ICD-9-CM to ICD-10-CM: What to Expectclient.blueskybroadcast.com/ACOG/downloads/2011- ICD...

ICD-9-CM to ICD-10-CM: What to Expect

August 9, 2011 Emily Hill, PA

Hill & Associates The Coding & Compliance Professionals

ACOG Committee on Coding and Nomenclature

Coding for Consultation Services August 9, 2011

CONFLICT OF INTEREST DISCLOSURE:

FACULTY

• NO DISCLOSURES TO DECLARE Emily Hill, PA

Donna Tyler, CPC, COBGC

ACCME Accreditation

• The American College of Obstetricians and Gynecologists (ACOG) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide medical education for physicians.

AMA PRA Category 1 Credit(s)™ and ACOG Cognate Credit(s)

• The American College of Obstetricians and Gynecologists (ACOG) designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits™ or up to a maximum of 2 Category 1 ACOG Cognate Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Disclosure of Faculty and Industry Relationships

• At the beginning of the program, faculty members are expected to disclose any such information to participants. Such disclosure allows you to evaluate better the objectivity of the information presented in lectures. Please report on your evaluation form any undisclosed conflict of interest you perceive. Thank you!

Disclaimer

• Inclusion of any product, procedure, or method of practice in this program does not constitute endorsement by ACOG.

Disclaimer

• ICD-10 codes included in this presentation are not valid prior to the implementation date of October 1, 2013

• ICD-10 codes included in this presentation may be revised prior to implementation

• ICD-9 codes should continue to be used until transition date of October 1, 2013

Learning Objectives

• Participants will: – Recognize the importance of ICD coding to a

physician practice – Comprehend the key distinctions between

ICD-9-CM and ICD-10-CM – Understand the principles of ICD coding and

how to apply them to clinical practice – Recognize the challenges and opportunities

presented by the transition to ICD-10-CM

Why The Change

• ICD-9-CM: Out of date- Out of space! • ICD-10: International standard for a

number of years • ICD: Important to Health Information

Technology (HIT) – Change needed to fully implement HIT

Understanding ICD

• ICD: World Health Organization’s (WHO) system of classification

• ICD-CM (clinical modification) used to track morbidity – Diseases or causes of illness

• ICD used to report mortality – Causes of death

History of ICD-10

• ICD-10 adopted by WHO in 1990 • First modification in 1998 • U.S. only industrialized nation that has not

yet implemented ICD-10 or a modification • U.S. first began exploring idea in 1994 • Draft versions available 2002, 2007, 2009,

2010, 2011 • Implementation Date: October 1, 2013

Key Differences: ICD-9-CM to ICD-10-CM

• ICD-10-CM : 21 chapters vs. ICD-9-CM: 17 chapters

• ICD-10 chapters divided into “blocks” of codes with additional subcategories

• V and E code supplemental classifications part of main classifications

• Sense organs separated from nervous system


• ICD-10: Reclassification of certain diseases to reflect current medical knowledge

• ICD-10:Injuries classified by specific site then type vs. ICD-9: Injuries classified by type

• ICD-10: Postoperative complications in procedure specific system chapters (complications of GU surgery in GU chapter)


• ICD-10-CM: Alphanumeric codes with up to 7 characters vs. ICD-9-CM: 3-5 characters in length (mostly numeric)

• ICD-10-CM: Full code titles vs. references to common 4th -5th digits – Addition of 6th characters for some – Addition of code extensions (7th digit) – Addition of dummy placeholder “X”

New Features in ICD-10-CM

• Combination codes for conditions and common symptoms/manifestations

• Combination codes for poisoning and external causes

• Added laterality for some codes (right vs. left)

Key Changes for OB/Gyn • Inclusion of trimesters in obstetric codes • Elimination of episodes of care for

obstetric codes • Changes in timeframes:

– Abortion vs. Fetal death ( 20 weeks) – Early vs. Late pregnancy (20 weeks)

• Extensions to denote specific fetus • New GU codes and notes including

category title changes

Structure and Format of ICD-10-CM

• First character is always alphabetic letter – Chapter 14 Diseases of the GU system (N00-

