Kay Potter, RHIT, CPC, CPC-I, PCS

*Guidelines Most Significantly Affected Under ICD-10-CM

*Tips And Resources

*ICD – 10*Keep Calm

*And

*Code On!

Official ICD 10 Guidelines

*Objectives:

*In this section you will learnReview the basic structure of ICD-10-CM

and differences/similarities to ICD-9-CM.

Describe updates to the ICD-10-CM system

Analyze changes to ICD-10-CM Official Guidelines for Coding and Reporting

*Key Point

*NCHS is responsible for developing the diagnostic portion of the ICD-10 coding system, ICD-10-CM.

*CMS is responsible for developing the procedure portion of the ICD-10 coding system, ICD-10-PCS.

*Who is NCHS? National Center for Health Statistics compiles statistical information used to guide actions and policies to improve the public health U.S. citizens.

*

*ICD-10 Code Set Draft Format

*Implementation date October 1, 2014

*Partial Code Freeze

*October 1, 2011 – Last regular update to ICD-9-CM

*October 1, 2012 – 2013 – Limited updates to both ICD-(-CM and ICD-10-CM

*October 1, 2014 – Limited updates to ICD-10-CM, ICD-9-CM no longer used.

*October 1, 2015 – Regular Updates to ICD-10-CM/PCS.

*ICD-10-CM Diagnosis Codes

*To be used in all settings*Hospital inpatients

*Hospital outpatients

*Physicians offices

*Emergency offices

*Home Health

*Long Term Care

*Rehabilitation Facilities

*For ANY diagnosis anywhere

*Advantages of ICD-10

*As additional detail is to be reported with ICD-10-CM, more detail will be required in the medical records from which the data for coding are extracted.

*For payers, the clarity afforded by the ICD-10-CM coding system is likely to greatly enhance and assist in supporting medical necessity.

*With ICD-10-CM, the diagnosis comes significantly closer to being “married” to the procedure; further, it intrinsically gives a more complex description of the condition, thereby leaving less room for denials.

*A Review of the Basics

*21 chapters and expanded codesSome chapters reorganized, some conditions put in to

different chaptersAlphanumeric – first character is always a letterAddition of up to 7 characters7th character code extensions in some cases

InjuriesInitial encounterSubsequent encounterSequela

Obstetrics Glaucoma

*Why so Many More Codes?

*Laterality

*__ Example: Acute angle closure glaucoma* ICD-9-CM 365.22

* ICD-10-CM H40.211 Right eyeH40.212 Left eye

H40.213 Bilateral

H40.214 Unspecified eye

Increased Specificity External Cause Codes

*What is Different in ICD-10-CM

• Alphanumeric

• Alpha characters are not case sensitive

• I and O are used but only as the 1st character

• U is not used – saved for the International version

• Restructured chapters E.g. injuries by site and then by type

• Increased specificity and detail E.g. laterality – as described

• Combination codes E.g. – Diabetes, Angina, and CAD

* The Good News – What is the SAME in ICD-10-CM

Many of the guidelines are exactly the same between ICD-9-CM and ICD-10-CM

Conventions Format of the Index and Tabular List

Abbreviations and Punctuation NEC, NOS, brackets, and colons etc.

Steps in assigning codes

Includes notes

General coding guidelines

* Some Differences – Conventions and General Guidelines

Conventions, general coding guidelines and chapter specific guidelines

X as a placeholder

7th character

Excludes Notes

-- Excludes 1 – not coded

-- Excludes 2 – not included here

General Coding Guidelines

Late Effects is now a Sequela

Laterality

*Documentation Needs

*The diagnosis coding system (ICD-10-CM) will affect both hospital and physician providers .

*In creating the clinical modification for ICD-10 in this country, the National Center for Hospital Statistics has made significant changes.

*The number of diagnostic codes available for use in the ICD-10-CM coding system is larger than the number available in ICD-9-CM by thousands.

*Documentation Needs

*The documentation principles and concepts, may apply to documentation considerations created by the impact of both systems.

*ICD-10-CM will pose certain significant challenges to coders in both physician and facility settings.

*As additional detail is to be reported with ICD-10-CM, more detail will be required in the medical records from which the data for coding are extracted.

*Coding Tip

*Never code strictly from the alphabetical index, always confirm your code choice in the tabular list to insure the most appropriate code choice selection.

*ICD 10 has 21 Chapters

*Alphabetic Index

*The alphabetic Index is divided into sections and is organized by main terms

*Index of Diseases and Injury

*Index of External Causes of Injury

*Table of Neoplasms

*Table o Drugs and Chemicals

*Terms

*Data Granularity

*Degree or detail contained in data; the fineness in which data fields are subdivided.

*The increased granularity, or in other words, the greater level of detail afforded by ICD-10 provides the quality data needed to support the medical necessity of rendering patient care, improving clinical outcomes, and improve cost-effective disease management.

*Terms

*Combination Code – The term represents a single code used to classify: two diagnoses, either a diagnosis with an associated sign or symptom or a diagnosis with an associated complication.

* IMPORTANT—Multiple codes should not be used when the classification provides a combination code that clearly identifies all of the elements documented in the diagnosis.

*Terms

*Granularity – The term refers to the level of hierarchy and the amount of information the increased hierarchy provides to the diagnostic description

*Laterality – ICD-10 code description include right or left designation.

* The right side is usually character 1,

* Left side character 2.

* Bilateral character is usually 3.

* Unspecified side is either a character 0 or 9, depending on whether it is a fifth or sixth character.

*New – placeholder “X” if the code only has 4 or 5 characters, but needs a 7th character (e.g., initial/subsequent/sequela to injury), use an “X” in the blank spaces

*Different – Exclude 1 (never code it here) and Exclude 2 (not included, if he has that code it separately

*New – Laterality

*New – Coding pregnancy trimesters

*New – Glasgow coma scale

*New – Functional quadriplegia

*What you can

do

*Be detailed in your diagnostic documentation:

*Identify laterality

*Identify specific site, anatomical location.

*ICD-10-CM Specific Guidelines for Selected

Chapters

*Thank you for Supporting

*AHIMA!