3 Implementation Date ICD-10-CM/PCS Compliance Deadline October 1, 2013 Claims for services provided on or after this date must use ICD-10 codesCPT codes will continue to be used for outpatient services
4 Compliance Timeline January 1, 2010 Internal testing of Version 5010 for electronic claimsDecember 31, 2010Internal testing must be completeJanuary 1, 2011External Testing of Version 5010 claimsCMS begins accepting Version 5010Version 4010 continue to be acceptedJanuary 1, 2012All claims must use Version 5010Version 4010 no longer accepted4
5 Outpatient Coder Training Approximately 16 hoursReview code Structure & Coding Conventions.Learn the fundamentalsAnalyze & practice applying the ICD-10-CM guidelinesReview and refresh knowledge of A & P concepts
6 Outpatient Coding Training Become an expert in applying ICD-10-CM codes to outpatient cases in the six to nine months preceding October 1, 2013.Practice using ICD-10-CM codes each week leading into “go live” on October 1, 2013.Network with peers to seek answers to cases and confirm application of ICD-10-CM codes.Take advantage of component MHIMA training opportunities
7 Inpatient Coder Training Approximately 50 hoursReview code structure and coding conventions for ICD-10-CM and ICD-10-PCS.Learn the fundamentals of the ICD-10-CM and ICD-10-PCS systems.Analyze and practice applying the ICD-10-CM and ICD-10-PCS Coding Guidelines.Continue to study ICD-10-PCS definitions (memorize the definitions of approaches and root operations).Continue to review and refresh knowledge of anatomy and physiology concepts
8 Inpatient Coder Training Become an expert in applying ICD-10-CM and ICD-10-PCS codes to inpatient cases in the 6 to 9 months preceding October 1, 2013Practice using ICD-10-CM and ICD-10-PCS codes each week leading into “go live” on October 1, 2013Network with peers to seek answers to cases and confirm application of ICD-10-CM/PCS codesTake advantage of MHIMA training opportunities
9 Continuing Education Unit (CEU) Requirements Required to participate in a predetermined number of mandatory baseline educational experiences specific to ICD-10-CM/PCS.*Can Begin Earning CEU’s January 1, thru December 31, 20132009 or 2010 ICD-10 –CM Academy
10 CEU RequirementsTotal number of ICD-10-cm/PCS CEU required, by AHIMA CredentialCHPS- 1 CEUCHDA; RHIT;RHIA- 6 CEUsCCS-P- 12 CEUsCCS; CCA- 18 CEUsIf you hold more than one credential, only report the highest number of CEUs
11 CEU RequirementsCEU requirements will be included within the total number of CEUs required for a given CEU Cycle. For example, if you hold an RHIA credential, you will obtain 6 CEUs that are in relation to ICD-10-CM/PCS along with the additional 24 CEUs to complete your recertification cycle.Reporting of the CEUs will be made available by Fall of 2011
12 Myths October 1, 2013 is considered a flexible date Implementation planning should be undertaken with an assumption that DPHHS will grant an extensionWorker’s comp & auto insurance companies may choose not to implement ICD-10-CM/PCSState Medicaid Programs will not be required to update their systems in order to utilize ICD-10-CM/PCSThe increased number of codes will make the new coding system impossible to useDeveloped without any clinical inputThere will no hard copy of ICD-10-CM/PCSAll coding will be done electronically
13 Myths Developed a number of years ago, so it is out of date Unnecessarily detailed medical record documentation will be requiredImplementation can wait until after electronic health records and other health care initiatives have been establishedICD-10-CM based super bills will be too long or too complexThe GEMs are intended to facilitate the process of coding medical recordsEach payer will be required to develop their own mappings, GEM have been developed for CMS use onlyMedically unnecessary diagnostic tests will need to be performed in order to assign an ICD-10-CM codeCPT will be replaced by ICD-10-CM/PCS
14 ICD 10-CM Code Structure ICD 10-CM Contains more than 68,000 codes Compare this to ICD-9-CM which contains 13,000 codesConsists of 3-7 charactersFirst digit is alphaAll Letters are used except U4th,5th,6th & 7th Digits can be numericDecimal placed after the 1st three characters
