ICD-9-CM Coding for

Post Acute Care

Presented by:

Lizeth Flores, RHIT, RAC-CT Anderson Health Information Systems,

Inc.

Objectives

• Participants will :• Correctly assign ICD-9-CM codes to diagnoses• Correctly identify primary / Secondary diagnoses • Identify correct sequence of diagnoses for coding

assignment • Identify difference between ICD-9-CM and ICD-10• Learn ICD-10 transition timeline

Purpose of ICD-9-CM Coding

• Gather statistical data• Reporting diagnoses and provides a method

for sequencing diagnosis to support billing transactions / reimbursement

• Ensure compliance with Federal Reporting Standards for diagnoses

• Provide insight into the types of residents and conditions

• Health Research

ICD-9-CM Official Guidelines for Coding and Reporting

• HIPAA • www.cdc.gov/nchs/icd.htm• Latest revision October 1, 2011

Post Acute Care

• Skilled Nursing Facility (SNF) • Inpatient Rehab Facility (IRF) • Home Health Agency (HHA) • Long Term Acute Care Hospital (LTACH)

ICD-9-CM Coding book

• Disease and Procedures (Books 1-3)• Alphabetical/Tabular (numeric) Index

Assigning Code Numbers

• Both the Alphabetic Index and the Tabular List must be used when locating and assigning a code.

• Do not rely on just one since this can lead to errors in code assignment and a less specific code selection

How to Select Codes

• Locate each main term and sub term in the alphabetical index, i.e., Chronic Kidney Disease 1. Disease 2. Kidney 3. Chronic

• Verify the code selected in the Tabular list• Read and be guided by instructional notations

that appear in both the Alphabetic Index and the Tabular List

Code to the Highest Level of Specificity

• Assign 3 digit codes only if there are no four digit codes within the category.– There are only 100 codes with only 3 digits

• Assign 4 digit codes only if there is no fifth digit.

• Assign 5 digit codes when indicated.• Samples – 486, 401.x, 250.xx

Types of Codes used in post acute care Settings

• Aftercare – used when the initial treatment of a disease or injury has been performed and the patients still requires continued care to heal or recover. Categories V51-V58

• Late Effects – a late effect is a residual condition that remains and requires medical evaluation, rehab treatments and/or nursing care after the initial illness or injury.

Types of Codes -2

• Chronic Conditions – Conditions that are stable but still require management or treatment.

• Acute Conditions –acute care codes should only be reported until the condition is resolved.

• Therapy – Physical, occupational, speech and respiratory therapy.

Types of Codes -3

• History of – (Hx) – history codes are acceptable on any Medical record regardless of reason for admission/encounter.

• A history code is distinct from a “status” code in that history codes indicate that the patient no longer has the condition and “status” codes indicated a present state.

• There are two types of history V-codes, personal and family.

Examples • Status post upper arm fracture • V54.11

• History of frequent falls • V15.88

• Admission for physical therapy following hip fracture • V57.1 , V54.13

Practice #1 (cont.)

• Hemiplegia following due to recent CVA

• Total Hip Replacement

• Acute UTI treated with Cipro.

• Dementia

• Late Effect

• After Care

• Acute Condition

• Chronic Condition

What to code?

ALL CONDITIONS THAT EXIST AT THE TIME OF ADMISSION, THAT EFFECT TREATMENT

RECEIVED

Do NOT Code

DIAGNOSES THAT DO NOT AFFECT TREATMENT OR LENGTH OF STAY

• WHEN CONDITION NO LONGER EXISTS• DO NOT ASSIGN PROCEDURE CODES• Examples: Fractured forearm 6 years ago,

pneumonia, UTI that were resolved (these will only be coded if the Resident is admitted with Antibiotics)

Definition of Principal Diagnosis

• “FIRST LISTED DIAGNOSES” is the diagnosis that is chiefly responsible for the admission to the facility and the diagnosis that supports the reimbursement and should be sequenced first.”

Locating Diagnoses

• Transfer Records• History & Physical• Progress Notes• Admission Orders

Additional Sources of Information

• Discharge summary• Transfer documentation, • Surgical reports• Consultations• Physician Progress notes • Lab reports and radiological studies

Locating Principal Diagnosis

Principal Diagnosis

• When two or more inter-related conditions potentially meet the definition of principal diagnosis– Either may be sequenced first unless therapy is

being provided, the Tabular list or Alphabetic Index indicate otherwise.

