Presented by:

Lizeth Flores, RHIT, RAC-CT Anderson Health Information Systems,

Inc.

Participants will : Correctly assign ICD-9-CM codes to diagnoses Correctly identify primary / Secondary

diagnoses Identify correct sequence of diagnoses for

coding assignment Identify difference between ICD-9-CM and ICD-

10 Learn ICD-10 transition timeline

Gather statistical dataReporting diagnoses and provides a

method for sequencing diagnosis to support billing transactions / reimbursement

Ensure compliance with Federal Reporting Standards for diagnoses

Provide insight into the types of residents and conditions

Health Research

HIPAA www.cdc.gov/nchs/icd.htmLatest revision October 1, 2011

Skilled Nursing Facility (SNF) Inpatient Rehab Facility (IRF) Home Health Agency (HHA) Long Term Acute Care Hospital

(LTACH)

Disease and Procedures (Books 1-3)Alphabetical/Tabular (numeric) Index

Both the Alphabetic Index and the Tabular List must be used when locating and assigning a code.

Do not rely on just one since this can lead to errors in code assignment and a less specific code selection

Locate each main term and sub term in the alphabetical index, i.e., Chronic Kidney Disease 1. Disease 2. Kidney 3. Chronic

Verify the code selected in the Tabular list

Read and be guided by instructional notations that appear in both the Alphabetic Index and the Tabular List

Assign 3 digit codes only if there are no four digit codes within the category. There are only 100 codes with only 3

digitsAssign 4 digit codes only if there is

no fifth digit.Assign 5 digit codes when indicated.Samples – 486, 401.x, 250.xx

Aftercare – used when the initial treatment of a disease or injury has been performed and the patients still requires continued care to heal or recover. Categories V51-V58

Late Effects – a late effect is a residual condition that remains and requires medical evaluation, rehab treatments and/or nursing care after the initial illness or injury.

Chronic Conditions – Conditions that are stable but still require management or treatment.

Acute Conditions –acute care codes should only be reported until the condition is resolved.

Therapy – Physical, occupational, speech and respiratory therapy.

History of – (Hx) – history codes are acceptable on any Medical record regardless of reason for admission/encounter.

A history code is distinct from a “status” code in that history codes indicate that the patient no longer has the condition and “status” codes indicated a present state.

There are two types of history V-codes, personal and family.

Status post upper arm fracture V54.11

History of frequent falls V15.88

Admission for physical therapy following hip fracture

V57.1 , V54.13

Hemiplegia due to recent CVA

Total Hip Replacement

Acute UTI treated with Cipro.

Dementia

Late Effect

After Care

Acute Condition

Chronic Condition

ALL CONDITIONS THAT EXIST AT THE TIME OF ADMISSION, THAT EFFECT

TREATMENT RECEIVED

DIAGNOSES THAT DO NOT AFFECT TREATMENT OR LENGTH OF STAY

WHEN CONDITION NO LONGER EXISTS

DO NOT ASSIGN PROCEDURE CODES Examples: Fractured forearm 6 years ago,

pneumonia, UTI that were resolved (these will only be coded if the Resident is admitted with Antibiotics)

“FIRST LISTED DIAGNOSES” is the diagnosis that is chiefly responsible for the admission to the facility and the diagnosis that supports the reimbursement and should be sequenced first.”

Transfer RecordsHistory & PhysicalProgress NotesAdmission Orders

Discharge summary Transfer documentation, Surgical reportsConsultations Physician Progress notes Lab reports and radiological studies

When two or more inter-related conditions potentially meet the definition of principal diagnosis Either may be sequenced first unless

therapy is being provided, the Tabular list or Alphabetic Index indicate otherwise.

Inter-related conditions – two or more diagnosis that equally meet the definition of principal diagnosis.