16 ICD-10-CM Structure Index & Tabular List Two Parts of the Index Disease & InjuryTable of Drugs & ChemicalsNeoplasm TableExternal CausesCoding GuidelinesSome changes from ICD-9Fractures- Default Displaced2 Categories for Acute MIAcute MI is 4 weeks instead of 8 weeksOsteoporosis with current pathological fractureV codes are now Z Codes
17 ICD-10-CMNew FeaturesCombination codes for conditions & common symptomsCombination codes for poisonings & external causesAdded lateralityAdded extensions for episode of careExpanded codesInclusion of trimester in obstetric codes and elimination of fifth digits for episode of careExternal cause codes no longer a supplementary classification
18 ICD-10-CM Diabetes Mellitus Codes Injuries No Longer Classified as uncontrolled/controlledIncludes diabetes & the complicationInjuriesGrouped by Anatomical site rather than type of injuryCode Extension to identify (7th Character)A- Initial encounterD-Subsequent encounterS-Sequelae
19 ICD-10-CM Code Examples I10- Hypertension Hypertension Table Removed Combination codes Certain Conditions and Associated SymptomsK57.21-Diverticulitis of large intestine with perforation and abscess with bleedingI Arteriosclerotic Heart Disease of native coronary artery with unstable angina pectorisK Toxic Liver disease with chronic active hepatitis with ascitesE Type 1 diabetes mellitus with diabetic neuropathic arthropathy
20 ICD-10-CM Combination codes for poisonings and their external cause T42.3x2S- Poisoning by barbituates, intentional self-harm, sequelaLateralityC Malignant neoplasm of upper-inner quadrant of left female breastL Pressure ulcer of right hip, stage IIIExample of Superbill20
21 ICD-10-CM Codes for clinical concepts that do not exist in ICD-9-CM T45.526D-Underdosing of antithrombotic drugs, subsequent encounterZ Type O Blood, RH positiveCodes for postoperative complications, intraoperative, and post- procedural disordersD Intraoperative hemorrhage and hematoma of spleen complicating a procedure on the spleenD Post-procedural hemorrhage and hematoma of spleen following a procedure on the spleenObstetric codes identify trimester instead of episode of careExcessive weight gain in pregnancy, second trimester
22 ICD-10-CM Coding Guidelines Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99)d. Sepsis, Severe Sepsis, and Septic ShockCase Study:Patient was taken to the emergency department and admitted to the hospital after being found semi-conscious with markedly abnormal vital signs, a fever of over 39 degrees C, a heart rate of 110, and a respiratory rate of 22/min. Final diagnoses included sepsis and septic shock with acute respiratory failureAnswer:A41.9 Sepsis (generalized)R65.21 Shock, septic (due to severe sepsis)J96.0 Failure, respiration, respiratory, acute(b) Severe sepsisThe coding of severe sepsis requires a minimum of 2 codes: first a code for the underlying systemic infection, followed by a code from subcategory R65.2, Severe sepsis. If the causal organism is not documented, assign code A41.9, Sepsis, unspecified, for the infection. Additional code(s) for the associated acute organ dysfunction are also required.Due to the complex nature of severe sepsis, some cases may require querying the provider prior to assignment of the codes.2) Septic shockSeptic shock is circulatory failure associated with severe sepsis, and therefore, it represents a type of acute organ dysfunction. For all cases of septic shock, the code for the underlying systemic infection should be sequenced first, followed by code R65.21, Severe sepsis with septic shock. Any additional codes for the other acute organ dysfunctions should also be assigned.Septic shock indicates the presence of severe sepsis. Code R65.21, Severe sepsis with septic shock, must be assigned if septic shock is documented in the medical record, even if the term severe sepsis is not documented.22