– Inter-related conditions – two or more diagnosis that equally meet the definition of principal diagnosis.

Example

• Resident admitted with Pneumonia and UTI – either can be used as the principal diagnosis if the resident is still receiving antibiotic therapy

Choose the Principal Diagnosis

• Fall 3 months ago• Chronic kidney disease • Above the knee amputation Rt. Leg (10 days

ago) with infection still on antibiotics • Anemia

Non-Specific Codes

• NEC – Not Elsewhere Classified• NOS – Not Otherwise Specified• Codes are used only when neither the

diagnostic statement nor a thorough review of the clinical record provides adequate information to permit assignment of a more specific code

Inclusion Terms

The coder must review the titles and inclusions under the three or four digit category to determine if the diagnosis is included in the category; however, the specific diagnosis may not always be listed

• Example: • Spinal Cord Inflammation 323.9

Combination Codes

• Single codes used to classify two diagnosis or a diagnosis with a manifestation

• Example: • Candidiasis with meningitis 112.83

Combination Codes

• Etiology codes – USE ADDITIONAL CODE• Manifestation codes – CODE 1st Underlying Dx.• Codes in parentheses identify conditions that

require multiple coding. Also, codes in parentheses CAN NOT be sequenced as PRINCIPAL Dx.

Multiple Coding

• Instructions for conditions that require multiple coding can appear in the Tabular List.– “Code also underlying disease”, “Use additional

code, if desired, to identify manifestation, as …” “Code also” instructs the coder to:

• Code the underlying disease, or etiology first as the primary diagnosis, followed by the code (s) for manifestation (s).

• It is mandatory to follow the “code also” instructions to assign both codes.

Combination Codes

• Anosmia following CVA • 438.6, 781.1

• “with”, “with mention of”, or “associated with” – this code can only be used if both conditions are present

• Kidney Infection …..590.9 with Calculus 592.0

Slanted Brackets [ ]

• Indicate proper sequencing for the two codes listed.– The code number before the bracket is coded

first.– The code number inside the brackets is coded

second.Codes in brackets in the alphabetic index can

NEVER be sequenced as the principal diagnosis.

EXAMPLES

1.Arthritis, arthritic --- due to or associated with hypothyroidism

244.9 [713.0]

Multiple Coding • Examples:

– Aftercare following kidney transplant – V58.44 (aftercare involving organ transplant), – V42.0 (Organ/tissue replacement by transplant , kidney)

– Aftercare following arteriocoronary bypass – V58.73 (aftercare following surgery of the circulatory system),

V45.81(aortocoronary bypass status)

– use aftercare codes to provide better detail

Sequencing Multiple Codes

• “Using Additional Codes”– When the instructions say “Use additional code….”

the additional code is sequences second.

Example

UTI due to E.coli 599.0, [041.4]

“Exclusions”

Let’s have a look: • See 429 section • Under Cardiovascular Disease, Unspecified

• Excludes: That due to hypertension

Diagnosis Sequencing

• The order in which codes are listed is called sequencing. The coder should make every effort to record the codes in a logical sequence that is descriptive of the resident’s condition.

Acute Diagnoses

• Acute dx treated in the hospital should be coded until the condition is resolved, after the resident is transferred to the SNF

Examples: MRSA Pneumonia UTI

Secondary Diagnoses

– May have multiple secondary codes– List and code conditions related to therapy and

services provided– Review and update as condition changes –

sequence may change over time– Billing staff should work with Nursing and Health

Information Department to know which diagnoses are current, which is principal, etc.

Secondary Diagnoses

• Order by complexity.• Assign the condition with the higher complexity first.

(those that require the most resources i.e. wound care vs. hypertension)

• All conditions present at the time of admission, and that affect the treatment provided and length of stay should be coded.

