ICD-10 Orientation In Post Acute Care (Part III) Rhonda Anderson, RHIA Anderson Health Information Systems, Inc. ICD-10 Orientation in Post Acute Care 4hrs PART III 3-14-14

Location, Date, Time Northern California Southern California Fairfield Post Acute Rehab March 20, 2014 9:00am – 3:00pm Southern California Garden View Post Acute Rehab April 9, 2014

Presenters Staci LePage, RHIT Email: stacilepage@comcast.net Mobile: 916-202-5797 Khaleelah Wagner, RHIA Email: khaleelahwagner@hotmail.com Mobile: 909-717-7102 ICD-10 Orientation in Post Acute Care 4hrs PART III 3-14-14

Chapter 6 – Diseases Of The Nervous System G00-G99 Alzheimer’s moved to this chapter (was in mental disorder category) G30. Expanded to include early and late onset of Alzheimer’s Requires a second code for Alzheimer’s dementia with or without behaviors Paralytic syndromes now include laterality in addition to dominant and non-dominant Paralytic syndromes such as hemiplegia, paraplegia, monoplegia… Not any changes in coding Parkinson’s G20. ICD-10 Orientation in Post Acute Care 4hrs PART III 3-14-14

Paralytic Syndrome Coding If the affected side is documented, but not specified as dominant or nondominant: For ambidextrous patients, the default should be dominant Left side affected, the default is nondominant Right side affected, the default is dominant Example: Hemiplegia, unspecified, affecting right dominant side G81.91 *excludes hemiplegia d/t sequela of CVD

Seizures/Convulsions Convulsions or seizures, NOS code to R56.- Seizure disorder, code to G40.- If “disorder” is not documented by provider, but resident is receiving medications for seizures, should query provider

Coding Pain Pain, not elsewhere classified - G89. Used in conjunction with codes from other categories to provide more detail about acute or chronic pain, neoplasm pain, or post-procedural pain Can be listed as principal diagnosis When pain control or pain mgmt is reason for admit, the underlying cause and site of pain should be reported as additional dx, if known. Code only as appropriate, not when resident has pain asso w/OA, fx, etc. Code only when it adds needed information. ICD-10 Orientation in Post Acute Care 4hrs PART III 3-14-14

More Pain Coding… Chronic pain syndrome G89.4 vs. Chronic pain G89.2 Provider must specifically document the condition Need to know: if Alzheimer’s; early or late onset + if associated dementia if paralytic syndrome; laterality, dominant/non-dominant status

Chapter 7 – Diseases Of Eye And Adnexa H00-H59 Assigning glaucoma codes: Assign as many codes from category H40, as needed, to identify the type of glaucoma, the affected eye, and the glaucoma stage. Need to know: which eye (right, left or bilateral) type of glaucoma (open-angle, primary angle-closure, glaucoma 2nd to trauma, drugs, or other eye disorders) Stage of glaucoma (mild, moderate, severe, indeterminate)

Chapter 8 – Diseases of the Ear and Mastoid Process H60-H95 Separate chapter in ICD-10-CM Need to know if disease is in right, left or bilateral ears

Chapter 9 – Diseases Of The Circulatory System I00-I99 No more hypertension table in index (malignant, benign, unspecified are all the same code now) Artery and vein diseases are broken down by laterality, in addition to the location Combination Codes for Conditions and Common Symptoms or Manifestations

Chapter 9 – Diseases Of The Circulatory System I00-I99 -2 Example: I25.110 - Arteriosclerotic heart disease of native coronary artery with unstable angina pectoris

Hypertension Coding I11 Hypertension with Heart Disease Heart conditions classified to I50 or I51.4-I51.9 are also assigned to, a code from category I11 when a causal relationship is stated (due to hypertension) or implied (hypertensive) Use an additional code to identify type of heart failure I50., if known Need to know: with or without heart failure

More Hypertension Coding I12 Hypertensive chronic kidney disease Cause and effect relationship is presumed Need add’l code to identify the stage of CKD Need to know: CKD stage I13 Hypertensive heart and CKD Causal relationship for HTN and heart dx must be doc’d by provider Need to know: stage and with or without heart failure

Sequelae of Cerebrovascular Diseases I69 I69.0 Nontraumatic subarachnoid hemorrhage I69.1 Nontraumatic intracerebral hemorrhage I69.2 Other nontraumatic intracranial hemorrhage I69.3 Sequelae of cerebral infarction I69.8 Sequelae of other cerebrovascular diseases

Sequelae of Cerebrovascular Diseases I69 -2 I69.9 Sequelae of unspecified cerebrovascular diseases

Sequelae of Cerebrovascular Diseases Sequelae of cerebrovascular disease I69 Used to indicate conditions in I60-I67 as the cause of sequelae. The “sequelae” include conditions specified as such, or as residuals which may occur at any time after the onset of the causal condition Need to know: type of CVD, what the residual condition is, if paralytic syndrome – right or left, dominant or non-dominant if tPA/rtPA given within 24 hrs, code Z92.82 Terminology change from “late effects of” to sequelae -types of CVD include: subarachnoid hemorrhage, intracerebral hemorrhage, intracranial hemorrhage, cerebral infarction, other CVD, unspecified CVD -tPA would be given at the hospital – review hospital records for this ICD-10 Orientation in Post Acute Care 4hrs PART III 3-14-14

