Agenda ICD-10-CM ICD-10-PCS ICD-10 / 5010 transaction changes

ICD-10 Code Structure and Definition
4/19/2017 Puerto Rico ICD-10 Implementation Site Visit Training segments to assist Puerto Rico with ICD-10 transition ICD-10 Code Structure and Definition Purpose of this set of slides xxx Talking Points Notes January 27-30, 2015

Agenda ICD-10-CM ICD-10-PCS ICD-10 / 5010 transaction changes
4/19/2017 ICD-10-CM ICD-9 / ICD-10 Differences Code Distribution Coding Structure Getting from Medical concepts to Code ICD-10-PCS Facts Overview ICD-10 PCS Definitions ICD-10 / 5010 transaction changes

ICD-9/ICD-10 Differences ICD-9 Diagnosis vs. ICD-10-CM
4/19/2017 ICD-9-CM Diagnosis Codes ICD-10-CM Diagnosis Codes 3 to 5 digits Alpha “E” and “V” on 1st character only No place holder characters Terminology Index and Tabular Structure Coding Guidelines Approximately 14,000 codes Severity parameters limited Does not include laterality (Right vs. Left) Combination codes limited 7 digits Alpha or numeric for any code character Include place holder characters (‘x’) Similar Somewhat similar Approximately 69,000 codes Extensive inclusion of severity parameters Common definition of laterality Combination codes common Purpose of the slide: This slide illustrates some key differences between ICD-9 diagnosis and ICD-10-CM Talking Points: 7 digits are allowable in ICD-10-CM but as little as 3 characters may be valid. A code is only valid if there are no more detailed subcategories or codes underneath it. Currently the first character is always an ‘alpha’ and the second character is ‘numeric’ but that could change over time. A place holder ( ‘x’ character) is used to assure that when a code is needed in the 5th, 6th, or 7th position that the position of that code is maintained. An example will be given later assuming that the more detailed presentation is done Emphasize that unlike the PCS codes, the overall terminology and documentation structure is quite similar to ICD-9 Coding guidelines have similarities but there are a number of specific changes that will be discussed in the coding module Severity parameters will be illustrated in the leveraging ICD-10-CM module Combination codes are codes that contain multiple clinical concepts within a single code. This is covered in the subsequent slides comparing a clinical example in ICD-9 and ICD-10-CM Source: Health Data Consulting

ICD-9/ICD-10 Differences Diagnosis Codes – Clinical Example
4/19/2017 A patient is seen in the emergency room with. [severe] [persistent] [asthma] with [acute exacerbation]. Source: Health Data Consulting ICD9 Code Description 49312 Intrinsic asthma with (acute) exacerbation Purpose of the slide: This illustrates the best ICD-9 code and the best ICD-10-CM code to represent this clinical scenario. This slide focuses on ICD-9 Talking Points: The bracketed items in red are clinical concepts represented in the ICD-9 code ICD10 Code Description J4551 Severe persistent asthma with (acute) exacerbation Source: Health Data Consulting

ICD-9/ICD-10 Differences Diagnosis Codes – Clinical Example
4/19/2017 A patient is seen in the emergency room with. [severe] [persistent] [asthma] with [acute exacerbation]. Source: Health Data Consulting ICD9 Code Description 49312 Intrinsic asthma with (acute) exacerbation Purpose of the slide: Same as the prior slide, but this is focused on the best ICD-10-CM code for this clinical scenario. Talking Points: The bracketed items in red are clinical concepts represented in the ICD-10-CM code For all codes related to fractures of the radius: # of ICD-9 codes = 33 # of ICD-10-CM codes = 1818 ICD10 Code Description J4551 Severe persistent asthma with (acute) exacerbation Source: Health Data Consulting

ICD-10-CM Distribution Code Distribution by Chapter
4/19/2017 Purpose of the slide: This slides illustrates the uneven distribution of codes in different chapters Talking Points: Most of the codes are in three chapters Chapter 19 Chapter 20 Chapter 13 This slide depicts break out by chapter. As a side note, 50% of all codes relate to the musculoskeletal system when looking at codes from a body system perspective. Source: Health Data Consulting

