1. 2010 UBO/UBU Conference Health Budgets & Financial Policy 1 Briefing: ICD-10-CM (International Classification of Diseases – 10 th Revision – Clinical Modifications) A Piece of Cake Date: 23 March 2010 Time: 1400–1450

2. 2010 UBO/UBU Conference Turning Knowledge Into Action Pre-Quiz 4. The ICD-9-CM codes are being “frozen” (will not change, no additions/deletions) in 2012 because – a. There is so much automation and all those programs need to have all the code numbers for the various conditions changed, tested, fixed, tested… – b. To give coders an entire year to goof off claiming they were studying VERY hard to understand the ICD-10-CM. – c. Because the cost of gasoline had gone up to $5/gallon and those of us driving up from Washington to Baltimore for the Coordination and Maintenance Meetings wanted a break for an entire year. – d. Because we knew Washington DC was going to get 30+ inches of snow in one week and we wanted all the coders to know how to spell “frozen” before December 2009 and February 2010. 2

3. 2010 UBO/UBU Conference Turning Knowledge Into Action Outdated ICD-9-CM is Outdated 30 years old –technology has changed Many categories full Not descriptive enough Why Do We Need a New Coding System? Reimbursement–would enhance accurate payment for services rendered Quality–would facilitate evaluation of medical processes and outcomes 3

4. 2010 UBO/UBU Conference Turning Knowledge Into Action What Characteristics Are Needed in a Coding System? Flexible enough to quickly incorporate emerging diagnoses and procedures Exact enough to identify diagnoses and procedures precisely ICD-9-CM is neither of these 4

5. 2010 UBO/UBU Conference Turning Knowledge Into Action Reimbursement and Quality Problems With ICD-9-CM Example –fracture of wrist Patient fractures left wrist A month later, fractures right wrist ICD-9-CM does not identify left versus right –requires additional documentation ICD-10-CM describes Left versus right Initial encounter, subsequent encounter Routine healing, delayed healing, nonunion, or malunion 5

6. 2010 UBO/UBU Conference Turning Knowledge Into Action Quality Problems Reimbursement and Quality Problems With ICD-9-CM – Example –combination defibrillator pacemaker device Codes for this device are not in the cardiovascular chapterof ICD-9-CM with other defibrillator and pacemaker devices – Coders and researchers have trouble findingthese codes with this type of erratic code assignment – ICD-10-PCS provides distinct codes for all these types of devices, in an orderly manner that is easy to find 6

7. 2010 UBO/UBU Conference Turning Knowledge Into Action Benefits Benefits of Adopting the New Coding System – Incorporates much greater specificity and clinical information, which results in Improved ability to measure health care services – Increased sensitivity when refining grouping and reimbursement methodologies – Enhanced ability to conduct public health surveillance – Decreased need to include supporting documentation with claims 7

8. 2010 UBO/UBU Conference Turning Knowledge Into Action Objectives Know that ICD-10-CM transition will be easy for coders Understand the General Equivalency Mappings Know the coding guidelines for ICD-10-CM 8

9. 2010 UBO/UBU Conference Turning Knowledge Into Action Difference Between ICD-10-CM, ICD-10-PCS and ICD-9-CM International Classification of Diseases – 9 th Revision – Clinical Modifications (ICD-9-CM) – Developed in USA in 1970s based on the World Health Organization’s ICD-9 Based on ICD-8, and ICD-8a – Clinical Modifications (CM) is the United States’ version Added to WHO ICD-9: – External Causes of Injury – Factors Influencing Health – Volume 3, Institutional Procedure Coding 9

10. 2010 UBO/UBU Conference Turning Knowledge Into Action Users of ICD-9-CM ICD-9-CM Users ICD-9-CM Diagnoses –used by all types of providers ICD-9-CM Procedures –used only by inpatient hospitals Current Procedural Terminology (CPT) –used for all ambulatory and physician procedure reporting 10

11. 2010 UBO/UBU Conference Turning Knowledge Into Action ICD-10-CM ICD-10-Clinical Modifications is for use in the United States – Other countries use modifications specific to their country, such as ICD-10-CA for Canada and ICD-10- AM for Australia ONLY: – Diagnoses, – Factors Influencing Health, and – External Causes of Injury Does not include procedures as did ICD-9-CM – No third volume – See ICD-10-Procedure Classification System Currently used for cause of death reporting in the United States 11

