Presentation on theme: "ICD-10 Getting There….. Neurosurgery. What Physicians Need To Know Claims for ambulatory and physician services provided on or after 10/1/2015 must use."— Presentation transcript:
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 Injury292574 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: Spina Bifida Inadequate DocumentationRequired ICD-10 Documentation Spina bifida with paralysis. Previous ventriculoperitoneal shunt placement. Lumbar spina bifida cystica, bilateral lower limb paralysis and hydrocephalus with previous ventriculoperitoneal shunt placement. Needed improvements: Location, type, and presence of complicating factors.
Inadequate vs. Adequate Documentation Example 2: Spondylopathies Inadequate DocumentationRequired ICD-10 Documentation Disc disease and stenosis with spondylolisthesis. Spinal curvature and Schmorl’s node present. Anterior lumbar interbody fusion scheduled for Tuesday. Degenerative disc disease and spinal stenosis with lumbar spondylolisthesis. Lumbar scoliotic curve secondary to disc disease. Schmorl’s node @ L3. Anterior lumbar interbody fusion L2 – L3 and L3 – L4 scheduled for Tuesday. Needed improvements: Location, complicating factor(s), and underlying disease(s).
Inadequate DocumentationRequired ICD-10 Documentation IMPRESSION: Epilepsy. IMPRESSION: Well controlled, cryptogenic left temporal lobe epilepsy with complex partial seizures, no status epilepticus. Inadequate vs. Adequate Documentation Example 3: Epilepsy Needed improvements: Types, control status, and presence or abscence of status epilepticus.
Inadequate DocumentationRequired ICD-10 Documentation Admitted for psychiatric eval. Back pain. Psychosocial dysfunction. Depressed, agoraphobia, and reports sleeping difficulty. Admitted for psychiatric eval. Chronic low back pain due to lumbar spinal stenosis. Psychosocial dysfunction secondary to pain. Recurrent major depression with psychotic symptoms such as locking self in bedroom for weeks at a time, agoraphobia with frequent panic attacks, and reports difficulty falling asleep. Inadequate vs. Adequate Documentation Example 4: Pain Needed improvements: Encounter reason, pain location, acute vs. chronic, underlying cause, and related psychological factors.
Inadequate DocumentationRequired ICD-10 Documentation 42-year-old with chronic kidney disease, HTN, & diabetes. Hbg & Hct decreased, transfuse 2 units PRBCs. 42-year-old on transplant list with ESRD on dialysis, HTN, IDDM type 2 with nephropathy & neuropathy. Chronic kidney disease related iron deficiency anemia, transfuse 2 units PRBCs. Inadequate vs. Adequate Documentation Example 5: Chronic Kidney Disease Needed improvements: Stage, transplant status, and related or contributing disease. E11.21 Type 2 diabetes mellitus with diabetic nephropathy I112.0 Hypertensive End Stage Renal Disease N18.6 Chronic Kidney Disease requiring chronic dialysis Z99.2 Dependence on Renal Dialysis E11.40 Type 2 diabetes mellitus with diabetic neuropathy, unspecified D63.1 Anemia in chronic kidney disease Z76.82 Awaiting Organ Transplant Status I12.9 Hypertensive Chronic Kidney Disease, NOS E11.9 Type 2 Diabetes Mellitus Without Complications N18.9 Chronic Kidney Disease, Unspecified (Stage)
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 – Feb 2015Dept. MeetingsICD-10 Introduction/Overview Feb 2015 – Mar 2015On-line/ClassroomFuture Order Entry Diagnosis Assistant Feb 2015 – Jul 2015Web-basedICD-10-CM Overview & Service Specific Documentation Mar 2015 – Jun 2015ClassroomPhysician Playbooks/ Documenting for ICD10 using the Electronic Health Record Jul 2015 – Sep 2015Web-basedDocumenting Operative and Procedure Notes for ICD-10-PCS