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ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved. ICD-10 Impact on Coding and Billing.

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Presentation on theme: "ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved. ICD-10 Impact on Coding and Billing."— Presentation transcript:

1 ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved. ICD-10 Impact on Coding and Billing

2 Use of this handout is for informational purposes only Refer to current updated version of ICD-10 manual at the time of implementation to confirm coding accuracy! ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved Paul Cadorette CPC, CPC-H, CPC-P, CASCC, COSC AAPC ICD-10 Proficiency Certified Director of Education

3 Why the Need for ICD-10? ICD-10 A98.4 Ebola virus disease ICD-9 ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved Other specified diseases due to viruses Arthropod-borne hemorrhagic fever Codes lack specificity which is necessary for identifying Ebola patients Makes the process of monitoring and tracking the disease more difficult

4 21 Chapters with alphanumeric codes ICD-9 14,000 codes vs. ICD-10 68,000 ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix. All Rights Reserved. E codes V codes Diseases of nervous system and sense organs

5 ICD-10 Guidelines For ambulatory surgery, code the diagnosis for which the surgery was performed. If the postoperative diagnosis is known to be different from the preoperative diagnosis at the time the diagnosis is confirmed, select the postoperative diagnosis for coding, since it is the most definitive ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix. All Rights Reserved.

6 ICD-10 CONVENTIONS General rules for the use of the classification system with instructional notes that are applicable regardless of the health care setting ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved

7 ICD-10 Conventions “See” - another term should be referenced, it is necessary for the coder to go to the main term indicated by the “see” note Arthritis, arthritic – spine rheumatoid – see Spondylitis, ankylosing “See Also” – another main term can be referenced that may have additional index entries that may be useful. When the main term provides an appropriate code, it is not necessary to follow the “see also” note Stricture (see also Stenosis) bladder N32.89 neck N32.0 ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix. All Rights Reserved. nasolacrimal duct (see also Stenosis, lacrimal duct) congenital Q10.5

8 “Excludes” Notes The two conditions cannot be reported together When present, the EXCLUCDED code/condition should be reported instead of the code listed above it It may be appropriate to use both the code listed along with the excluded code when supported by the medical documentation S92 Fracture of foot and toe, except ankle traumatic amputation of ankle and foot (S98.-) fracture of ankle (S82.-) fracture of malleolus (82.-) ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved.. EXCLUDES 2 EXCLUDES 1 EXCLUDES 2 EXCLUDES 1

9 Anatomy and Terminology ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved.. Spondylo- (vertebra or spinal column) -pathy (disease process) Atlanto-occipital Atlanto-axial - L5-S1 - T12-L1 - C7-T1 Expansion of diagnosis code sets

10 Anatomy and Terminology Enthesopathy Enthesis – the point where a tendon or ligament inserts into a bone Enthesopathy – disease process in the zones of attachment for ligaments or tendons to bone, a disorder of entheses (bone attachments) ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved.

11 Anatomy and Terminology Spondylopathies (M45-M49) spondylo (vertebra) pathy (disease process) Spondylosis - a term referring to degenerative osteoarthritis of the joints between the center of the spinal vertebra and/or neural foramina ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved.

12 S96.2 Injury of Intrinsic Muscle at Ankle and Foot Level ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved.. A – Flexor digitorum brevis B – Abductor digiti minimi C – Abductor hallucis A B C A - Quadratus plantae B - Lumbricales A B A – Flexor hallucis brevis B – Adductor hallucis C – Flexor digiti minimi AB C B Dorsal Interossei Plantar Interossei

13 Diagnosis Code Structure S52.551A ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix. All Rights Reserved. Base code - Fracture of forearm Other extra-articular fracture lower end of radius Laterality Type of Encounter Fracture lower end of radius Fracture of right distal radius, extra-articular

14 Diagnosis Code Structure ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved. - Base Codes

15 Diagnosis Code Structure ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix. All Rights Reserved.

16 Fractures of Femur (23 Different Classifications plus 9 Other/Unspecified codes) Current Procedural Terminology © 2014 American Medical Association. All Rights Reserved.

