Preparing for ICD-10-CM/PCS: What does a coder need to do now?

Presented by:

Jennifer McManis, RHIT

ICD-10-CM/PCS Compliance TimelineTraining TimelineContinuing Education RequirementsMyth BustersCode StructureCoding Fundamentals

Case StudiesResources

Implementation Date ICD-10-CM/PCS Compliance Deadline

October 1, 2013 Claims for services provided on or after

this date must use ICD-10 codes CPT codes will continue to be used for

outpatient services

Compliance Timeline January 1, 2010

Internal testing of Version 5010 for electronic claims December 31, 2010

Internal testing must be complete January 1, 2011

External Testing of Version 5010 claims CMS begins accepting Version 5010 Version 4010 continue to be accepted

January 1, 2012 All claims must use Version 5010 Version 4010 no longer accepted

Outpatient Coder Training Outpatient Coder Training

Approximately 16 hours 2011-2012

Review code Structure & Coding Conventions. Learn the fundamentals Analyze & practice applying the ICD-10-CM

guidelines Review and refresh knowledge of A & P

concepts

Outpatient Coding Training 2012-2013

Become an expert in applying ICD-10-CM codes to outpatient cases in the six to nine months preceding October 1, 2013.

Practice using ICD-10-CM codes each week leading into “go live” on October 1, 2013.

Network with peers to seek answers to cases and confirm application of ICD-10-CM codes.

Take advantage of component MHIMA training opportunities

Inpatient Coder Training Approximately 50 hours 2011-12

Review code structure and coding conventions for ICD-10-CM and ICD-10-PCS.

Learn the fundamentals of the ICD-10-CM and ICD-10-PCS systems.

Analyze and practice applying the ICD-10-CM and ICD-10-PCS Coding Guidelines.

Continue to study ICD-10-PCS definitions (memorize the definitions of approaches and root operations).

Continue to review and refresh knowledge of anatomy and physiology concepts

Inpatient Coder Training 2012-13

Become an expert in applying ICD-10-CM and ICD-10-PCS codes to inpatient cases in the 6 to 9 months preceding October 1, 2013

Practice using ICD-10-CM and ICD-10-PCS codes each week leading into “go live” on October 1, 2013

Network with peers to seek answers to cases and confirm application of ICD-10-CM/PCS codes

Take advantage of MHIMA training opportunities

Continuing Education Unit (CEU) RequirementsRequired to participate in a

predetermined number of mandatory baseline educational experiences specific to ICD-10-CM/PCS.

*Can Begin Earning CEU’s January 1, 2011 thru December 31, 2013 2009 or 2010 ICD-10 –CM Academy

CEU RequirementsTotal number of ICD-10-cm/PCS CEU

required, by AHIMA Credential CHPS- 1 CEU CHDA; RHIT;RHIA- 6 CEUs CCS-P- 12 CEUs CCS; CCA- 18 CEUs

If you hold more than one credential, only report the highest number of CEUs

CEU Requirements CEU requirements will be included within the

total number of CEUs required for a given CEU Cycle. For example, if you hold an RHIA credential, you will obtain 6 CEUs that are in relation to ICD-10-CM/PCS along with the additional 24 CEUs to complete your recertification cycle.

Reporting of the CEUs will be made available by Fall of 2011

Myths October 1, 2013 is considered a flexible date Implementation planning should be undertaken with an

assumption that DPHHS will grant an extension Worker’s comp & auto insurance companies may choose not to

implement ICD-10-CM/PCS State Medicaid Programs will not be required to update their

systems in order to utilize ICD-10-CM/PCS The increased number of codes will make the new coding

system impossible to use Developed without any clinical input There will no hard copy of ICD-10-CM/PCS

All coding will be done electronically

Myths Developed a number of years ago, so it is out of date Unnecessarily detailed medical record documentation will be

required Implementation can wait until after electronic health records and

other health care initiatives have been established ICD-10-CM based super bills will be too long or too complex The GEMs are intended to facilitate the process of coding

medical records Each payer will be required to develop their own mappings,

GEM have been developed for CMS use only Medically unnecessary diagnostic tests will need to be

performed in order to assign an ICD-10-CM code CPT will be replaced by ICD-10-CM/PCS

ICD 10-CM Code Structure ICD 10-CM

Contains more than 68,000 codes Compare this to ICD-9-CM which contains 13,000 codes

Consists of 3-7 characters First digit is alpha All Letters are used except U 4th,5th,6th & 7th Digits can be numeric Decimal placed after the 1st three characters