Resident admitted with Pneumonia and UTI – either can be used as the principal diagnosis if the resident is still receiving antibiotic therapy

Fall 3 months agoChronic kidney disease Above the knee amputation Rt. Leg

(10 days ago) with infection still on antibiotics

Anemia

NEC – Not Elsewhere ClassifiedNOS – Not Otherwise SpecifiedCodes are used only when neither

the diagnostic statement nor a thorough review of the clinical record provides adequate information to permit assignment of a more specific code

The coder must review the titles and inclusions under the three or four digit category to determine if the diagnosis is included in the category; however, the specific diagnosis may not always be listed

Example: Spinal Cord Inflammation 323.9

Single codes used to classify two diagnosis or a diagnosis with a manifestation

Example: Candidiasis with meningitis 112.83

Etiology codes – USE ADDITIONAL CODE

Manifestation codes – CODE 1st Underlying Dx.

Codes in parentheses identify conditions that require multiple coding. Also, codes in parentheses CAN NOT be sequenced as PRINCIPAL Dx.

Instructions for conditions that require multiple coding can appear in the Tabular List. “Code also underlying disease”, “Use

additional code, if desired, to identify manifestation, as …” “Code also” instructs the coder to:▪ Code the underlying disease, or etiology first

as the primary diagnosis, followed by the code (s) for manifestation (s).

▪ It is mandatory to follow the “code also” instructions to assign both codes.

Anosmia following CVA 438.6, 781.1

“with”, “with mention of”, or “associated with” – this code can only be used if both conditions are present

Kidney Infection …..590.9 with Calculus 592.0

Indicate proper sequencing for the two codes listed. The code number before the bracket

is coded first. The code number inside the brackets

is coded second.Codes in brackets in the alphabetic

index can NEVER be sequenced as the principal diagnosis.

1.Arthritis, arthritic --- due to or associated with hypothyroidism

244.9 [713.0]

Examples: Aftercare following kidney transplant V58.44 (aftercare involving organ transplant), V42.0 (Organ/tissue replacement by transplant ,

kidney)

Aftercare following arteriocoronary bypass V58.73 (aftercare following surgery of the

circulatory system), V45.81(aortocoronary bypass status)

use aftercare codes to provide better detail

“Using Additional Codes” When the instructions say “Use

additional code….” the additional code is sequences second.

Example UTI due to E.coli

599.0[041.4]

Let’s have a look: See 429 section Under Cardiovascular Disease,

Unspecified ▪ Excludes: That due to hypertension

The order in which codes are listed is called sequencing. The coder should make every effort to record the codes in a logical sequence that is descriptive of the resident’s condition.

Acute dx treated in the hospital should be coded until the condition is resolved, after the resident is transferred to the SNF

Examples: MRSA Pneumonia UTI

May have multiple secondary codes List and code conditions related to

therapy and services provided Review and update as condition changes

– sequence may change over time Billing staff should work with Nursing

and Health Information Department to know which diagnoses are current, which is principal, etc.

Order by complexity. Assign the condition with the higher

complexity first. (those that require the most resources i.e. wound care vs. hypertension)

All conditions present at the time of admission, and that affect the treatment provided and length of stay should be coded.

Residual condition After initial / acute phase of illness

Official coding guidelines state that Category 438 is used for admission and encounter for post acute care following treatment of the CVA in the acute hospital

Codes from categories 430 to 436 are reserved for the “initial” (first) episode of care for an acute CVA that was provided in the qualifying hospital stay and should not be used in SNF

Which of the following is a late effect?

a. End stage renal disease b. Anosmia following recent CVA c. Diabetic retinopathy d. Paraplegia due to polio

Left hemiplegia secondary to CVA (patient is right handed)

Late Effects Cerebrovascular disease With hemiplegia – nondominant side

Codes from categories 041 or 079 can be used as principal diagnosis as long as the nature or site of the infection is not specified or when the Alphabetical index instructs you to do so.

