2010 ubo/ubu conference health budgets & financial policy 1 briefing: icd-10-cm (international...

2010 UBO/UBU Conference

Health Budgets & Financial Policy

1

Briefing: ICD-10-CM(International Classification of Diseases – 10th Revision – Clinical Modifications)A Piece of Cake

Date: 23 March 2010

Time: 1400–1450

2010 UBO/UBU ConferenceTurning Knowledge Into Action Pre-Quiz

Quiz – jot down your answers 1. ICD-10-CM is

– a. ICD-9-CM where they replaced the three digit categories with three digit alpha-numeric categories to have more space

– b. Pretty much volumes 1 and 2 of ICD-9-CM (volume 3 is now ICD-10-PCS)

– c. Mapped to ICD-9-CM with about 95% of the codes being a one-to-one mapping

– d. All of the above

2


2. When you think “Personal History of” you think – – a. V10 – Personal History of malignant neoplasm, through V15

Other Personal History Presenting Hazard to Health– b. V86 Estrogen Receptor Status – c. V87 Other specified personal exposures and history

presenting hazards to health– d. V88 Acquired absence of other organs and tissue– e. Both a and c even though they are not in the same place –

this just makes coding more challenging!

3


3. The coding guidelines for ICD-10-CM (e.g., assign all the digits available) are– a. Are pretty much the same as for ICD-9-CM.– b. Are pretty much the same as for ICD-8-A.– c. Are pretty much the same as for ICD-7.– d. Are pretty much the same as for ICD-6.– e. All of the above.

4


4. The ICD-9-CM codes are being “frozen” (will not change, no additions/deletions) in 2012 because

– a. There is so much automation and all those programs need to have all the code numbers for the various conditions changed, tested, fixed, tested…

– b. To give coders an entire year to goof off claiming they were studying VERY hard to understand the ICD-10-CM.

– c. Because the cost of gasoline had gone up to $5/gallon and those of us driving up from Washington to Baltimore for the Coordination and Maintenance Meetings wanted a break for an entire year.

– d. Because we knew Washington DC was going to get 30+ inches of snow in one week and we wanted all the coders to know how to spell “frozen” before December 2009 and February 2010.

5


5. The General Equivalency Mappings (GEMs) don’t have a one-for-one mapping because

– a. Some few medical concepts have changed so the ICD-10-CM reflects the thought process of the current medical understanding.

– b. ICD-10-CM has expanded some concepts so it may have five codes while ICD-9-CM only has one code.

– c. If there was a one-for-one mapping to ICD-9-CM from ICD-10-CM, and a one-for-one mapping to 10 from 9, why bother with ICD-10?

– d. All of the above.– e. None of the above.

6


6. I plan to get ready for the new codes:– a. On 1 Oct 2013 and not a second before.– b. When I take the Oct 2013 AHIMA CCS-P quiz I will borrow a

book and hope for the best.– c. I’d be willing to attend teleclasses for a few weeks prior so

long as they let me do it from work– d. What – you silly goose, who actually believes the MHS will be

ready on 1 Oct 2013, they can’t even get the new codes out until Jan/Feb/Mar on a normal year – I’m sticking with the MHS and plan never to have to learn the new codes

– e. Other:

7

2010 UBO/UBU ConferenceTurning Knowledge Into Action Objectives

Know that ICD-10-CM transition will be easy for coders Understand the General Equivalency Mappings Know the coding guidelines for ICD-10-CM

8

2010 UBO/UBU ConferenceTurning Knowledge Into Action ICD-10-CM

Why How – Direct Care

– Issue: CAPER (Comprehensive Ambulatory/Professional Encounter Record) diagnosis field is only 7 characters

– Issue: SIDR (Standard Inpatient Data Record) diagnosis field is only 8 characters

– Issue: AHLTA (Armed Forces Healthcare Longitudinal Tracking Application)

– Issue: CCE (Coding Compliance Editor)– Issue: All the other direct and purchased care MHS (Military

