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Presentation on theme: "ICD-10 Ready or Not here it comes!"— Presentation transcript:

1 ICD-10 Ready or Not here it comes!
Coding & Clinical Documentation Class Presented by: Kathryn Melton- SIP and John Hailes- SMF September 23, 2015

2 Countdown to ICD-10 Implementation

3 Sutter Independent Physicians ICD-10
8 days to go!!! Compliance date: October 1, 2015 The Nation switches from ICD-9 to ICD-10 coding for medical diagnosis and inpatient hospital procedures No grace period for Medicare, SIP or any other organization

4 Sutter Independent Physicians ICD-10
Claim Submissions A valid ICD-10 code will be required on all claims for diagnosis reporting with dates of service, or dates of discharge for inpatients, that occur on or after 10/1/2015 ICD-10 codes will be rejected if submitted prior to 10/1/2015 SIP processing systems are not able to accept the new codes prior to the compliance date. No combo diagnosis coding Mixed reporting of both ICD-9 and ICD-10 codes will be rejected.

5 Sutter Independent Physicians ICD-10
Importance of Documentation Will require greater detail for medical conditions Acuity, Disease Type, Laterality (Left, Right, Bilateral), Disease Stage Documentation must support the assignment of codes No assumption with coding “If it is not documented, it did not happen” Compliance Good documentation practice protects you from penalties and audit reviews RAF- Risk Adjustment Factor CMS reimburses Medicare Advantage plans based on patients health status RAF data is pulled from diagnosis on claims and medical records documentation

6 Sutter Independent Physicians ICD-10
Resources & Provider Support CMS Road to 10- Training videos, common ICD-10 codes by specialty Clinical documentation tips Clinical scenarios Noridian JE Part B- ICD-10 Web-based workshop September 24, 2015 and October 22,

7 Sutter Independent Physicians ICD-10
ICD-10 Update on RAF CMS list of ICD-10-CM diagnosis codes for the CMS-Hierarchical Condition Category (HCC) risk adjustment model:

8 Sutter Independent Physicians ICD-10
Optum 2015 WebEx Training These classes are FREE to Providers, Coders, Billers and Office Staff California Training Sessions Intro to ICD-10-CM and Coding for Risk Adjustment -1.5 Hours ICD-10-CM training will include emphasis on clinical documentation improvement and compares coding in ICD-9-CM and ICD-10-CM for chronic conditions such as Diabetes Mellitus (DM), Chronic Kidney Disease (CKD), Hypertensive Diseases (CKD and Heart Failure [HF]), and Peripheral Arterial Disease (PAD). National Training Sessions Specialty Presentations-1 hour Content will include both ICD-9-CM and ICD-10-CM coding and documenting for Medicare Advantage. Specialties covered: Pulmonary Diseases Peripheral Vascular Diseases Diabetes Space is limited! To register contact Kathryn at

9 Sutter Independent Physicians ICD-10
Training American Academy of Professional Coders (AAPC)- ICD-10 Training for Physicians, Coders and office staff ICD-9 to ICD-10 Crosswalks (by Specialty) Contemporary Forums- in association with AAPC Live ICD-10-CM 2 day Boot Camp training sessions

10

11 ICD-10 Documentation Tips
Sutter Health ICD-10 Documentation Tips Clinical Documentation Improvement

12 Keys to ICD-10 Clinical Documentation

13 Documentation Tips

14 Documentation Tips

15 Documentation Tips

16 Documentation Tips

17 Documentation Tips

18 Documentation Tips

19 Documentation Tips

20 Procedure Documentation Tips

21 Procedure Documentation Tips

22 Sutter Health ICD-10 Resources
HealthStream: Pre-Test provides option to test out of further training if proficient in ICD-10 documentation concepts Specialty-specific modules and videos assigned based on your designated specialty Available both inside and outside of the Sutter Network Logging in from outside of Sutter? You can VPN into the Physician Education Site at You have already been assigned HealthStream courses based on your specialty. To access your HealthStream courses use your network login. (Your password will be your last name, all lowercase.) To access HealthStream from outside the network, click here:

23 Documentation Drives ICD-10
John Hailes ASC-E/M, CCS, CCS-P, CPC, CPC-H, CIRCC, CPMA, CPC-I, CEMC, CFPC, Trainer

24 Objectives Identify areas in ICD-10-CM that include new terminology for clinical documentation Define areas in ICD-10-CM that enable improved data capture if more specific conditions are documented Acuity Disease type Site specifity Disease stage Show providers examples of the type of terminology needed to show. stage, status, exacerbation, relapse and other qualifiers for conditions that can vary widely in their acuity and severity Track x – xxx day –

25 Top Clinical Documentation Issues for ICD‐10‐CM
Expanded anatomy specificity requirements in high volume diseases Extensive code categories that combine the underlying cause with manifestations or complications for many common acute and chronic diseases Increased numbers of codes that identify both the infective cause or agent and the specific state of the infectious disease diagnosis Track x – xxx day –

26 Documentation Matters
“If it was not documented, it was not done”

27 Documentation Matters
Impact of clinical documentation Patient Quality of care provided Continuity of care Non-payment by Insurance Physician Demonstrates accountability Performance Management Reduced or denied payment Relative Value Unit (RVU) Hierarchy Coding Category (HCC) Facility Coding and Billing Supporting documentation for treatment and services rendered Appropriate reimbursement DRG

28 ICD-10 Code Build Anatomical location Laterality Severity
Which anatomical structure Proximal, distal, medial, lateral, central, peripheral, superior, inferior, anterior, posterior… Laterality Right side or left side Severity Mild, moderate or severe Environmental factors Smoking

29 ICD-10 Code Build (cont.) Time parameters
Intermittent/Paroxysmal Recurring Acute or chronic Post-op, post delivery Comorbidities or complications Diabetes with neuropathic joint Intracranial injury Manifestations Paralysis Loss of consciousness Healing level Routing healing, delayed healing, non-union, malunion…

30 Historical Clinician Education
 Findings and symptoms   Fever Hypoglycemia/hyperglycemia Wheezing External causes Motor vehicles, injury locations Assault, accidental, work related, intentional self harm Type of encounter Initial encounter, subsequent encounter, encounter for condition sequela, routine evaluation

31 ICD- 9 VS. ICD-10

32 Coding and 7th Character Extensions
2 Numeric 3 - 7 Numeric or Alpha Additional Characters Alpha (Except U) . . X M S A X 2 X 6 X X 5 X x A X Category Etiology, anatomic site, severity Added code extensions (7th character) for obstetrics, injuries, and external causes of injury 3 – 7 Characters

33 ICD-10 Big Picture 50% of all ICD-10 codes are related to the musculoskeletal system 36% of all ICD-10 codes distinguish right from left 25% of all ICD-10 codes are related to fractures 25% of the code increase is related to specification of encounter 1st trimester, 2nd trimester, 3rd Trimester

34 ICD- 10 Overview

35 Encounter Form

36 One More Example ICD-10-CM ICD-9-CM Sprained Ankle Sprained Ankle
45 Codes Which part of the ankle was injured? Right or Left? First-time Injury? Sprained Ankle 5 Codes 36

37 Non-Coronary Artery Arteriosclerosis
ICD-9 ICD-10 440.XX Renal Extremities Native/Graft Other Specified site(s) I70.XXX More specific Sites Concept of laterality Right Left Bilateral Intermittent claudication Rest pain Ulceration Gangrene

38 707.13 Ulcer of ankle, except pressure ulcer
ICD-10-CM Codes L Non-pressure chronic ulcer of unspecified ankle with unspecified severity ** There are more specific code choice selections available in ICD-10-CM. These include: L Non-pressure chronic ulcer of unspecified ankle limited to breakdown of skin L Non-pressure chronic ulcer of unspecified ankle with fat layer exposed L Non-pressure chronic ulcer of unspecified ankle with necrosis of muscle L Non-pressure chronic ulcer of unspecified ankle with necrosis of bone L Non-pressure chronic uler of unspecified ankle with unspecified severity L Non-pressure chronic ulcer of right ankle limited to breakdown of skin ** Code first any associated underlying condition: Atherosclerosis of the lower extremities (I70.23-, I70.24-, I70.33-, I70.34-, I70.43-, I70.44-, I70.53-, I70.54-, I70.63-, I70.64-, I70.73-, I70.74-) Chronic venous hypertension (I87.31-, I87.33-) Diabetic ulcers (E08.621, E08.622, E09.621, E09.622, E10.621, E10.622, E11.621, E11.622, E13.621, E13.622) Postphlebetic syndrome (I87.01-, I87.03-) Postthrombotic syndrome (I87.01-, I87.03-) Varicose ulcer (I83.0-, I83.2-) Code first any associated gangrene (I96)