Distribution of ICD-10 equivalent “E” Codes
ICD10 codes based on bidirectional GEM Mapping of ICD9 “E” codes Source: Health Data Consulting Purpose of the slide: Illustrate the distribution of ICD-10 codes associated with ICD-9 “E” codes Talking Points: Based on the bidirectional GEM mapping of ICD-9 “E” codes Illustrates the “E” codes are widely distributed among ICD-10 codes. Health Data Consulting © 2013 Source: Health Data Consulting

Distribution of ICD-10 equivalent “V” Codes
ICD10 codes based on bidirectional GEM Mapping of ICD9 “V” codes Source: Health Data Consulting Purpose of the slide: Illustrate the distribution of ICD-10 codes associated with ICD-9 “V” codes Talking Points: Based on the bidirectional GEM mapping of ICD-9 “V” codes Illustrates the “V” codes are widely distributed among ICD-10 codes. Source: Health Data Consulting Health Data Consulting © 2013

ICD-10-CM Structure Index Structure (Volume II)
4/19/2017 Purpose of the slide: This slide illustrates the structure for the alphabetical index file of the ICD-10-CM official documentation. Talking Points: The base concept, in this case ‘Osteoarthritis’ has a number of qualifiers at different levels of detail. Each sub level is indicated by a ‘-’ example ‘-hip’ Multiple sub-levels are indicated by addition ‘-’ Example ‘--bilateral’ The referenced code at each level points the user to an area of the tabular index that provides the definitive definition The guide for use suggests that the alphabetical index should be used first when searching for a code, but the tabular index is the reference of truth

ICD-10-CM Structure Tabular Structure – Level 1 (Chapters)
4/19/2017 1 Certain infectious and parasitic diseases 2 Neoplasms 3 Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism 4 Endocrine nutritional and metabolic diseases 5 Mental and behavioral disorders 6 Diseases of the nervous system 7 Diseases of the eye and adnexa 8 Diseases of the ear and mastoid process 9 Diseases of the circulatory system 10 Diseases of the respiratory system 11 Diseases of the digestive system 12 Diseases of the skin and subcutaneous tissue 13 Diseases of the musculoskeletal system and connective tissue 14 Diseases of the genitourinary system 15 Pregnancy childbirth and the puerperium 16 Certain conditions originating in the perinatal period 17 Congenital malformations deformations and chromosomal abnormalities 18 Symptoms signs and abnormal clinical and laboratory findings not elsewhere classified 19 Injury poisoning and certain other consequences of external causes 20 External causes of morbidity 21 Factors influencing health status and contact with health services Purpose of the slide: This slide illustrates the level of organization of codes in the tabular index at the highest level. Talking Points: This is the chapter level There are 21 chapters in ICD-10-CM There are 19 chapters in ICD-9 Clicking on the ‘13’ will take you to a drill down in the next slide to the ‘block’ level for this chapter

ICD-10-CM Structure Tabular Structure – Level 2 (Blocks)
4/19/2017 13.1 Infectious arthropathies 13.2 Inflammatory polyarthropathies 13.3 Osteoarthritis 13.4 Other joint disorders 13.5 Dentofacial anomalies [including malocclusion] and other disorders of jaw 13.6 Systemic connective tissue disorders 13.7 Deforming dorsopathies 13.8 Spondylopathies 13.9 Other dorsopathies 13.10 Disorders of muscles 13.11 Disorders of synovium and tendon 13.12 Other soft tissue disorders 13.13 Disorders of bone density and structure 13.14 Other osteopathies 13.15 Chondropathies 13.16 Other disorders of the musculoskeletal system and connective tissue 13.17 Intraoperative and postprocedural complications and disorders of musculoskeletal system not elsewhere classified 13.18 Biomechanical lesions not elsewhere classified Purpose of the slide: This illustrates the second level of code categorization called the ‘blocks’ Talking Points: There are 259 ‘blocks’ that include different ranges of the 3 characters of the codes Clicking on the ’13.3’ will take you to a drill down on the next slide to the ‘category’ level in this ‘block’ of codes