Healthcare System) systems/programs using ICD codes Training Proposal Development

– Coders– Providers– Data Analysts

9

2010 UBO/UBU ConferenceTurning Knowledge Into Action

Difference Between ICD-10-CM,ICD-10-PCS and ICD-9-CM

International Classification of Diseases – 9th Revision – Clinical Modifications (ICD-9-CM)– Developed in USA in 1970s based on the World

Health Organization’s ICD-9Based on ICD-8, and ICD-8a

– Clinical Modifications (CM) is the United States’ version

Added to WHO ICD-9:– External Causes of Injury– Factors Influencing Health– Volume 3, Institutional Procedure Coding

10


ICD-10-Clinical Modifications is for use in the United States– Other countries use modifications specific to their

country, such as ICD-10-CA for Canada and ICD-10-AM for Australia

ONLY: – Diagnoses, – Factors Influencing Health, and – External Causes of Injury

Does not include procedures as did ICD-9-CM – No third volume– See ICD-10-Procedure Classification System

Currently used for cause of death reporting in the United States

11


Available for download from:– http://www.cdc.gov/nchs/icd/icd10cm.htm#10update

At the bottom of the page A bit easier and less expensive than going to Ingenix

and buying it on disc for $119.00 Would recommend buying one book every other year

until 2013 as they are much easier to work with The downloads are nice for a quick word search

12

2010 UBO/UBU ConferenceTurning Knowledge Into Action ICD-10-CM Is Better Due To

Addition of information relevant to ambulatory and managed care encounters– Expanded injury codes

Creation of combination diagnosis/symptom codes to reduce the number of codes needed to fully describe a condition

Addition of a sixth character for some codes Incorporation of common 4th and 5th digit

subclassifications Laterality; and Greater specificity in code assignment for many codes. The new structure will allow further expansion than was

possible with ICD-9-CM.

13


“Piece of Cake” for anyone who can code using ICD-9-CM– Same basic guidelines– Same basic layout/organization– Same basic index– Same basic tabular– Some codes are more detailed– Some codes indicate initial or subsequent encounter– Format – alpha + 2 numerics + decimal point + numeric+3

alphanumerics H66.9 Otitis media, unspecified

– Otitis media NOS – Acute otitis media NOS – Chronic otitis media NOS

H66.90 Otitis media, unspecified, unspecified ear H66.91 Otitis media, unspecified. right ear H66.92 Otitis media, unspecified, left ear H66.93 Otitis media, unspecified, bilateral

14

2010 UBO/UBU ConferenceTurning Knowledge Into Action Review of Existing Code Formats

ICD-9-CM diagnoses (look for the decimal point)– 3-5 numeric characters with decimal point after the 3rd – External cause of injury Exxx.x– Factors influencing health Vxx.xx

ICD-9-CM procedure (look for the decimal point)– Numeric xx.xx

CPT – 5 numeric, or 4 numeric with terminal F or T (no decimal point)

HCPCS – alpha with 4 numeric (no decimal point) – does not currently use F or T

15

2010 UBO/UBU ConferenceTurning Knowledge Into Action ICD-9-CM Comparison to ICD-10-CM

ICD-9-CM ICD-10-CMChapter

Title Category Range

Chapter Title Category Range

I Infectious and parasitic diseases 001-139 I Certain infectious and parasitic diseases A00-B99

II Neoplasms 140-239 II Neoplasms C00-D48III Endocrine, nutritional and metabolic

diseases and immunity disorders240-279 III Diseases of the blood and blood-forming

organs and certain disorders involving the immune mechanism

D50-D89

IV Diseases of blood and blood-forming organs

280-289 IV Endocrine, nutritional and metabolic diseases

E00-E90

V Mental disorders 290-319 V Mental and behavioral disorders F00-F99VI Diseases of the nervous system and

