1. ICD-10
Getting There…..
Cardiology

2. What Physicians Need To Know
Claims for ambulatory and physician services provided on or after 10/1/2015 must use ICD-10-CM diagnosis codes.
Hospital inpatient claims for discharges occurring on or after 10/1/2015 must use ICD-10-CM diagnosis codes.
CPT Codes will continue to be used for physician inpatient and outpatient services and for hospital outpatient procedures.
ICD-10-PCS – a NEW procedure coding classification system, must be used to code all inpatient procedures on Facility Claims for discharges on or after 10/1/15.
ICD-9-CM codes must continue to be used for all dates of services on or before 9/30/2015.
Further delays are not likely.
What Physicians Need To Know

3. ICD-9 vs ICD-10 Diagnosis Codes
ICD-9-CM Diagnosis Codes
ICD-10-CM Diagnosis Codes
3 to 5 digits
7 digits
Alpha “E” & “V” – 1st Character
Alpha or numeric for any character
No place holder characters
Include place holder characters (“x”)
Terminology
Similar
Index and Tabular Structure
Coding Guidelines
Somewhat similar
Approximately 14,000 codes
Approximately 69,000 codes
Severity parameters limited
Extensive severity parameters
Does not include laterality
Common definition of laterality
Combination codes limited
Combination codes common
ICD-9 vs ICD-10 Diagnosis Codes

4. Number of Codes by Clinical Area
ICD-9 Codes
ICD-10 Codes
Fractures
747
17,099
Poisoning and Toxic Effects
244
4,662
Pregnancy Related Conditions
1,104
2,155
Brain Injury
292
574
Diabetes 69
239
Migraine 40 44
Bleeding Disorders 26 29
Mood Related Disorders 78 71
Hypertensive Disease 33 14
End Stage Renal Disease 11 5
Chronic Respiratory Failure 7 4
Right vs. left accounts for nearly ½ the increase in the # of codes.
Number of Codes by Clinical Area

5. The Importance of Good Documentation
The role of the provider is to accurately and specifically document the nature of the patient’s condition and treatment.
The role of the Clinical Documentation Specialist is to query the provider for clarification, ensuring the documentation accurately reflects the severity of illness and risk of mortality.
The role of the coder is to ensure that coding is consistent with the documentation.
Good documentation….
Supports proper payment and reduces denials
Assures accurate measures of quality and efficiency
Captures the level of risk and severity
Supports clinical research
Enhances communication with hospital and other providers
It’s just good care!
The Importance of Good Documentation

6. Inadequate Documentation
Required ICD-10 Documentation
Received in transfer from Medical Center A with AMI. Hx tobacco use and obesity.
Received Alteplase prior to transfer.
Coded upon arrival.
Received in transfer from Medical Center A with LAD STEMI. Hx tobacco dependence with cessation x 6 months, morbid obesity d/t excess calories, BMI of 42.5.
Received Alteplase 6 hrs prior to transfer.
Cardiac arrest on arrival secondary to MI.
Needed improvements:
Site, clot buster administration, contributory history, type, cause, and complication(s).
Inadequate vs. Adequate Documentation Example 1: Acute Myocardial Infarction

7. Inadequate Documentation
Required ICD-10 Documentation
Coronary artery disease with angina, tobacco dependence, abnormal exercise eval.
Cardiac cath reveals partial occlusion prox left anterior descending artery.
Successful PCI with drug eluting stent.
Coronary artery disease with unstable angina, cigarette dependence, abnormal exercise eval.
Cardiac cath reveals atherosclerotic partial occlusion native prox left anterior descending artery with lipid rich plaque. Successful PCI with drug eluting stent.
Needed improvements:
Type of tobacco, type of vessel, type of intervention, and complicating factor(s).
Inadequate vs. Adequate Documentation Example 2: Atherosclerosis of Coronary Vessels

8. Type, acuity, complication(s), and delta-agent status.
Inadequate Documentation
Required ICD-10 Documentation
CARDIOVASCULAR:
Cardiomyopathy
OTHER PROBLEMS:
Thyroid, hepatitis
Congenital cardiomyopathy
Thyrotoxicosis with uninodular goiter, no crisis or storm, chronic hepatitis B with delta-agent.
Needed improvements:
Type, acuity, complication(s), and delta-agent status.
Inadequate vs. Adequate Documentation Example 3: Cardiomyopathy

9. Site, type, and tobacco status.
Inadequate Documentation
Required ICD-10 Documentation
BRIEF HISTORY:
43 year old positive for tobacco use and markedly positive family history of coronary artery disease. EKG showing old MI and atrial flutter. He has had episodes of angina and coronary angiography has been recommended.
43 year old with chewing tobacco dependence currently having withdrawal and markedly positive family history of coronary artery disease. EKG showing old anterior septal MI and atypical atrial flutter. He has had episodes of unstable angina and coronary angiography has been recommended.
Needed improvements:
Site, type, and tobacco status.
Inadequate vs. Adequate Documentation Example 4: Dysrhythmias

10. Key Requirements for Documenting Cardiovascular Diseases
The acuity of the disease (e.g., acute, chronic)
Disease specificity and granularity (e.g., cardiomyopathy – dilated, obstructive, or hypertrophic)
The causal disease, contributory drug, chemical or non-medical substance (e.g., cardiac tamponade due to radiation therapy)
The manifestation of the disease (e.g. obstruction of vessels, angina, heart failure, or renal disease)
The site of the manifestation (e.g. the specific coronary vessel affected by atherosclerosis and whether or not a bypass or stent has occurred at this site in the past.)
Alcohol, tobacco, or drug use, abuse, or dependence and their impact on other disease processes that are being treated.
With ICD-10, the need for specific and accurate documentation is increased significantly.

11. Using Sign/Symptom and Unspecified Codes
Sign/symptom and “unspecified” codes have acceptable, even necessary, uses.
If a definitive diagnosis has not been established by the end of the encounter, it is appropriate to report codes for signs and/or symptoms in lieu of a definitive diagnosis.
When sufficient clinical information is not known or available about a particular health condition, it is acceptable to report the appropriate “unspecified” code.
It is inappropriate to select a SPECIFIC code that is not supported by the medical record documentation.
Using Sign/Symptom and Unspecified Codes

12. Training for Physicians
Dates
Method
Content
Nov 2014 – Jan 2015
Department Meetings
Introduction/Overview
Jan 2015 – Mar 2015
Web-based
Overview
Service Specific Documentation
Future Order Entry
Diagnosis Assistant
Mar 2015 – Jun 2015
Classroom
Documenting for ICD10 using the Electronic Health Record
Jun 2015 – Sep 2015
Documenting Operative and Procedure Notes for ICD-10-PCS
Training for Physicians

13. Future Orders & Diagnosis Assistant
Demonstration
Future Orders & Diagnosis Assistant