ICD-10-CM Structure Tabular Structure – Level 3 (1st 3 Character Categories)
4/19/2017 M15 Polyosteoarthritis M16 Osteoarthritis of hip M17 Osteoarthritis of knee M18 Osteoarthritis of first carpometacarpal joint M19 Other and unspecified osteoarthritis Purpose of the slide: This slide shows the 3rd category level referred to as the ‘category’ Talking Points: This is represented by the first three characters of the code If the ‘category’ has no children (further detail under that category), then it is considered a ‘code’ and not a category Clicking on the ’M15’ will take you to a drill down to the tabular documentation related to this ‘category’

ICD-10-CM Structure Tabular Structure (Volume I)
4/19/2017 Purpose of the slide: This illustrates the documentation within the tabular index Talking Points: Osteoarthritis (M15-M19) - illustrate the block of codes related to ‘Osteoarthritis’ M16 illustrates the category ‘Osteoarthritis of hip’ If this did not have children, then it would be a code at this level M16.0 Bilateral primary osteoarthritis of hip – illustrates a child or more detailed definition of the parent M16 category. It is a code since it has no child codes beneath it M16.1 is a subcategory since it has a child code - M16.11 Unilateral primary osteoarthritis, right hip If M16.11 had child codes, then it would be referred to as a subcategory and not a code. Sub-categories (codes with children) are not listed as valid codes in the ICD-10-CM code file distributed by CMS.

4/19/2017 Purpose of the slide: This illustrates descriptive information at the category level. Talking Points: Information at the category level applies to all codes in that category The rule ‘A fracture not indicated as displaced or nondisplaced should be coded to displaced’, would apply to all codes that start with S72… Similarly the rule ‘Excludes1: traumatic amputation of hip and thigh (S78.-)’ also states the no code in this range should be coded with codes that are in the ‘S78’ category. The rule ‘The appropriate 7th character is to be added to each code from category S72’, states that all codes in this category must have a 7th character that is defined in this list

4/19/2017 Purpose of the slide: This slide illustrates descriptive information at the sub-category level that applies to all codes within that sub-category Talking Points: Code S72.02 (Fracture of epiphysis (separation) (upper) of femur) has children codes that are more detailed. The Excludes1 rule states that code S79.01 cannot be used with S or any code that starts with S72.02.

4/19/2017 Purpose of the slide: This slide illustrates the use of the ‘x’ place holder. Talking Points: S72.8x Other fracture of femur is not a code since it has children code S72.8x1, S72.8x2 and S72.8x9. The ‘x’ holds the place for the required 6th character in this case An ‘x’ is never used at the end of a valid code (one without children codes)

Slides 48-50 - High level discussion of the business impacts of ICD-10
Coding Guidelines

Coding ICD-10 CM Guidelines
Source: Health Data Consulting Initial Encounter The intent is to represent an encounter which is the first encounter for the clinician for a problem. The definition of “active treatment” is somewhat of a grey area. Health Data Consulting © 2010

Signs & symptom codes Signs and symptom codes are commonly used to represent conditions where a definitive diagnosis has not been made. They are also frequently overused as generic codes for many conditions. The following guidelines apply for the use of these codes. May be used as primary when a definitive diagnosis has not be established and the sign or symptom was the primary reason for encounter as determined at the conclusion of the encounter Additional reporting of sign &symptom codes: Should not be used if the sign or symptom is routinely associated with the diagnosis Should not be used if a combination code already references the sign or symptom in the description May be used to report sign or systems (as a secondary code) that are not routinely associated with the diagnosed condition

Laterality Laterality includes the concepts of “Right”, “Left”, “Bilateral” or “Unilateral” Documentation should support laterality for all conditions that apply. An “Unspecified side” type of code should rarely if ever be used. Some codes do not include a “bilateral” option. In that case where there is a bilateral involvement, a code for both the “left” and “right” side should be used.

The use of terms like “suspected”, “probable”, “likely” and other qualifications of conditions have different guidelines for coding in the inpatient vs. the outpatient setting.

ICD-10 PCS Facts Overview
4/19/2017 ICD-10 PCS Facts Overview ICD-10 PCS is a system of coding for institutional procedures. These procedure codes do not apply to coding for services or procedure delivered in a non-institutional environment ICD-9CM chapter 3 is the equivalent of ICD-10-PCS The WHO (World Health Organization) is not involved in the standardization of institutional procedure codes CMS is responsible for maintenance of ICD-10-PCS codes Contract with 3-M to develop the codes in 1993; first draft in 1993. 1998 initial release of ICD-10-PCS with annual updates every year Purpose of the slide: Provides some basic background facts about the PCS Codes Talking Points: As noted Re-iterate that these codes are only used for inpatient procedures and have no international counterpart.

