Preparing for ICD-10 for Hospitals May 2011 Copyright 2011 Medtronic.

Notices These coding suggestions and coverage guidelines do not replace seeking coding advice from the payer and/or your coding staff. The ultimate responsibility for correct coding lies with the provider of services. Please contact your local payer for interpretation of the appropriate codes to use for specific procedures. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other third party payers as to the correct form of billing or the amount that will be paid to providers of service. See NCD 20.8 for Medicare covered indications for pacemakers and NCD 20.4 for Medicare covered indications for defibrillators. Copyright 2011 Medtronic 2

CEUs for Coders A survey will be sent out to all registered participants a few days after the session. The CEU certificates will be included in the survey as attachments for those who listened to the entire session. AAPC This program has the prior approval of the American Academy of Professional Coders (AAPC) for 2 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor. AAPC Index# MTI A. AHIMA This program has been approved for 2 continuing education units for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Copyright 2011 Medtronic 3

An Introduction to ICD-10 for Cardiovascular
Topics Preparing for ICD-10 An Introduction to ICD-10 for Cardiovascular  Background  ICD-10-CM Diagnosis Codes  ICD-10-PCS Procedure Codes  DRGs under ICD-10  Appendix Copyright 2011 Medtronic 4

Components of ICD-10 ICD-10 has two main components:
 ICD-10-CM is for diagnosis codes and includes a tabular list, an index, and tables for drugs and neoplasms.  ICD-10-PCS is for procedure codes and includes code tables and an index. There are other materials that are also officially part of the classification system, including:  GEMs  Official Guidelines for Coding and Reporting  Body Part Key  Device Key  ICD-10-PCS Reference Manual Copyright 2011 Medtronic 6

This Is Going to Happen  ICD-10 was adopted as the national standard under HIPAA and its use is mandatory (Federal Register, January 16, 2009, pp )  The effective date for implementation is October 1, 2013  Which components of ICD-10 must be used depends on the type of provider: Provider Setting Diagnoses Procedures Hospitals Inpatient ICD-10-CM ICD-10-PCS Outpatient CPT® ASCs Physicians Facility/Office Copyright 2011 Medtronic 7

ICD-10 Freeze Starting October 1, 2011, all codes in ICD-10 will be frozen for 3 years. The ICD-10 Coordination and Maintenance Committee announced the freeze to allow a period of stability for programming, publishing, and training for implementation of ICD-10.  Limited updates may take place on October 1, 2012 and October 1, 2013 for new technologies and new diseases  The deadline for submitting change requests prior to the freeze has already passed  The C&M Committee will continue to meet during the freeze  Regular annual updates will resume on October 1, 2014 Copyright 2011 Medtronic 8

GEMS The General Equivalence Mappings are a very useful tool for translating between ICD-9-CM and ICD-10.  The “forward” GEM converts current ICD-9-CM codes to their equivalent ICD-10 codes  The “backward” GEM converts ICD-10 codes back to ICD-9-CM codes While very handy, GEMS are not a substitute for learning ICD-10. They’re intended for use in converting large databases, not for coding individual cases. Copyright 2011 Medtronic 9

Limits of GEMS Particularly for procedure codes, many ICD-9-CM codes convert to far more than one ICD-10 code. ICD-9-CM ICD-10-PCS 3795 02H63ME 02H73ME 02HK3ME 02HL3ME 02HN0ME 02HN4ME Example: 37.95, implantation of ICD lead(s) There are other limits in GEMs conversion of ICD-9-CM codes to ICD-10:  Some conversions are theoretically possible but unlikely  Some codes convert to a “cluster” rather than one-for-one  Some codes don’t convert directly to ICD-10 at all In making the transition to ICD-10, the best way to use the GEMs is either as a starting place or for confirmation. Copyright 2011 Medtronic 10