39 Diseases of the Circulatory System
ICD-10-CM Gray’s Anatomy 1918 Diseases of the Circulatory System

40 Type of hypertension not used as an axis
ICD-9-CM guidelines indicate that an MI is acute for 8 weeks, whereas ICD-10-CM guidelines state “4 weeks.” Type of hypertension not used as an axis Acute MI codes changed from 8 weeks to 4 weeks or less Gray’s Anatomy 1918

41 401.9 Hypertension (essential), unspecified
ICD-10-CM Codes I10 Essential (primary) hypertension *Instructional note in ICD-10-CM indicates to use additional code to identify: exposure to environmental tobacco smoke (Z77.22) history of tobacco use (Z87.891) occupational exposure to environmental tobacco smoke (Z57.31) tobacco dependence (F17-) tobacco use (Z72.0)

42 Hypertension Essential (primary) hypertension I10
Type 1 Excludes hypertensive disease complicating pregnancy, childbirth and the puerperium (O10-O11, O13-O16) Type 2 Excludes essential (primary) hypertension involving vessels of brain (I60-I69) essential (primary) hypertension involving vessels of eye (H35.0-)

43 I11 Hypertensive heart disease
I11.0 Hypertensive heart disease with heart failure I11.9 Hypertensive heart disease without heart failure Use Additional code to identify type of heart failure (I50)

44 I50 Heart failure I50.20 Unspecified systolic (congestive) heart failure I50.21 Acute systolic (congestive) heart failure I50.22 Chronic systolic (congestive) heart failure I50.23 Acute on chronic systolic (congestive) heart failure I50.30 Unspecified diastolic (congestive) heart failure I50.31 Acute diastolic (congestive) heart failure I50.32 Chronic diastolic (congestive) heart failure I50.33 Acute on chronic diastolic (congestive) heart failure I50.40 Unspecified combined systolic (congestive) and diastolic (congestive) heart I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) I50.9 Heart failure, unspecified

45 O10 Pre-existing hypertension complicating pregnancy, childbirth and the puerperium
O10.0 Pre-existing essential hypertension complicating pregnancy, childbirth and the puerperium O10.01 Pre-existing essential hypertension complicating pregnancy, O …… first trimester O …… second trimester O …… third trimester O …… unspecified trimester O10.02 Pre-existing essential hypertension complicating childbirth O10.03 Pre-existing essential hypertension complicating the puerperium O10.1 Pre-existing hypertensive heart disease complicating pregnancy, childbirth and the puerperium O10.11 Pre-existing hypertensive heart disease complicating pregnancy O …… first trimester O …… second trimester O …… third trimester O …… unspecified trimester

46 O10.219 …… unspecified trimester
O10.2 Pre-existing hypertensive chronic kidney disease complicating pregnancy, childbirth and the puerperium O10.21 Pre-existing hypertensive chronic kidney disease complicating pregnancy O …… first trimester O …… second trimester O …… third trimester O …… unspecified trimester

47 427.31 Atrial fibrillation ICD-10-CM Codes
I48.0 Paroxysmal atrial fibrillation I48.1 Persistent atrial fibrillation I48.2 Chronic atrial fibrillation I48.91 Unspecified atrial fibrillation

48 427.0 Paroxysmal Supraventricular Tachycardia
ICD-10-CM Codes I47.1 Supraventricular tachycardia *Instructional note in ICD-10-CM indicates to code first tachycardia complicating: abortion or ectopic or molar pregnancy (O00-O07, O08.8) obstetric surgery and procedures (O75.4)

49 427.89 Cardiac Dysrhythmias, other specified
ICD-10-CM Codes I49.8 Other specified cardiac arrhythmias *Instructional note in ICD-10-CM indicates to code first cardiac arrhythmia complicating: abortion or ectopic or molar pregnancy (O00-O07, O08.8) obstetric surgery and procedures (O75.4)