23 ICD-10-CM Coding Guidelines Chapter 4: Endocrine, Nutritional, and Metabolic Diseases (E00-E89) a. Diabetes mellitus6) Secondary Diabetes MellitusCase StudyThis 34-year-old patient is being seen for ongoing management of steroid- induced diabetes mellitus which was due to the prolonged use of corticosteroids, which have been discontinued. The patient’s diabetes is managed with insulin which he has been taking for the last two yearsAnswer:T38.0x5S Refer to Drug and Chemical Table, Corticosteroid, adverse effectE09.9 Diabetes, diabetic, (mellitus) (sugar), due to drug or chemicalZ79.4 Long-term (current) drug therapy (use of), insulin6) Secondary Diabetes MellitusCodes under categories E08, Diabetes mellitus due to underlying condition, and E09, Drug or chemical induced diabetes mellitus, identify complications/manifestations associated with secondary diabetes mellitus. Secondary diabetes is always caused by another condition or event (e.g., cystic fibrosis, malignant neoplasm of pancreas, pancreatectomy, adverse effect of drug, or poisoning).(b) Assigning and sequencing secondary diabetes codes and its causesThe sequencing of the secondary diabetes codes in relationship to codes for the cause of the diabetes is based on the Tabular List instructions for categories E08 and E09. For example, for category E08, Diabetes mellitus due to underlying condition, code first the underlying condition; for category E09, Drug or chemical induced diabetes mellitus, code first the drug or chemical (T36-T65).23
24 ICD-10-CM Coding Guidelines Chapter 9 Diseases of Circulatory System (I00-I99)Case StudyPatient is seen for treatment of unstable angina. The patient has a history of atherosclerotic heart disease and underwent a 3-vessel coronary bypass approximately 2 years ago. The patient recently underwent a cardiac catheterization of all three coronary bypass grafts which showed them patentAnswer:I Angina (attack) (cardiac) (chest) (heart) (pectoris) (syndrome) (vasomotor), with atherosclerotic heart disease – see Arteriosclerosis, coronary (artery), native vessel with angina pectoris, unstableZ95.1 Status (post), aortocoronary bypassb. Atherosclerotic Coronary Artery Disease and AnginaICD-10-CM has combination codes for atherosclerotic heart disease with angina pectoris. The subcategories for these codes are I25.11, Atherosclerotic heart disease of native coronary artery with angina pectoris and I25.7, Atherosclerosis of coronary artery bypass graft(s) and coronary artery of transplanted heart with angina pectoris.When using one of these combination codes it is not necessary to use an additional code for angina pectoris. A causal relationship can be assumed in a patient with both atherosclerosis and angina pectoris, unless the documentation indicates the angina is due to something other than the atherosclerosis.If a patient with coronary artery disease is admitted due to an acute myocardial infarction (AMI), the AMI should be sequenced before the coronary artery disease.24
25 ICD-10-CM Coding Guidelines Chapter 12: Diseases of Skin and Subcutaneous Tissue (L00-L99)a. Pressure ulcer stage codesCase StudyThis patient has a gangrenous pressure ulcer of the right hip and a pressure ulcer of the sacrum documented by the physician. The nursing assessment indicates a stage II pressure ulcer of the sacrum with a stage III decubitus ulcer of the right hip.Answer:I96 Ulcer, gangrenous – see Gangrene. Gangrene, gangrenous (connective tissue) (dropsical) (dry) (moist) (skin) (ulcer) (see also necrosis), Necrosis, skin or subcutaneous tissue NECL Ulcer, ulcerated, ulcerating, ulceration, ulcerative, pressure (pressure area) stage III, (healing) (full thickness skin loss involving damage or necrosis of subcutaneous tissue)L Ulcer, ulcerated, ulcerating, ulceration, ulcerative, pressure (pressure area) stage II, (healing) (abrasion, blister, partial thickness skin loss involving epidermis and/or dermis) sacral region (tailboneWhat is different- only one code required for ulcers combination code25
26 ICD-10-CM Coding Guidelines Chapter 9: Diseases of Circulatory System (I00-I99)a. Hypertension1) Hypertension with Heart Disease3) Hypertensive Heart and Chronic Kidney DiseaseCase StudyThis patient is hospitalized with a diagnosis of congestive heart failure due to hypertensive heart disease. Patient also has Stage 5 chronic kidney failure. The patient has been prescribed Lasix previously but admits he forgets to take his medication every day. This is due to his advanced age.