ICD-10-CM Code Structure ICD-10-CM Code Structure

XXX.XXX X 1st 3 Characters- Category 4th 5th 6th Characters-Etiology, Anatomic Site, Severity 7th Character-Extension (Visit Encounter, Sequelae,

External Causes)

ICD-9-CM Code Structure XXX.XX

1st 3 Characters-Category 4th 5th Characters- Etiology, Anatomic Site, Manifestation

ICD-10-CM Structure

Index & Tabular List Two Parts of the Index

Disease & Injury Table of Drugs & Chemicals Neoplasm Table

External Causes Coding Guidelines

Some changes from ICD-9 Fractures- Default Displaced 2 Categories for Acute MI

Acute MI is 4 weeks instead of 8 weeks Osteoporosis with current pathological fracture

V codes are now Z Codes

ICD-10-CM New Features

Combination codes for conditions & common symptoms

Combination codes for poisonings & external causes

Added laterality Added extensions for episode of care Expanded codes Inclusion of trimester in obstetric codes and

elimination of fifth digits for episode of care External cause codes no longer a supplementary

classification

ICD-10-CM Diabetes Mellitus Codes

No Longer Classified as uncontrolled/controlled Includes diabetes & the complication

Injuries Grouped by Anatomical site rather than type of

injury Code Extension to identify (7th Character)

A- Initial encounter D-Subsequent encounter S-Sequelae

ICD-10-CM Code Examples

I10- Hypertension Hypertension Table Removed

Combination codes Certain Conditions and Associated Symptoms K57.21-Diverticulitis of large intestine with perforation and

abscess with bleeding I25.110- Arteriosclerotic Heart Disease of native coronary

artery with unstable angina pectoris K571.51- Toxic Liver disease with chronic active hepatitis

with ascites E10.610- Type 1 diabetes mellitus with diabetic neuropathic

arthropathy

ICD-10-CM Combination codes for poisonings and their external

cause T42.3x2S- Poisoning by barbituates, intentional

self-harm, sequela Laterality

C50.212- Malignant neoplasm of upper-inner quadrant of left female breast

L89.213- Pressure ulcer of right hip, stage III

ICD-10-CM Codes for clinical concepts that do not exist in ICD-9-CM

T45.526D-Underdosing of antithrombotic drugs, subsequent encounter

Z67.40- Type O Blood, RH positive Codes for postoperative complications, intraoperative, and post-

procedural disorders D78.01- Intraoperative hemorrhage and hematoma of spleen complicating a

procedure on the spleen D78.21- Post-procedural hemorrhage and hematoma of spleen following a

procedure on the spleen

Obstetric codes identify trimester instead of episode of care 026.02- Excessive weight gain in pregnancy, second trimester

ICD-10-CM Coding Guidelines Chapter 1: Certain Infectious and Parasitic

Diseases (A00-B99) d. Sepsis, Severe Sepsis, and Septic Shock

Case Study: Patient was taken to the emergency department and

admitted to the hospital after being found semi-conscious with markedly abnormal vital signs, a fever of over 39 degrees C, a heart rate of 110, and a respiratory rate of 22/min. Final diagnoses included sepsis and septic shock with acute respiratory failure

Answer: A41.9 Sepsis (generalized) R65.21 Shock, septic (due to severe sepsis) J96.0 Failure, respiration, respiratory, acute

ICD-10-CM Coding Guidelines Chapter 4: Endocrine, Nutritional, and Metabolic Diseases

(E00-E89) a. Diabetes mellitus 6) Secondary Diabetes Mellitus

Case Study This 34-year-old patient is being seen for ongoing management of steroid-

induced diabetes mellitus which was due to the prolonged use of corticosteroids, which have been discontinued. The patient’s diabetes is managed with insulin which he has been taking for the last two years

Answer: T38.0x5S Refer to Drug and Chemical Table, Corticosteroid, adverse effect E09.9 Diabetes, diabetic, (mellitus) (sugar), due to drug or chemical Z79.4 Long-term (current) drug therapy (use of), insulin

ICD-10-CM Coding Guidelines Chapter 9 Diseases of Circulatory System (I00-I99) Case Study

Patient is seen for treatment of unstable angina. The patient has a history of atherosclerotic heart disease and underwent a 3-vessel coronary bypass approximately 2 years ago. The patient recently underwent a cardiac catheterization of all three coronary bypass grafts which showed them patent

Answer: I25.110 Angina (attack) (cardiac) (chest) (heart) (pectoris) (syndrome)

(vasomotor), with atherosclerotic heart disease – see Arteriosclerosis, coronary (artery), native vessel with angina pectoris, unstable

Z95.1 Status (post), aortocoronary bypass

ICD-10-CM Coding Guidelines Chapter 12: Diseases of Skin and Subcutaneous Tissue

(L00-L99) a. Pressure ulcer stage codes

Case Study This patient has a gangrenous pressure ulcer of the right hip and a pressure

ulcer of the sacrum documented by the physician. The nursing assessment indicates a stage II pressure ulcer of the sacrum with a stage III decubitus ulcer of the right hip.