• Gastroenteritis due to E.coli• 008.00

• MRSA infection of Lt. toe • 041.12

• Herpetic septicimia • 054.5

Go to alphabetic index Look up Ex: fibroma, upper jaw Find “fibroma” Cross reference “see neoplasm, by site,

benign” Turn to neoplasm locate sub term “Jaw / upper” Follow across to Benign Locate code 213.0 Go to Tabular list for any coding

instructions or notes*

Only used when stated as such in Alpha Index

Unspecified Behavior – Only used when Neoplasm is not fully

described Or not specified as to behavior Or listed in Alphabetic index

Ex: Neoplastic Cyst of Tongue Cross reference Alpha Index Under Cyst, neoplastic

see neoplasm, by site, unspecified nature

Two codes One for primary (original site) One for each secondary site

Code primary before secondary Except when using “V” code for primary

site that has been surgically removed

Determine the primary siteTurn to Neoplasms TableEx: Carcinoma of Rectum (154.1)Find Neoplasm, rectum, malignant,

primary

Ex: Secondary malignant neoplasm of prostate (198.82)

Find Neoplasm, prostate, malignant, secondary Determine the site(s) of metastasis

Turn to Neoplasm tableFind correct sub term(s) for siteCross over to Malignant and column

secondary

Ex: Cancer of Lower lobe of lung with metastases (162.5, 199.0)

Code primary site firstTo code the unknown secondary site

Refer to Neoplasm table Multiple sites NEC Cross over to column for code (199.0)

• Refer to neoplasm table • Unknown or Unspecified site• Cross over to primary column 199.1• Sequence after secondary site(s)• Ex: abdominal metastasis from

unknown origin (198.89, 199.1)• Unknown primary would not be used

as principle diagnosis in SNF • The metastatic site is coded first

• Primary site must still be identified if removed, eradicated no longer under treatment

• Use a personal history V-code, History, site, malignant neoplasm

• Identify primary site responsible for metastasis but no longer present

• Secondary site code is sequenced first and then the V-code

Do not use codes from category V10 for secondary metastatic sites removed or not

ICD-9-CM does not provide code numbers for “history of secondary neoplasm site

Official coding guidelines for neoplasm apply when using the aftercare following surgery for neoplasm V58.42

Aftercare code V58.42 may be used with either the current neoplasm code or a code from category V10, whichever is applicable

• History of breast cancer with metastasis to the lung

• 197.0, V10.3

• Carcinoma of prostate with metastasis to spine

• 185, 198.5

• Basal cell carcinoma of chest • 173.5

Examples:

HypothyroidismDiabetes Metabolic disorders Obesity

Hypothyroidism due to history of thyroid cancer (thyroid removed)

244.0, V10.87Uncontrolled, Type II Diabetes 250.01

There are written instructions in ICD-9-CM coding books for sequencing codes.

The underlying Dx (cause/s) coded first, followed by codes for manifestations.

Some Diabetic Conditions Require 2 Codes “Diabetic” or “Due to”

▪ One Code for Cause▪ One Code for Complication

Always sequence cause before complication

Example: Diabetic foot ulcer

▪ Diabetes with other manifestation▪ 250.8x

▪ Ulcer of lower limb, except decubitus▪ 707.1x

Diabetic Neuropathy Diabetes with neurological manifestations

must be coded first (250.60) The tabular list will guide you to “Use

additional code to identify manifestation, as:”

Polyneuropathy in diabetes (357.2) The tabular section will tell you that this

code is not allowed as a principal Dx and will guide you to code underlying disease, as (Diabetes with complication…)

1. ALZHEIMER’S DEMENTIA 331.0, 294.10

2. DIABETIC GLAUCOMA 250.50, 365.9

Chronic illnesses that are managed with medication or treatments, such as hypertension, hypothyroidism, diabetes mellitus, atrial fibrillation, assign the appropriate ICD 9 code

The chronic condition exists, but is under control by medication

A code from category 410.XX must be assigned if the admission is strictly for rehabilitation within eight weeks of the acute MI.