Coding Changes: ICD-9 Procedure vs. ICD-10-PCS
4/19/2017 Coding Changes: ICD-9 Procedure vs. ICD-10-PCS ICD-9-CM procedure codes ICD-10-PCS procedure codes 3 to 4 digits Not Structured Approximately 4,000 codes Chapter 3 of ICD-9-CM Diagnosis included NOS and NEC common Use of eponyms and named procedures Uses “combination” codes 7 digits Structured (Complex) Approximately 72,000 codes Managed separately from ICD-10-PCS Diagnosis excluded NOS and NEC uncommon Avoids eponyms and named procedures Avoids “combination” codes Purpose of the slide: This slide lists some key differences between ICD-9 procedure and ICD-10-PCS codes Talking Points: All 7 digits are required for the PCS codes Structured in the sense that each character has a meaning unlike ICD-9 Reinforce that ICD-10-CM does not include procedure codes like ICD-9-CM and the procedure codes are handled through the separate ‘PCS’ structure Procedures like ‘Billroth II’ are no longer supported as eponyms in ICD-10 Identify that combination codes, where a code includes multiple concepts, are limited in ICD-10-PCS unlike in ICD-10-CM where combination codes are common. This means that it may take multiple codes to describe the same operation that was covered by one ICD-9 procedure combination code. Source: Health Data Consulting

ICD-9 Comparison to ICD-10-PCS Procedure Codes – Clinical Example
4/19/2017 While hospitalized, a patient has a procedure done through an [endoscope] inserted [through the skin] to [bypass] the blood flow from the [abdominal aorta] to the [right] [renal artery] using a [synthetic material] ICD-9 Code Description 3924 Aorta-renal Bypass ICD-10 Code Description 04104J3 Bypass Abdominal Aorta to Right Renal Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Purpose of the slide: This illustrates the best ICD-9 code and the best ICD-10-PCS code to represent this clinical scenario. This slide focuses on ICD-9 Talking Points: The bracketed items in red are clinical concepts represented in the ICD-9 code Source: Health Data Consulting

ICD-9 Comparison to ICD-10-PCS Procedure Codes – Clinical Example
4/19/2017 ICD-9 Comparison to ICD-10-PCS Procedure Codes – Clinical Example While hospitalized, a patient has a procedure done through an [endoscope] inserted [through the skin] to [bypass] the blood flow from the [abdominal aorta] to the [right] [renal artery] using a [synthetic material] ICD9 Code Description 3924 Aorta-renal Bypass ICD10 Code Description 04104J3 Bypass Abdominal Aorta to Right Renal Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Purpose of the slide: This illustrates the best ICD-9 code and the best ICD-10-PCS code to represent this clinical scenario. This slide focuses on ICD-10 Talking Points: The bracketed items in red are clinical concepts represented in the ICD-10-PCS code [Note] For all codes related to Aorta-renal Bypass: # of ICD-9 codes = 2 # of ICD-10 codes = 30 Source: Health Data Consulting

ICD-10-PCS Distribution by Section
4/19/2017 Purpose of the slide: Illustrating the distribution of codes by section Talking Points: Note that the preponderance of codes are in the “Medical Surgical” section Source: Health Data Consulting

ICD-10-PCS Distribution by Body Systems (Medical Surgical Section)
4/19/2017 Purpose of the slide: Illustrates the distribution of codes by clinical body system within the “Medical Surgical” section (this section as noted accounts for 86% of the codes) Talking Points: Note that over 50% of the codes are related to either ‘musculoskeletal’ or ‘cardiovascular’ procedures Source: Health Data Consulting

ICD-10-PCS Structure Sections
4/19/2017 Medical and Surgical 1 Obstetrics 2 Placement 3 Administration 4 Measurement and Monitoring 5 Extracorporeal Assistance and Performance 6 Extracorporeal Therapies 7 Osteopathic 8 Other Procedures 9 Chiropractic B Imaging C Nuclear Medicine D Radiation Oncology F Physical Rehabilitation and Diagnostic Audiology G Mental Health H Substance Abuse All codes are defined within 16 sections 0: Medical Surgical 1-9 : Medical and Surgically related Sections B-D/F-H: Ancillary Section Purpose of the slide: This slide illustrates 16 different Sections within ICD-10-PCS Talking Points: Note that sections that start with 1-9 are considered the medical and surgical related sections and the B-D and F-H are considered the ancillary sections.