27 ICD-10-CM Coding Guidelines Answer:I13.2 Disease, diseased, heart (organic), hypertensive – see Hypertension, heart. Hypertension, hypertensive (accelerated) (benign) (essential) (idiopathic) (malignant) (systemic), heart (disease) with kidney disease (chronic) – see Hypertension, cardiorenal (disease), with heart failure, with stage 5 or end stage renal diseaseI50.9 Failure, heart (acute) (sudden), congestive (compensated) (decompensated). The “use additional code” statement under code I13.2 indicates the use of this code to identify the type of heart failureN18.5 Disease, diseased, kidney (functional) (pelvis), chronic, stage 5. The “use additional code” statement under code I13.2 indicates the use of this code to identify the stage of the chronic kidney diseaseT50.1x6A Refer to Table of Drugs and Chemicals, Lasix, underdosingZ Noncompliance, medication regimen, underdosing, unintentional, due to patient’s age-related debility
28 ICD-10-CM Coding Guidelines Chapter 20: Chapter 20: External Causes of Morbidity (V01- Y99)Case StudyAn 18 year-old driver of a car that collided with a pickup truck on the interstate highway. The driver confessed to using his cell phone to send a text message to his girlfriend.Assign the external cause codes onlyAnswer:V43.53xA Index to External Causes. Accident, car – see Accident, transport, car occupant, Accident, transport, car occupant, driver, collision (with) pickup truck (traffic)Y Index to External Causes, Place of occurrence, highway (interstate)Y93.c2 Index to External Causes, Activity (involving) (of victim at time of event), cellular, telephoneExternal cause codes are intended to provide data for injury research and evaluation of injury prevention strategies. These codes capture how the injury or health condition happened (cause), the intent (unintentional or accidental; or intentional, such as suicide or assault), the place where the event occurred the activity of the patient at the time of the event, and the person’s status (e.g., civilian, military).External Cause may be used for subsequent visits, Place of Occurrence, Activity only used once28
29 ICD-9-CM Coding Guidelines Chapter 21: Factors influencing health status and contact with health services (Z00-Z99)Case StudyThis patient had a lateral wall STEMI and was brought by ambulance to the emergency room. He received tPA and was transferred to a tertiary care center for continued care. The patient was received with tPA infusion continuing, and immediately taken to the cardiac cath lab. Answer:I21.29 Infarct, infarction, myocardium, myocardial (acute) (with stated duration of 4 weeks or less), ST elevation (STEMI), lateral (apical-lateral) (basal-lateral) (high)Z92.82 Status(post) – see also Presence (of), administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facilityOld V codes- DNR status, Tpa status, restraints- page 8029
30 ICD-10-PCS ICD-10-PCS Inpatient Procedures Contains Over 72,000 codes7 Character-alphanumeric code structureEach character contains up to 34 possible valuesThe letter O is not usedNo Decimals
31 ICD-10-PCS Structure Index Root Operations Approach Codes found based on type of procedure- No diagnostic information in the descriptionOne you know the tables; you can go directly to the tables the index does not need to be used firstFirst Three values in the index direct you to the tableTablesEach page in the section is composed of rows that specify valid combinations of code valuesRoot OperationsApproach
33 ICD-10-PCS Code Examples 0HTT0ZZ- Right Total Mastectomy 0X6C0ZZ- Amputation at left elbow level0FT44ZZ- Lap Chole0HBT0ZX- Right Breast Biopsy0- Medical SurgicalH- Skin & BreastB-ExcisionT- body Part0- ApproachZ-DeviceX-QualifierMastectomy- resectionChole- resectionAmputation- DetachmentBiopsy33
34 ICD-10-PCS Root Operations 30 Root Operations Identifies the objective of the procedureIn order to determine the appropriate root operation, the full definition of the root operation as contained in the PCS Tables must be applied.Components of a procedure specified in the root operation definition and explanation are not coded separately. Procedural steps necessary to reach the operative site and close the operative site are also not coded separately.Example: Resection of a joint as part of a joint replacement procedure is included in the root operation definition of Replacement and is not coded separately. Laparotomy performed to reach the site of an open liver biopsy is not coded separately.