The fifth digit 2 would be used in LTC to designate observation, treatment or evaluation of MI within eight weeks of onset, following the acute phase or in the healing state.

The fifth digit “1” should be used if the acute myocardial infarction occurred at the nursing facility and was the reason for transfer to the hospital or the cause of death.

If the admission takes place after eight weeks assign code (412) Old Myocardial Infarction

Unless the diagnosis statement specifies as “benign” or “Malignant”

“unspecified” code (401.9) must be assigned

When there is a causal relationship stated as “hypertensive” or “due to hypertension” heart conditions are assigned by Category 402 Hypertensive Heart Disease

Arteriosclerotic disease due to hypertension 402.90

Let’s Code 1. Chronic hypertensive kidney

disease 2. 403.9, 585.93. Deep vein thrombosis patient on

Coumadin 4. 453.40, V58.61

Let’s Code

Aspiration Pneumonia 507.0

Chronic bronchitis with emphysema 491.20

• Clarification of clinical terms related to skin ulcers www.cms.hhs.gov/manuals/pm trans/r4som.pdf

• Pressure Ulcer is a synonym for decubitus ulcer – due to prolonged pressure

• Subcategory 707.0x has fifth digits to identify site

2009- New- additional code must be used to identify stage

Non pressure ulcers of lower legFifth digits to identify siteMultiple coding, code first the

underlying dx, such as arteriosclerosis, diabetes, venous hypertension i.e. diabetic ulcer of left fifth toe 250.80,

707.15

The most common type of vascular ulcers In Alphabetical index under “ulcer” , the

index lists “venous” as a non-essential modifier under the sub term “stasis” that refers to code 459.81.

Under section 459.81 in the Tabular List you will be instructed to code any associated ulceration from category 707.0-707.9

Category 870-897 Codes for wounds are not to be used for normal, healing surgical wounds or to identify complications of surgical wounds

Per ICD-9-CM Official Guidelines for Coding and Reporting, aftercare codes are generally first to explain the specific reason for the encounter (admission)

Certain aftercare code categories need a secondary dx code to describe the resolving condition or sequela

For others (V codes) the condition is inherent in code title

Published rules for the use of V codesAddressed the use of V codes in LTC

settings Coding clinic Fourth Quarter 2003Clarified the use of aftercare V codes

for all subsequent encounters after the initial treatment for a fracture

“for statistical purposes, a facture should only be reported once”

V-codes are assigned to problems that affect the patient’s health but are not in themselves a current illness or injury

V-codes can be used to represent status or history.

Examples: Status Cardiac Pacemaker V45.01 Status heart valve prosthesis V43.3 History of falls V15.88 History of alcoholism V11.3

▪ Remember not to use acute care codes when coding aftercare

A resident is admitted for physical therapy following a hip replacement for an inter-trochanteric right hip fracture due to a fall.

Physical therapy:▪ V57.1 Physical Therapy

Intertrochantic right hip fracture due to a fall:

▪ V54.13 Aftercare following traumatic hip fracture

Hip replacement:▪ V54.81 Aftercare following joint replacement▪ V43.64 Joint replacement, hip

A resident is admitted for P.T. & O.T.following a hip fracture after a fall.The physician indicated that the fracture was due to osteoporosis. The Discharge Summary stated that old compression fractures of the vertebrae due to osteoporosis were present on x-ray.

Physical Therapy and Occupational Therapy

▪ V57.89 Multiple therapiesHip Fracture (due to osteoporosis)

▪ V54.23 Aftercare for continuing treatment of healing pathologic fracture of hip

Osteoporosis▪ 733.00 Osteoporosis

Compression fractures of vertebrae▪ 733.13 Pathologic fractures of vertebrae

Admitted for physical therapy, status post total knee replacement due to arthritis

1) Admission – rehabilitation – physical

2 ) Aftercare – following surgery for – joint replacement 3) Replacement – joint – Knee

V57.1, V54.81 , V43.65

Post hysterectomy for uterine cancer three years ago (no further treatment)

History – personal – malignant neoplasm – uterus

V10.42

Select the correct Code Fracture of upper arm due to fall,

resident wearing a sling, admitted for ADL assistance.