Late Effects

• Residual condition • After initial / acute phase of illness

438 Late Effects of CVA

• Official coding guidelines state that Category 438 is used for admission and encounter for post acute care following treatment of the CVA in the acute hospital

• Codes from categories 430 to 436 are reserved for the “initial” (first) episode of care for an acute CVA that was provided in the qualifying hospital stay and should not be used in SNF

Let’s Practice

• Which of the following is a late effect? a. End stage renal disease b. Anosmia following recent CVA c. Diabetic retinopathy d. Paraplegia due to polio

Let’s Code

• Left hemiplegia secondary to CVA (patient is right handed)

• Late Effects • Cerebrovascular disease • With hemiplegia – nondominant side

Infections

• Codes from categories 041 or 079 can be used as principal diagnosis as long as the nature or site of the infection is not specified or when the Alphabetical index instructs you to do so.

Code it

• Gastroenteritis due to E.coli• 008.00

• MRSA infection of Lt. toe • 041.12

• Herpetic septicimia • 054.5

Neoplasms • Go to alphabetic index• Look up Ex: fibroma, upper jaw • Find “fibroma”• Cross reference “see neoplasm, by site, benign”• Turn to neoplasm locate sub term • “Jaw / upper”• Follow across to Benign • Locate code 213.0• Go to Tabular list for any coding instructions or

notes*

Neoplasms of Uncertain Behavior

• Only used when stated as such in Alpha Index

• Unspecified Behavior – • Only used when Neoplasm is not fully described

– Or not specified as to behavior– Or listed in Alphabetic index

• Ex: Neoplastic Cyst of Tongue– Cross reference Alpha Index Under Cyst, neoplastic see

neoplasm, by site, unspecified nature

Neoplasms with Metastasis

• Two codes– One for primary (original site)– One for each secondary site

• Code primary before secondary– Except when using “V” code for primary site that

has been surgically removed

Neoplasms with Metastasis • Determine the primary site• Turn to Neoplasms Table• Ex: Carcinoma of Rectum (154.1)• Find Neoplasm, rectum, malignant, primary

Neoplasms with Metastasis

• Ex: Secondary malignant neoplasm of prostate (198.82)

• Find Neoplasm, prostate, malignant, secondary Determine the site(s) of metastasis

• Turn to Neoplasm table• Find correct sub term(s) for site• Cross over to Malignant and column

secondary

Unknown secondary sites

• Ex: Cancer of Lower lobe of lung with metastases (162.5, 199.0)

• Code primary site first• To code the unknown secondary site

– Refer to Neoplasm table– Multiple sites NEC– Cross over to column for code (199.0)

Unknown Primary Site

• Refer to neoplasm table • Unknown or Unspecified site• Cross over to primary column 199.1• Sequence after secondary site(s)• Ex: abdominal metastasis from unknown

origin (198.89, 199.1)• Unknown primary would not be used as

principle diagnosis in SNF • The metastatic site is coded first

“V” Codes for Cancer

• Primary site must still be identified if removed, eradicated no longer under treatment

• Use a personal history V-code, History, site, malignant neoplasm

• Identify primary site responsible for metastasis but no longer present

• Secondary site code is sequenced first and then the V-code

“V” Codes for Cancer

• Do not use codes from category V10 for secondary metastatic sites removed or not

• ICD-9-CM does not provide code numbers for “history of secondary neoplasm site

V58.42 Neoplasm

• Official coding guidelines for neoplasm apply when using the aftercare following surgery for neoplasm V58.42

• Aftercare code V58.42 may be used with either the current neoplasm code or a code from category V10, whichever is applicable

Code It

• History of breast cancer with metastasis to the lung

• 197.0, V10.3

• Carcinoma of prostate with metastasis to spine • 185, 198.5

• Basal cell carcinoma of chest • 173.5

Endocrine, Nutritional and Metabolic Diseases and immunity disorders

Examples:

• Hypothyroidism• Diabetes • Metabolic disorders • Obesity

Code It

• Hypothyroidism due to history of thyroid cancer (thyroid removed)

• 244.0, V10.87• Uncontrolled, Type II Diabetes • 250.01

Manifestations Codes

• There are written instructions in ICD-9-CM coding books for sequencing codes.

• The underlying Dx (cause/s) coded first, followed by codes for manifestations.