ICD-10-CM Diagnosis Codes
Copyright 2011 Medtronic 11

Format of ICD-10-CM Diagnosis Codes
The format of ICD-10-CM has several new features:  Codes can be from 3 to 7 characters long  The first digit is always a letter (only “U” is not used)  The second and third digits are always numbers  The fourth to seventh digits can be letters or numbers  A decimal is placed after the third digit Examples I11.0 Hypertensive heart disease with heart failure R55 Syncope T82.120A Displacement of cardiac electrode, initial encounter Copyright 2011 Medtronic 12

Greater Specificity ICD-10-CM has far more diagnosis codes than ICD-9-CM. System # Diagnosis Codes ICD-9-CM 14,025 ICD-10-CM 68,069 The majority of new codes involve:  Greater specificity for injuries, including site, type, and encounter  Laterality (left, right, bilateral)  Specificity for device complications, including encounter Copyright 2011 Medtronic 13

Heart Block The heart block codes in ICD-10-CM are quite similar to those in ICD-9-CM.  Complete heart block retains a distinct code, which remains a CC I44 Atrioventricular and left bundle-branch block I44.0 Atrioventricular block, first degree I44.1 Atrioventricular block, second degree Atrioventricular block, type I and II Mobitz block, type I and II Second degree block, type I and II Wenckebach's block I44.2 Atrioventricular block, complete Complete heart block NOS Third degree block ………………………………………  ICD-10-CM doesn’t make a distinction between Mobitz and other second degree blocks Copyright 2011 Medtronic 14

Other Conduction Disorders
Other codes for pacemaker and defibrillator indications related to conduction are located in I45.  Codes for bifascicular and trifascicular blocks were actually simplified; the codes reflect pacemaker indications and also remain CCs I45 Other conduction disorders I45.2 Bifascicular block I45.3 Trifascicular block I45.6 Pre-excitation syndrome Lown-Ganong-Levine syndrome Wolff-Parkinson-White syndrome ……………………………………… I45.8 Other specified conduction disorders I45.81 Long QT syndrome I Other specified conduction disorders Atrioventricular dissociation Interference dissociation Nonparoxysmal AV nodal tachycardia  Long QT syndrome retains a distinct code, as needed to reflect the defibrillator indication Copyright 2011 Medtronic 15

Paroxysmal Tachycardia
 VT is an indication for defibrillators and remains a CC I47 Paroxysmal tachycardia I47.0 Re-entry ventricular arrhythmia I47.1 Supraventricular tachycardia Atrial paroxysmal tachycardia Atrioventricular paroxysmal tachycardia Junctional paroxysmal tachycardia Nodal paroxysmal tachycardia I47.2 Ventricular tachycardia I47.9 Paroxysmal tachycardia unspecified  Re-entry ventricular arrhythmia has its own code  Note that I47.0 and I47.1 are not assigned for AVNRT (atrioventricular nodal reentrant tachycardia) Note: As in ICD-9-CM, tachycardia not otherwise specified is assigned to a symptom code. Copyright 2011 Medtronic 16

Atrial Fibrillation and Flutter
Like ICD-9-CM, the current version of ICD-10-CM has just two codes for atrial fibrillation and flutter. I48 Atrial fibrillation and flutter I48.0 Atrial fibrillation I48.1 Atrial flutter However, it is likely that this will be expanded on October 1, 2011 to capture more detail. WHO is updating the international version of ICD-10 for these codes and the US must maintain compatibility. A proposal was recently presented before the C&M Committee to create specific codes within I48 for atrial fibrillation documented as:  First episode  Paroxysmal  Persistent  Permanent March 9-10, 2011 proposals, pages 48-50 Copyright 2011 Medtronic 17

Other Cardiac Arrhythmias
 VF is a defibrillator indication and remains an MCC I49 Ventricular fibrillation and flutter I49.0 Ventricular fibrillation and flutter I49.01 Ventricular fibrillation I49.02 Ventricular flutter I49.1 Atrial premature beats I49.2 Junctional premature depolarization I49.3 Ventricular premature depolarization …………………………………… I49.5 Sick sinus syndrome Tachycardia-bradycardia syndrome I49.8 Other specified cardiac arrhythmias I49.9 Cardiac arrhythmia unspecified  SSS retains a distinct code, as needed to reflect the pacemaker indication  The depolarization codes are new  According to the index, AVNRT is assigned to I49.8 Copyright 2011 Medtronic 18

