICD-10 Coding StepsOsteoarthritis, foot, left

ICD-10 Coding StepsOsteoarthritis, foot (primary), left foot

ICD-10 Coding Steps

So far we have…M20.12 – Hallux valgus (acquired), left footM20.22 – Hallux rigidus, left footgM19.072 – Primary osteoarthritis, left foot

That leaves one to go: Pain

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ICD-10 Coding StepsPain

1) Go to ICD-10 Index to Diseases & Injuries2) Under “P”, find

“pain”pain

see Pain, lower limb

ICD-10 Coding StepsPain, limb, lower

1) Go to “Pain, limb, lower”2) Find “foot” or “toe”

M79.67-

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M79.67

ICD-10 Coding StepsM79.67

1) Go to the ICD-10 Tabular List of Diseases & Injuries

2) In the list look up “M” (Chapter 13 – Diseases2) In the list, look up M (Chapter 13 Diseases of the Musculoskeletal System and Connective Tissue)

3) Under “M” find M79.67

ICD-10 Coding StepsPain, foot (or is pain in the “toe”?)

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ICD-10 Coding StepsFinally…

ICD-10 M20.12 – Hallux valgus (acquired), left foot

ICD-10 M20 22 – Hallux rigidus left footICD-10 M20.22 Hallux rigidus, left foot

ICD-10 M19.072 – Primary osteoarthritis, left foot

and either

ICD-10 M79.672 – Pain, left foot or

ICD-10 M79.675 – Pain, left toe

Stop!

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Let’s Play with ICD-10

Clinical Example: Plantar SpurPre-Op Diagnosis: painful plantar fasciitis with

heel spur, left footPost-Op Diagnosis: sameProcedure: endoscopic plantar fasciotomy, left p p y

ICD-10 Code(s)?

Painful Plantar Fasciitis withHeel Spur, Left Foot

Key term(s)?

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Key term(s)?

Fasciitis


Key term(s)?

FasciitisSpur


Begin by looking up fasciitis in the Alphabetic Index

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1) Go to ICD-10 Index to Diseases & Injuries2) Under “F” find “fasciitis”3) Under “fasciitis” find3) Under fasciitis find

“plantar”


Plantar fasciitis:

M72.2


M72.2

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M72.2 Plantar fasciitis

1) In the Tabular List, look up M72.2(Chapter 13 – Diseases of MusculoskeletalSystem and Connective Tissue)





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Need next main term spurNeed next main term…spur


Go to Alphabetic Index and look up spur


1) Go to ICD-10 Index to Diseases & Injuries2) Under “S” find “spur”

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1) Go to ICD-10 Index to Diseases & Injuries2) Under “S” find “spur”3) Under “spur” find3) Under spur find

“heel”

What? No Heel?


1) Think “calcaneal”

M77.3-

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But look…there’s an instruction: “see also Enthesopathy”

Let’s follow that instruction and see where it takes us, shall we?


1) In the Index, under “E” find “enthesopathy”


1) Under “enthesopathy” find “calcaneal spur”

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Instruction #1: M77.3- Spur, bone, calcaneal – see also Enthesopathy

Instruction #2: Enthesopathy, calcaneal spur – see Spur, bone, calcaneal

Back to Calaneal Spur


1) Going back to “spur” stick with “calcaneal”

M77.3-

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M77.3-

Painful Plantar Fasciitis withHeel Spur, Left FootM77.3- Bone Spur, calcaneal



M77.3- Calcaneal spur

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M77.3- Calcaneal spur


M77.32 Calcaneal spur, left foot


M72.2 Plantar fasciitisM77.32 Calcaneal spur, left foot

One term left…pain, painful

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Question: Do you need to add “pain”?


Go to Alphabetic Index and look up pain


1) Go to ICD-10 Index to Diseases & Injuries2) Under “p” find “pain”

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1) Go to ICD-10 Index to Diseases & Injuries2) Under “pain” find “foot”

Go to “Pain, lower limb”


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M79.67-


M79.67-


M79.67- Pain, lower limb, foot


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M72.2 Plantar fasciitisM77.32 Calcaneal spur, left footp ,M79.672 Pain, lower limb, foot (optional)

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Ta da

Clinical Example: Skin LesionPre-Op Diagnosis: skin lesion, sub4th metatarsal

head, right foot; plantar verruca, right foot

Post-Op Diagnosis: sameProcedure: excision and ablation of verruca, right

foot with CO2 laser; biopsy skin lesion, sub4th metatarsal, right foot

ICD-10 Code(s)?