35 ICD-10-PCS: Root Operations Excision vs. ResectionPCS contains specific body parts for anatomical subdivisions of a body part, such as lobes of the lungs or liver and regions of the intestine. Resection of the specific body part is coded whenever all of the body part is cut out or off, rather than coding Excision of a less specific body part.Example: Left upper lung lobectomy is coded to Resection of Upper Lung Lobe, Left rather than Excision of Lung, Left.
36 ICD-10-PCS: Root Operations Biopsy followed by more definitive treatmentIf a diagnostic Excision, Extraction, or Drainage procedure (biopsy) is followed by a more definitive procedure, such as Destruction, Excision or Resection at the same procedure site, both the biopsy and the more definitive treatment are coded.Example: Biopsy of breast followed by partial mastectomy at the same procedure site, both the biopsy and the partial mastectomy procedure are coded.Control vs. more definitive root operationsThe root operation Control is defined as, “Stopping, or attempting to stop, postprocedural bleeding.” If an attempt to stop postprocedural bleeding is initially unsuccessful, and to stop the bleeding requires performing any of the definitive root operations Bypass, Detachment, Excision, Extraction, Reposition, Replacement, or Resection, then that root operation is coded instead of Control.Example: Resection of spleen to stop postprocedural bleeding is coded to Resection instead of Control
37 ICD-10-PCS: Root Operations Release proceduresIn the root operation Release, the body part value coded is the body part being freed and not the tissue being manipulated or cut to free the body part.Example: Lysis of intestinal adhesions is coded to the specific intestine body part value.Release vs. DivisionIf the sole objective of the procedure is freeing a body part without cutting the body part, the root operation is Release. If the sole objective of the procedure is separating or transecting a body part, the root operation is Division.Examples: Freeing a nerve root from surrounding scar tissue to relieve pain is coded to the root operation Release. Severing a nerve root to relieve pain is coded to the root operation Division.
38 ICD-10-PCS Approach Technique used to reach the site of the procedure 7 Different ApproachesOpenPercutaneousPercutaneous EndoscopicVia Natural or Artificial OpeningOpen with Percutaneous endoscopic assistanceExternal
39 ICD-10-PCSDeviceA device is coded only if a device remains after the procedure is completed. If no device remains, the device value No Device is coded.
40 ICD-10-PCS Obstetrics Products of conception Procedures performed on the products of conception are coded to the Obstetrics section. Procedures performed on the pregnant female other than the products of conception are coded to the appropriate root operation in the Medical and Surgical section.Example: Amniocentesis is coded to the products of conception body part in the Obstetrics section. Repair of obstetric urethral laceration is coded to the urethra body part in the Medical and Surgical section.Procedures following delivery or abortionProcedures performed following a delivery or abortion for curettage of the endometrium or evacuation of retained products of conception are all coded in the Obstetrics section, to the root operation Extraction and the body part Products of Conception, Retained. Diagnostic or therapeutic dilation and curettage performed during times other than the postpartum or post-abortion period are all coded in the Medical and Surgical section, to the root operation Extraction and the body part Endometrium
41 ICD-10-CM/PCS Resources Download the Index & TabularCompliance DatesQuick Reference GuideICD-10-CM/PCS Resource Page
42 ICD-10-CM/PCS Resources Subscribe and read the monthly ICD- TEN free newsletter from AHIMAComplete exercises in the CodeWrite free e-newsletter from AHIMANetwork with peers in the ICD-10 Implementation CoP (available only to AHIMA members)