ICD-10-PCS Structure Code Example
4/19/2017 0D1B8JM Bypass Ileum to Descending Colon with Synthetic Substitute, Via Natural or Artificial Opening Endoscopic Char Char Description Value Value Description 1 Section Medical Surgical 2 Body System D Gastrointestinal System 3 Root Operation Bypass 4 Body Part B Ileum 5 Approach 8 Via Natural or Artificial Opening Endoscopic 6 Device J Synthetic Substitute 7 Qualifier M Descending Colon Purpose of the slide: This slide illustrates the structure of the ICD-10-PCS code where each character has a meaning Talking Points: Note that this applies to the “Medical Surgical” Section and that the characters vary in meaning for different sections as illustrated in the next slide Source: Health Data Consulting

ICD-10-PCS Structure Section character definitions
4/19/2017 Sect. Section Char 1 Char 2 Char 3 Char 4 Char 5 Char6 Char7 Medical and Surgical Sections Medical and Surgical Body System Root Operation Body Part Approach Device Qualifier 1 Obstetrics 2 Placement Body Region 3 Administration Body System / Region Substance 4 Measurement and Monitoring Function/ 5 Extracorporeal Assistance and Performance Duration Function 6 Extracorporeal Therapies 7 Osteopathic Method 8 Other Procedures 9 Chiropractic Ancillary Sections B Imaging Root Type Contrast C Nuclear Medicine Radionuclide D Radiation Oncology Modality Treatment Site Modality Qualifier Isotope F Physical Rehabilitation and Diagnostic Audiology Section Qualifier Type Qualifier Equipment G Mental Health H Substance Abuse Treatment Purpose of the slide: Illustrates the changes in meaning for different characters depending on the section the code is in Talking Points: Also note that even though some characters are supposed to represent meanings like “Body System” this is not always apparent when looking at values. For example, Character 2 for the Obstetrics section has only one body system called “Pregnancy”, which would not normally be considered a body system.

ICD-10-PCS Structure Table Structure
4/19/2017 Purpose of the slide: Illustrates the table structure of PCS Talking Points: Each table is define by the 1st three characters. In any table, you can select one value from each row, but cannot select values across rows. For example, if you select the 4th character as “E” (cranial nerve), you cannot select the 6th Character “K” (Nonautologous tissue substitute)

ICD-10-PCS Definitions Terminology Changes
4/19/2017 ICD-9 Term ICD-10 Term Bunionectomy Resection of Metatarsal Amputation Detachment Arthroscopy, Cystoscopy… Inspection… Endoscopic Approach Incision No Term Closed Reduction Reposition (also repair) of (right or left) , (percutaneous, endoscopic, external) Radical Mastectomy Resection (right, left or bilateral) Subtotal Mastectomy Excision Tracheotomy Bypass Cesarean section Extraction of Products of Conception Debridement Excision, Extraction, Irrigation, Extirpation Purpose of the slide: This slide demonstrates some of the changes in terminology associated with ICD-10-PCS Talking Points: Note in particular, change to ‘Tracheotomy’ is now ‘Bypass’ and ‘Cesarean Section’ is now ‘Extraction of Products of Conception’ If the provider says “removal of the right upper lobe of the lung” in the operative report, the coder needs to know that this is coded as a “resection” rather than a “removal” or “excision” Source: Health Data Consulting

ICD-10-PCS Definitions Root operations (Medical Surgical Section)
4/19/2017 Removing from the body Inserting into the body Changing in the body Destruction Insertion Alteration Detachment Inspection Bypass Drainage Reattachment Change Excision Replacement Control Extirpation Supplement Creation Extraction Transplantation Dilation Removal Map Division Resection Fragmentation Fusion Occlusion Release Repair Reposition Restriction Revision Transfer Purpose of the slide: This illustrates the 31 root operations defined in PCS Talking Points: These root operations are defined in a variety of groupings, but they are just grouped here by the three categories above for simplicity Source: Health Data Consulting