N99) – Chapter 15 Pregnancy, Childbirth and

Puerperium (O00-O9A) • Second character is always a number • Characters 3-7 alpha or numeric

– O9A.311: Physical abuse complicating pregnancy, first trimester


• Alphabetic Index: Alphabetic Listing of Terms and Codes – Index to Diseases and Injury – Index to External Causes of Injury – Neoplasm Table – Table of Drugs and Chemicals

• Tabular List: Chronological list divided into chapters based on body system or condition


• Code Format: XXX.XXX X • XXX= Category • XXX= Etiology, anatomic site, severity • X= Extension

• Placeholder Character X – Used with certain codes for potential future

expansion – When placeholder exists, must use X in that

location for valid code


• Labor and delivery complicated by cord around neck, without compression: O69.81X2 – O69:Labor and delivery complicated by

umbilical cord complications – 81:Cord around neck, without compression – X: Placeholder – 2: Fetus 2

Abbreviations

• NEC: – “Not elsewhere classifiable” – Represents “other specified”

• Detail provided for which a code does not exist

• NOS: – “Not otherwise specified” – Represents “unspecified”

• Information insufficient to assign code

Punctuation and Definitions

• [ ] Brackets – Tabular List to enclose synonyms, alternative

wording or explanatory phrases – Alphabetic Index to identify manifestation

codes • ( ) Parenthesis (Alphabetic and Tabular)

– Non-essential modifiers – May be present or absent without affecting

the code number

Punctuation and Definition

• : Colon – Tabular List after an incomplete term which

needs one or more of the modifiers following the colon to make it assignable to a given category

• “And”: Means “and” or “and/or” • “With”: Means “associated with” or “due to”

Punctuation and Definitions

• N90.0 Mild vulvar dysplasia Vulvar intraepitheal neoplasia [VIN], grade 1

• N 95 Menopausal and other perimenopausal disorders due to naturally occurring (age related) menopause and perimenopause

• N61 Inflammatory disorders of the breast Abcess (acute) (chronic) (nonpuerperal) of breast

General Terminology

• Inclusion terms: Conditions for which that code is to be used – May be synonyms – Other specified: list of conditions assigned to

code – List is not exhaustive – Additional terms found in Alphabetic Index

may be assigned to code

General Terminology

• N92.0 Excessive and frequent menstruation with regular cycle Heavy periods NOS Menorrhagia NOS Polymenorrhea NOS

General Terminology

• N92.1 Excessive and frequent menstruation with irregular cycle Irregular intermenstrual bleeding Irregular, shortened intervals between

menstrual bleeding Menometrorrhagia Metrorrhagia

General Terminology

• Exclude Notes: 2 Types – Excludes 1: Means “NOT CODED HERE!”

• Cannot report excludes code with code above • Used when two conditions cannot occur together

– Excludes 2: Means “Not included here” • Acceptable to use both the code and the excluded

code together • Indicates condition excluded is not part of the

condition represented by the code, patient may have both conditions

Etiology/ Manifestation Convention

• Conditions may have underlying etiology and multiple related manifestations

• Underlying condition coded FIRST followed by manifestation codes

• Etiology code note: “use additional code” • Manifestation code note: “code first” other

condition • “Diseases classified elsewhere” can never

be first-listed or principle diagnosis

General Guidelines

• Locate code in Alphabetic Index and confirm in Tabular list

• Report the highest number of characters available

• Signs and symptoms are acceptable if diagnosis has not been confirmed by provider (Chapter 18 contains many but not all)

General Guidelines

• Signs and symptoms routinely associated with a disease process should not be assigned as additional codes

• Signs and symptoms NOT routinely associated should be assigned

• Multiple codes for single condition follow guidelines for etiology/manifestations

General Guidelines

• Combination codes should be reported when code fully describes condition – Combination code is single code that

describes: • Two diagnoses • Diagnosis with an associated secondary process

(manifestation) • Diagnosis with an associated complication

Chapter 14: Diseases of the

Genitourinary System (N00-N99) • Important “Blocks” (new concept) :