50 427.81 Sinoatrial Node Dysfunction
ICD-10-CM Codes I49.5 Sick sinus syndrome *Instructional note in ICD-10-CM indicates to code first cardiac arrhythmia complicating: abortion or ectopic or molar pregnancy (O00-O07, O08.8) obstetric surgery and procedures (O75.4)

51 414.01 Coronary athersclerosis of native coronary artery
ICD-10-CM Codes I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris **Assign code from I25.110–I when angina pectoris is present *Instructional note in ICD-10-CM indicates to use additional code, if applicable, to identify coronary atherosclerosis due to lipid rich plaque (I25.83) Use additional code to identify: chronic total occlusion of coronary artery (I25.82) exposure to environmental tobacco smoke (Z77.22) history of tobacco use (Z87.891) occupational exposure to environmental tobacco smoke (Z57.31) tobacco dependence (F17-) tobacco use (Z72.0)

52 AV Block 426.0 Atrioventricular block, complete
I44.2 Atrioventricular block, complete Atrioventricular block, first degree I44.0 Atrioventricular block, first degree

53 424.1 Aortic valve disorders
ICD-10-CM Codes I35.9 Nonrheumatic aortic valve disorder, unspecified I35.0 Nonrheumatic aortic (valve) stenosis I35.1 Nonrheumatic aortic (valve) insufficiency I35.2 Nonrheumatic aortic (valve) stenosis with insuffisiciency I35.8 Other nonrheumatic aortic valve disorders

54 786.50 Chest pain, unspecified
ICD-10-CMCodes R07.9 Chest pain, unspecified **There are more specific code choice selections available in ICD-10-CM. These include: R07.89 Other chest pain R07.2 Precordial pain R07.1 Chest pain on breathing R07.81 Pleurodynia

55 Chapter 9 I21 Initial AMIs I22 Subsequent AMIs
I23 Complication following STEMI and NSTEMI MI (within 28 day period)

56 410.40 Myocardial infarction, acute, of other inferior wall, episode of care unspecified
ICD-10-CM Codes I21.19 ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall I22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wall *Instructional note in ICD-10-CM indicates to use additional code to identify: exposure to environmental tobacco smoke (Z77.22) history of tobacco use (Z87.891) occupational exposure to environmental tobacco smoke (Z57.31) status post administration of TPA in a different facility within the last 24 hours prior to admission to current facility (Z92.82) tobacco dependence (F17-) tobacco use (Z72.0)

57 Category I22 Chapter 9 A code from category I22 must be used in conjunction with a code from category I21. Category I22 is never used alone. The sequencing of the I22 and I21 codes depends on the circumstances of the encounter.

58 Endocrine, Nutritional and Metabolic Diseases
ICD-10-CM Endocrine, Nutritional and Metabolic Diseases

59 ICD-10 versus ICD-9

60 Chapter 4 ICD-10 Diabetes Mellitus Combination codes
No longer classified as controlled or uncontrolled Inadequately, out of control or poorly controlled coded by type with hyperglycemia Chapter 4 ICD-10

61 Chapter 4 Diabetes mellitus ICD-10 Combination codes
No longer classified as controlled or uncontrolled Inadequately, out of control or poorly controlled coded by type with hyperglycemia Chapter 4

62 ICD-10 DM FORMAT Diabetes mellitus codes (DM) in ICD-10-CM are combination codes that include the (1) type of DM (2) the body system affected (3) the complication affecting that body system

63 ICD-10 DM Category E08 Diabetes mellitus due to underlying condition E09 Drug or chemical induced diabetes mellitus E10 Type 1 diabetes mellitus E11 Type 2 diabetes mellitus E13 Other specified diabetes mellitus

64 DM Add-ON Identify any insulin use (Z79.4) Poisoning due to drug or toxin, if applicable (T36-T65) Adverse effect, if applicable, to identify drug (T36-T50)

65 E08 Diabetes mellitus due to underlying condition
Code First the underlying condition, such as: Congenital rubella (P35.0) Cushing's syndrome (E24.-) Cystic fibrosis (E84.-) Malignant neoplasm (C00-C96) Malnutrition (E40-E46) Pancreatitis and other diseases of the pancreas (K85-K86.-)