V54.11 812.20 (NO)

For residents admitted to a SNF for care following treatment in the acute hospital for a traumatic fx use the aftercare codes from Subcategory V54.1

Do not code the (acute) fractureCoding Guidelines require an

aftercare code be used after the initial encounter for care of a fx.

For statistical purposes, a fracture should only be coded once. If the same fx is coded for all encounters, it makes collection of fracture statistics difficult

The V54.1 identifies the site of the fracture and that it is in the healing phases

Aftercare for Fractures; Pathologic and Traumatic

The fifth digits identify the specific site of the healing fracture

The fifth digit 9 is used for other specified sites

If there are several bones that would be classified to the other specified site, only one code is used

DO NOT code V58.43 Aftercare following surgery for injury and trauma (conditions classifiable to 800-999) Exclusion note states “Excludes: aftercare for healing traumatic fracture”

Remember to always refer to the tabular list and carefully read the instructions and exclusions.

Pathological fracture is a fracture in a bone due to weakening of the bone structure by disease process such as osteoporosis.

For admissions in LTC following a hospital stay for treatment of a pathological fracture assign a code from Subcategory V54.2 Aftercare for healing pathologic fracture

A compression fracture of the vertebrae is considered pathologic if it is not caused by trauma

V13.51 personal hx of healed pathologic fx

V13.52 personal hx of healed stress fxV15.51 personal hx of healed

traumatic fx

Note added to subcategory 733.0-use add’l code to identify personal hx of pathologic (healed) fx (V13.51)

Joint replacement of knee for osteoarthritis (V58.78), V54.81, V43.65

Do not code the disease condition that was treated with the surgery

2008 will have a change in the tabular list for V58.78 that will exclude it when there is orthopedic aftercare; codes from section V54.01-V54.9 will be used.

Use multiple coding to fully describe the resident’s condition

FX hip (traumatic) with joint replacement V54.13, V54.81, V43.64

Do not use V58.43 Aftercare following surgery for injury and trauma-(not for fx)

(conditions classifiable to 800-999) see excludes note: (V54.10-V54.19)

Category V57 does not indicate that rehab services were provided, only that the resident was admitted for this purpose

Use only one code from Category V57 for an admission

If the resident is admitted for multiple therapies, use V57.89

Code also the condition requiring the rehab, such as: Residuals Late effects Aftercare symptoms

The acute dx for which the surgery was preformed is not reported for aftercare encounters or admissions

Use other aftercare or symptom codes to provide better detail

Note the instructions with each code that identifies the range of conditions that are included in the aftercare code number i.e. aftercare post cataract extraction

with lens implant: V58.71, V45.61, V43.1

Implementation date of new, revised and invalid codes October 1, 201

Chart # 1

Chart # 2

Provide a roadmap back to the qualifying stay

Paint a clear picture of your patient

Pay attention to details

Go beyond the code and communicate through documentation

ICD 10ICD 10

Presented by:

Lizeth Flores, RHIT, RAC-CT Anderson Health Information Systems,

Inc.

OBJECTIVESOBJECTIVESParticipants will identify:

◦Dates for New ICD-10◦Documentation support◦New terms encounter principal

diagnosis re-defined◦Some general coding guidelines◦.

