ICD-10-CM Changes Pat Shaw

 ICD-10-CM replaces ICD-9-CM for diagnosis in all settings  ICD-10-PCS replaces ICD-9-CM volume 3 procedures codes for hospital inpatient procedures only  CPT/HCPCS is not affected  Implementation discharges/encounters on or after October 1, ICD-10

XXXX Category. Etiology, anatomic site, severity Added code extensions (7 th character) for obstetrics, injuries, and external causes of injury 3 Coding and 7 th Character Extensions XXX AMS x A Additional Characters Alpha (Except U) 2 Numeric Numeric or Alpha 3 – 7 Characters

Coding in ICD-10-CM 4 ICD-9-CMICD-10-CM Three to five charactersThree to seven characters First digit is numeric but can be alpha (E or V) First character always alpha 2-5 are numericAll letters used except U Always at least three digitsCharacter 2 always numeric: 3-7 can be alpha or numeric Decimal placed after the first three characters (or with E codes, placed after the first four characters) Always at least three digits Alpha characters are not case-sensitiveDecimal placed after the first three characters Alpha characters are not case-sensitive

 Diagnoses  ICD-9-CM - 14,025  ICD-10-CM - 68,069  Procedures  ICD-9-CM - 3,824  ICD-10-PCS - 72,589 ICD-10-CM Overview

 Benefits of ICD-10-CM  ICD-10-CM incorporates much greater clinical detail and specificity than ICD-9-CM  Terminology and disease classification have been updated to be consistent with current clinical practice  A new modern classification system will provide much better data needed for:  Measuring care, quality, safety, and efficacy of care  Reduction of paper work related to documentation queries  Improving payment systems and reimbursement ICD-10-CM Overview

 New ICD-10-CM features  Laterality (left, right, bilateral)  Examples:  C Malignant neoplasm of lower-outer quadrant of right female breast  H Central corneal ulcer, bilateral  L Pressure ulcer of right elbow, stage II ICD-10-CM Overview

 Combination codes for certain conditions and common associated symptoms and manifestations  Examples:  K Diverticulitis of large intestine with perforation and abscess with bleeding  E Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema  I Atherosclerotic heart ICD-10-CM Overview

 Combination codes for poisonings and associated external cause  Example:  T42.3X2S - Poisoning by barbiturates, intentional self-harm, sequela  Obstetric codes identify trimester instead of episode of care  Example:  O Excessive weight gain in pregnancy, second trimester ICD-10-CM Overview

 Character “X”  Used as a 5 th character placeholder in to allow for future expansion and to fill in other empty characters  Used when a code less than 6 characters in length requires a 7 th character  Examples:  T46.1X5A - Adverse effect of calcium-channel blockers, initial encounter  T15.02XD - Foreign body in cornea, left eye, subsequent encounter ICD-10-CM Overview

 Two types of Excludes notes  Excludes 1  Indicates the code excluded should never be used with the code where the note is located  Do not report both codes  Example:  Q03 - Congenital hydrocephalus  Excludes 1: Acquired hydrocephalus - G91

ICD-10-CM Overview  Excludes 2  Indicates the condition excluded is not part of the condition represented by the code  A patient may have both conditions at the same time  Both codes may be assigned together to capture both conditions  Example:  L Dermatitis due to ingested food  Excludes 2: Dermatitis due to food in contact with skin - L23.6, L24.6, L25.4

 Inclusion of Clinical Concepts  Underdosing, blood type, blood alcohol level  Examples:  T45.526D - Underdosing of antithrombotic drugs, subsequent encounter  Z Type O blood, Rh positive  Y Blood alcohol level of mg/100 ml ICD-10-CM Overview

 Code Expansion  Injuries, diabetes, substance abuse, postoperative complications  Examples:  E Type 1 diabetes mellitus with diabetic neuropathic arthropathy  F Alcohol abuse with alcohol-induced sleep disorder  T82.02XA - Displacement of heart valve prosthesis, initial encounter ICD-10-CM Overview

 Postoperative complications  Expanded distinction between intraoperative complications and postprocedural disorders  Examples:  D Intraoperative hemorrhage and hematoma of spleen complicating a procedure on the spleen  D Postprocedural hemorrhage and hematoma of spleen following a procedure on the spleen ICD-10-CM Overview

 Other Changes in ICD-10-CM  Injuries grouped by anatomical site rather than by type of injury  Restructuring and reorganization in number of chapters  Reclassification for certain diseases to different chapters  New code definitions  Definition of acute myocardial infarction is now 4 weeks rather than 8 weeks ICD-10-CM Overview

Case 1 75-year-old woman receiving continued care for multiple facial lacerations, abrasions, and contusions. She was previously treated in the ER for these injuries.