Combination Codes

• Some Diabetic Conditions Require 2 Codes– “Diabetic” or “Due to”

• One Code for Cause• One Code for Complication

– Always sequence cause before complication

Combination Codes

• Example:– Diabetic foot ulcer

• Diabetes with other manifestation– 250.8x

• Ulcer of lower limb, except decubitus– 707.1x

Manifestation Codes

• Diabetic Neuropathy • Diabetes with neurological manifestations must be

coded first (250.60) • The tabular list will guide you to “Use additional code

to identify manifestation, as:” • Polyneuropathy in diabetes (357.2) • The tabular section will tell you that this code is not

allowed as a principal Dx and will guide you to code underlying disease, as (Diabetes with complication…)

Let’s Code

• 1. ALZHEIMER’S DEMENTIA• 331.0, 294.10

• 2. DIABETIC GLAUCOMA • 250.50, 365.9

Chronic Illnesses

• Chronic illnesses that are managed with medication or treatments, such as hypertension, hypothyroidism, diabetes mellitus, atrial fibrillation, assign the appropriate ICD 9 code

• The chronic condition exists, but is under control by medication

Myocardial Infarction

• A code from category 410.XX must be assigned if the admission is strictly for rehabilitation within eight weeks of the acute MI.

• The fifth digit 2 would be used in LTC to designate observation, treatment or evaluation of MI within eight weeks of onset, following the acute phase or in the healing state.

Myocardial Infarction

• The fifth digit “1” should be used if the acute myocardial infarction occurred at the nursing facility and was the reason for transfer to the hospital or the cause of death.

• If the admission takes place after eight weeks assign code (412) Old Myocardial Infarction

Hypertension

• Unless the diagnosis statement specifies as “benign” or “Malignant”

• “unspecified” code (401.9) must be assigned

Heart Conditions Due to Hypertension

• When there is a causal relationship stated as “hypertensive” or “due to hypertension” heart conditions are assigned by Category 402 Hypertensive Heart Disease

• Arteriosclerotic disease due to hypertension 402.90

Circulatory System

• Let’s Code 1. Chronic hypertensive kidney disease 2. 403.9, 585.93. Deep vein thrombosis patient on Coumadin 4. 453.40, V58.61

Respiratory System

• Let’s Code

• Aspiration Pneumonia • 507.0

• Chronic bronchitis with emphysema • 491.20

Skin Ulcers

• Clarification of clinical terms related to skin ulcers www.cms.hhs.gov/manuals/pm trans/r4som.pdf

• Pressure Ulcer is a synonym for decubitus ulcer – due to prolonged pressure

• Subcategory 707.0x has fifth digits to identify site 2009- New- additional code must be used

to identify stage

Skin Ulcers of Lower Limbs

• Non pressure ulcers of lower leg• Fifth digits to identify site• Multiple coding, code first the underlying dx,

such as arteriosclerosis, diabetes, venous hypertension– i.e. diabetic ulcer of left fifth toe 250.80, 707.15

Stasis Ulcers

• The most common type of vascular ulcers– In Alphabetical index under “ulcer” , the index lists

“venous” as a non-essential modifier under the sub term “stasis” that refers to code 459.81.

– Under section 459.81 in the Tabular List you will be instructed to code any associated ulceration from category 707.0-707.9

Wounds

• Category 870-897 Codes for wounds are not to be used for normal, healing surgical wounds or to identify complications of surgical wounds

V- Codes

• Per ICD-9-CM Official Guidelines for Coding and Reporting, aftercare codes are generally first to explain the specific reason for the encounter (admission)

• Certain aftercare code categories need a secondary dx code to describe the resolving condition or sequela

• For others (V codes) the condition is inherent in code title

Coding Clinic Fourth Quarter 1999

• Published rules for the use of V codes• Addressed the use of V codes in LTC settings • Coding clinic Fourth Quarter 2003• Clarified the use of aftercare V codes for all

subsequent encounters after the initial treatment for a fracture

• “for statistical purposes, a facture should only be reported once”

V- Codes -2

• V-codes are assigned to problems that affect the patient’s health but are not in themselves a current illness or injury

• V-codes can be used to represent status or history. • Examples:

– Status Cardiac Pacemaker V45.01– Status heart valve prosthesis V43.3– History of falls V15.88– History of alcoholism V11.3

• Remember not to use acute care codes when coding aftercare

To “V” or not to “V”Scenario # 1

• A resident is admitted for physical therapy following a hip replacement for an inter-trochanteric right hip fracture due to a fall.

