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Finding the right ICD-10 Code for Family Medicine 1 Presented by Evan M. Gwilliam, DC MBA BS CPC CCPC NCICS CCCPC CPC-I MCS-P CPMA Chief Product Officer.

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Presentation on theme: "Finding the right ICD-10 Code for Family Medicine 1 Presented by Evan M. Gwilliam, DC MBA BS CPC CCPC NCICS CCCPC CPC-I MCS-P CPMA Chief Product Officer."— Presentation transcript:

1 Finding the right ICD-10 Code for Family Medicine 1 Presented by Evan M. Gwilliam, DC MBA BS CPC CCPC NCICS CCCPC CPC-I MCS-P CPMA Chief Product Officer

2 Dr. Evan Gwilliam Education Bachelor’s of Science, Accounting - Brigham Young University Master’s of Business Administration - Broadview University Doctor of Chiropractic, Valedictorian - Palmer College of Chiropractic Certifications Certified Professional Coder (CPC) - AAPC Nationally Certified Insurance Coding Specialist (NCICS) - NCCT Certified Chiropractic Professional Coder (CCPC) - AAPC ChiroCode Certified Chiropractic Professional Coder (CCCPC) - ChiroCode Certified Professional Coder – Instructor (CPC-I) - AAPC Medical Compliance Specialist – Physician (MCS-P) - MCS Certified Professional Medical Auditor (CPMA) – AAPC, NAMAS Certified ICD-10 Trainer - AAPC 2

3 ICD-9 14,567 codes ICD-10 69,832 codes 3 Why can’t we keep using ICD-9?

4 Why ICD-10? 4 ICD-9 ICD-10

5 5 ICD-10 examples In ICD-9: E844.8 Sucked into jet without accident to aircraft; ground crew

6 6 ICD-10 examples In ICD-10: V97.3 Person on ground injured in air transport accident;

7 7 ICD-10 examples In ICD-10: V97.33 Person on ground injured in air transport accident; sucked into jet engine

8 8 ICD-10 examples In ICD-10: V97.33 & Person on ground injured in air transport accident; sucked into jet engine, male;

9 9 ICD-10 examples In ICD-10: V97.33 &µ Person on ground injured in air transport accident; sucked into jet engine, male; under 5’5” in height;

10 10 ICD-10 examples In ICD-10: V97.33 &µ# Person on ground injured in air transport accident; sucked into jet engine, male; under 5’5” in height; slightly bald;

11 11 ICD-10 examples In ICD-10: V97.33 &µ#$ Person on ground injured in air transport accident; sucked into jet engine, male; under 5’5” in height; slightly bald; wearing a jump suit;

12 12 ICD-10 examples In ICD-10: V97.33 &µ#$€ Person on ground injured in air transport accident; sucked into jet engine, male; under 5’5” in height; slightly bald; wearing a jump suit; during a full moon

13 ICD-10-CM code for chronic gout due to renal impairment, left shoulder, without tophus. Note: there are 11 gout codes in ICD-9 and 365 in ICD-10 13 ICD-10 examples

14 Tabular list layout Chapter 21 of them from A to Z Block Ranges of categories Categories 3 characters Subcategories 4 th or 5 th characters Codes 6 th or 7 th characters 14

15 15 Tabular List Chapter: 8, Diseases of the ear and mastoid process (H6Ø-H95) (always white font in a black box)

16 Tabular list layout Chapter 21 of them from A to Z (body system or condition) Block Ranges of categories (related conditions) Categories 3 characters (more specific condition) Subcategories 4 th or 5 th characters (etiology, location, etc.) Codes 6 th or 7 th characters (laterality, encounter, etc.) 16

17 Tabular List 17 Block: Diseases of Middle Ear and Mastoid (H65-H75) (Always bold CAPS, lined above and below )

18 Tabular list layout Chapter 21 of them from A to Z (body system or condition) Block Ranges of categories (related conditions) Categories 3 characters (more specific condition) Subcategories 4 th or 5 th characters (etiology, location, etc.) Codes 6 th or 7 th characters (laterality, encounter, etc.) 18