113

FINAL REGULATIONFINAL REGULATIONJanuary 15, 2009 Final Regulation

ReleasedEXCHANGE the ICD-9 for the ICD-

10 by October, 1, 2013ICD-10 for billing purposes as far

as ability to accept the code known as “5010” is required by October 2011

114

HIPAAHIPAA

Assigning ICD-10 diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA)

HIPAA has evolved from HIPAA – 1996, to (HIPAA-II) HITECH which relates to security and breaches

And most recently HIPAA Transactions 5010

ICD-10 Code Set 115

WHO IS AFFECTED??WHO IS AFFECTED??• All inpatient and outpatient facility

visits as well as freestanding providers and ancillary services “that means all of us really” who provide services and bill for them under Medicare, MediCal and private insurances. Current Procedural

• Terminology (CPT) is still used for the Physician and some services, but they must have a diagnosis that is ICD-10 Complaint

116

Benefits Benefits More specific coding system Reflects medical advancements Standardization, UK implemented

in 1995 used worldwide

What do you think? What do you think?

The U.S. is the only industrialized nation that has not yet implemented ICD-10?

True What is the date for implementation of

ICD-1010/1/2013ICD-10-CM has more chapters than ICD-9-

CMTrue ICD10 has 21 chapters while ICD-9-CM

only had 17

ICD-9 vs ICD 10 What are ICD-9 vs ICD 10 What are the differences? the differences? ICD-9 ……•3-5 characters in length•Approximately 14,000 codes•First digit may be alpha (E or V) or numeric•Digits 2-5 are numeric•Always at least three digits•Decimal placed after the first three characters•Limited space for new codes

119

ICD-9-CM DIAGNOSIS CODES ICD-9-CM DIAGNOSIS CODES -2-2Lacks detailLacks laterality, difficult to

analyze, dated, non-specific and does not adequately define diagnoses needed for medical research

Does not support interoperability because it is not used in other countries.

120

ICD-10-CM DIAGNOSIS ICD-10-CM DIAGNOSIS CODES – FORMAT & CODES – FORMAT & STRUCTURESTRUCTURE• 3-7 characters in length• Over 69,000 codes • Digit 1 is always alpha, digit 2 is

always numeric, 3-7 are alpha or numeric

• Decimal placed after the first 3 characters

• All letters used except “U”• Flexible for adding new codes• Very specific• Has laterality

121

ICD-10 STRUCTUREICD-10 STRUCTUREIndex and Tabular list similar to ICD-

9ICD-10 index larger, Categories,

subcategories and codes are contacted in the tabular list.

More combined codes i.e. diabetic retinopathy

More specificity i.e. Alzheimer’s disease with specific details of early or late onset

122

CONVENTIONS FOR THE ICD-CONVENTIONS FOR THE ICD-10-CM10-CMGeneral rules for use of the

classification independent of the guidelines◦Alphabetic Index and Tabular List

Alphabetic Index – List of terms and their corresponding code

Tabular List – chronological list of codes divided into chapters based on body system/condition

123

CONVENTIONS FOR THE ICD-CONVENTIONS FOR THE ICD-10-CM -210-CM -2General rules for use of the

classification independent of the guidelines◦Format and Structure

Three character category that has no further subdivision is equivalent to a code

Subcategories are either 4 or 5 characters

Codes may be 3, 4, 5, 6 or 7 characters

124

CODE FORMATCODE FORMATICD-10 Code Format

125

ICD-9-CM Code Format ICD-10-CM Code Format

                                                      

    

                                                  

                                 

NO MORE V CODES NO MORE V CODES • Former V=codes • are now

Z=codesZ=codes

126

Some of the differences Some of the differences

274 –Gout ICD-10-CM = M10

250 – Diabetes ICD-10-CM= E10 Type 1 E12 Type 2 E13 Other

Aftercare Aftercare Aftercare Z code is not to be used

with injuries. The acute injury code with the

appropriate seventh character (for subsequent encounter)

Let’s take a look Let’s take a look

Aftercare for fracture of right upper arm V54.11Aftercare fracture – code to

fracture with extension D Fracture arm (upper) see also

fracture, humerus, shaft) S42.30 S42.301(right arm) S42.301D (subsequent

encounter for fracture with routine healing)