Acute Myocardial Infarction (AMI) Myocardial Infarctions now have subcategories for ST elevation/STEMI and non-ST elevation/NSTEMI Time frame change from eight weeks old to four weeks (28 days) or less from onset Separate code for a subsequent MI within four weeks (28 days) of a previous MI

Acute Myocardial Infarction I21 For encounters occurring while the AMI is equal to, or less than, four weeks old, including transfers to another acute setting or a post-acute setting and pt requires continued care for the AMI Sites include: left ant descending coronary artery, inferior wall of coronary artery, anterior wall, transmural Q wave ICD-10 Orientation in Post Acute Care 4hrs PART III 3-14-14

Acute Myocardial Infarction -2 I22 Subsequent MI When a pt who has suffered an MI, has a new MI within the 4 wk time frame of the initial MI, code I22 in conjunction with I21 code Need to know for both I21 or I22 if STEMI or NSTEMI and site of MI Sites include: left ant descending coronary artery, inferior wall of coronary artery, anterior wall, transmural Q wave ICD-10 Orientation in Post Acute Care 4hrs PART III 3-14-14

Complications Following MI’s I23 Certain current complications following STEMI and NSTEMI MI within 28 day period a code from category I23 must be used in conjunction with a code from category I21 or category I22 Still use a different code for old MI (greater than 28 days after initial MI onset) I25.2

Atrial Fibrillation and Flutter I48 More specific than ICD-9: I48.0 Paroxysmal atrial fibrillation I48.1 Persistent atrial fibrillation I48.2 Chronic atrial fibrillation I48.3 Typical atrial flutter/type I I48.4 Atypical atrial flutter/type II I48.9- Unspecified atrial fibrillation/flutter Need to know type

Congestive Heart Failure/CHF I50 Same organization as ICD-9 Need to know: type of heart failure (left, systolic, diastolic, combined) acute, chronic, acute on chronic

Chapter 10 – Diseases Of Respiratory System (J00-J99) J44 Other Chronic Obstructive Pulmonary Disease (COPD) Includes asthma with COPD Organized differently than in ICD-9 J44.0 COPD with acute lower resp infection J44.1 COPD with acute exacerbation J44.9 COPD, unspecified Acute exacerbation is a worsening or a decompensation of a chronic condition

Asthma J45 Asthma is now in subcategories of: J45.2 Mild intermittent J45.3 Mild persistent J45.4 Moderate persistent J45.5 Severe persistent J45.9 Unspecified J45.901 Unspecified asthma with exacerbation J45.902 Unspecified asthma with status asthmaticus J45.909 Unspecified asthma, uncomplicated J45.909 is the correct code for asthma, NOS - NOT J45.998 ICD-10 Orientation in Post Acute Care 4hrs PART III 3-14-14

Asthma J45 -2 Asthma is now in subcategories of: J45.99_ Other asthma Need to know type and if complicated J45.909 is the correct code for asthma, NOS - NOT J45.998 ICD-10 Orientation in Post Acute Care 4hrs PART III 3-14-14

Influenza J09 Influenza due to certain identified influenza viruses J10 Influenza d/t other identified influenza virus J11 Influenza d/t unidentified influenza virus Need to know what the influenza is due to and if any manifestations Only on confirmed cases Seasonal influenza d/t other identified influenza virus code J10.- All J09-J11 now include coding of associated manifestations – pneumonia, other resp conditions, GI manifestations, other manifestations – more specific with ICD-10 ICD-10 Orientation in Post Acute Care 4hrs PART III 3-14-14

Pneumonia J12 Viral pneumonia, not elsewhere classified J13 Pneumonia d/t Streptococcus pneumoniae J14 Pneumonia d/t H. influenzae J15 Bacterial pneumonia, not elsewhere classified J16 Pneumonia d/t other infectious organisms, not elsewhere classified

Pneumonia -2 J17 Pneumonia in disease classified elsewhere J18 Pneumonia, unspecified organism J69 Pneumonitis d/t solids and liquids Need to know type of virus/bacteria

Respiratory Failure J96 J96.0 Acute respiratory failure J96.1 Chronic respiratory failure J96.2 Acute and chronic respiratory failure J96.9 Respiratory failure, unspecified Need to know: for all of above acute or chronic and if with hypoxia or hypercapnia Hypoxia: a condition in which the body or a region of the body is deprived of adequate oxygen supply

Respiratory Failure J96 -2 Hypercapnia: a condition of abnormally elevated carbon dioxide (CO2) levels in the blood

Chapter 11- Diseases of the Digestive System K00-K95 Increase in sections from seven (in ICD-9) to ten (in ICD-10) Expanded breakdown of all types of ulcers and colitis Need to know for ulcers, type and with/without hemorrhage and/or perforation