12. 2010 UBO/UBU Conference Turning Knowledge Into Action ICD-10-CM Available for download from: – http://www.cdc.gov/nchs/icd/icd10cm.htm#10update http://www.cdc.gov/nchs/icd/icd10cm.htm#10update At the bottom of the page A bit easier and less expensive than going to Ingenix and buying it on disc for $119.00 Would recommend buying one book every other year until 2013 as they are much easier to work with The downloads are nice for a quick word search 12

13. 2010 UBO/UBU Conference Turning Knowledge Into Action ICD-10-CM Is Better Due To Addition of information relevant to ambulatory and managed care encounters – Expanded injury codes Creation of combination diagnosis/symptom codes to reduce the number of codes needed to fully describe a condition Addition of a sixth character for some codes Incorporation of common 4th and 5th digit subclassifications Laterality; and Greater specificity in code assignment for many codes. The new structure will allow further expansion than was possible with ICD-9-CM. 13

14. 2010 UBO/UBU Conference Turning Knowledge Into Action ICD-10-CM “Piece of Cake” for anyone who can code using ICD-9-CM – Same basic guidelines – Same basic layout/organization – Same basic index – Same basic tabular – Some codes are more detailed – Some codes indicate initial or subsequent encounter – Format – alpha + 2 numerics + decimal point + numeric+3 alphanumerics H66.9 Otitis media, unspecified – Otitis media NOS – Acute otitis media NOS – Chronic otitis media NOS H66.90 Otitis media, unspecified, unspecified ear H66.91 Otitis media, unspecified. right ear H66.92 Otitis media, unspecified, left ear H66.93 Otitis media, unspecified, bilateral 14

15. 2010 UBO/UBU Conference Turning Knowledge Into Action Review of Existing Code Formats ICD-9-CM diagnoses (look for the decimal point) – 3-5 numeric characters with decimal point after the 3 rd – External cause of injury Exxx.x – Factors influencing health Vxx.xx ICD-9-CM procedure (look for the decimal point) – Numeric xx.xx CPT – 5 numeric, or 4 numeric with terminal F or T (no decimal point) HCPCS – alpha with 4 numeric (no decimal point) – does not currently use F or T 15

16. 2010 UBO/UBU Conference Turning Knowledge Into Action ICD-9-CM Comparison to ICD-10-CM 16

17. 2010 UBO/UBU Conference Turning Knowledge Into Action ICD-9-CM Comparison to ICD-10-CM 17

18. 2010 UBO/UBU Conference Turning Knowledge Into Action Sample of Downloaded Index 18

19. 2010 UBO/UBU Conference Turning Knowledge Into Action The Tabulars ICD-9-CM 001 Cholera – 001.0 Due to Vibrio cholerae – 001.1 Due to Vibrio cholerae el tor – 001.9 Cholera, unspecified 002 Typhoid and paratyphoid fevers ICD-10-CM A00 Cholera – A00.0 Cholera due to Vibrio cholerae 01, biovar cholerae (classical cholera) – A00.1 Cholera due to Vibrio cholerae 01, biovar eltor (cholera eltor) – A00.9 Cholera, unspecified A01 Typhoid and paratyphoid fevers 19

20. 2010 UBO/UBU Conference Turning Knowledge Into Action The Tabular – Example J00 (Currently 460) Excludes1 = NOT CODED HERE (both conditions cannot occur at same time Excludes2 = Not included in this diagnosis, if it is there, code them both 20

21. 2010 UBO/UBU Conference Turning Knowledge Into Action ICD-9-CM vs ICD-10-CM Tabular ICD-9-CM 8. Diseases of the Respiratory System (460-591) Acute Respiratory Infections (460-466) 460 Acute nasopharyngitis [common cold] ICD-10-CM Chapter X – Diseases of the Respiratory System (J00-J99) Acute Upper Respiratory Infections (J00-J06) J00 Acute nasopharyngitis [common cold] 21

22. 2010 UBO/UBU Conference Turning Knowledge Into Action ICD-10-CM Morbidity classification – Includes potentially fatal conditions – Treatable For use in – Hospitals; acute short-term, long-term – Provider office – Other outpatient settings 22

23. 2010 UBO/UBU Conference Turning Knowledge Into Action Benefit to the MHS Ability to – Collect more detailed information – Compare morbidity data to mortality data – Compare to international data – Collect some laboratory results (e.g., blood alcohol levels and ABO blood types) 23