Plantar Verruca, Right Foot andSkin Lesion, Right Foot

Key term(s)?

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Key term(s)?

VVerruca


Key term(s)?

VVerrucaLesion


Begin by looking up verruca in the Alphabetic Index

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1) Go to ICD-10 Index to Diseases & Injuries2) Under “V” find “verruca”3) Under “verruca” find3) Under verruca find

“plantar” or “plantaris”


B07.0


B07.0 Verruca plantaris

1) In the Tabular List, look up B07.0(Chapter 1 – Certain Infectious and Parasitic Diseases)

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lantar Verruca, Right Foot andSkin Lesion, Right Foot


Need next main term lesionNeed next main term…lesion


Go to the Alphabetic Index

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1) Go to ICD-10 Index to Diseases & Injuries2) Under “L” find “lesion”3) Under “lesion” find3) Under lesion find

“skin”


L98.9


L98.9 Lesion, skin

1) In the Tabular List, look up L98.9(Chapter 12 – Diseases of the Skin and Subcutaneous Tissue)

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L98.9 Lesion, skin


B07.0 Verruca plantarisL98 9 Lesion skinL98.9 Lesion, skin



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Plantar Verruca andSkin Lesion


Ta da

Educational Moment

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NEOPLASMS OF UNCERTAIN BEHAVIOR


What is a neoplasm of uncertain behavior?

“Certain histo-morphologically well-defined neoplasms the subsequent behavior of which cannotneoplasms, the subsequent behavior of which cannot be predicted from the present appearance.”

In English, please…


1. The term "neoplasm of uncertain behavior" is a specific pathologic diagnosis.

2. This is a lesion whose behavior cannot be predicted It's currently benign but there's apredicted. It s currently benign, but there s a chance that it could undergo malignant transformation over time.

3. It is not a lesion you are waiting for a pathology report or you are not willing to make a diagnosis on.

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Next

Clinical Example: HammertoePre-Op Diagnosis: hammertoe, 2nd toe, left;

plantarflexed 2nd met, right (congential)Post-Op Diagnosis: sameProcedure: hammertoe correction 2nd toe, left;

osteotomy, 2nd metatarsal, left

ICD-10 Code(s)?

Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left

Key term(s)?

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Key term(s)?

Hammertoe


Key term(s)?

HammertoeMetatarsal????


Begin by looking up hammertoe in the Alphabetic Index

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1) Go to ICD-10 Index to Diseases & Injuries2) Under “H” find “hammertoe”3) Is it acquired or3) Is it acquired or

congenital?


See also Deformity, toe, hammertoe

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1) Go to ICD-10 Index to Diseases & Injuries2) Under “D” find “deformity”


1) Under “deformity” find “toe”2) Under “toe” find

“hammertoe”hammertoe

M20.4-


M20.4-

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M20.4 Hammertoe

1) In the Tabular List, look up M20.4(Chapter 13 – Diseases of the MusculoskeletalSystem)


M20.4 Hammertoe


M20.4 Hammertoe

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M20.42 Hammertoe (acquired), left

Need next main term…metatarsal


Look up “metatarsal” in the Alphabetic Index


1) Go to ICD-10 Index to Diseases & Injuries2) Under “M” find “metatarsal”3) What now?3) What now?

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And what condition might that be?And what condition might that be?Plantarflexion?

HINT: There ain’t no “plantarflexion” listing


And what condition might that be?Plantarflexion?

How about…deformity, foot?