Non-Infective Enteritis and Colitis K50-K52 K50 Crohn’s disease K51 Ulcerative colitis K52 Other and unspecified noninfective gastroenteritis and colitis

Non-Infective Enteritis and Colitis K50-K52 -2 Need to know if associated manifestation of: Rectal bleeding Intestinal obstruction Fistula Abscess Other complication

Chapter 12 – Diseases Of Skin & Subcutaneous Tissue L00-L99 L89 codes for Pressure Ulcer are combination codes that identify the site as well as the stage of the ulcer and also have added laterality Assignment of the pressure ulcer stage should be guided by clinical documentation of the stage Assign code for the highest stage reported for that site

Chapter 12 – Diseases Of Skin & Subcutaneous Tissue L00-L99 -2 Need to know for pressure ulcer coding site (including laterality) and stage

Non-Pressure Chronic Ulcers of Lower Limbs L97 Expanded breakdown of this section to include level of severity: Limited to breakdown of skin With fat layer exposed With necrosis of muscle With necrosis of bone With unspecified severity Need to know for chronic ulcer coding, site, laterality, level of severity

Chapter 13 – Diseases Of Musculoskeletal (M00-M99) Gout now in this section Site and laterality needed Represents the bone, joint or muscle involved Where more than one bone, joint or muscle is involved, such as osteoarthritis, use the assigned “multiple sites” code; if not available, use multiple codes to indicate the sites Bone vs. Joint – Certain conditions where the bone may be affected at the upper & lower end; site designation will be the bone, not the joint Some sites listed in ICD-9 include upper arm, forearm, lower leg – in ICD-10, this section is just listed by joint (shoulder, elbow, wrist, hand, hip, knee, ankle/foot) Most codes listed by joint site, but a few by bone (M21.7 unequal limb length of which limb bone), and muscle (M23.0 cystic meniscus of which part of the meniscus muscle) M32 Lupus is listed by organ/system involvement ICD-10 Orientation in Post Acute Care 4hrs PART III 3-14-14

Chapter 13 – Diseases Of Musculoskeletal (M00-M99) -2 Bone, joint or muscle conditions that are the result of a healed injury are coded to this chapter Chronic or recurrent conditions are also coded to this chapter Pathologic fractures are coded with 7th character of “D” for subsequent encounters after active treatment is completed, if routine healing is occurring

Osteoarthritis M15-M19 M15 Polyosteoarthritis *new for multiple sites M16 Osteoarthritis of hip M17 Osteoarthritis of knee M18 Osteoarthritis of first carpometacarpal joint M19 Other and unspecified osteoarthritis In ICD-10, sites are the main sub-categories, followed by primary/secondary, laterality, and if there was an underlying condition identified as the cause Excludes OA spine M47. If site had joint replacement, only code Z96.6- ICD-10 Orientation in Post Acute Care 4hrs PART III 3-14-14

Osteoarthritis M15-M19 -2 Need to know joint site, laterality and underlying condition, and whether primary or secondary osteoarthritis In ICD-10, sites are the main sub-categories, followed by primary/secondary, laterality, and if there was an underlying condition identified as the cause Excludes OA spine M47. If site had joint replacement, only code Z96.6- ICD-10 Orientation in Post Acute Care 4hrs PART III 3-14-14

Back Pain Low back pain was under disorders of muscle, now is under category of M54 Dorsalgia M54.0- Panniculitis of neck and back M54.1- Radiculopathy M54.2 Cervicalgia M54.3- Sciatica M54.4- Lumbago with sciatica M54.5 Low back pain M54.6 Pain in thoracic spine Dorsalgia = back pain M54.8 Other dorsalgia M54.9 unspecified dorsalgia ICD-10 Orientation in Post Acute Care 4hrs PART III 3-14-14

Osteoporosis M80 Osteoporosis with current pathological fracture is used for any patient with known osteoporosis who has a fracture, even if patient had minor fall or trauma, if that fall would not usually break a normal bone M81 Osteoporosis without current pathological fracture is used for patients who do not currently have a pathologic fracture d/t osteoporosis, even if they have had a fracture in the past

Osteoporosis -2 Need to know if current pathological fx, site and laterality

Chapter 14 – Diseases Of Genitourinary (N00-N99) Still need stage of chronic kidney disease (CKD) – stages 1-5 N18.1-N18.5 If both a stage of CKD and ESRD are documented, then assign code N18.6 only Code first any associated disease: Diabetic chronic kidney disease Hypertensive chronic kidney disease Need to know stage and any associated dx

Renal Disease N17 Acute kidney failure N18 Chronic kidney disease N19 Unspecified kidney failure N28.9 Disorder of kidney and ureter, unspecified Includes Renal disease (acute), NOS Includes Renal insufficiency (acute) Need to know if condition is acute or chronic In long term care, typically we are usually treating the chronic condition, not the acute (these are usually conditions that would require the pt to be hospitalized). Need MD to document “chronic”, as appropriate. -N18.9 includes chronic renal insufficiency -N19 includes Uremia, NOS ICD-10 Orientation in Post Acute Care 4hrs PART III 3-14-14