24. 2010 UBO/UBU Conference Turning Knowledge Into Action Benefit to the MHS Ability to collect concepts such as – “Do Not Resuscitate” – Initial versus subsequent encounters – Right, left, bilateral – First, second, third trimester – Identification of fetus in multiple gestations – Classifications of fractures – Dominate versus non-dominate side – Burns separated based on heat or chemical – Cesarean delivery without medical indication 24

25. 2010 UBO/UBU Conference Turning Knowledge Into Action Benefit to the MHS Better data on which to base decisions Easier to pull records with criteria needed for a specific study Expandable, more space for new conditions More detailed external causes of injury – e.g., Y93.5B Cellular telephone usage in work-related activity 25

26. 2010 UBO/UBU Conference Turning Knowledge Into Action Example of Expanded Code Set F10.2 Alcohol dependence – Excludes1: alcohol abuse (F10.1-) – alcohol use, unspecified (F10.9-) – Excludes2: toxic effect of alcohol (T51.0-) – F10.20 Alcohol dependence, uncomplicated – F10.21 Alcohol dependence, in remission – F10.22 Alcohol dependence with intoxication – Acute drunkenness (in alcoholism) Excludes1: alcohol dependence with withdrawal (F10.23-) – F10.220 Alcohol dependence with intoxication, uncomplicated – F10.221 Alcohol dependence with intoxication delirium – F10.229 Alcohol dependence with intoxication, unspecified – F10.23 Alcohol dependence with withdrawal Excludes1: Alcohol dependence with intoxication (F10.22-) – F10.230 Alcohol dependence with withdrawal, uncomplicated – F10.231 Alcohol dependence with withdrawal delirium – F10.232 Alcohol dependence with withdrawal with perceptual disturbance – F10.239 Alcohol dependence with withdrawal, unspecified – F10.24 Alcohol dependence with alcohol-induced mood disorder – F10.25 Alcohol dependence with alcohol-induced psychotic disorder – F10.250 Alcohol dependence with alcohol-induced psychotic disorder with delusions – F10.251 Alcohol dependence with alcohol-induced psychotic disorder with hallucinations – F10.259 Alcohol dependence with alcohol-induced psychotic disorder, unspecified – F10.26 Alcohol dependence with alcohol-induced persisting amnestic disorder – F10.27 Alcohol dependence with alcohol-induced persisting dementia – F10.28 Alcohol dependence with other alcohol-induced disorders – F10.280 Alcohol dependence with alcohol-induced anxiety disorder – F10.281 Alcohol dependence with alcohol-induced sexual dysfunction – F10.282 Alcohol dependence with alcohol-induced sleep disorder – F10.288 Alcohol dependence with other alcohol-induced disorder – F10.29 Alcohol dependence with unspecified alcohol-induced disorder 26

27. 2010 UBO/UBU Conference Turning Knowledge Into Action Example of New Code Set O35 Maternal care for known or suspected fetal abnormality and damage – Includes: the listed conditions in the fetus as a reason for hospitalization or other obstetric care to the mother, or for termination of pregnancy – Code also any associated maternal condition – Excludes1: encounter for suspected maternal and fetal conditions ruled out (Z03.7-) – One of the following 7th characters is to be assigned to each code under category O35. 7th character 0 is for single gestations and multiple gestations where the fetus is unspecified. 7th characters 1 through 9 are for cases of multiple gestations to identify the fetus for which the code applies. The appropriate code from category O30, Multiple gestation, must also be ICD-10-CM Tabular Page 1025 2010 – assigned when assigning a code from category O35 that has a 7th character of 1 through 9. 0 not applicable or unspecified 1 fetus 1 2 fetus 2 3 fetus 3 4 fetus 4 5 fetus 5 9 other fetus – O35.0 Maternal care for (suspected) central nervous system malformation in fetus – O35.1 Maternal care for (suspected) chromosomal abnormality in fetus – O35.2 Maternal care for (suspected) hereditary disease in fetus – O35.3 Maternal care for (suspected) damage to fetus from viral disease in mother – O35.4 Maternal care for (suspected) damage to fetus from alcohol – O35.5 Maternal care for (suspected) damage to fetus by drugs – O35.6 Maternal care for (suspected) damage to fetus by radiation – O35.7 Maternal care for (suspected) damage to fetus by other medical procedures – O35.8 Maternal care for other (suspected) fetal abnormality and damage – O35.9 Maternal care for (suspected) fetal abnormality and damage, unspecified 27