66 E09 Drug or Chemical induced diabetes mellitus
Code first (T36-T65) to identify drug or chemical Use additional code to identify any insulin use (Z79.4)

67 E10 Type 1 diabetes mellitus
Type 1 Excludes diabetes mellitus due to underlying condition (E08.-) drug or chemical induced diabetes mellitus (E09.-) gestational diabetes (O24.4-) hyperglycemia NOS (R73.9) neonatal diabetes mellitus (P70.2) postpancreatectomy diabetes mellitus (E13.-) postprocedural diabetes mellitus (E13.-) secondary diabetes mellitus NEC (E13.-) type 2 diabetes mellitus (E11.-)

68 E11 Type 2 diabetes mellitus
Use additional code to identify any insulin use (Z79.4) Type 1 Excludes diabetes mellitus due to underlying condition (E08.-) drug or chemical induced diabetes mellitus (E09.-) gestational diabetes (O24.4-) neonatal diabetes mellitus (P70.2) postpancreatectomy diabetes mellitus (E13.-) postprocedural diabetes mellitus (E13.-) secondary diabetes mellitus NEC (E13.-) type 1 diabetes mellitus (E10.-)

69 E13 Other specified diabetes mellitus (specified type with)
Use additional code to identify any insulin use (Z79.4) Type 1 Excludes diabetes (mellitus) due to autoimmune process (E10.-) diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destruction (E10.-) diabetes mellitus due to underlying condition (E08.-) drug or chemical induced diabetes mellitus (E09.-) gestational diabetes (O24.4-) neonatal diabetes mellitus (P70.2) type 2 diabetes mellitus (E11.-) Includes diabetes mellitus due to genetic defects of beta-cell function diabetes mellitus due to genetic defects in insulin action postpancreatectomy diabetes mellitus postprocedural diabetes mellitus secondary diabetes mellitus NEC

70 DM 4th Digit 0 = Hyperosmolarity 1 = Ketacidosis 2 = Nephropathy
usually complication of type 2 diabetes that involves extremely high blood sugar (glucose) levels without the presence of ketones. Ketones are byproducts of fat breakdown 1 = Ketacidosis metabolic state associated with high concentrations of ketone bodies, formed by the breakdown of fatty acids and the deamination of amino acids (usually type 1) 2 = Nephropathy 3 = Opthalmic 4= Neurological 5 = Circulatory 6 = Other

71 2 = Nephropathy E08.2 Diabetes mellitus due to underlying condition with kidney complications E08.21Diabetes mellitus due to underlying condition with diabetic nephropathy E08.22Diabetes mellitus due to underlying condition with diabetic chronic kidney disease E08.29Diabetes mellitus due to underlying condition with other diabetic kidney complication

72 3 = Opthalmic E08.31Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy E08.311…… with macular edema E08.319…… without macular edema E08.32Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy E08.321…… with macular edema E08.329…… without macular edema E08.33Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy E08.331…… with macular edema E08.339…… without macular edema

73 3 = Opthalmic E08.34Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy E08.341…… with macular edema E08.349…… without macular edema E08.35Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy E08.351…… with macular edema E08.359…… without macular edema E08.36Diabetes mellitus due to underlying condition with diabetic cataract E08.39Diabetes mellitus due to underlying condition with other diabetic ophthalmic complication

74 4= Neurological E08.4 Diabetes mellitus due to underlying condition with neurological complications E08.40Diabetes mellitus due to underlying condition with diabetic neuropathy, unspecified E08.41Diabetes mellitus due to underlying condition with diabetic mononeuropathy E08.42Diabetes mellitus due to underlying condition with diabetic polyneuropathy E08.43Diabetes mellitus due to underlying condition with diabetic autonomic (poly)neuropathy E08.44Diabetes mellitus due to underlying condition with diabetic amyotrophy E08.49Diabetes mellitus due to underlying condition with other diabetic neurological complication

75 5 = Circulatory E08.5 Diabetes mellitus due to underlying condition with circulatory complications E08.51 Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy without gangrene E08.52Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene E08.59Diabetes mellitus due to underlying condition with other circulatory complications

