Real World Experiences with ICD-10:Trips, Traps, and Shifts

Jzanus Consulting Inc. 1

Real World Experiences with ICD-10:Trips, Traps, and Shifts

Eva M. Gregorek, RHIT, CCSSenior Consultant

AHIMA Approved ICD-10-CM/PCS TrainerJzanus Consulting, Inc


• Overview of ICD-10 Shift• Examples• Tools


ICD-10 Shift Project


DRG Shift Project

• A DRG change due to ICD-10-CM/PCS implementation

• Findings are used to evaluate– Financial/case mix impact– Coding education need– Physician documentation gaps

• Coders will experience this when doing dual coding


My Reaction to the First ICD-10 Shift Project


Day 1


Day Two

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&docid=QlzixHWC3igKMM&tbnid=ql84r2ktZZifRM:&ved=0CAUQjRw&url=http://www.unlockingthegrowth.com/2013/11/frustration-quotient/&ei=Ijx9U9fqE4W_sQTU14FA&bvm=bv.67229260,d.aWw&psig=AFQjCNFXHcwxvJPZ2Gi-ejotMvGUQrxoxg&ust=1400802632464975


Day Three


Eventually


DRG Shifts

• Identify why the shift happened– Procedure mapping– Diagnosis mapping– PCS change– Coding Guideline Change– Incorrect ICD-9 DRG • Not really a shift


DRG ShiftExamples


ICD-9 Decompressive Laminectomy

• Spinal Fusion


ICD-10 Decompressive Laminectomy


ICD-10 Spinal Decompression Guidance• Spinal Decompression

• Coding Clinic, Fourth Quarter 2013 Page: 116• New codes contained in this issue effective with discharges October1, 2013. Other coding advice or

code assignments contained in this issue effective with discharges October 21, 2013.

• Question:

• What is the appropriate code assignment for a spinal decompression?

• Answer:

• Spinal decompression is the removal of pressure from the spinal cord. Assign a code for the surgery that is performed to relieve the pressure. For example, if a laminectomy is performed to remove pressure from the spinal cord, assign a code from table 0QB or 0PB based on the Index to Procedures:

• Laminectomy• see Excision, Lower Bones 0QB-• see Excision, Upper Bones 0PB-


ICD-9 Embolization


ICD-10 Embolization


ICD-9 Embolization


ICD-10 Embolization


Spinal Tap ICD-9


Spinal Tap – ICD-10


Placement of Central Venous Catheter– ICD-9


Isolation –ICD-9


Isolation –ICD-10


Opioid Dependence –ICD-9


Drainage of Retroperitoneal abscess–ICD-9


Planning a Positive ICD-10 Experience


• You might need a bigger boat

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&docid=Z36_9ud9NxAJ5M&tbnid=P0edolBc8TQCjM:&ved=0CAUQjRw&url=http://www.thedocumentaryblog.com/index.php/2009/02/25/the-shark-is-still-working-review/&ei=Ni1pU-GhHZDBoASi9oHYCg&bvm=bv.66111022,d.aWw&psig=AFQjCNFp7AK68gr_Pmpz8MNU9GdAjnoHPQ&ust=1399488177116881


Education/Development• ICD-10-CM/PCS training program

– Include payment methodology

• Dual Coding/Review– Peer review– Independent review

• Coding Roundtable– Group discussion about specific cases– Document decisions– Recognize that initial decisions may change– Send questions to Coding Clinic


Education/Development

• Identify opportunities from shift analysis• Invite physicians to any/all of your educational

activities.– The usual suspects in physician documentation• Laterality• Site• Depth of debridement• Specificity in general


Cerebral Infarction

• ICD-9-CM

• Etiology: – Embolism – Thrombosis – Unspecified

occlusion/stenosis

• ICD-10-CM

• Etiology: Same as ICD-9-CM – Embolism – Thrombosis – Unspecified occlusion/stenosis

• Site: – Cerebral artery – Anterior – Middle – Posterior – Cerebellar – Other specified cerebral artery – Unspecified cerebral artery

• Laterality– Right – Left – Bilateral


AsthmaICD-9-CM

Forms – Chronic obstructive – Cough variant – Exercise induced bronchospasm – Extrinsic – Intrinsic – Unspecified

Complications – Acute exacerbation – Status asthmaticus – Unspecified

ICD-10-CM

Forms – Cough variant – Exercise induced bronchospasm – Extrinsic allergic – Idiosyncratic – Intrinsic nonallergic – Other – Unspecified

Severity – Mild intermittent – Mild persistent – Moderate persistent – Severe persistent – Complications – Acute exacerbation – Status asthmaticus – Uncomplicated


Best Effort

Dual Coding Review Non Punitive Feedback/Education/Roundtable

Research/Document Decisions/Follow-up


Research

• It is important to dig in with research. • Attend meetings• Network• Use resources– Coding Clinic– Regulatory– Professional Associations


Example

• Removal of polydactyl• Multiple opinions– Detachment– Repair– Resection– Excision

• Posted question on professional websites including AHIMA Engage Online Community

• Sent to Coding Clinic


Follow-up• DRG shift was identified for a total hip revision that involved ICD-10-PCS codes

0SR9049

• Grouped to MS-DRG 464 - wound debridement and skin graft exc hand, for musculoskeletal connective tissue disease with CC.

• MS-DRG 467 - revision of hip or knee replacement with CC as did the other PCS codes for hip replacement seemed more appropriate

• Checked with various encoders and it to be appeared to be global in nature. Contacted Center for Medicaid and Medicare Services (CMS) ICD-10 Coordination Committee. Informed that it would be included on the next ICD-10 Coordination Committee agenda.

• It wasn’t


Coder responsibilities

• Identify how many hats coders are wearing.– Deficiency Analysis– Filing– Registry– Birth certificates– Charges/billing– Phone duty

• Validate and take action.– Delegate to other staff

or department– Eliminate the issue


Identification without validation or action


Just because!


A well balanced 2 hat coder


Other helpful hints

• Ancillary procedure coding– What needs to be coded– Why is it being coded– Who is using the data

• Work setting


Other helpful hints

• Queries–Develop or convert templates– http://journal.ahima.org/2013/02/01/physician-

query-examples/

• Tools– Encoder– Publications


So you need a bigger boat

• Temporary vs permanent staff

• Consultants

• Mentor new professionals

• Be creative


Resources

• www.ahima.org• www.munsonhealthcare.org/icd10/tips• www.cms.gov

http://www.ahima.org/

http://www.cms.gov/


Thank you

• Contact information– Phone 518-649-2151– Email – [email protected]

Real World Experiences with ICD-10:Trips, Traps, and Shifts

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