To ‘V’ or Not to ‘V’: Scenario #1• Physical therapy:

• V57.1 Physical Therapy

• Intertrochantic right hip fracture due to a fall:• V54.13 Aftercare following traumatic hip fracture

• Hip replacement:• V54.81 Aftercare following joint replacement• V43.64 Joint replacement, hip

To ‘V’ or Not to ‘V’: Scenario #2

• A resident is admitted for P.T. & O.T.following a hip fracture after a fall.The physician indicated that the fracture was due to osteoporosis. The Discharge Summary stated that old compression fractures of the vertebrae due to osteoporosis were present on x-ray.

To ‘V’ or Not to ‘V’: Scenario #2

• Physical Therapy and Occupational Therapy• V57.89 Multiple therapies

• Hip Fracture (due to osteoporosis)• V54.23 Aftercare for continuing treatment of healing

pathologic fracture of hip

• Osteoporosis• 733.00 Osteoporosis

• Compression fractures of vertebrae• 733.13 Pathologic fractures of vertebrae

Let’s Practice

• Admitted for physical therapy, status post total knee replacement due to arthritis

1) Admission – rehabilitation – physical 2 ) Aftercare – following surgery for – joint replacement 3) Replacement – joint – Knee

V57.1, V54.81 , V43.65

• Post hysterectomy for uterine cancer three years ago (no further treatment)

• History – personal – malignant neoplasm – uterus

• V10.42

Select the correct Code • Fracture of upper arm due to fall, resident

wearing a sling, admitted for ADL assistance.

V54.11 812.20 (NO)

V54.1 Aftercare for healing traumatic fracture

• For residents admitted to a SNF for care following treatment in the acute hospital for a traumatic fx use the aftercare codes from Subcategory V54.1

• Do not code the (acute) fracture• Coding Guidelines require an aftercare code

be used after the initial encounter for care of a fx.

V54.1 Aftercare for healing traumatic fracture

• For statistical purposes, a fracture should only be coded once. If the same fx is coded for all encounters, it makes collection of fracture statistics difficult

• The V54.1 identifies the site of the fracture and that it is in the healing phases

• Aftercare for Fractures; Pathologic and Traumatic

V54.1 Aftercare for healing traumatic fracture

• The fifth digits identify the specific site of the healing fracture

• The fifth digit 9 is used for other specified sites• If there are several bones that would be

classified to the other specified site, only one code is used

V54.1 Aftercare for healing traumatic fracture

• DO NOT code V58.43 Aftercare following surgery for injury and trauma (conditions classifiable to 800-999) Exclusion note states “Excludes: aftercare for healing traumatic fracture”

• Remember to always refer to the tabular list and carefully read the instructions and exclusions.

Aftercare for healing Pathological fracture

• Pathological fracture is a fracture in a bone due to weakening of the bone structure by disease process such as osteoporosis.

• For admissions in LTC following a hospital stay for treatment of a pathological fracture assign a code from Subcategory V54.2 Aftercare for healing pathologic fracture

• A compression fracture of the vertebrae is considered pathologic if it is not caused by trauma

Hx of Fracture

• V13.51 personal hx of healed pathologic fx• V13.52 personal hx of healed stress fx• V15.51 personal hx of healed traumatic fx

• Note added to subcatagory 733.0-use add’l code to identify personal hx of pathologic (healed) fx (V13.51)

V54.81 Joint replacement

• Joint replacement of knee for osteoarthritis (V58.78), V54.81, V43.65

• Do not code the disease condition that was treated with the surgery

• 2008 will have a change in the tabular list for V58.78 that will exclude it when there is orthopedic aftercare; codes from section V54.01-V54.9 will be used.

Joint Replacement for Fx

• Use multiple coding to fully describe the resident’s condition

• FX hip (traumatic) with joint replacement V54.13, V54.81, V43.64

• Do not use V58.43 Aftercare following surgery for injury and trauma-(not for fx)

(conditions classifiable to 800-999) see excludes note: (V54.10-V54.19)

V57 Care Involving Rehab

• Category V57 does not indicate that rehab services were provided, only that the resident was admitted for this purpose

• Use only one code from Category V57 for an admission

• If the resident is admitted for multiple therapies, use V57.89

V57 Care Involving Rehab

• Code also the condition requiring the rehab, such as:– Residuals– Late effects– Aftercare– symptoms