Heart Failure ICD-10-CM codes for heart failure are essentially the same as the ICD-9-CM codes. This is actually by intent. The main differences are:  ICD-10-CM has no code for “congestive heart failure” per se; it is included in I50.9 for unspecified heart failure  “Congestive” is a non-essential term for heart failure  When any form of pulmonary edema (acute, chronic, unspecified) is present with heart failure, L50.1 for left ventricular failure is assigned In addition to being a CC or MCC, heart failure is a major indication for defibrillators and bi-ventricular devices. Copyright 2011 Medtronic 19

Heart Failure Code Structure
 CCs and MCCs remain the same I50 Heart failure I50.1 Left ventricular failure I50.2 Systolic (congestive) 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 I50.3 Diastolic (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 I50.4 Combined systolic (congestive) and diastolic (congestive) heart failure I50.40 Unspecified combined (congestive) heart failure I50.41 Acute combined (congestive) heart failure I50.42 Chronic combined (congestive) heart failure I50.43 Acute on chronic combined (congestive) heart failure I50.9 Heart failure, unspecified  Because it is coded to I50.1, pulmonary edema is a CC rather than an MCC Copyright 2011 Medtronic 20

Heart Failure Due to Hypertension
ICD-10-CM maintains the current coding practices for heart failure due to hypertension.  An additional code is used from I50 to show the type of heart failure I11 Hypertensive heart disease I11.0 Hypertensive heart disease with heart failure Hypertensive heart failure Use additional code to identify type of heart failure (I50.-) I11.9 Hypertensive heart disease without heart failure  ICD-10-CM does not differentiate between benign, malignant, and unspecified hypertensive disease ICD-10-CM has similar codes for hypertensive heart and chronic kidney disease. Copyright 2011 Medtronic 21

Chest Pain Chest pain codes are both reorganized and expanded.
 ICD-10-CM more clearly differentiates anterior chest wall pain from types of respiratory- related pain R07 Pain in throat and chest R07.0 Pain in throat R07.1 Chest pain on breathing Painful respiration R07.2 Precordial pain R07.8 Other chest pain R07.81 Pleurodynia R07.82 Intercostal pain R07.89 Other chest pain Anterior chest wall pain R07.9 Chest pain unspecified  According to the index, code R07.89 also classifies chest pressure, tightness, and discomfort Copyright 2011 Medtronic 22

Coronary Artery Disease
There are over 35 codes for CAD, reflecting different types of vessels as well as combination codes for CAD with angina.  Category I25.1 is for CAD of native coronary vessels  Category I25.7 is CAD of other coronary vessels with angina Subcategory Vessel Type I25.70 Coronary artery bypass graft(s), unspecified type I25.71 Coronary artery bypass graft(s), autologous vein I25.72 Coronary artery bypass graft(s), autologous artery I25.73 Coronary artery bypass graft(s), nonautologous biological I25.75 Coronary artery, native, transplanted heart I25.76 Coronary artery bypass graft(s), transplanted heart I25.79 Coronary artery bypass graft(s), other type  Category I25.8 is CAD of other coronary vessels without angina Copyright 2011 Medtronic 23

CAD of Native Coronary Arteries
Subcategory I25.11 shows the basic structure for the combination codes for CAD with angina. I25.1 Atherosclerotic heart disease of native coronary artery Coronary artery disease I ASHD of native coronary artery without angina pectoris I ASHD of native coronary artery with angina pectoris I ASHD of native coronary artery with unstable angina pectoris I ASHD of native coronary artery with angina pectoris with documented spasm I ASHD of native coronary artery with other forms of angina pectoris I ASHD of native coronary artery with unspecified angina pectoris ICD-10-CM assumes a causal relationship between angina and atherosclerosis. Copyright 2011 Medtronic 24