76 6 = Other E08.6 Diabetes mellitus due to underlying condition with other specified complications E08.61Diabetes mellitus due to underlying condition with diabetic arthropathy E08.610Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy E08.618Diabetes mellitus due to underlying condition with other diabetic arthropathy E08.62Diabetes mellitus due to underlying condition with skin complications E08.620Diabetes mellitus due to underlying condition with diabetic dermatitis E08.621Diabetes mellitus due to underlying condition with foot ulcer E08.622Diabetes mellitus due to underlying condition with other skin ulcer E08.628Diabetes mellitus due to underlying condition with other skin complications

77 Examples of compliant documentation
Diabetic nephrosis, type 1 Secondary diabetes mellitus due to pancreatic malignancy, snowflake cataract Type 1 diabetes with ketoacidosis Diabetes mellitus, type 2 with hyperosmolar, nonketotic coma CKD stage IV due to type 1 diabetes Impotence due to diabetic peripheral neuropathy Neonatal hypoglycemia Hyperglycemic Type 1 diabetes mellitus with peripheral vascular disease and gangrene of the right foot

78 Pregnancy, Childbirth and the Puerperium
ICD-10-CM Pregnancy, Childbirth and the Puerperium

79 Chapter 15 Trimester axis of classification rather than episode of care Not all conditions include codes for all three trimesters or is N/A Counted from first day of last menstrual period Trimesters 1st Less than 14 weeks 0 days 2nd 14 weeks 0 days to less than 28 weeks 0 days 3rd 28 weeks 0 days until delivery

80 Chapter 15 Definitions Abortion vs. fetal death
20 weeks instead of 22 Early vs. late vomiting Preterm labor 37 completed weeks of gestation

81 0 – not applicable or unspecified
7th Character Chapter 15 0 – not applicable or unspecified 1 – fetus 1 2 – fetus 2 3- fetus 3 4 – fetus 4 5 – fetus 5 9 – other fetus

82 Coding Note: The note at the beginning of Chapter 15 specifies the use of an additional code from category Z3A, Weeks of gestation, to identify the specific week of the pregnancy. This is found in the alphabetic Index under Pregnancy, weeks of gestation.

83 V72.31 Routine Gynecological Exam
ICD-10-CM Codes Z01.411 Encounter for gynecological examination (general) (routine) with abnormal findings * Use additional code to identify abnormal findings Z01.419 Encounter for gynecological examination (general) (routine) without abnormal findings Instructional note under codes should be as follows: **Use additional code: for screening for human papillomavirus, if applicable (Z11.51) for screening vaginal pap smear, if applicable (Z12.72) to identify acquired absence of uterus, if applicable (Z90.71-)

84 626.2 Excessive Menstruation
ICD-10-CM Codes N92.0 Excessive and frequent menstruation with regular cycle N92.1 Excessive and frequent menstruation with irregular cycle N92.2 Excessive menstruation at puberty N92.4 Excessive bleeding in the premenopausal period

85 632 Missed Abortion ICD-10-CM Codes O02.1 Missed abortion
** Use additional code from category O08 to identify any associated complication ** An additional code from category Z3A is needed to specify the weeks of gestation of the pregnancy.

86 616.10 Vaginitis and Vulvovaginitis, unspecified
ICD-10-CM Codes N76.0 Acute vaginitis **Use additional code (B95-B97), to identify infectious agent There are other codes from this subcategory to describe vaginitis: N76.1 Subacute and chronic vaginitis N76.2 Acute vulvitis N76.3 Subacute and chronic vulvitis N76.89 Other specified inflammation of vagina and vulva

87 626.4 Irregular menstrual cycle
ICD-10-CM Codes N92.5 Other specified irregular menstruation N92.6 Irregular menstruation, unspecified * There are more specific code choice selections available in ICD-10-CM. These include: N92.0 Excessive and frequent menstruation with regular cycle N92.1 Excessive and frequent menstruation with irregular cycle N92.2 Excessive menstruation at puberty N92.4 Excessive bleeding in the premenopausal period