V58 Aftercare Following Surgery

• The acute dx for which the surgery was preformed is not reported for aftercare encounters or admissions

• Use other aftercare or symptom codes to provide better detail

• Note the instructions with each code that identifies the range of conditions that are included in the aftercare code number– i.e. aftercare post cataract extraction with lens

implant: V58.71, V45.61, V43.1

2011 ICD-9-CM UPDATES

• Implementation date of new, revised and invalid codes October 1, 201

The New Kid – ICD 10

FINAL REGULATION

• January 15, 2009 Final Regulation Released• EXCHANGE the ICD-9 for the ICD-10 by

October, 1, 2013• ICD-10 for billing purposes as far as ability to

accept the code known as “5010” is required by October 2011

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HIPAA

• Assigning ICD-10 diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA)

• HIPAA has evolved from HIPAA – 1996, to (HIPAA-II) HITECH which relates to security and breaches

• And most recently HIPAA Transactions 5010 • ICD-10 Code Set

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WHO IS AFFECTED??

• All inpatient and outpatient facility visits as well as freestanding providers and ancillary services “that means all of us really” who provide services and bill for them under Medicare, MediCal and private insurances. Current Procedural

• Terminology (CPT) is still used for the Physician and some services, but they must have a diagnosis that is ICD-10 Complaint

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Benefits

• More specific coding system • Reflects medical advancements • Standardization, UK implemented in 1995

used worldwide

ICD-9 vs ICD 10 What are the differences?

ICD-9 ……•3-5 characters in length•Approximately 14,000 codes•First digit may be alpha (E or V) or numeric•Digits 2-5 are numeric•Always at least three digits•Decimal placed after the first three characters•Limited space for new codes

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ICD-9-CM DIAGNOSIS CODES -2

• Lacks detail• Lacks laterality, difficult to analyze, dated,

non-specific and does not adequately define diagnoses needed for medical research

• Does not support interoperability because it is not used in other countries.

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ICD-10 STRUCTURE

• Index and Tabular list similar to ICD-9• ICD-10 index larger, Categories, subcategories

and codes are contacted in the tabular list.• More combined codes i.e. diabetic retinopathy• More specificity i.e. Alzheimer’s disease early

or late onset

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ICD-10-CM DIAGNOSIS CODES – FORMAT & STRUCTURE

• 3-7 characters in length• Over 69,000 codes • Digit 1 is always alpha, digit 2 and 3 are

numeric; digit 4-7 are alpha or numeric• Decimal placed after the first 3 characters• All letters used except “U”• Flexible for adding new codes• Very specific• Has laterality

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ICD-10 CM STRUCTURE -3

• Former V=codes • are now • Z=codesZ=codes

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CODE FORMAT

• ICD-10 Code Format

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ICD-9-CM Code Format ICD-10-CM Code Format

                                                      

    

                                                  

                                 

Examples

• Acute Hepatitis with Hepatic Coma • ICD-9-CM = 070.41• ICD-10-CM =B17.11

• Alzheimer’s Disease with Behavioral Disturbance

• ICD-9-CM = 331.0, 294.11• ICD-10-CM = F02.81

Examples

• Stage 4 pressure ulcer of the sacrum

• ICD-9-CM = 707.03 707.24

• ICD-10-CM = L89.154

ICD 10 “HAS TWO PARTS”

• ICD-10 CM = Clinical Modification• ICD-10 PCS = Procedural Code System (used

for procedures, operations within the hospital inpatient setting i.e., acute hospital)

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ICD-10 has 21 Chapters

• Chapter 1- Certain Infectious & Parasitic Diseases (A00-B99)

• Chapter 2-Neoplasms (C00-D49)• Chapter 3- Diseases Blood & Blood Forming

Organs & disorders Immune System (D50-D89)• Chapter 4- Endocrine, Nutritional and

Metabolic Diseases (E00-E89)

CHAPTERS 5 – 8

• Chapter 5 – Mental (F00-F99)• Chapter 6 – Diseases of Nervous System (G00-

G99)• Chapter 7 – Disease s of Eye and Adnexa (H00-

H59)• Chapter 8 – Disease of Ear and Mastoid (H60-

H95)

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Chapters 9-12

• Chapter 9- Diseases of the Circulatory System (I00-I99)

• Chapter 10- Diseases of the Respiratory System (J00-J99)