ICD-10 PCS Definitions Example root operation definitions
4/19/2017 Purpose of the slide: Here are some examples of the definitions of ‘root operations’ using the new PCS terminology Talking Points: Excision refers to the partial ‘cutting out’ of a ‘body part’. You will need to know what is defined as a body part to assign this vs. resection which is the ‘cutting’ out of the entire body part For example, “Patellae”, “Femur”, “Femoral Surface” of the femur are considered body parts, but the “navicular” bone in the hand is not a body part, but a portion of the body part “carpal” bone. Note the definition of “Extraction” may not be intuitive when associated with C-Section (extraction of products of conception)

ICD-10-PCS Summary Observations
4/19/2017 ICD-10-PCS presents a totally new model for definition of institutionally related procedures Some of the challenges around ICD-10-PCS implementation from a clinical informatics perspective include: The changes in the meaning of characters may be confusing. Definitions of common terminology around procedures, systems, and anatomical structures may be inconsistent with traditional thinking around these terms The “broad brush” approach to categorization of various axis of description can result in a large number of codes that may rarely if ever be used. Operating within the ICD-10-PCS environment will have considerable impacts on the coding, processing, and analysis Close observation of coding practices will be needed during the transition to assure proper coding according to these new definitions Purpose of the slide: A summary of observations about challenges associated with ICD-10-PCS codes Talking Points: The changes in ICD-10-PCS are dramatic compared to ICD-10-CM Considerable training will be required and there may be challenges to the quality and reliability of data until coders are fully educated in this new model An ‘axis’ of description in these codes is the set of values for a character. For example in looking at surgical approach, the 5th character includes values for various approaches; ‘Open’ (A surgical incision), ‘Percutaneous’ (A procedure accomplished through a small puncture in the skin), ‘Endoscopic’ (A procedure done through a scope instrument). In PCS, axis of description such as approach appear to be applied broadly across many different scenarios resulting in many codes that would be highly unlikely, such as the repair of an open wound through and endoscope as an approach even though that type of procedure really doesn't make sense.

Key Anatomical Considerations
4/19/2017 Purpose of the slide: A summary of observations about challenges associated with ICD-10-PCS codes Talking Points: The changes in ICD-10-PCS are dramatic compared to ICD-10-CM Considerable training will be required and there may be challenges to the quality and reliability of data until coders are fully educated in this new model An ‘axis’ of description in these codes is the set of values for a character. For example in looking at surgical approach, the 5th character includes values for various approaches; ‘Open’ (A surgical incision), ‘Percutaneous’ (A procedure accomplished through a small puncture in the skin), ‘Endoscopic’ (A procedure done through a scope instrument). In PCS, axis of description such as approach appear to be applied broadly across many different scenarios resulting in many codes that would be highly unlikely, such as the repair of an open wound through and endoscope as an approach even though that type of procedure really doesn't make sense. Key Anatomical Considerations

The Femur Anatomy 4/19/2017 Purpose of the slide:
A summary of observations about challenges associated with ICD-10-PCS codes Talking Points: The changes in ICD-10-PCS are dramatic compared to ICD-10-CM Considerable training will be required and there may be challenges to the quality and reliability of data until coders are fully educated in this new model An ‘axis’ of description in these codes is the set of values for a character. For example in looking at surgical approach, the 5th character includes values for various approaches; ‘Open’ (A surgical incision), ‘Percutaneous’ (A procedure accomplished through a small puncture in the skin), ‘Endoscopic’ (A procedure done through a scope instrument). In PCS, axis of description such as approach appear to be applied broadly across many different scenarios resulting in many codes that would be highly unlikely, such as the repair of an open wound through and endoscope as an approach even though that type of procedure really doesn't make sense.