88 Pediatrics Top 5 Diagnosis
V Routine infant or child health check 465.9 Acute upper respiratory infection 382.9 Unspecified otitis media 462 Acute pharyngitis Asthma, unspecified type

89 V20.2 Routine infant or child health check
Z00.0 Encounter for general adult medical examination Z00.00 …… without abnormal findings Z00.01 …… with abnormal findings Z00.1 Encounter for newborn, infant and child health examinations Z00.11 Newborn health examination Z Health examination for newborn under 8 days old Z Health examination for newborn 8 to 28 days old Z00.12 Encounter for routine child health examination Z …… with abnormal findings Z …… without abnormal findings Z00.2 Encounter for examination for period of rapid growth in childhood Z00.3 Encounter for examination for adolescent development state Z00.5 Encounter for examination of potential donor of organ and tissue Z00.6 Encounter for examination for normal comparison and control in clinical research program Z00.7 Encounter for examination for period of delayed growth in childhood Z00.70 …… without abnormal findings Z00.71 …… with abnormal findings

90 Otitis Media H65 Nonsuppurative otitis media
H66 Suppurative and unspecified otitis media H67 Otitis media in diseases classified elsewhere

91 382.9 Unspecified Otitis Media
H66.0 Acute suppurative otitis media H66.00 Acute suppurative otitis media without spontaneous rupture of ear drum H …… right ear H …… left ear H …… bilateral H …… recurrent, right ear H …… recurrent, left ear H …… recurrent, bilateral H …… recurrent, unspecified ear H …… unspecified ear

92 Upper Respiratory Infections
J00 Acute nasopharyngitis [common cold] J01 Acute sinusitis J02 Acute pharyngitis J03 Acute tonsillitis J04 Acute laryngitis and tracheitis J05 Acute obstructive laryngitis [croup] and epiglottitis J06 Acute upper respiratory infections of multiple and unspecified sites

93 462 Acute Pharyngitis J02.0 Streptococcal pharyngitis
J02.8 Acute pharyngitis due to other specified organisms J02.9 Acute pharyngitis, unspecified

94 465.9 Acute upper respiratory infection
J06 Acute upper respiratory infections of multiple and unspecified sites J06.0 Acute laryngopharyngitis J06.9 Acute upper respiratory infection, unspecified

95 462 Acute Pharyngitis J02.0 Streptococcal pharyngitis
J02.8 Acute pharyngitis due to other specified organisms J02.9 Acute pharyngitis, unspecified

96 Asthma ICD-9 ICD-10 493.XX J45.XXX 4th Digit 5th Digit Extrinsic
Intrinsic Chronic Obstructive Other 5th Digit Exacerbation or status asthmatics J45.XXX Extrinsic Intrinsic Chronic Obstructive Other

97 493.90 Asthma, unspecified type
J45 Asthma J45.2 Mild intermittent asthma J45.20 …… uncomplicated J45.21 …… with (acute) exacerbation J45.22 …… with status asthmaticus J45.3 Mild persistent asthma J45.30 …… uncomplicated J45.31 …… with (acute) exacerbation J45.32 …… with status asthmaticus J45.4 Moderate persistent asthma J45.40 …… uncomplicated J45.41 …… with (acute) exacerbation J45.42 …… with status asthmaticus J45.5 Severe persistent asthma J45.50 …… uncomplicated J45.51 …… with (acute) exacerbation J45.52 …… with status asthmaticus

98 496 Chronic airway obstruction, not elsewhere classified
ICD-10-CM Codes J44.9 Chronic obstructive pulmonary disease, unspecified ** There are more specific code choice selections available in ICD-10-CM. These include: J44.0 Chronic obstructive pulmonary disease with acute lower respiratory infection J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation ** Code also type of asthma, if applicable (J45.-) ** Use additional code to identify: Exposure to environmental tobacco smoke (Z77.22) History of tobacco use (Z87.891)

99 Shortness of breath Shortness of breath R06.02 Shortness of breath

100 786.09 Other dyspnea and respiratory abnormalities
ICD-10-CM Codes R06.83 Snoring R06.3 Periodic breathing R06.4 Hyperventilation R06.00 Dyspnea, unspecified R06.89 Other abnormalities of breathing

