Guidelines Most Significantly Affected Under ICD-10-CM Kay Potter, RHIT, CPC, CPC-I, PCS

ICD – 10 Keep Calm And Code On! Tips And Resources

Official ICD 10 Guidelines Objectives: In this section you will learn Review the basic structure of ICD-10-CM and differences/similarities to ICD-9-CM. Describe updates to the ICD-10-CM system Analyze changes to ICD-10-CM Official Guidelines for Coding and Reporting Official ICD 10 Guidelines

NCHS is responsible for developing the diagnostic portion of the ICD-10 coding system, ICD-10-CM. CMS is responsible for developing the procedure portion of the ICD-10 coding system, ICD-10-PCS. Who is NCHS? National Center for Health Statistics compiles statistical information used to guide actions and policies to improve the public health U.S. citizens. Key Point

ICD-10 Code Set Draft Format Implementation date October 1, 2014 Partial Code Freeze October 1, 2011 – Last regular update to ICD-9-CM October 1, 2012 – 2013 – Limited updates to both ICD-(-CM and ICD-10-CM October 1, 2014 – Limited updates to ICD-10-CM, ICD-9-CM no longer used. October 1, 2015 – Regular Updates to ICD-10- CM/PCS. ICD-10 Code Set Draft Format

ICD-10-CM Diagnosis Codes To be used in all settings Hospital inpatients Hospital outpatients Physicians offices Emergency offices Home Health Long Term Care Rehabilitation Facilities For ANY diagnosis anywhere ICD-10-CM Diagnosis Codes

As additional detail is to be reported with ICD-10- CM, more detail will be required in the medical records from which the data for coding are extracted. For payers, the clarity afforded by the ICD-10-CM coding system is likely to greatly enhance and assist in supporting medical necessity. With ICD-10-CM, the diagnosis comes significantly closer to being “married” to the procedure; further, it intrinsically gives a more complex description of the condition, thereby leaving less room for denials. Advantages of ICD-10

A Review of the Basics 21 chapters and expanded codes Some chapters reorganized, some conditions put in to different chapters Alphanumeric – first character is always a letter Addition of up to 7 characters 7th character code extensions in some cases Injuries Initial encounter Subsequent encounter Sequela Obstetrics Glaucoma A Review of the Basics

Why so Many More Codes? Laterality __ Example: Acute angle closure glaucoma ICD-9-CM 365.22 ICD-10-CM H40.211 Right eye H40.212 Left eye H40.213 Bilateral H40.214 Unspecified eye Increased Specificity External Cause Codes Why so Many More Codes?

What is Different in ICD-10-CM Alphanumeric Alpha characters are not case sensitive I and O are used but only as the 1st character U is not used – saved for the International version Restructured chapters E.g. injuries by site and then by type Increased specificity and detail E.g. laterality – as described Combination codes E.g. – Diabetes, Angina, and CAD What is Different in ICD-10-CM

The Good News – What is the SAME in ICD-10-CM Many of the guidelines are exactly the same between ICD-9-CM and ICD-10-CM Conventions Format of the Index and Tabular List Abbreviations and Punctuation NEC, NOS, brackets, and colons etc. Steps in assigning codes Includes notes General coding guidelines The Good News – What is the SAME in ICD-10-CM

Some Differences – Conventions and General Guidelines Conventions, general coding guidelines and chapter specific guidelines X as a placeholder 7th character Excludes Notes -- Excludes 1 – not coded -- Excludes 2 – not included here General Coding Guidelines Late Effects is now a Sequela Laterality Some Differences – Conventions and General Guidelines

The diagnosis coding system (ICD-10-CM) will affect both hospital and physician providers . In creating the clinical modification for ICD-10 in this country, the National Center for Hospital Statistics has made significant changes. The number of diagnostic codes available for use in the ICD-10-CM coding system is larger than the number available in ICD-9-CM by thousands. Documentation Needs

The documentation principles and concepts, may apply to documentation considerations created by the impact of both systems. ICD-10-CM will pose certain significant challenges to coders in both physician and facility settings. As additional detail is to be reported with ICD- 10-CM, more detail will be required in the medical records from which the data for coding are extracted. Documentation Needs

Never code strictly from the alphabetical index, always confirm your code choice in the tabular list to insure the most appropriate code choice selection. ICD 10 has 21 Chapters Coding Tip

The alphabetic Index is divided into sections and is organized by main terms Index of Diseases and Injury Index of External Causes of Injury Table of Neoplasms Table o Drugs and Chemicals Alphabetic Index

Terms Data Granularity Degree or detail contained in data; the fineness in which data fields are subdivided. The increased granularity, or in other words, the greater level of detail afforded by ICD-10 provides the quality data needed to support the medical necessity of rendering patient care, improving clinical outcomes, and improve cost- effective disease management. Terms

Combination Code – The term represents a single code used to classify: two diagnoses, either a diagnosis with an associated sign or symptom or a diagnosis with an associated complication. IMPORTANT—Multiple codes should not be used when the classification provides a combination code that clearly identifies all of the elements documented in the diagnosis. Terms

Granularity – The term refers to the level of hierarchy and the amount of information the increased hierarchy provides to the diagnostic description Laterality – ICD-10 code description include right or left designation. The right side is usually character 1, Left side character 2. Bilateral character is usually 3. Unspecified side is either a character 0 or 9, depending on whether it is a fifth or sixth character. Terms

New – placeholder “X” if the code only has 4 or 5 characters, but needs a 7th character (e.g., initial/subsequent/sequela to injury), use an “X” in the blank spaces Different – Exclude 1 (never code it here) and Exclude 2 (not included, if he has that code it separately New – Laterality New – Coding pregnancy trimesters New – Glasgow coma scale New – Functional quadriplegia

What you can do Be detailed in your diagnostic documentation: Identify laterality Identify specific site, anatomical location. What you can do

ICD-10-CM Specific Guidelines for Selected Chapters

Thank you for Supporting AHIMA!