The Femur Fracture Patterns
4/19/2017 Sub Capital Inter-Trochanteric Sub-Trochanteric Oblique Transverse Purpose of the slide: A summary of observations about challenges associated with ICD-10-PCS codes Talking Points: The changes in ICD-10-PCS are dramatic compared to ICD-10-CM Considerable training will be required and there may be challenges to the quality and reliability of data until coders are fully educated in this new model An ‘axis’ of description in these codes is the set of values for a character. For example in looking at surgical approach, the 5th character includes values for various approaches; ‘Open’ (A surgical incision), ‘Percutaneous’ (A procedure accomplished through a small puncture in the skin), ‘Endoscopic’ (A procedure done through a scope instrument). In PCS, axis of description such as approach appear to be applied broadly across many different scenarios resulting in many codes that would be highly unlikely, such as the repair of an open wound through and endoscope as an approach even though that type of procedure really doesn't make sense. Supra-Condylar Spiral Medial Condylar Lateral Condylar Intra-Condylar

Lower Limb Arteries Foot Artery? 4/19/2017 Purpose of the slide:
A summary of observations about challenges associated with ICD-10-PCS codes Talking Points: The changes in ICD-10-PCS are dramatic compared to ICD-10-CM Considerable training will be required and there may be challenges to the quality and reliability of data until coders are fully educated in this new model An ‘axis’ of description in these codes is the set of values for a character. For example in looking at surgical approach, the 5th character includes values for various approaches; ‘Open’ (A surgical incision), ‘Percutaneous’ (A procedure accomplished through a small puncture in the skin), ‘Endoscopic’ (A procedure done through a scope instrument). In PCS, axis of description such as approach appear to be applied broadly across many different scenarios resulting in many codes that would be highly unlikely, such as the repair of an open wound through and endoscope as an approach even though that type of procedure really doesn't make sense. Foot Artery?

ICD-10/5010 Transaction code content changes
4/19/2017 837P (Professional) ICD-9 Qualifier 4010 Count ICD-10 Qualifier Count Principal Diagnosis BK 1 ABK Secondary Diagnosis BF 7 ABF 11 Total 8 12 837I (Institutional) ICD-9 Qualifier 4010 Count ICD-10 Qualifier 5010 Count Principal Diagnosis BK 1 ABK Admitting Diagnosis BJ ABJ Reason for Visit N/A APR 3 External Cause BN ABN 12 Other Diagnosis BF 24 ABF ICD-9 Principal Procedure BR BBR ICD-9 Other Procedure BQ BBQ Total 52 66 Purpose of the slide: A summary of observations about challenges associated with ICD-10-PCS codes Talking Points: The changes in ICD-10-PCS are dramatic compared to ICD-10-CM Considerable training will be required and there may be challenges to the quality and reliability of data until coders are fully educated in this new model An ‘axis’ of description in these codes is the set of values for a character. For example in looking at surgical approach, the 5th character includes values for various approaches; ‘Open’ (A surgical incision), ‘Percutaneous’ (A procedure accomplished through a small puncture in the skin), ‘Endoscopic’ (A procedure done through a scope instrument). In PCS, axis of description such as approach appear to be applied broadly across many different scenarios resulting in many codes that would be highly unlikely, such as the repair of an open wound through and endoscope as an approach even though that type of procedure really doesn't make sense. Source: Health Data Consulting

4/19/2017 Closing Points Communicate to leadership and teams ICD-10 CM and PCS codes definition, structure, and implications for migration. Identify a POC to gather all official documentation related to ICD-10 and ICD-9 from the CMS website for ready reference. Establish communication links with the CMCS team to obtain available support/assistance for their project team. Begin practicing with various scenarios to increase skills and understanding of ICD-10-CM and ICD-10-PCS. Consider sending a business and medical management analyst to the AHIMA ICD-10 coding trainer courses to provide training resources internally to develop ICD-10 expertise. Join support organizations that provider resources to help answer your questions as those questions come up during the transition process.

4/19/2017 Discussion What roles in your organization need to understand ICD-10 codes? From the perspective of: How ICD-10 codes are defined? What ICD-10 codes are used for? How do you plan to manage awareness and communication within your internal organization? How are you evaluating tools to help you research and use these codes? What are your concerns about coding quality? Discussion To Think About… Supporting Tools and Artifacts: Training Needs Assessment template Communication Plan/Awareness Plan template Business and Clinical Scenarios ICD-9 and ICD-10 Clinical Concepts Examples

Agenda ICD-10-CM ICD-10-PCS ICD-10 / 5010 transaction changes

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Agenda ICD-10-CM ICD-10-PCS ICD-10 / 5010 transaction changes

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