101 466.0 Acute bronchitis ICD-10-CM Codes
J20.9 Acute bronchitis, unspecified ** There are more specific code choice selections available in ICD-10-CM. These include: J20.0 Acute bronchitis due to Mycoplasma pneumoniae J20.1 Acute bronchitis due to Hemophilus influenzae J20.2 Acute bronchitis due to streptococcus J20.3 Acute bronchitis due to coxsackievirus J20.4 Acute bronchitis due to parainfluenza virus J20.5 Acute bronchitis due to respiratory syncytial virus J20.6 Acute bronchitis due to rhinovirus J20.7 Acute bronchitis due to echovirus J20.8 Acute bronchitis due to other specified organisms

102 ICD-10-CM Neoplasms

103 What’s new in ICD-10-CM for Coding Neoplasms?
Laterality Greater specificity (anatomical site) Greater Clarity (Acuity)

104 Examples - Laterality C34.31 – Malignant neoplasm RIGHT main bronchus or lung C34.32 – Malignant neoplasm LEFT main bronchus or lung C4A. 71 – Merkel cell carcinoma of the RIGHT lower limb, including hip C4A.72 - Merkel cell carcinoma of the LEFT lower limb, including hip

105 Examples - Greater specificity in terms of anatomical sites:
C Malignant neoplasm of external upper lip Malignant neoplasm of lipstick area of upper lip Malignant neoplasm of upper lip NOS Malignant neoplasm of vermilion border of upper lip C Malignant neoplasm of middle ear Malignant neoplasm of antrum tympanicum Malignant neoplasm of auditory tube Malignant neoplasm of eustachian tube Malignant neoplasm of inner ear Malignant neoplasm of mastoid air cells Malignant neoplasm of tympanic cavity

106 Some 1 to 1 Conversions C61 Malignant neoplasm of prostate
Replaces 185 Malignant neoplasm of prostate D07.5 Carcinoma in situ of prostate 233.4 Carcinoma in situ of prostate  

107 Other Skin L57.0 Actinic keratosis
L Inflamed seborrheic keratosis OR L82.1 other seborrheic keratosis L Sebaceous cyst ICD Actinic keratosis ICD SK ICD Sebaceous Cyst

108 N63 Unspecified lump in breast
Breast Lump/Mass ICD-9 code NOW N63 Unspecified lump in breast

109 Breast Cancer ICD-10 Malignant neoplasm breast 54 choices for male/female breast Documentation must include: Laterality Location Estrogen receptor status (when necessary)

110 Breast Neoplasms

111 +Estrogen receptor status (Z17)
Code 1st malignant neoplasm of breast (C50.-) Z17.0 Estrogen receptor positive status [ER+] Z17.1 Estrogen receptor negative status [ER-]

112 ICD-10 Ophthalmic Codes

113 ICD-10 Ophthalmic Codes

114 ICD-10 Cataract

115 ICD-9-CM vs. ICD-10-CM Codes
ICD-9-CM for aqueous misdirection (malignant glaucoma) ICD-10-CM H40.83 for aqueous misdirection (malignant glaucoma) H Aqueous misdirection, right eye H Aqueous misdirection, left eye H Aqueous misdirection, bilateral eyes H Aqueous misdirection, unspecified eye . 115

116 Primary Care Most Common Codes ICD-9 to ICD-10

117 Primary Care Most Common Codes ICD-9 to ICD-10

118 Primary Care Most Common Codes ICD-9 to ICD-10

119 Primary Care Most Common Codes ICD-9 to ICD-10

120 ICD-10 Resources CMS.gov provider resources link:
CMS.gov provider implementation timelines and checklists link: CMS.gov ICD-10 basics for medical practices link: 13[1].pdf Hospital Association - AHA.org website link: Specialized training resources (extra cost): American Health Information Association – AHIMA.org and American Association Professional Coders – AAPC.com links: Coding Tipsheets - AHIMA.org and Californiahia.org links: American Medical Association – AMA.org website links: billing-insurance/hipaahealth-insurance-portability-accountability-act/transaction-code-set- standards/icd10-code-set.page

121 Questions. Contact: Kathryn Melton CPC meltonk@sutterhealth
Questions? Contact: Kathryn Melton CPC (916) Visit for upcoming coding classes and much more!


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