february, 2013 icd-10-cm/pcs what does it mean to us? lynda starbuck, ms, rhia, c-cdi ahima approved...
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February, 2013
ICD-10-CM/PCSWhat does it mean to us?
Lynda Starbuck, MS, RHIA, C-CDIAHIMA Approved ICD-10-CM/PCS Trainer
ICD-10 TimelineOctober 1, 2011 - Last full update to ICD-9-
CM and ICD-10 (revised with implementation delay)
January 1, 2012 - 5010 electronic claims submission
October 1, 2014 - ICD-10 codes required on all discharges (NEW DATE)
February, 2013
What is Coding Used for?All patient encounters are coded by
Health Information Management coding staff using physician documentation of diagnoses, signs, symptoms, and procedures.
This information is then abstracted onto a billing form and sent to the third party payer for payment of services rendered based on coded data.
February, 2013
February, 2013
ICD-10-CM/PCS What is it?ICD-10-CM
US clinical modification of the World Health Organization’s ICD-10Diagnostic coding system (no procedure codes)
ICD-10-PCSDeveloped under contract by CMS specifically to replace the ICD-9-CM procedural coding system
ICD-10-CM Code StructureAlphanumericUp to 7 charactersPlace holders of “x” are used when code is
5 characters and needs a seventh character code extension
21 chapters and codes are dispersed differently
V and E codes are incorporated into the main code
February, 2013
February, 2013
ICD-10-CM Code ExtensionsCODE
S73.011A– Posterior subluxation, right hip, initial encounter
064.0XX1- Obstructed labor due to incomplete rotation of fetal head, fetus 1 of multiple
MEANING
Initial encounter, subsequent encounter, sequela
Fetus number
February, 2013
ICD-9-CMFull Code Titles
ICD-9-CM
802. Fracture malar, maxillary and zygoma bones- 802.4 Closed- 802.5 Open
ICD-10-CM S02.4
- S02.40 – Fracture of malar, maxillary, and zygoma bones, unspecified- S02.400 Malar Fracture, unspec.- S02.401 Maxillary Fracture, unspecified- S02.402 Zygomatic fracture, unspecified- S02.41 LeFort fracture - S02.411 LeFort I fracture - S02.412 LeFort II fracture - S02.413 LeFort III fracture
February, 2013
New FeaturesCombination codes for conditions and
common symptoms or manifestationsCombination codes for poisonings and
external causesAdded lateralityExpanded codes (injury, diabetes,
alcohol/substance abuse, postoperative complications)
Impending/threatening condition codes
Injuries grouped by anatomical site rather than injury category
Official Coding Guidelines Chapter SpecificInfectious Disease
- Urosepsis is a non-specific term – no reference in the alpha index- Post-procedural infection by procedure
Mental and Behavioral Disorders- Added disorders due to psychoactive substance use
Nervous System and Sense Organs- Hemiplegia/hemiparesis – new rule for
dominant vs. non-dominant sides
February, 2013
Chapter Specific Guidelines continued…Circulatory System
- MI timeframes reduced to 4 weeks vs. 8- Causal relationship assumed between CAD and Angina
Obstetrics- Trimester indicated in code (or weeks of
gestation)- Fetal extension – used to distinguish to
which fetus complication applies
February, 2013
Chapter Specific Guidelines continued…Injuries
- Code extensions used to indicate what phase of care the patient is receiving (initial, subsequent, or sequela)
Adverse effects / Poisonings- Includes under-dosing- Codes indicate how the adverse effect
occurred
February, 2013
February, 2013
ICD-10-PCSCode Structure 1st character is the Section2nd character is the Body System
3rd character is the Root Operation4th character is the Body Part 5th character is the Approach6th character is the Device7th character is the Qualifier
ICD-10-PCS Coding ExamplePTCA with Stent RCA
- Root Term – Dilation= Dilation
- Artery >> Coronary
>> Four or more sites 0273
>> One site 0270>> Three sites 0272>> Two sites 0271
February, 2013
ICD-10-PCS Coding Example… 027 table
February, 2013
ICD-10-PCS Obstetric Delivery- ForcepsExtraction –pulling or stripping out or off
all or a portion of a body part (10D)- Products of Conception (10DO) - Via Natural or Artificial Opening (10DO7)
- No Device (10D07Z)>> Qualifier – Mid Forceps-4ICD-10-PCS Code 10D07Z4
February, 2013
February, 2013
Impact of ICD-10-CM/PCSHospitalsPotentially have the most system
changesAdvantage in added detail (to identify
severity and reduced billing paperwork)Large learning curve for coders (no
Coding Clinic guidance as of Oct.,2013)More physician specificity required –
thus more queriesDRG ‘s / CC’s / MCC’s – have not been
formulated for ICD-10 codes.
