1. ICD-10 Getting There….. Psychiatry

2. 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.

3. 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

4. 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.

5. 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!

6. Inadequate vs. Adequate Documentation Example 1: Behavioral and Emotional Disorders Inadequate DocumentationRequired ICD-10 Documentation 12-year-old male with attention deficit hyperactivity disorder, autism & Tourette’s. Mother reports speech problems worse & continues to have difficulty in school especially with reading due to dyslexia. Her today for eval of purulent eye drainage. 12-year-old male with hyperactive type attention deficit hyperactivity disorder, autism & Tourette’s. Mother reports stuttering worse & continues to have difficulty in school especially with reading due to developmental dyslexia. Her today for eval of purulent left eye drainage. Needed improvements: Type, associated manifestation(s), laterality, and related problem(s).

7. Inadequate vs. Adequate Documentation Example 2: Non-Psychotic Mental Disorders Inadequate DocumentationRequired ICD-10 Documentation Patient with post-traumatic stress disorder after friend’s car plunged off bridge now exhibiting extreme phobia. Continues to have anxiety & depression. Patient with chronic post-traumatic stress disorder after friend’s car plunged off bridge 10 years ago now exhibiting extreme gephyrophobia. Continues to have grief reactions of anxiety & depression. Needed improvements: Acute vs. chronic, specific phobia(s), symptom(s), and linkage.

8. Inadequate DocumentationRequired ICD-10 Documentation 19-year-old male with mutism & movement abnormalities such as walking backwards, posturing & rigidity. Dad reports pt is using drugs weekly. Hallucinations secondary to drug abuse. Will attempt additional electroconvulsive therapy for schizophrenia. 19-year-old male with mutism & movement abnormalities such as walking backwards, posturing & rigidity. Dad reports pt is smoking cannabis weekly. Visual hallucinations secondary to drug abuse. Will attempt additional electroconvulsive therapy for catatonic schizophrenia. Inadequate vs. Adequate Documentation Example 3: Schizophrenia Needed improvements: Type, symptom(s), underlying condition(s), and substance use.

9. Key Requirements for Documenting Mental Disorders Disease etiology (e.g. dementia vitamin B deficiency) Causal agents (e.g. causal disease, contributory drug, chemical or non-medical substance) Disorder status or stage (e.g. manic episodes with severe psychotic symptoms) Coexisting conditions (e.g. cannabis dependence with hallucinations) The manifestation of the disease (e.g. psychoactive substance abuse, mood disorders, and adjustment disorders) With ICD-10, the need for specific and accurate documentation is increased significantly.

10. 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.

11. 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

12. Future Orders & Diagnosis Assistant Demonstration