28. 2010 UBO/UBU Conference Turning Knowledge Into Action Example of New Data Collection R40.2 Coma – Coma NOS; Unconsciousness NOS – Codes first any associated: coma in fracture of skull (S02.-) coma in intracranial injury (S06.-) – The appropriate 7th character is to be added to each code from subcategory R40.21-, R40.22-, R40.23-: 0 unspecified time 1 in the field [EMT or ambulance] 2 at arrival to emergency department 3 at hospital admission 4 24 hours or more after hospital admission – A code from each subcategory is required to complete the coma scale – Note: These codes are intended primarily for trauma registry and research use but may be utilized by all users of the classification who wish to collect this information R40.20 Unspecified coma – R40.21 Coma scale, eyes open – R40.211 Coma scale, eyes open, never – R40.212 Coma scale, eyes open, to pain – R40.213 Coma scale, eyes open, to sound – R40.214 Coma scale, eyes open, spontaneous 28

29. 2010 UBO/UBU Conference Turning Knowledge Into Action Coma R40.22 Coma scale, best verbal response – R40.221 Coma scale, best verbal response, none – R40.222 Coma scale, best verbal response, incomprehensible words – R40.223 Coma scale, best verbal response, inappropriate words – R40.224 Coma scale, best verbal response, confused conversation – R40.225 Coma scale, best verbal response, oriented R40.23 Coma scale, best motor response – R40.231 Coma scale, best motor response, none – R40.232 Coma scale, best motor response, extension – R40.233 Coma scale, best motor response, abnormal – R40.234 Coma scale, best motor response, flexion withdrawal – R40.235 Coma scale, best motor response, localizes pain – R40.236 Coma scale, best motor response, obeys commands 29

30. 2010 UBO/UBU Conference Turning Knowledge Into Action Coding Guidelines Same – Look it up in the alphabetic, then check in the tabular Same – Abbreviations Same – Punctuation Same – use of “and,” “with,” “see,” “see also” Same – other and unspecified codes Same – includes notes and inclusion terms Same – etiology/manifestation (code first, use additional code, in disease classified elsewhere) Same – must use all available characters Same – conditions that are or are not an integral part of the disease process 30

31. 2010 UBO/UBU Conference Turning Knowledge Into Action Coding Guidelines Same – Acute and Chronic conditions Same – Late Effects (sequela) Same – Human Immunodeficiency Virus (HIV) coding Same – Treatment directed at malignancy Same – Treatment of secondary site of maligancy Same – Primary malignancy previously excised Same – Admission/Encounter for chemo Same – Hypertension Same – Acute myocardial infarction Same – Coding Pathologic Fractures… 31

32. 2010 UBO/UBU Conference Turning Knowledge Into Action Coding Guidelines New – placeholder “x” if the code only has 4 or 5 characters, but needs a 7 th character (e.g., initial/subsequent/sequela to injury), use an “x” in the blank spaces Different – Exclude1 (never code it here) and Exclude2 (not included, if he has that code it separately) New – Laterality New – Coding pregnancy trimesters New – Glasgow coma scale New – Functional quadriplegia 32

33. 2010 UBO/UBU Conference Turning Knowledge Into Action Review ICD-10-CM Diagnoses, not procedures Very similar to ICD-9-CM diagnoses, volumes 1 and 2 (diagnosis index and tabular) Up to 7 alphanumeric characters BOTTOM LINE: If you can code with ICD-9-CM, you can easily transition to ICD-10-CM 33

34. 2010 UBO/UBU Conference Turning Knowledge Into Action 34 Summary MHS is working on the transition The transition will be most difficult for the soft-ware programs ICD-10-CM is much better than ICD-9-CM Coders will not have a problem transitioning from ICD-9- CM to ICD-10-CM.

35. 2010 UBO/UBU Conference Turning Knowledge Into Action 35 Quiz Take the quiz again =-)

36. 2010 UBO/UBU Conference Turning Knowledge Into Action 36 Q&A Questions? Training – Who needs ICD-10-CM training? – When (e.g., 2 months prior)? – Intensity (e.g., 1 hour teleclass a day with 1 hour a day at work to do the assigned lessons)? – Format (e.g., train-the-trainer to come back to work to train you, teleclasses, one REALLY large class [400 students in an auditorium], good teacher sent to each site for a week)? – For more information please check: – http://www.cdc.gov/nchs/icd/icd10cm.htm http://www.cdc.gov/nchs/icd/icd10cm.htm