17 ICD-10 Laterality RT is usually indicated with 1 LT is usually indicated with 2 Bilateral is usually indicated with 3 M20.40 Other hammertoe(s) (acquired), unspecified foot M20.41 Other hammertoe(s) (acquired), right foot M20.42 Other hammertoe(s) (acquired), left foot Unspecified character is 0 if in the fifth position or 9 when it is in the sixth position M Mallet finger of right finger(s) M Mallet finger of left finger(s) M Mallet finger of unspecified finger(s) ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix. All Rights Reserved. (When no bilateral code exists, report both the RT and LT code) (Bilateral refers to paired organs)

18 ICD-10 Laterality ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved.. NOTE: Although toes are identified by proximal, medial or distal phalanx the specific toe (second, third, fourth or fifth) is not mentioned

19 ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved.. Wrist and Hand Level CPT Code Sections Forearm, Wrist Hand, Finger Select CPT code based on the anatomical site where at which the procedure was performed Hand or Wrist For categories where no multiple site code is provided and more than one bone, joint or muscle is involved, multiple codes should be used to indicate the different sites involved

20 ICD-10 Laterality Exceptions ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix. All Rights Reserved. Other and Unspecified

21 ICD-10 Laterality ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix. All Rights Reserved.

22 ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved. Eyelid Characters. CPT Code Modifiers

23 Seventh Character Extensions Additional digits required ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix. All Rights Reserved.

24 Seventh Character Extension 7 th vs. X7 th When a diagnosis code requires a 7 th character - that character must always be the 7 th character in the data field, which sometimes necessitates the use of placeholder “X” Some codes may be only 4 characters long, but they require a 7 th character extension - so placeholder “x” is used twice ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved. S33.0XXA S43.50XA The appropriate 7 th character is to be added to each code from category S00 A initial encounter D subsequent encounter S sequela S33.0 Traumatic rupture of lumbar intervertebral disc S43.50 Sprain of acromioclavicular joint S Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder S46.011A

25 Encounters (7 th Character Extensions) A - Initial encounter – Active treatment (surgical treatment, emergency department encounter or evaluation and treatment by new physician) D - Subsequent encounter – Routine care during healing or recovery phase (cast change/removal, removal of internal/external fixation device, medication adjustment, follow-up visits) S - Sequela - Late effect from initial injury Condition that occurs after the acute phase of an injury No time limit to identify a late effect ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved.

26 Fracture Encounters ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix. All Rights Reserved. No open fx code Defaults

27 Implant Removal ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved.. Previous Injury Fracture of 1 st metatarsal bone right foot S92.311D (Subsequent encounter “D” – defaulted to displaced) Previous Surgery Austin bunionectomy for hallux valgus Z47.2 (Acquired deformity)

28 Acute vs. Chronic ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix. All Rights Reserved. Chapter 13. Diseases of the Musculoskeletal System and Connective Tissue Chapter 19. Injury, Poisoning and Certain Other Consequences of External Causes

29 Strains and Sprains Strain – injury to a muscle or tendon Tendons connect muscle to bone Quadriceps tendon to superior pole of patella S76.119A Strain of unspecified quadriceps muscle, fascia and tendon, initial encounter Sprain – stretching or tearing of a ligament Ligaments connect bone to bone Anterior cruciate ligament S83.519A Sprain of anterior cruciate ligament of unspecified knee, initial encounter ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved..

30 Herniated Disk ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved. Chapter 13 - Old/Chronic Chapter 19 - Acute/Current

31 Barrett’s Esophagus ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved ICD-9 Different codes in ICD-10 Same ICD-9 code Precancerous changes Severe precancerous changes

32 K22.70 Barrett’s esophagus without dysplasia Barrett’s esophagus NOS ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved NOS – Not Otherwise Specified

33 Carrier Policy Treatment of Barrett’s Radiofrequency ablation is considered investigational as a treatment of Barrett’s esophagus in the absence of dysplasia (Nondysplastic Barrett’s) Radiofrequency ablation may be considered medically necessary for treatment of Barrett’s esophagus with low-grade dysplasia, when the initial diagnosis of low-grade dysplasia is confirmed by a second pathologist who is an expert in GI [gastrointestinal] pathology Radiofrequency ablation may be considered medically necessary for treatment of Barrett’s esophagus with high-grade dysplasia The diagnosis of high-grade dysplasia should be confirmed by two pathologists prior to radiofrequency ablation BCBS of NC Current Procedural Terminology © 2014 American Medical Association. All Rights Reserved.

