real world experiences with icd-10:trips, traps, and shifts
DESCRIPTION
Real World Experiences with ICD-10:Trips, Traps, and Shifts. Eva M. Gregorek, RHIT, CCS Senior Consultant AHIMA Approved ICD-10-CM/PCS Trainer Jzanus Consulting, Inc. Overview of ICD-10 Shift Examples Tools. ICD-10 Shift Project. DRG Shift Project. - PowerPoint PPT PresentationTRANSCRIPT
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Real World Experiences with ICD-10:Trips, Traps, and Shifts
Eva M. Gregorek, RHIT, CCSSenior Consultant
AHIMA Approved ICD-10-CM/PCS TrainerJzanus Consulting, Inc
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• Overview of ICD-10 Shift• Examples• Tools
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ICD-10 Shift Project
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DRG Shift Project
• A DRG change due to ICD-10-CM/PCS implementation
• Findings are used to evaluate– Financial/case mix impact– Coding education need– Physician documentation gaps
• Coders will experience this when doing dual coding
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My Reaction to the First ICD-10 Shift Project
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Day 1
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Day Three
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Eventually
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DRG Shifts
• Identify why the shift happened– Procedure mapping– Diagnosis mapping– PCS change– Coding Guideline Change– Incorrect ICD-9 DRG • Not really a shift
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DRG ShiftExamples
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ICD-9 Decompressive Laminectomy
• Spinal Fusion
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ICD-10 Decompressive Laminectomy
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ICD-10 Spinal Decompression Guidance• Spinal Decompression
• Coding Clinic, Fourth Quarter 2013 Page: 116• New codes contained in this issue effective with discharges October1, 2013. Other coding advice or
code assignments contained in this issue effective with discharges October 21, 2013.
• Question:
• What is the appropriate code assignment for a spinal decompression?
• Answer:
• Spinal decompression is the removal of pressure from the spinal cord. Assign a code for the surgery that is performed to relieve the pressure. For example, if a laminectomy is performed to remove pressure from the spinal cord, assign a code from table 0QB or 0PB based on the Index to Procedures:
• Laminectomy• see Excision, Lower Bones 0QB-• see Excision, Upper Bones 0PB-
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ICD-9 Embolization
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ICD-10 Embolization
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ICD-9 Embolization
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ICD-10 Embolization
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Spinal Tap ICD-9
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Spinal Tap – ICD-10
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Spinal Tap – ICD-9
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Spinal Tap – ICD-10
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Placement of Central Venous Catheter– ICD-9
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Placement of Central Venous Catheter– ICD-10
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Placement of Central Venous Catheter– ICD-9
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Placement of Central Venous Catheter– ICD-10
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Isolation –ICD-9
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Isolation –ICD-10
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Opioid Dependence –ICD-9
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Opioid Dependence –ICD-10
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Opioid Dependence –ICD-9
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Opioid Dependence –ICD-10
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Drainage of Retroperitoneal abscess–ICD-9
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Drainage of Retroperitoneal abscess–ICD-10
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Drainage of Retroperitoneal abscess–ICD-9
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Drainage of Retroperitoneal abscess–ICD-10
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Planning a Positive ICD-10 Experience
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• You might need a bigger boat
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Education/Development• ICD-10-CM/PCS training program
– Include payment methodology
• Dual Coding/Review– Peer review– Independent review
• Coding Roundtable– Group discussion about specific cases– Document decisions– Recognize that initial decisions may change– Send questions to Coding Clinic
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Education/Development
• Identify opportunities from shift analysis• Invite physicians to any/all of your educational
activities.– The usual suspects in physician documentation• Laterality• Site• Depth of debridement• Specificity in general
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Cerebral Infarction
• ICD-9-CM
• Etiology: – Embolism – Thrombosis – Unspecified
occlusion/stenosis
• ICD-10-CM
• Etiology: Same as ICD-9-CM – Embolism – Thrombosis – Unspecified occlusion/stenosis
• Site: – Cerebral artery – Anterior – Middle – Posterior – Cerebellar – Other specified cerebral artery – Unspecified cerebral artery
• Laterality– Right – Left – Bilateral
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AsthmaICD-9-CM
Forms – Chronic obstructive – Cough variant – Exercise induced bronchospasm – Extrinsic – Intrinsic – Unspecified
Complications – Acute exacerbation – Status asthmaticus – Unspecified
ICD-10-CM
Forms – Cough variant – Exercise induced bronchospasm – Extrinsic allergic – Idiosyncratic – Intrinsic nonallergic – Other – Unspecified
Severity – Mild intermittent – Mild persistent – Moderate persistent – Severe persistent – Complications – Acute exacerbation – Status asthmaticus – Uncomplicated
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Best Effort
Dual Coding Review Non Punitive Feedback/Education/Roundtable
Research/Document Decisions/Follow-up
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Research
• It is important to dig in with research. • Attend meetings• Network• Use resources– Coding Clinic– Regulatory– Professional Associations
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Example
• Removal of polydactyl• Multiple opinions– Detachment– Repair– Resection– Excision
• Posted question on professional websites including AHIMA Engage Online Community
• Sent to Coding Clinic
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Follow-up• DRG shift was identified for a total hip revision that involved ICD-10-PCS codes
0SR9049
• Grouped to MS-DRG 464 - wound debridement and skin graft exc hand, for musculoskeletal connective tissue disease with CC.
• MS-DRG 467 - revision of hip or knee replacement with CC as did the other PCS codes for hip replacement seemed more appropriate
• Checked with various encoders and it to be appeared to be global in nature. Contacted Center for Medicaid and Medicare Services (CMS) ICD-10 Coordination Committee. Informed that it would be included on the next ICD-10 Coordination Committee agenda.
• It wasn’t
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Coder responsibilities
• Identify how many hats coders are wearing.– Deficiency Analysis– Filing– Registry– Birth certificates– Charges/billing– Phone duty
• Validate and take action.– Delegate to other staff
or department– Eliminate the issue
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Identification without validation or action
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Just because!
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A well balanced 2 hat coder
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Other helpful hints
• Ancillary procedure coding– What needs to be coded– Why is it being coded– Who is using the data
• Work setting
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Other helpful hints
• Queries–Develop or convert templates– http://journal.ahima.org/2013/02/01/physician-
query-examples/
• Tools– Encoder– Publications
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So you need a bigger boat
• Temporary vs permanent staff
• Consultants
• Mentor new professionals
• Be creative
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Resources
• www.ahima.org• www.munsonhealthcare.org/icd10/tips• www.cms.gov
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Thank you
• Contact information– Phone 518-649-2151– Email – [email protected]