Acute Myocardial Infarction
The ICD-10-CM AMI codes have several key differences from the AMI codes in ICD-9-CM.  ICD-10-CM differentiates primarily between anterior wall and inferior wall, then by the coronary artery involved  ICD-10-CM does not differentiate by episode of care  Rather than 8 weeks, acute MI is defined as a duration of 4 weeks (28 days) or less from onset  ICD-10-CM has distinct categories for the initial MI and for subsequent re-infarction Copyright 2011 Medtronic 25

Subsequent Infarction
Codes in I22 are used for a repeat infarction within 4 weeks (28 days) of a previous AMI, regardless of site. I22 Subsequent STEMI and NSTEMI myocardial infarction I22.0 Subsequent STEMI of anterior wall I22.1 Subsequent STEMI of inferior wall I22.2 Subsequent NSTEMI I22.8 Subsequent STEMI of other sites I22.9 Subsequent STEMI of unspecified site  Codes in I22 are never used alone; they are always used with a code from I21  The I22 code is sequenced first if the repeat AMI leads to a second admission, or after the I21 code if it occurs during the same admission as the initial AMI Copyright 2011 Medtronic 27

Cardiomyopathy Cardiomyopathy, an indication for defibrillators, has expanded codes for greater specificity.  Ischemic cardiomyopathy has its own code, distinct from other forms of chronic ischemic heart disease I25.5 Ischemic cardiomyopathy I42 Cardiomyopathy I42.0 Dilated cardiomyopathy Congestive cardiomyopathy I42.1 Obstructive hypertrophic cardiomyopathy I42.2 Other hypertrophic cardiomyopathy Non-obstructive …………………………………… I42.5 Other restrictive cardiomyopathy I42.8 Other cardiomyopathies I42.9 Cardiomyopathy unspecified  Congestive, restrictive and non-obstructive hypertrophic cardiomyopathy have their own codes, all CCs Copyright 2011 Medtronic 28

Non-Rheumatic Valve Disorders
In ICD-10-CM, each valve has its own code category.  Within each category, there are distinct codes for each specific type of valve disorder I35 Non-rheumatic aortic valve disorders I35.0 Non-rheumatic aortic (valve) stenosis I35.1 Non-rheumatic aortic (valve) insufficiency Non-rheumatic aortic (valve) incompetence Non-rheumatic aortic (valve) regurgitation I35.2 Non-rheumatic aortic (valve) stenosis with insufficiency I35.8 Other non-rheumatic aortic valve disorders I35.9 Non-rheumatic aortic valve disorder unspecified Category Valve I34 Mitral I35 Aortic I36 Tricuspid I37 Pulmonary Copyright 2011 Medtronic 29

Historical Conditions
As with ICD-9-CM, historical conditions which are indications for defibrillators are distinctly identified in ICD-10-CM. Old Myocardial Infarction  This has its own code in chronic ischemic heart disease I25.2 Old myocardial infarction History of SCD  Family and personal history are separately identified Z Family history of sudden cardiac death Z Personal history of sudden cardiac arrest Personal history of sudden cardiac death successfully resuscitated Copyright 2011 Medtronic 30

Attention to Cardiac Device
Like ICD-9-CM, ICD-10-CM has specific codes for use when the encounter focuses on attention to a device rather than the underlying condition, as in:  Routine device replacement, eg. end-of-battery life  Encounter for device interrogation or programming Z45.0 Encounter for adjustment and management of cardiac device Z45.01 Encounter for adjustment/management of cardiac pacemaker Z Encounter for checking and testing pacemaker pulse generator Encounter for replacing cardiac pacemaker pulse generator [battery] Z Encounter for adj/mgt of other part of cardiac pacemaker Z45.02 Encounter for adj/mgt of automatic implantable cardiac defibrillator Z Encounter for adj/mgt of other cardiac device Copyright 2011 Medtronic 31

Device Complications ICD-10-CM continues to classify device complications as mechanical, infection, and other (non-mechanical).  Definitions are the same as ICD-9-CM for mechanical (eg. breakdown) and other non-mechanical (eg. pain)  Mechanical complication codes are defined as electrode vs generator, rather than by the type of device  The nature of the mechanical complication is more specific, eg. breakdown, displacement or other complication  The nature of the non-mechanical complication is also more specific, eg. embolism, hemorrhage Copyright 2011 Medtronic 32