34 Colon Polyps ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved Adenomatous polyps are site specific and code to benign neoplasms Hyperplastic polyps code to K63.5 Hyperplastic polyps of anus/rectum

35 Screening Testing for disease in seemingly well individuals Testing to rule out or confirm a sign or symptom is a diagnostic exam and not a screening List the screening code as the primary diagnosis Conditions found during screening exam should be listed as additional diagnoses ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved

36 “Accidental” Dural Puncture ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved.. ICD-9 Diagnosis Coding

37 Complications (998.2 Accidental puncture or laceration) K91.71 Accidental puncture and laceration of a digestive system organ or structure during a digestive system procedure K91.72 Accidental puncture and laceration of a digestive system organ or structure during other procedure ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix. All Rights Reserved. N99.71 Accidental puncture and laceration of a genitourinary system organ or structure during a genitourinary system procedure N99.72 Accidental puncture and laceration of a genitourinary system organ or structure during other procedure Female pelvic pain with lysis of adhesions and destruction of endometriosis. Colon is perforated during/while lysing adhesions. While placing tape during a TVT procedure, the bladder is perforated. Chapter 11 Diseases of the digestive system K00-K94 Chapter 14 Diseases of the Genitourinary System N00-N99

38 Discontinued Procedure ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved. V64.1 – Surgical or other procedure not carried our because of contraindication (unacceptable primary diagnosis in ICD-9) Z53.09 – Procedure and treatment not carried out because of other contraindication DO NOT USE V64.1 (ICD-9) OR Z53.09 (ICD-10) AS A PRIMARY OR FIRST LISTED DIAGNOSIS

39 Chapter 20 External Causes of Morbidity Chapter 21 Factors Influencing Health Status ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix. All Rights Reserved. Unless a provider is subject to state-based reporting or these codes are required by a specific payer - reporting of External Causes of Morbidity codes is not required ICD-9ICD-10 S51.851A Open bite right forearm, initial encounter Y04.1XXA Assault by human bite, initial encounter Y Daycare center as the place of occurrence of the external cause Y93.F9 Activity, other caregiving Y99.0 Civilian activity done for income or pay Daycare worker bitten by child, bleeding wound on right forearm Personal and Family History codes

40 CMS-1500 Claim Forms ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix. All Rights Reserved. Z12.11 D12.3 A B45385PT

41 ICD-10 Testing Week: November 17-21, 2014 Test claims with ICD-10 codes must be submitted with current dates of service (i.e. October 1, 2014 through November 17, 2014), since testing does not support future dated claims. Test claims will be subject to all existing EDI front-end edits including Submitter authentication and NPI validation. Test claims will receive the 277CA or 999 acknowledgement as appropriate, to confirm that the claim was accepted or rejected in the system. Testing will not confirm claim payment or produce remittance advice. ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix. All Rights Reserved. Next test dates - March 2-6, 2015, June 1-5, 2015

42 FUTURE: Local Coverage Determination (LCD): (L35350) UPPER GASTROINTESTINAL ENDOSCOPY (DIAGNOSTIC AND THERAPEUTIC) Diagnosis Codes meeting Medical Necessity Non-Covered Diagnosis Codes ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix. All Rights Reserved. Effective: Oct. 1, 2015 Approximately 290 ICD-10 codes vs 234 ICD-9 codes

43 FUTURE: Local Coverage Determination (LCD): (L34974) Facet Joint Injections ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix. All Rights Reserved. Code Comparison Approximately 264 ICD-10 LCD diagnosis codes 38 ICD-9 LCD diagnosis codes Diagnosis codes with “A” Encounters only Effective: Oct. 1, 2015

44 FUTURE: Local Coverage Determination (LCD): (L34974) Facet Joint Injections Spondylolysis M43.00 – M43.09 Aka. Pars defect Spondylolisthesis M43.10 – M43.19 Pars defect-vertebra slips forward Spondylosis M47.11 – M47.9 Osteoarthritis, Osteoarthrosis Osteoarthropathy ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix. All Rights Reserved.

45 ICD-10-CM Complete Official Draft Code Set © 2014 Ingenix All Rights Reserved. ICD-10 Impact on Coding and Billing Paul Cadorette CPC, CPC-H, CPC-P, CASCC, COSC AAPC ICD-10 Proficiency Certified Director of Education


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