sense organs320-389 VI Diseases of the nervous system G00-G99

VII Diseases of the circulatory system 390-459 VII Diseases of the eye and adnexa H00-H59VIII Diseases of the respiratory system 460-519 VIII Diseases of the ear and mastoid process H60-H95IX Diseases of the digestive system 520-579 IX Diseases of the circulatory system I00-I99X Diseases of the genitourinary

system580-629 X Diseases of the respiratory system J00-J99

XI Complications of pregnancy, childbirth and the puerperium

630-676 XI Diseases of the digestive system K00-K99

XII Diseases of the skin and subcutaneous tissue

680-709 XII Diseases of the skin and subcutaneous tissue

L00-L99

16

2010 UBO/UBU ConferenceTurning Knowledge Into Action ICD-9-CM Comparison to ICD-10-CM

ICD-9-CM ICD-10XIII Diseases of the musculoskeletal

system and connective tissue710-739 XIII Diseases of the musculoskeletal system

and connective tissueM00-M99

XIV Congenital 740-759 XIV Diseases of the genitourinary system N00-N99XV Certain conditions originating in the

perinatal period760-779 XV Pregnancy, childbirth and the puerperium O00-O99

XVI Symptoms, signs and ill-defined conditions

780-799 XVI Certain conditions originating in the perinatal period

P00-P99

XVII Injury and Poisoning 800-999 XVII Congenital malformations, deformations and chromosomal abnormalities

Q00-Q99

No # External causes of injury and poisoning

E800-E999

XVIII Symptoms, signs and abnormal clinical and laboratory findings, NEC

R00-R99

No # Factors influencing health status and contact with health services

V01-V82 XIX Injury, poisoning and certain other consequences of external causes

S00-T98

XX External causes of morbidity and mortality V01-Y98

XXI Factors influencing health status and contact with health services

Z00-Z99

XXII Codes for special purposes U00-U99

17

2010 UBO/UBU ConferenceTurning Knowledge Into Action Sample of Downloaded Index

18

2010 UBO/UBU ConferenceTurning Knowledge Into Action The Tabulars

ICD-9-CM 001 Cholera

– 001.0 Due to Vibrio cholerae– 001.1 Due to Vibrio cholerae el tor– 001.9 Cholera, unspecified

002 Typhoid and paratyphoid fevers

ICD-10-CM A00 Cholera

– A00.0 Cholera due to Vibrio cholerae 01, biovar cholerae (classical cholera)

– A00.1 Cholera due to Vibrio cholerae 01, biovar eltor (cholera eltor)

– A00.9 Cholera, unspecified A01 Typhoid and paratyphoid fevers

19

2010 UBO/UBU ConferenceTurning Knowledge Into Action The Tabular – Example J00 (Currently 460)

Excludes1 = NOT CODED HERE (both conditions cannot occur at same time

Excludes2 = Not included in this diagnosis, if it is there, code them both

20

2010 UBO/UBU ConferenceTurning Knowledge Into Action ICD-9-CM vs ICD-10-CM Tabular

ICD-9-CM

8. Diseases of the Respiratory System (460-591)

Acute Respiratory Infections (460-466)

460 Acute nasopharyngitis [common cold]

ICD-10-CM

Chapter X – Diseases of the Respiratory System (J00-J99)

Acute Upper Respiratory Infections (J00-J06)

J00 Acute nasopharyngitis [common cold]

21


Morbidity classification – Includes potentially fatal conditions– Treatable

For use in – Hospitals; acute short-term, long-term – Provider office– Other outpatient settings

22

2010 UBO/UBU ConferenceTurning Knowledge Into Action Benefit to the MHS

Ability to – Collect more detailed information– Compare morbidity data to mortality data– Compare to international data– Collect some laboratory results (e.g., blood alcohol

levels and ABO blood types)

23


Ability to collect concepts such as – “Do Not Resuscitate” – Initial versus subsequent encounters– Right, left, bilateral– First, second, third trimester– Identification of fetus in multiple gestations– Classifications of fractures– Dominate versus non-dominate side– Burns separated based on heat or chemical– Cesarean delivery without medical indication