Answer: I96 Ulcer, gangrenous – see Gangrene. Gangrene, gangrenous (connective

tissue) (dropsical) (dry) (moist) (skin) (ulcer) (see also necrosis), Necrosis, skin or subcutaneous tissue NEC

L89.213 Ulcer, ulcerated, ulcerating, ulceration, ulcerative, pressure (pressure area) stage III, (healing) (full thickness skin loss involving damage or necrosis of subcutaneous tissue)

L89.152 Ulcer, ulcerated, ulcerating, ulceration, ulcerative, pressure (pressure area) stage II, (healing) (abrasion, blister, partial thickness skin loss involving epidermis and/or dermis) sacral region (tailbone

ICD-10-CM Coding Guidelines Chapter 9: Diseases of Circulatory System (I00-I99) a. Hypertension

1) Hypertension with Heart Disease 3) Hypertensive Heart and Chronic Kidney Disease

Case Study This patient is hospitalized with a diagnosis of congestive heart failure due

to hypertensive heart disease. Patient also has Stage 5 chronic kidney failure. The patient has been prescribed Lasix previously but admits he forgets to take his medication every day. This is due to his advanced age.

 

ICD-10-CM Coding Guidelines Answer:

I13.2 Disease, diseased, heart (organic), hypertensive – see Hypertension, heart. Hypertension, hypertensive (accelerated) (benign) (essential) (idiopathic) (malignant) (systemic), heart (disease) with kidney disease (chronic) – see Hypertension, cardiorenal (disease), with heart failure, with stage 5 or end stage renal disease

I50.9 Failure, heart (acute) (sudden), congestive (compensated) (decompensated). The “use additional code” statement under code I13.2 indicates the use of this code to identify the type of heart failure

N18.5 Disease, diseased, kidney (functional) (pelvis), chronic, stage 5. The “use additional code” statement under code I13.2 indicates the use of this code to identify the stage of the chronic kidney disease

T50.1x6A Refer to Table of Drugs and Chemicals, Lasix, underdosing Z91.130 Noncompliance, medication regimen, underdosing, unintentional,

due to patient’s age-related debility

ICD-10-CM Coding Guidelines Chapter 20: Chapter 20: External Causes of Morbidity (V01-

Y99) Case Study

An 18 year-old driver of a car that collided with a pickup truck on the interstate highway. The driver confessed to using his cell phone to send a text message to his girlfriend.

Assign the external cause codes only Answer:

V43.53xA Index to External Causes. Accident, car – see Accident, transport, car occupant, Accident, transport, car occupant, driver, collision (with) pickup truck (traffic)

Y92.411 Index to External Causes, Place of occurrence, highway (interstate)

Y93.c2 Index to External Causes, Activity (involving) (of victim at time of event), cellular, telephone

ICD-9-CM Coding Guidelines Chapter 21: Factors influencing health status and contact

with health services (Z00-Z99) Case Study

This patient had a lateral wall STEMI and was brought by ambulance to the emergency room. He received tPA and was transferred to a tertiary care center for continued care. The patient was received with tPA infusion continuing, and immediately taken to the cardiac cath lab.

 Answer: I21.29 Infarct, infarction, myocardium, myocardial (acute) (with stated

duration of 4 weeks or less), ST elevation (STEMI), lateral (apical-lateral) (basal-lateral) (high)

Z92.82 Status(post) – see also Presence (of), administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility

ICD-10-PCS ICD-10-PCS

Inpatient Procedures Contains

Over 72,000 codes 7 Character-alphanumeric code structure

Each character contains up to 34 possible values

The letter O is not used No Decimals

ICD-10-PCS Structure

Index Codes found based on type of procedure- No diagnostic

information in the description One you know the tables; you can go directly to the

tables the index does not need to be used first First Three values in the index direct you to the tableTables Each page in the section is composed of rows that

specify valid combinations of code values Root Operations Approach

ICD-10-PCS ICD-10 Structure

XXXXXXX 1st- Section (Medical & Surgical; OB; Imaging) 2nd- Body System 3rd- Root Operation ( Resection, Transfusion) 4th- Body Part 5th- Approach 6th- Device 7th- Qualifier

