Presentation on theme: "ICD-10 Getting There….. Dermatology. What Physicians Need To Know Claims for ambulatory and physician services provided on or after 10/1/2015 must use."— Presentation transcript:
ICD-10 Getting There….. Dermatology
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 CodesICD-10-CM Diagnosis Codes 3 to 5 digits7 digits Alpha “E” & “V” – 1 st CharacterAlpha or numeric for any character No place holder charactersInclude place holder characters (“x”) TerminologySimilar Index and Tabular StructureSimilar Coding GuidelinesSomewhat similar Approximately 14,000 codesApproximately 69,000 codes Severity parameters limitedExtensive severity parameters Does not include lateralityCommon definition of laterality Combination codes limitedCombination codes common
Number of Codes by Clinical Area Clinical AreaICD-9 CodesICD-10 Codes Fractures74717,099 Poisoning and Toxic Effects2444,662 Pregnancy Related Conditions1,1042,155 Brain Injury Diabetes69239 Migraine4044 Bleeding Disorders2629 Mood Related Disorders7871 Hypertensive Disease3314 End Stage Renal Disease115 Chronic Respiratory Failure74 Right vs. left accounts for nearly ½ the increase in the # of codes.
The Importance of Good Documentation The role of the provider is to accurately and specifically document the nature of the patient’s condition and treatment. The role of the Clinical Documentation Specialist is to query the provider for clarification, ensuring the documentation accurately reflects the severity of illness and risk of mortality. The role of the coder is to ensure that coding is consistent with the documentation. Good documentation…. Supports proper payment and reduces denials Assures accurate measures of quality and efficiency Captures the level of risk and severity Supports clinical research Enhances communication with hospital and other providers It’s just good care!
Inadequate vs. Adequate Documentation Example 1: Dermatitis Related to Ingested Substances Inadequate DocumentationRequired ICD-10 Documentation Here for rash eval. On day 4 of antibiotic course for strep throat. Woke up with maculopapular rash. Reports taking antibiotics this morning. Rash secondary to drug allergy. Here for rash eval. On day 4 of Amoxicillin course for strep throat. Woke up with generalized maculopapular rash. Reports taking antibiotics as prescribed. Rash secondary to PCN allergy. Needed improvements: Severity, cause, specific ingested substance, and encounter type.
Inadequate vs. Adequate Documentation Example 2: Skin Cancer Inadequate DocumentationRequired ICD-10 Documentation Biopsy proven skin cancer of arm and vitiligo. Biopsy proven malignant melanoma of left upper arm. Right lower eyelid and periocular vitiligo. Needed improvements: Site, laterality, type, stage and underlying condition(s).
Inadequate DocumentationRequired ICD-10 Documentation Consulted to assist with management of patient with multiple burns due to an incident occurring 2 weeks ago. Approximately 13.5% of BSA with burns. Consulted to assist with management of patient with third degree burn of left anterior arm, second degree burns bilateral thighs. Third degree burn covers 4.5% of BSA. Second degree burns cover 9% of BSA. Patient was using pressure cooker at home and accidently spilled scalding water on herself 2 weeks ago. Inadequate vs. Adequate Documentation Example 3: Burns Needed improvements: Site, laterality, body surface area (BSA) by degree of burn, and injury specifics.
Inadequate DocumentationRequired ICD-10 Documentation Terminally ill nursing home resident with diabetes, S/P above knee amputation presents for G-tube placement. He has multiple pressure ulcers of varying stages & measurements. Ulcer noted on back, hip, & buttock. There is also some injury noted on the coccyx. Terminally ill nursing home resident with type II NIDDM, S/P (L) above knee amputation presents for G-tube placement. Stage 1 decubitus (L) upper back, stage 2 decubitus extending from (R) hip to (R) lower back including (R) buttock. Coccyx with deep tissue injury. Inadequate vs. Adequate Documentation Example 4: Pressure Ulcers Needed improvements: Location, laterality, contiguous ulcers, stages(s), underlying condition(s), and complication(s).
Key Requirements for Documentation Identify dermatological disorders with and etiology of physiological origin. Identify the exact site, laterality, and the morphology type as either primary or secondary. Identify conditions that are known to be the cause of any disorder Clarify the specific disease type, if known, rather than using umbrella terms such as “dermatitis”. List any associated conditions (e.g., Type I Diabetes, Allergies) With ICD-10, the need for specific and accurate documentation is increased significantly.
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 DatesMethodContent Nov 2014 – Jan 2015Department Meetings Introduction/Overview Jan 2015 – Mar 2015Web-basedOverview Service Specific Documentation Future Order Entry Diagnosis Assistant Mar 2015 – Jun 2015ClassroomDocumenting for ICD10 using the Electronic Health Record Jun 2015 – Sep 2015Web-basedOverview Documenting Operative and Procedure Notes for ICD-10-PCS