24


Better data on which to base decisions Easier to pull records with criteria needed for a specific

study Expandable, more space for new conditions More detailed external causes of injury

– e.g., Y93.5B Cellular telephone usage in work-related activity

25

2010 UBO/UBU ConferenceTurning Knowledge Into Action Example of Expanded Code Set

F10.2 Alcohol dependence – Excludes1: alcohol abuse (F10.1-) – alcohol use, unspecified (F10.9-) – Excludes2: toxic effect of alcohol (T51.0-) – F10.20 Alcohol dependence, uncomplicated – F10.21 Alcohol dependence, in remission – F10.22 Alcohol dependence with intoxication

– Acute drunkenness (in alcoholism) Excludes1: alcohol dependence with withdrawal (F10.23-)

– F10.220 Alcohol dependence with intoxication, uncomplicated – F10.221 Alcohol dependence with intoxication delirium – F10.229 Alcohol dependence with intoxication, unspecified

– F10.23 Alcohol dependence with withdrawal Excludes1: Alcohol dependence with intoxication (F10.22-)

– F10.230 Alcohol dependence with withdrawal, uncomplicated – F10.231 Alcohol dependence with withdrawal delirium – F10.232 Alcohol dependence with withdrawal with perceptual disturbance – F10.239 Alcohol dependence with withdrawal, unspecified

– F10.24 Alcohol dependence with alcohol-induced mood disorder – F10.25 Alcohol dependence with alcohol-induced psychotic disorder

– F10.250 Alcohol dependence with alcohol-induced psychotic disorder with delusions – F10.251 Alcohol dependence with alcohol-induced psychotic disorder with hallucinations – F10.259 Alcohol dependence with alcohol-induced psychotic disorder, unspecified

– F10.26 Alcohol dependence with alcohol-induced persisting amnestic disorder – F10.27 Alcohol dependence with alcohol-induced persisting dementia – F10.28 Alcohol dependence with other alcohol-induced disorders

– F10.280 Alcohol dependence with alcohol-induced anxiety disorder – F10.281 Alcohol dependence with alcohol-induced sexual dysfunction – F10.282 Alcohol dependence with alcohol-induced sleep disorder – F10.288 Alcohol dependence with other alcohol-induced disorder

– F10.29 Alcohol dependence with unspecified alcohol-induced disorder

26

2010 UBO/UBU ConferenceTurning Knowledge Into Action Example of New Code Set

O35 Maternal care for known or suspected fetal abnormality and damage – Includes: the listed conditions in the fetus as a reason for hospitalization or other obstetric

care to the mother, or for termination of pregnancy – Code also any associated maternal condition – Excludes1: encounter for suspected maternal and fetal conditions ruled out (Z03.7-) – One of the following 7th characters is to be assigned to each code under category O35. 7th

character 0 is for single gestations and multiple gestations where the fetus is unspecified. 7th characters 1 through 9 are for cases of multiple gestations to identify the fetus for which the code applies. The appropriate code from category O30, Multiple gestation, must also be

ICD-10-CM Tabular Page 1025 2010 – assigned when assigning a code from category O35 that has a 7th character of 1 through 9.

0 not applicable or unspecified 1 fetus 1 2 fetus 2 3 fetus 3 4 fetus 4 5 fetus 5 9 other fetus

– O35.0 Maternal care for (suspected) central nervous system malformation in fetus – O35.1 Maternal care for (suspected) chromosomal abnormality in fetus – O35.2 Maternal care for (suspected) hereditary disease in fetus – O35.3 Maternal care for (suspected) damage to fetus from viral disease in mother – O35.4 Maternal care for (suspected) damage to fetus from alcohol – O35.5 Maternal care for (suspected) damage to fetus by drugs – O35.6 Maternal care for (suspected) damage to fetus by radiation – O35.7 Maternal care for (suspected) damage to fetus by other medical procedures – O35.8 Maternal care for other (suspected) fetal abnormality and damage – O35.9 Maternal care for (suspected) fetal abnormality and damage, unspecified