February, 2013
IMPACTHealthcare Providers
Non-inpatient facilities including physician offices will only use ICD-10-CM, not ICD-10-PCS
CPT will continue to be used by Part B providers to describe procedures (all outpatient claims)
Physicians will be asked to document specificity and detail
Physicians offices will have to learn ICD-10-CM (diagnosis only)
Training and new materials costRevising Super Bills
Staff Training and PreparationLimited knowledge to Business office,
Registration staff, Radiology, Lab, Unit secretaries, and IT staff who support coding software.
Intermediate knowledge to Hospital Administration, Physicians, Finance, Rehabs, Home Health, Hospice, Case Management, and Outpatient Diagnostic coders
High levels of knowledge to Inpatient coders, Outpatient Surgical Coders, Quality, Chief Medical Officer, Educators, Documentation Improvement Managers, and CDI Staff/Nurses.
February, 2013
Impact of ICD 10 CM/PCSAcute Care HospitalsRequired to use ICD-10-CM and ICD-10-PCSPotentially have the most system changesAdvantage in added detail (to identify severity
and reduce billing paperwork)Coder productivity is predicted to decrease by
1/3 for potentially up to 2 years.Medical Staff will be required to document more
accurately
February, 2013
IMPACT continued…Coding System Changes
- Data trending challenges include maintenance of crosswalks among coding systems for longitudinal data analysis and the potential for faulty decisions due to distorted, inaccurate, or misinterpreted data
Other Healthcare Providers-Non-inpatient facilities including physician offices will only use ICD-10-CM, not ICD-10-PCS-CPT will continue to be used by Part B providers to describe procedures (outpatient claims)
February, 2013
Why ICD 10 Is Worth The TroubleMoving to the new code sets will permit improved efficiencies and
lower administrative costs due to replacement of a dysfunctional classification system. This in turn allows:
Increased use of automated tools to facilitate the coding process Decreased claims submission or claims adjudication costs Fewer rejected and improper reimbursement claims Greater interoperability Decreased need for manual review of health records to meet the
information needs of payers, researchers, and other data mining purposes
Decreased need for large research organizations to maintain dual classification systems (one for reimbursement and one for research)
Reduced coding errors Reduced labor costs and increased productivity Increased ability to prevent and detect healthcare fraud and
abuse
February, 2013
What should we be doing now?Conduct an ICD-10 update once a month in
RAC/UR CommitteeCDI Chart Reviews – early identification of
high-impact areasCreation of Queries for ICD-10 in relation to
top 10-15 DRG’s
February, 2013
References:ICD-10-CM/PCS – The Complete Official
Draft Code Set, Draft 2012MLN Matters/CMSCDI: Improve Documentation Now for
Effective Transition Later – HCPro, Inc. "Why ICD-10 Is Worth the Trouble." Journal
of AHIMA 79, no.3 (March 2008): 24-29.AHIMA ICD-10-CM/PCS Update (2011-2012)Journal of AHIMA (2011 -2013)
February, 2013
Questions?
February, 2013