19 Tabular List 19 Category: H65.- Nonsuppurative Otitis Media (Always all CAPS, with a line above. A hyphen indicates an incomplete code)

20 Tabular list layout Chapter 21 of them from A to Z (body system or condition) Block Ranges of categories (related conditions) Categories 3 characters (more specific condition) Subcategories 4 th or 5 th characters (etiology, location, etc.) Codes 6 th or 7 th characters (laterality, encounter, etc.) 20

21 Tabular List Subcategory: H65.0-Acute serous otitis media Acute & subacute secretory otitis (Codes with a hyphen are incomplete) 21

22 Tabular list layout Chapter 21 of them from A to Z (body system or condition) Block Ranges of categories (related conditions) Categories 3 characters (more specific condition) Subcategories 4 th or 5 th characters (etiology, location, etc.) Codes 6 th or 7 th characters (laterality, encounter, etc.) 22 Note: Codes may be complete with fewer than 6 characters. Some codes only have 3.

23 Tabular List Highest specificity code: H65.06 Recurrent acute serous otitis media, bilateral (Complete codes are bolded.) Note: Approximately 40% of the new codes are due to laterality. 23

24 Proposed Chapter 22

25 Finding the ICD-10 code

26 Three methods: 1.Specialty specific common codes list (but don’t stop there!) 2.GEMs code map (don’t stop here either!) 3.Alphabetic index (still not safe!) Always confirm the code using the Tabular List 26 Finding the ICD-10 code

27 27 1. Common Codes

28 2. GEMs 28

29 29 2. GEMs General Equivalence Mappings (GEMs) o Created by the National Center for Health Statistics, part of the CDC o Forward maps from ICD-9 to ICD-10 o Backward maps from ICD-10 to ICD-9 o Approximations only

30 3. Alphabetic index 30

31 Example Patient is an 18-month old fussy, white female with a three-day history of otalgia, runny nose and fever of 100. There is no exposure to tobacco smoke. Otoscopic examination reveals acute serous otitis media of the right ear. Assessment: Acute serous otitis media, right ear. On September 30, 2015, the diagnosis is 381.01 Acute serous otitis media. On October 1, 2015, it is: 31

32 1. Common Codes 32

33 33 2. GEMs

34 34 3. Alphabetic index

35 35 Tabular List

36 Example Patient is an 18-month old fussy, white female with a three-day history of otalgia, runny nose and fever of 100. There is no exposure to tobacco smoke. Otoscopic examination reveals acute serous otitis media of the right ear. Assessment: Acute serous otitis media, right ear. On September 30, 2015, the diagnosis is 381.01 Acute serous otitis media On October 1, 2015, it is: H65.01 Acute serous otitis media, right ear NOTE: Common codes lists are just an expert guess GEMs often leads to unspecified codes Alphabetic Index often gives incomplete or multiple options 36

37 Three methods: 1.Specialty specific common code list (but don’t stop there!) 2.GEMs code map (don’t stop here either!) 3.Alphabetic index (still not safe!) Always confirm the code using the tabular list..then be sure to check instructional notes and guidelines 37 Finding the ICD-10 code

38 The next step for converting to ICD-10 38 1.Go to the Tabular List o Look at the following: 1.Notes 2.Includes and alternative wording 3.Excludes1 4.Excludes2 5.Code Also, Code First, Use Additional 6.Seventh character extensions 2.Repeat at the level of the code, then the subcategory, category, block, and chapter 3.Reverse map for confirmation if necessary

39 Example This 30-year old white male sustained a right knee injury while playing basketball on Saturday. He was seen in our urgent care clinic and sent for MRI of the right knee to rule out meniscal tear. MRI revealed right bucket-handle medial meniscal tear and tear of the anterior cruciate ligament (ACL). Patient will be scheduled for surgery on Tuesday. Initial care visit. 39

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