ICD-10-PCS Code Examples

0HTT0ZZ- Right Total Mastectomy 0X6C0ZZ- Amputation at left elbow level 0FT44ZZ- Lap Chole 0HBT0ZX- Right Breast Biopsy

0- Medical Surgical H- Skin & Breast B-Excision T- body Part 0- Approach Z-Device X-Qualifier

ICD-10-PCS Root Operations 30 Root Operations Identifies the objective of the procedure

In order to determine the appropriate root operation, the full definition of the root operation as contained in the PCS Tables must be applied.

Components of a procedure specified in the root operation definition and explanation are not coded separately. Procedural steps necessary to reach the operative site and close the operative site are also not coded separately.

Example: Resection of a joint as part of a joint replacement procedure is included in the root operation definition of Replacement and is not coded separately. Laparotomy performed to reach the site of an open liver biopsy is not coded separately.

ICD-10-PCS: Root Operations Excision vs. Resection

PCS contains specific body parts for anatomical subdivisions of a body part, such as lobes of the lungs or liver and regions of the intestine. Resection of the specific body part is coded whenever all of the body part is cut out or off, rather than coding Excision of a less specific body part.

Example: Left upper lung lobectomy is coded to Resection of Upper Lung Lobe, Left rather than Excision of Lung, Left.

ICD-10-PCS: Root Operations Biopsy followed by more definitive treatment

If a diagnostic Excision, Extraction, or Drainage procedure (biopsy) is followed by a more definitive procedure, such as Destruction, Excision or Resection at the same procedure site, both the biopsy and the more definitive treatment are coded.

Example: Biopsy of breast followed by partial mastectomy at the same procedure site, both the biopsy and the partial mastectomy procedure are coded.

Control vs. more definitive root operations The root operation Control is defined as, “Stopping, or attempting to stop,

postprocedural bleeding.” If an attempt to stop postprocedural bleeding is initially unsuccessful, and to stop the bleeding requires performing any of the definitive root operations Bypass, Detachment, Excision, Extraction, Reposition, Replacement, or Resection, then that root operation is coded instead of Control.

Example: Resection of spleen to stop postprocedural bleeding is coded to Resection instead of Control

ICD-10-PCS: Root Operations Release procedures

In the root operation Release, the body part value coded is the body part being freed and not the tissue being manipulated or cut to free the body part.

Example: Lysis of intestinal adhesions is coded to the specific intestine body part value.

Release vs. Division If the sole objective of the procedure is freeing a body part without cutting

the body part, the root operation is Release. If the sole objective of the procedure is separating or transecting a body part, the root operation is Division.

Examples: Freeing a nerve root from surrounding scar tissue to relieve pain is coded to the root operation Release. Severing a

nerve root to relieve pain is coded to the root operation Division.

ICD-10-PCS Approach

Technique used to reach the site of the procedure 7 Different Approaches

Open Percutaneous Percutaneous Endoscopic Via Natural or Artificial Opening Open with Percutaneous endoscopic assistance External

ICD-10-PCSDevice

A device is coded only if a device remains after the procedure is completed. If no device remains, the device value No Device is coded.

ICD-10-PCSObstetrics

Products of conception Procedures performed on the products of conception are coded to the

Obstetrics section. Procedures performed on the pregnant female other than the products of conception are coded to the appropriate root operation in the Medical and Surgical section.

Example: Amniocentesis is coded to the products of conception body part in the Obstetrics section. Repair of obstetric urethral laceration is coded to the urethra body part in the Medical and Surgical section.

Procedures following delivery or abortion Procedures performed following a delivery or abortion for curettage of

the endometrium or evacuation of retained products of conception are all coded in the Obstetrics section, to the root operation Extraction and the body part Products of Conception, Retained. Diagnostic or therapeutic dilation and curettage performed during times other than the postpartum or post-abortion period are all coded in the Medical and Surgical section, to the root operation Extraction and the body part Endometrium

ICD-10-CM/PCS Resourceshttp://www.cms.gov/ICD10/

Download the Index & Tabular Compliance Dates Quick Reference Guide

www.ahima.org ICD-10-CM/PCS Resource Page

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