Device Complication Code Structure
 All codes require a 7th digit for episode of care T82.1 Mechanical complication of cardiac electronic device T82.11 Breakdown (mechanical) of cardiac electronic device T Breakdown of cardiac electrode T Breakdown of cardiac pulse generator T Breakdown of other cardiac electronic device T82.12 Displacement of cardiac electronic device T Displacement of cardiac electrode T Displacement of cardiac pulse generator T Displacement of other cardiac electronic device ………………………………………………… T82.7 Infection/inflammatory reaction to other cardiac devices …………………………………………………. T82.8 Other specified complications of cardiac/vascular devices T Pain from cardiac and vascular devices T Pain from cardiac devices, implants and grafts T Pain from vascular devices, implants and grafts ………………………………………………….. A initial encounter D subsequent encounter S sequela  All codes are CCs but only for the initial episode of care Copyright 2011 Medtronic 33

ICD-10-CM Coding Guidelines
Codes aren’t complete without uniform guidelines on usage.  As with ICD-9-CM, there is a set of “ICD-10-CM Official Guidelines for Coding and Reporting”  Use of the Official Guidelines is mandatory under HIPAA  The Official Guidelines are still in draft form but will be finalized prior to October 1, 2013  The quarterly journal Coding Clinic® will also continue  Coding Clinic® will begin addressing ICD-10 guidance in advance of the implementation date Copyright 2011 Medtronic 34

ICD-10-PCS Procedure Codes
Copyright 2011 Medtronic 35

A New Concept ICD-10-PCS is completely unlike ICD-9-CM, or any other coding system for that matter. Key characteristics are:  Codes are not assigned, they are built character-by-character from tables of values  Within a section, each character represents a standard element  All terms, particularly root operations, have standard definitions  There are very few defaults Copyright 2011 Medtronic 36

Format of ICD-10-PCS Codes
The format of ICD-10-PCS is a complete departure from the past.  All codes are 7 characters long, without exception  All codes are alphanumeric (letters “I” and “O” are not used)  There are no decimal points Examples 027034Z Dilation of Coronary Artery, One Site, with Drug-Eluting Intraluminal Device, Percutaneous Approach 0JH60P5 Insertion of CRT-D Pulse Generator into Subcutaneous Tissue/Fascia, Chest, Open Approach Copyright 2011 Medtronic 37

Character Counts! In section “0”, Medical and Surgical procedures, the character meanings are: 1 2 3 4 5 6 7 section root operation approach qualifier body system body part device  Body system, eg. urinary, GI, respiratory, upper arteries  Root operation, eg. bypass, dilation, destruction  Body part, eg. left external iliac artery, duodenum, sacrum  Approach, eg. open, endoscopic via natural opening  Device, eg. infusion device, cardiac lead, tissue expander Copyright 2011 Medtronic 38

Coding Character by Character
027034Z Dilation of Coronary Artery, One Site, with Drug-Eluting Intraluminal Device, Percutaneous Approach 1 Section Medical & Surgical 2 Body system 2 Heart & Great Vessels 3 Root operation 7 Dilation 4 Body part Coronary Artery, One Site 5 Approach 3 Percutaneous 6 Device 4 Drug-Eluting Intraluminal Device 7 Qualifier Z No Qualifier Copyright 2011 Medtronic 39

Code Table Example: PTCA and Stent
PTCA with drug-eluting stent 027034Z Dilation of Coronary Artery, One Site, with Drug-Eluting Intraluminal Device, Percutaneous Approach PTCA with non-drug-eluting (bare metal) stent 02703DZ Dilation of Coronary Artery, One Site, with Intraluminal Device, Percutaneous Approach Copyright 2011 Medtronic 40

Insertion of CRDM Generators
Pacemaker: 0JH60P2 CRT-P (BiV): 0JH60P3 Defibrillator: 0JH60P4 CRT-D (BiV): 0JH60P5 Copyright 2011 Medtronic 41