Case 1 ICD-9-CM V58.89 Encounters for procedures and aftercare ICD-10-CM S01.81xD Laceration w/o foreign body of other part of head, subsequent encounter X58.xxxD Accident, NOS, subsequent encounter

Case 2 Patient presents for results of an MRI of the right knee, has severe pain and inability to descend stairs. She fell while running in the park. MRI showed complex medial meniscus tear and a Baker’s cyst, along with mild chondromalacia of the patella. Options for treatment were discussed and the patient will determine what she’d like to do.

ICD-9-CM  Tear of medical cartilage/meniscus of knee, current  E885.9 Fall on same level from slipping/tripping/stumbling  E849.4 Injury or poisoning occurring at/in place for recreation and sport  E001.1 Activities involving running  E000.8 External cause status  Synovial cyst of popliteal space  Chondromalacia of patella

ICD-10-CM  S83.231A Tear, torn (traumatic) meniscus (knee) (current injury), medial, complex  M71.21Baker’s cyst – see Cyst, Baker’s  M22.41Chondromalacia (systemic), patella  W19.xxxA Index to External Causes – Fall, falling (accidental)  Y Index to External Causes – Place of occurrence, park (public)  Y93.02Index to External Causes – Activity (involving) running  Y99.8Index to External Causes – External cause status, leisure activity

Case 3 A patient is seen in the hospital with a diagnosis of congestive heart failure due to hypertensive heart disease. The patient responds positively to Lasix therapy. The patient also has chronic kidney disease stage 5.

ICD-9-CM  Hypertensive heart and chronic kidney disease stage V or end state renal disease, with heart failure, unspecified benign or malignant  Chronic kidney disease, stage V  Congestive heart failure, unspecified

ICD-10-CM  I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end state renal disease  I50.9 Heart failure, unspecified  N18.5 Chronic kidney disease, stage 5

Case 4 This woman is G1P0 at 39 weeks with twin gestation. The delivery was complicated by nuchal cord, without compression, of fetus 2. Both infants were liveborn and healthy.

ICD-9-CM  Twin pregnancy, delivered  Other and unspecified cord entanglement, without mention of compressions, delivered  V27.2 Mother with twins, both liveborn

ICD-10-CM  O Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, third  O69.81x2 Labor and delivery complicated by cord around neck, without compression, fetus 2  Z37.2 Outcome of delivery, twins, both liveborn

Case 5 55 year old male was admitted for OT following hospitalization for type I open traumatic fracture of the left radius and ulna.

ICD-9-CM  V57.21 Encounter for Occupational Therapy  V54.12 Aftercare for healing traumatic fracture of lower arm

ICD-10-CM  S52.92xE Fracture, traumatic, radius  S52.202E Fracture, traumatic, ulna  X58.xxxD Index to External Cause, accident

Case 6 This type 1 diabetic patient has a severe chronic diabetic left foot ulcer with diabetic peripheral angiopathy. He also has diabetic stage 2 chronic kidney disease. He is being evaluated to see if debridement is required for this ulcer with breakdown of the skin.

ICD-9-CM  Diabetes mellitus with specified manifestation, type I (juvenile type), not stated as uncontrolled  Ulcer of foot (toes)  Diabetes mellitus with peripheral circulatory disorder, type I (juvenile type), not stated as uncontrolled  Peripheral angiopathy in diseases classified elsewhere  Diabetes mellitus with renal manifestations, type I (juvenile type), ), not stated as uncontrolled  Chronic kidney disease, stage II (mild)

ICD-10-CM E Type 1 diabetes mellitus with foot ulcer L Non-pressure chronic ulcer of other part of left foot limited to breakdown of skin E10.51 Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene E10.22 Type 1 diabetes mellitus with diabetic chronic kidney disease N18.2 Chronic kidney disease, stage 2 (mild)

Mapping between Old & New Systems 34 GEMs Maps = GEMs Crosswalks ICD-9-CM ICD-10-PCS via CMS web site ICD-9-CM ICD-10-CM via CMS /NCHS web sites General equivalence maps (GEMs) between ICD-9-CM and ICD-10-CM/PCS have been developed

ICD-10 Resources  _GEMs.asp _GEMs.asp  2012 Code Set, Official Guidelines, GEMS 