– N30-N39: Other diseases of urinary system – N60-N65: Disorders of breast – N70-N77: Inflammatory diseases of pelvic

organs – N80-N98: Noninflammatory disorders of

female genital track – N99: Intraoperative and postprocedural

complications and disorders of gu system, not classified elsewhere

Chapter 14: Diseases of the Genitourinary System (N00-N99)

• Acute cystitis-ICD-10 – N30.00 Acute cystitis without hematuria OR – N30.01 Acute cystitis with hematuria – Plus appropriate B code to describe infectious

agent (B96.2-E.coli as cause of disease classified elsewhere)

• Acute cystitis-ICD-9: 595.0 (acute cystitis) plus 041.4 (E. coli)


• Overactive Bladder ICD-10 – N32.81

• Cystocele (N81.1) is listed as Type2 exclusion code so may also be reported if applicable

• N81.10 Unspecified • N81.11 Midline • N81.12 Lateral

• Overactive Bladder ICD-9: 596.51 (hypertonicity of bladder)


• ICD-10: N39.4 Other specified urinary incontinence – Multiple 5 character codes for specific

conditions ( urge, mixed, continuous leakage, etc.)

• ICD-9: 788.3 Urinary incontinence – Multiple 5 digit codes for specific conditions – Category in signs/symptoms chapter


• ICD-10: 3 subcategories related to bleeding disorders (other than menopausal) – N91: Absent, scanty and rare menstruation – N92: Excessive, frequent and irregular

menstruation – N93: Other abnormal uterine and vaginal

bleeding • ICD-9: 1 category

– 626 Disorders of menstruation and other abnormal bleeding from female genital tract


• ICD-10: N99.820 Postprocedural hemorrhage and hematoma of a genitourinary system organ or structure following a genitourinary system procedure

• ICD-9: – 998.11 Hemorrhage complicating a procedure – 998.12 Hematoma complicating a procedure – Located in Injury and Poisoning Chapters

Chapter 15: Pregnancy, Childbirth and the Puerperium(O00-O9A)

• 9 Blocks – Pregnancy with abortive outcomes – Supervision of high risk pregnancy – Edema, proteinuria and hypertensive

disorders in pregnancy, childbirth and puerperium

– Other maternal disorders primarily related to pregnancy


– Maternal care related to the fetus and amniotic cavity and possible delivery problems

– Complications of labor and delivery – Encounter for delivery – Complications predominately related to the

puerperium – Other obstetric conditions, not elsewhere

classified


• Codes have been moved from other chapters to Chapter 15 – Supervision of high risk pregnancy from

Supplementary Classification to Chapter 15 • Several code titles have been revised

– ICD 9: Abnormality of organs and soft tissue of pelvis

– ICD-10: Maternal care for abnormality of pelvic organs


• Codes identify trimester in which condition occurred in 5th or 6th character as appropriate – Trimester counted from first day of LMP – Trimester based on the trimester for current

encounter • Applies to pre-existing conditions and those that

develop during or are due to pregnancy – Assign “ in childbirth” code for complication

when delivery occurs (represents delivery phase)


• ICD-10: O10.012 Pre-existing essential hypertension complicating pregnancy, second trimester

• ICD-9: 642.03 Antepartum benign essential hypertension


• ICD-10: O10.02 Pre-existing essential hypertension complicating childbirth

• ICD-9: 642.01 Benign essential hypertension with delivery


• Certain codes require 7th character to identify multiple gestation affected by condition – 0: Not applicable (single gestations) or

unspecified – 1-5: Fetus number – 9: Other fetus

• Must assign code from O30 (Multiple Gestation)


• ICD-10: O40.3xx1 Polyhydramnios, third trimester, fetus 1 – xx placeholders

• ICD-10: O30.043 Twin pregnancy dichorionic/diamniotic


• ICD-9: 657.03 Polyhydramnios antepartum condition or complication

• ICD-9: 651.03 Twin pregnancy, antepartum condition or complication

• ICD-9: V91.03 Twin gestation, dichorionic/diamniotic


• Combination codes for obstructed labor that incorporates reason for the obstruction