Right Hip replacement:Now:

V54.81 Aftercare following joint replacement V43.64 Joint replacement, hip

Then: Z47.1 Aftercare following joint replacement surgery Z96.6 Presence of right artificial hip joint

DIABETIC RETINOPATHYNow: 250.50, 362.01

Then: E11.319 Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema

Deep vein thrombosis patient on Coumadin

Now = 453.40, V58.61

Then= I82.409 Could be more specific with laterality Long Term use of Coumadin = Z79.01

Therapy Therapy

ICD-10-CM does not provide a separate code for physical, occupational and speech therapy

You will no longer code admission for rehab services V57

With ICD-10-CM you will only code the pertinent diagnoses

What now?????What now?????Resident admitted for physical

therapy following CABG.

ICD-10-CM codes Z48.812 Aftercare following

surgery (for) (on), circulatory system

Z95.1 Status (post) aortocoronary bypass

Status post Lt BKA. Admitted for dressing changes following resolved infection of the amputation stump

Z48.01 Aftercare, following surgery, attention to dressings, surgical Z89.52 Absence (of) (organ or part) (complete partial), extremity(acquired), lower, below knee

Stage 3 decubitus ulcer to Rt. Ankle with gangrene I96 Gangrene lower extremity L89.513 Decubitus ulcer of Rt. Ankle Stage 3

Late effects of CVA Late effects of CVA I69 = Sequelae of Cerebrovascular

Disease

Admission for OT and PT due to left hemiplegia of non-dominant side secondary to a recent CVA

I69.354 Hemiplegia and hemiparesis following cerebral infarction affecting left nondominant side

Examples Examples • Acute Hepatitis with Hepatic

Coma • ICD-9-CM = 070.41• ICD-10-CM =B17.11

• Alzheimer’s Disease with Behavioral Disturbance

• ICD-9-CM = 331.0, 294.11• ICD-10-CM = F02.81

Examples Examples

Stage 4 pressure ulcer of the sacrum

ICD-9-CM = 707.03 707.24

ICD-10-CM = L89.154

ICD 10 “HAS TWO PARTS”ICD 10 “HAS TWO PARTS”ICD-10 CM = Clinical

ModificationICD-10 PCS = Procedural Code

System (used for procedures, operations within the hospital inpatient setting i.e., acute hospital)

141

ICD-10 has 21 Chapters ICD-10 has 21 Chapters Chapter 1- Certain Infectious &

Parasitic Diseases (A00-B99)Chapter 2-Neoplasms (C00-D49)Chapter 3- Diseases Blood &

Blood Forming Organs & disorders Immune System (D50-D89)

Chapter 4- Endocrine, Nutritional and Metabolic Diseases (E00-E89)

CHAPTERS 5 – 8CHAPTERS 5 – 8Chapter 5 – Mental (F00-F99)Chapter 6 – Diseases of Nervous

System (G00-G99)Chapter 7 – Disease s of Eye and

Adnexa (H00-H59)Chapter 8 – Disease of Ear and

Mastoid (H60-H95)

143

Chapters 9-12Chapters 9-12Chapter 9- Diseases of the

Circulatory System (I00-I99) Chapter 10- Diseases of the

Respiratory System (J00-J99) Chapter 11- Diseases of the

Digestive System (K00-K94) Chapter 12-Diseases of the skin

and Subcutaneous Tissue (L00-L99)

Chapters 13-16Chapters 13-16Chapter 13- Diseases of the

Musculoskeletal System and Connective Tissue (M00-M99)

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

Chapter 15- Conditions Related to Pregnancy and Childbirth (O00-O99)

Chapter 16- Conditions Originating in the Perinatal Period (P00-P96)

Chapters 17-20Chapters 17-20• Chapter 17- Congenital

Malformations, Deformations, & Chromosomal Abnormalities (Q00-Q99)

• Chapter 18- Symptoms, Signs & Abnormal Clinical & Laboratory Findings (R00-R99)