Look up “deformity” in the Alphabetic Index

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1) Go to ICD-10 Index to Diseases & Injuries2) Under “D” find “deformity, then find “foot”





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NOS & NECNOS – Not Otherwise Specified

Equivalent to “unspecified” (not enough information in the medical record to assign a more specific code)more specific code)

NEC – Not Elsewhere ClassifiedEquivalent to “other” or “other specified” (the medical record details or condition have noICD-9 or ICD-10 code that is specific for it)



Q66.9Q66.89

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Q66.9 and Q66.89


Q66.9 and Q66.89

1) In the Tabular List, look up Q66(Chapter 17 – Congenital Malformations, Deformations and Chromosomal Abnormalities)


Q66.9 and Q66.89

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Q66.9 and Q66.89


Q66.9 and Q66.89


Q66.89

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M20.42 Hammertoe (acquired), left Q66.89 Other specified congenital

deformities of feet

Ta da

Clinical Example: RFCDiagnosis: long nails x10; corn 5th bilateral;

diabetes with peripheral vascular disease

Procedure: palliative foot care

ICD-10 Code(s)?

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Nails and Corns and Diabetes with PVD, Oh My!

What’s wrong with this picture?1) “Nails”, even “long nails”, is not a

pathologypathology2) Is it type I or type II diabetes?3) Specifically, what peripheral arterial

disease does your patient have?

Nailing It: Who’yah Gonna Call?

Nailing It

ICD-9 703.8 (other specified diseases of nail)

crosswalks to

ICD 10 L60 8ICD-10 L60.8 (other nail disorders)

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L60.8 Other nail disorders

Next: Corns


1) Go to ICD-10 Index to Diseases & Injuries2) Under “C” find “corn”

L84 – infected?


L84

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L84

1) In the Tabular List, look up L84(Chapter 12 – Diseases of the Skin and Subcutaneous Tissue)


L84

No mention of “infected”


L60.8 Other nail disordersL84 Corn

Next: Diabetes with PVD

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1) Go to ICD-10 Index to Diseases & Injuries2) Under “D” find “diabetes”


1) Go to ICD-10 Index to Diseases & Injuries2) Under “D” find “diabetes”

Then find the specific diabetic condition:Wi h i h l i h (E11 1)?• With peripheral angiopathy (E11.51)?

• Due to an underlying condition: peripheral angiopathy (E08.51)?

• Specific type with peripheral angiopathy(E13.51)?

• Type I with peripheral angiopathy (E10.51)? • Type II with peripheral angiopathy (E11.51)?


In our example, it will be

Diabetes, type II, with peripheral angiopathy

E11.51

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E11.51


E11.51

1) In the Tabular List, look up E11.51(Chapter 4 – Endocrine, Nutritional and Metabolic Diseases)


Important to check at the beginning of the root code (E11) section for any instructions…

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E11.51


E11.51

Nails and Corns and Diabetes with PVD, Oh My!L60.8 Other nail disordersL84 CornE11.51 Diabetes, type II,

with peripheral angiopathy

Issues?

There is the Medicare Administrative Contractor’sLCD billing instructions…

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Ta da

Clinical Example: FractureA 32 year old male was sliding into 2nd base when he hit the bag. He felt a snap and instant pain in the outside of his right foot.

X-rays revealed a non-displaced, slightly oblique y p , g y q5th metatarsal base fracture

Diagnosis: closed 5th metatarsal fracture, right

ICD-10 Code(s)?

Fracture 5th Metatarsal, Closed, Right1) Go to ICD-10 Index to Diseases & Injuries2) Under “F” find “fracture”

3) Look by “site”: foot?

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Fracture 5th Metatarsal, Closed, Right

See Fracture, metatarsal

Fracture 5th Metatarsal, Closed, Right1) Go to “Fracture, metatarsal”

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Fracture 5th Metatarsal, Closed, Right1) Go to “Fracture, metatarsal”


S92.35-

Fracture 5th Metatarsal, Closed, RightS92.35-

1) In the Tabular List, look up S92.35(Chapter 19 – Injury, Poisoning, and ExternalCauses)Causes)

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Fracture 5th Metatarsal, Closed, RightS92.354A

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Fracture 5th Metatarsal, Closed, Right

S92.354A Non-placed fracture 5th metatarsal, closed, right, initial visit

Thank you, CMS

October 1, 2014™Boy Scouts of America

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ICD-10 Wisconsin - Clean - WPMA Podiatrists

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