• ICD-10: O64.1xx0 Obstructed labor due to breech presentation, single gestation

• ICD-9: 660.01 Obstruction caused by malposition of fetus at onset of labor with delivery

• ICD-9: 652.21 Breech presentation without version delivered

Chapter 18: Symptoms, Signs and Abnormal Clinical Findings, Not Elsewhere Classified (R00-R99)

• Organizational changes as compared to corresponding chapter in ICD-9 – General symptoms follow those related to a

system or other grouping • Some codes moved from or to “disease”

chapters • Titles changed for some codes

Chapter 18: Symptoms, Signs and Abnormal Clinical Findings, Not Elsewhere Classified (R00-R99)

• ICD-10: R87 Abnormal findings in specimens from female genital organs – R87.613 High grade squamous intraepithelial

lesion on cytologic smear of cervix (HGSIL) • ICD-9: 795 Other and nonspecific abnormal

cytological, histological, immunological and DNA test findings – 795.04 Papanicolaou smear of cervix with high grade

squamous intraepithelial lesion (HGSIL)

Chapter 21: Factors Influencing Health Status and Contact with Health

Services (Z00-Z99) • Certain codes moved from other chapters

to Chapter 21 – Codes for elective abortion without

complication • Personal and family history codes

expanded • Codes for circumstances related to

reproduction (Z32-Z39)

Chapter 21: Factors Influencing Health Status and Contact with Health

Services (Z00-Z99)

• ICD-10: – Z01.411 Encounter for gynecological examination

(general) (routine) with abnormal findings – Z01.419 Encounter for gynecological examination

(general) (routine) without abnormal finding • ICD-9:

– V72.31 Routine gynecological examination

Summary

• Codes/changes are not valid until Oct.1, 2013

• Changes and additions are being worked through the ICD code process

• ACOG seeking some additional changes such as gestational age by weeks/day

Summary • System changes necessary to

accommodate increased digits and character changes

• May require changes in medical record documentation to support increased specificity

• Education will be necessary for staff and providers

Planning for the Transition

• Verify with software vendors plans for testing and implementation

• Assign internal implementation team – Include physicians and other providers – Clinical staff (nursing, lab, etc) – Administrative staff – Coding/ Billing staff

• Contact payers/read notices/bulletins re: payer implementation

Planning for the Transition

• Assess current uses and users of ICD-9 in practice – Assess skills and understanding of ICD

• Determine who needs ICD-10 training • Evaluate training options • Evaluate current documentation practices • Plan for changes to charge capture

documents

ICD-10 Resources

• CMS – http://www.cms.gov/ICD10

• NCHS (CDC) – http://www.cdc.gov/nchs/icd/icd10.htm

• AHIMA – http://www.ahima.org/icd10/

• AAPC – http://www.aapc.com/icd-10/

http://www.cms.gov/ICD10

http://www.ahima.org/icd10/

Questions

ACOG Resources

• Use ACOG’s coding reference materials to: – Enhance coding knowledge in Ob/Gyn – Appeal denied claims – Develop internal coding policies – Dispute insurance company policies

• Ob/Gyn CPT Coding Manual with CD Rom • ICD-9-CM “Abridged” Diagnostic Coding in Ob/Gyn • Frequently Asked Questions in Ob/Gyn Coding • Essential Guide to Coding in Ob/Gyn Order from: http://www.acog.org/bookstore/Coding_Resources_C56.cfm

http://www.acog.org/bookstore/Coding_Resources_C56.cfm

Contact Information

Hill & Associates, The Coding & Compliance Professionals

221 North Front Street Wilmington, NC 28401

www.codingandcompliance.com Phone: 910.762.1978

Fax: 910.762.2159

http://www.codingandcompliance.com

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• Please fax the evaluation form and list of participants for CME credit to ACOG at: 202-484-7480. Thank you.

61 6/14/2011 ACOG - ICD-10: What to Expect

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• If you have questions… • Please contact ACOG’s Coding and

Nomenclature Department by email at [email protected] or by fax to 202-484-7480.


ICD-9-CM to ICD-10-CM: What to Expectclient.blueskybroadcast.com/ACOG/downloads/2011- ICD...

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