• Chapter 11- Diseases of the Digestive System (K00-K94)

• Chapter 12-Diseases of the skin and Subcutaneous Tissue (L00-L99)

Chapters 13-16

• Chapter 13- Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)

• Chapter 14- Diseases of the Genitourinary System (N00-N99)

• Chapter 15- Conditions Related to Pregnancy and Childbirth (O00-O99)

• Chapter 16- Conditions Originating in the Perinatal Period (P00-P96)

Chapters 17-20

• Chapter 17- Congenital Malformations, Deformations, & Chromosomal Abnormalities (Q00-Q99)

• Chapter 18- Symptoms, Signs & Abnormal Clinical & Laboratory Findings (R00-R99)

• Chapter 19- Injury, Poisoning & Certain Other Consequences of External Causes (S00-T88)

• Chapter 20- External Causes of Morbidity (V00-Y99)

Chapter 21

• Chapter 21- Factors Influencing Health Status & Contact with Health Services (Z00-Z99)

CONVENTIONS FOR THE ICD-10-CM -3

• General rules for use of the classification independent of the guidelines– 7th Characters

• Certain ICD-10-Cm categories have applicable 7th characters

• Required for all codes within the category or as instructed by the notes in the Tabular List

• Must always be the 7th character in the data field• If a code that requires a7th character is not 6

characters, a placeholder X must be used to fill in the empty characters

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Example

• 7th characters for a fracture - A = initial encounter for fracture - D = Subsequent encounter for fracture with routine healing - G = Subsequent encounter for fracture with delayed healing - K = Subsequent encounter for fracture with non-union - P = Subsequent encounter for fracture with malunion - S= Sequela

It’s in the details…..

• Coma scale - Eyes open- Best verbal response- Best motor response

CODE STRUCTURE OF ICD-10• ICD-10 Codes may consist of up to 7 digits, with the 7th digit

extensions representing visit encounter or sequel for injuries or external causes.

• In some cases the place holder “X” will be used to expand the code and accommodate the 7th character

• Example: • Pathological vertebral fracture due to age related

osteoporosis (Subsequent encounter with delayed healing • M80.808XG

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ICD-10-CM DIAGNOSIS CODES-2

• Specificity improves coding accuracy and depth of data for analysis

• Detail improves the accuracy of data used in medical research

• Supports interoperability and the exchange of health care data between other countries and the U.S.

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ICD-10 NEW FEATURES -2

• Added Laterality– C50.212 Malignant neoplasm of upper-inner

quadrant of left female breast– L80.213, Pressure Ulcer of right hip, Stage III

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LET’S SEE SOME CODES

• Hypertensive Retinopathy– H35.03 Hypertensive Retinopathy– 031-Right eye, 032, left eye, 033, bilateral,– 039 unspecified (and this would be a ?? For billing

most likely)!!– I10, Essential Primary Hypertension

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ABBREVIATIONS

• NEC – “Not elsewhere classifiable• Punctuation

– [ ] Brackets– ( ) Parentheses

• Use of “and”• “Other” or “other specified” • “Unspecified”• “Includes Notes”• “Inclusion Terms”

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ABBREVIATIONS -2

• “Excludes Notes”• “Code first”, “Use additional code” and

“elsewhere notes”• “And”, “and” or “or”• “With”• “See”, “see also”• “Code also note”• “Default codes”• “Syndromes”

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PRINCIPAL DIAGNOSIS -6

• Complications of surgery and other medical care– Is sequenced as the principal diagnosis

• Uncertain Diagnosis– “probable”, “suspected”, “likely”, “questionable”, “possible”, or

“still to be ruled out”, or other similar terms indicating uncertainty, code the condition as if it existed/established

– Applicable only to inpatient admissions to short-term, acute, long-term care & psychiatric hospitals

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Focus

DOCUMENTATION

TIMELINE

• 10/01/2011 – Last major update to ICD-9-CM and ICD10-CM/PCS

• 10/01/2012 – Limited changes to ICD-9-CM and ICD-10CM/PCS

• 10/01/2013 ICD-10-CM/PCS Implemented

References

• http://www.cdc.gov/nchs/icd/icd10cm.htm• http://www.cdc.gov/nchs/icd/icd9cm.htm

Questions and Answers

Thanks for attending