ICD-10Getting There…..

Radiology

What Physicians Need To Know

• Claims for ambulatory and physician services provided on or after 10/1/2015 must use ICD-10-CM diagnosis codes.

• Hospital inpatient claims for discharges occurring on or after 10/1/2015 must use ICD-10-CM diagnosis codes.

• CPT Codes will continue to be used for physician inpatient and outpatient services and for hospital outpatient procedures.

• ICD-10-PCS – a NEW procedure coding classification system, must be used to code all inpatient procedures on Facility Claims for discharges on or after 10/1/15.

• ICD-9-CM codes must continue to be used for all dates of services on or before 9/30/2015.

• Further delays are not likely.

ICD-9 vs ICD-10 Diagnosis Codes

ICD-9-CM Diagnosis Codes ICD-10-CM Diagnosis Codes

3 to 5 digits 7 digits

Alpha “E” & “V” – 1st Character Alpha or numeric for any character

No place holder characters Include place holder characters (“x”)

Terminology Similar

Index and Tabular Structure Similar

Coding Guidelines Somewhat similar

Approximately 14,000 codes Approximately 69,000 codes

Severity parameters limited Extensive severity parameters

Does not include laterality Common definition of laterality

Combination codes limited Combination codes common

Number of Codes by Clinical Area

Clinical Area ICD-9 Codes ICD-10 Codes

Fractures 747 17,099

Poisoning and Toxic Effects 244 4,662

Pregnancy Related Conditions 1,104 2,155

Brain Injury 292 574

Diabetes 69 239

Migraine 40 44

Bleeding Disorders 26 29

Mood Related Disorders 78 71

Hypertensive Disease 33 14

End Stage Renal Disease 11 5

Chronic Respiratory Failure 7 4

Right vs. left

accounts for nearly ½

the increase in the #

of codes.

ICD-10-CM EnhancementsLocation and Laterality

ICD-9-CM Code Choices ICD-10 Code Choices

Cellulitis of upper arm and forearm. • Cellulitis of right axilla• Cellulitis of left axilla• Cellulitis of right upper limb• Cellulitis of left upper limb• Cellulitis of unspecified part of limb

250.61Type I Diabetes with

Neurological Manifestations

357.2Diabetic Polyneuropathy

E10.42Type I Diabetes Mellitus

with Diabetic Polyneuropathy

ICD-10-CM EnhancementsCombination Codes

ICD-10-CM EnhancementsAcuity, Type and Circumstances

Acuity Type Circumstances

• Acute• Chronic• Acute on Chronic

• Left Ventricular• Systolic• Diastolic• Combined

• Following Surgery• Due to Hypertension• Due to Chronic Kidney Disease

For example, a patient with dyspnea

referred for a chest x-ray to rule out

congestive heart failure.

Information Needed Required ICD-10 Documentation

• How did the injury occur?• What type of injury was sustained?• What activity was taking place?• When did the injury occur in

relation to this encounter?• Where was the patient when the

injury occurred?• Why was the activity happening?

32-year-old female S/P external fixation right displaced pilon fracture due to jumping from her second story bedroom window in a suicide attempt. Fracture shows nonunion four weeks post op.

Here for additional surgical intervention.

ICD-10-CM EnhancementsCircumstances Surrounding Injuries

For example, fracture

resulting from suicide

attempt.

Anemia Cardiomyopathy Headache

• Nutritional• Hemolytic• Aplastic• Blood Loss

• Dilated/Congestive• Obstructive

Non-obstructive• Endomyocardial fibrosis

• Cluster• Tension• Post-traumatic• Drug-induced

ICD-10-CM EnhancementsType

The specific type of a patient’s disease may

impact treatment and medical necessity for

services rendered.

DIABETES COPD CANCER ARTHRITIS

• Skin Ulcers• Gout• Kidney

Disease• PVD• Eye Problems

• Malnutrition• Pneumonia• Musculoskeletal

Changes• CHF

• Anemia• Depression• Malnutrition• Thrombosis

• Lung Disease• Heart Disease• Skin Problems• Sickle Cell

Disease• Hypothyroidism

ICD-10-CM EnhancementsUnderlying and Associated Conditions

Accurate and complete documentation

includes underlying or associated conditions

and their impact on diagnostic findings.

Major Changes in ICD-10-CM

Acuity

Circumstances Surrounding Injuries

Combination Codes

Identification Affected Fetus

Laterality

Site

Trimester

Type

Underlying and associated Conditions

ICD-10-CM EnhancementsSpecificity and Granularity

Using Sign/Symptom and Unspecified Codes

• Sign/symptom and “unspecified” codes have acceptable, even necessary, uses.

• If a definitive diagnosis has not been established by the end of the encounter, it is appropriate to report codes for signs and/or symptoms in lieu of a definitive diagnosis.

• When sufficient clinical information is not known or available about a particular health condition, it is acceptable to report the appropriate “unspecified” code.

• It is inappropriate to select a SPECIFIC code that is not supported by the medical record documentation.

Training for Physicians

Dates Method Content

Nov 2014 – Jan 2015 Department Meetings

Introduction/Overview

Jan 2015 – Mar 2015 Web-based OverviewService Specific DocumentationFuture Order EntryDiagnosis Assistant

Mar 2015 – Jun 2015 Classroom Documenting for ICD10 using the Electronic Health Record

Jun 2015 – Sep 2015 Web-based OverviewDocumenting Operative and Procedure Notes for ICD-10-PCS

Future Orders & Diagnosis Assistant

Demonstration