• Chapter 19- Injury, Poisoning & Certain Other Consequences of External Causes (S00-T88)

• Chapter 20- External Causes of Morbidity (V00-Y99)

Chapter 21Chapter 21Chapter 21- Factors Influencing

Health Status & Contact with Health Services (Z00-Z99)

CONVENTIONS FOR THE ICD-CONVENTIONS FOR THE ICD-10-CM -310-CM -3• General rules for use of the

classification independent of the guidelines–7th Characters

• Certain ICD-10-Cm categories have applicable 7th characters

• Required for all codes within the category or as instructed by the notes in the Tabular List

• Must always be the 7th character in the data field• If a code that requires a7th character is not 6

characters, a placeholder X must be used to fill in the empty characters

148

Example Example 7th characters for a fracture - A = initial encounter for fracture - D = Subsequent encounter for fracture with

routine healing - G = Subsequent encounter for fracture with

delayed healing - K = Subsequent encounter for fracture with

non-union - P = Subsequent encounter for fracture with

malunion - S= Sequela

It’s in the details…..It’s in the details…..Coma scale - Eyes open- Best verbal response- Best motor response

CODE STRUCTURE OF ICD-10CODE STRUCTURE OF ICD-10 ICD-10 Codes may consist of up to 7 digits,

with the 7th digit extensions representing visit encounter or sequel for injuries or external causes.

In some cases the place holder “X” will be used to expand the code and accommodate the 7th character

Example: Pathological vertebral fracture due to age

related osteoporosis (Subsequent encounter with delayed healing

M80.808XG

151

ICD-10-CM DIAGNOSIS ICD-10-CM DIAGNOSIS CODES-2CODES-2Specificity improves coding

accuracy and depth of data for analysis

Detail improves the accuracy of data used in medical research

Supports interoperability and the exchange of health care data between other countries and the U.S.

152

ICD-10 NEW FEATURES -2ICD-10 NEW FEATURES -2Added Laterality

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

◦L80.213, Pressure Ulcer of right hip, Stage III

153

LET’S SEE SOME CODESLET’S SEE SOME CODESHypertensive Retinopathy

◦H35.03 Hypertensive Retinopathy◦031-Right eye, 032, left eye, 033,

bilateral,

◦039 unspecified (and this would be a ?? For billing most likely)!!

◦I10, Essential Primary Hypertension

154

ABBREVIATIONSABBREVIATIONS• NEC – “Not elsewhere classifiable• Punctuation

–[ ] Brackets–( ) Parentheses

• Use of “and”• “Other” or “other specified” • “Unspecified”• “Includes Notes”• “Inclusion Terms”

155

ABBREVIATIONS -2ABBREVIATIONS -2• “Excludes Notes”• “Code first”, “Use additional

code” and “elsewhere notes”• “And”, “and” or “or”• “With”• “See”, “see also”• “Code also note”• “Default codes”• “Syndromes”

156

PRINCIPAL DIAGNOSIS -6PRINCIPAL DIAGNOSIS -6Complications of surgery and other

medical care◦ Is sequenced as the principal diagnosis

Uncertain Diagnosis◦ “probable”, “suspected”, “likely”,

“questionable”, “possible”, or “still to be ruled out”, or other similar terms indicating uncertainty, code the condition as if it existed/established

◦ Applicable only to inpatient admissions to short-term, acute, long-term care & psychiatric hospitals

157

FocusFocus

DOCUMENTATION

TIMELINE TIMELINE • 10/01/2011 – Last major update

to ICD-9-CM and ICD10-CM/PCS• 10/01/2012 – Limited changes to

ICD-9-CM and ICD-10CM/PCS• 10/01/2013 ICD-10-CM/PCS

Implemented

References References http://www.cdc.gov/nchs/icd/icd1

0cm.htmhttp://www.cdc.gov/nchs/icd/icd9

cm.htm

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