27

2010 UBO/UBU ConferenceTurning Knowledge Into Action Example of New Data Collection

R40.2 Coma – Coma NOS; Unconsciousness NOS – Codes first any associated:

coma in fracture of skull (S02.-) coma in intracranial injury (S06.-)

– The appropriate 7th character is to be added to each code from subcategory R40.21-, R40.22-, R40.23-:

0 unspecified time 1 in the field [EMT or ambulance] 2 at arrival to emergency department 3 at hospital admission 4 24 hours or more after hospital admission

– A code from each subcategory is required to complete the coma scale – Note: These codes are intended primarily for trauma registry and research

use but may be utilized by all users of the classification who wish to collect this information

R40.20 Unspecified coma – R40.21 Coma scale, eyes open – R40.211 Coma scale, eyes open, never – R40.212 Coma scale, eyes open, to pain – R40.213 Coma scale, eyes open, to sound – R40.214 Coma scale, eyes open, spontaneous

28

2010 UBO/UBU ConferenceTurning Knowledge Into Action Coma

R40.22 Coma scale, best verbal response – R40.221 Coma scale, best verbal response, none – R40.222 Coma scale, best verbal response,

incomprehensible words – R40.223 Coma scale, best verbal response, inappropriate

words – R40.224 Coma scale, best verbal response, confused

conversation – R40.225 Coma scale, best verbal response, oriented

R40.23 Coma scale, best motor response – R40.231 Coma scale, best motor response, none – R40.232 Coma scale, best motor response, extension – R40.233 Coma scale, best motor response, abnormal – R40.234 Coma scale, best motor response, flexion

withdrawal – R40.235 Coma scale, best motor response, localizes pain – R40.236 Coma scale, best motor response, obeys

commands

29

2010 UBO/UBU ConferenceTurning Knowledge Into Action Coding Guidelines

Same – Look it up in the alphabetic, then check in the tabular

Same – Abbreviations Same – Punctuation Same – use of “and,” “with,” “see,” “see also” Same – other and unspecified codes Same – includes notes and inclusion terms Same – etiology/manifestation (code first, use additional

code, in disease classified elsewhere) Same – must use all available characters Same – conditions that are or are not an integral part of

the disease process

30


Same – Acute and Chronic conditions Same – Late Effects (sequela) Same – Human Immunodeficiency Virus (HIV) coding Same – Treatment directed at malignancy Same – Treatment of secondary site of maligancy Same – Primary malignancy previously excised Same – Admission/Encounter for chemo Same – Hypertension Same – Acute myocardial infarction Same – Coding Pathologic Fractures…

31


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 – Exclude1 (never code it here) and Exclude2 (not included, if he has that code it separately)

New – Laterality New – Coding pregnancy trimesters New – Glasgow coma scale New – Functional quadriplegia

32

2010 UBO/UBU ConferenceTurning Knowledge Into Action Review ICD-10-CM

Diagnoses, not procedures Very similar to ICD-9-CM diagnoses, volumes 1 and 2

(diagnosis index and tabular) Up to 7 alphanumeric characters

BOTTOM LINE: If you can code with ICD-9-CM, you can easily

transition to ICD-10-CM

33


34

Summary

MHS is working on the transition The transition will be most difficult for the soft-ware

programs ICD-10-CM is much better than ICD-9-CM Coders will not have a problem transitioning from ICD-9-

CM to ICD-10-CM.


35

Quiz

Take the quiz again =-)


36

Q&A

Questions? Training

– Who needs ICD-10-CM training?– When (e.g., 2 months prior)?– Intensity (e.g., 1 hour teleclass a day with 1 hour a

day at work to do the assigned lessons)?– Format (e.g., train-the-trainer to come back to work to

train you, teleclasses, one REALLY large class [400 students in an auditorium], good teacher sent to each site for a week)?

2010 ubo/ubu conference health budgets & financial policy 1 briefing: icd-10-cm (international...

Documents