Insertion of CRDM Leads
Pacemaker leads, RA and RV, transvenous: 02H63MA, 02HK3MA CRT-P leads, RA and RV, transvenous: 02H63MA, 02HK3MA Defibrillator leads, RV, epicardial placement: 02HN0ME CRT-D leads, RA, RV, and LV via the CS, transvenous: 02H63ME, 02HK3ME, 02H43ME Copyright 2011 Medtronic 42

Codes for CRDM Systems Unlike ICD-9-CM, ICD-10-PCS does not have codes for implantation of an entire device system. Instead, components are coded individually. Implantation of dual chamber pacemaker with transvenous RA and RV leads Generator 0JH60P2 RA lead 02H63MA RV lead 02H6KMA Implantation of CRT-D with transvenous RA and RV leads, and transvenous LV lead via the coronary sinus Generator 0JH60P5 RA lead 02H63ME RV lead 02HK3ME LV (CS) lead 02H43ME Copyright 2011 Medtronic 44

Replacement of Device Root operation R-Replacement is not used to code replacement of devices. It’s used for replacing a native body part with a device, eg. valve replacement. Root operation W-Revision is also not used to code replacement of devices. It’s for correcting an existing device, eg. repositioning a lead. Instead, device replacement in ICD-10-PCS takes two codes:  Insertion of the new device, using operation H-Insertion  Removal of the old device, using operation P-Removal Removal codes contain less detail than Insertion codes. Copyright 2011 Medtronic 45

Removal of CRDM Generators
Pacemaker Defibrillator CRT-P (BiV) CRT-D (BiV) 0JPT0PZ Copyright 2011 Medtronic 46

Removal of CRDM Leads Pacemaker Defibrillator CRT-P (BiV) CRT-D (BiV)
Any chamber or location 02PA3MZ Copyright 2011 Medtronic 47

Replacement of Rhythm Devices
When a device is replaced, eg. end-of-battery life, complication, or upgrade, Insertion and Removal codes are used together. Replacement of defibrillator generator due to end-of-life Insertion of new generator 0JH60P4 Removal of old generator 0JPT0PZ Upgrade of pacemaker to CRT-D (replacement of generator, new LV lead via coronary sinus, retention of existing RA and RV leads) Insertion of new CRT-D generator 0JH60P5 Removal of old pacer generator 0JPT0PZ Insertion of LV lead via CS 02H43ME Replacement of broken CRT-D RV lead, transvenous Insertion of new lead 02HK3ME Removal of old lead 02PA3MZ Copyright 2011 Medtronic 48

Diagnostic EPS Diagnostic EPS : 4A023FZ  The ICD-10-PCS Reference Manual uses EPS as an example of root operation K-Map but the example is incomplete * See the Appendix for table 02K for mapping and table 025 for EP ablation  It is essential to use code 4A023FZ to obtain correct DRG assignment for EPS Copyright 2011 Medtronic 49

Cardiac Catheterization
RHC: 4A023N6 LHC: 4A023N7 R&L HC: 4A023N8  It’s essential to use code 4A023N~ to obtain correct DRG assignment, particularly when the cardiac cath is performed with other CRDM and cardiac procedures  Additional codes are assigned from table B20 or B21 for angiography of the heart and coronary arteries * See the Appendix for table B21 as used for arteriography of the heart/coronary arteries Copyright 2011 Medtronic 50

PTCA : What is a Site?  A “site” does not equal a single coronary artery  Interventions at distinct sites within the same coronary artery are coded as multiple sites, but multiple stents in the same coronary artery may or may not be different sites  Different interventions require separate codes Angioplasty of two distinct sites in the LAD each with a drug-eluting stent, LCx with a drug-eluting stent, and angioplasty of RCA without stent: Z, 02703ZZ Copyright 2011 Medtronic 51

Atherectomy  In ICD-9-CM, angioplasty and atherectomy use the same code but in ICD-10-PCS, they are separate codes  Angioplasty is coded to root operation 7-Dilation but atherectomy is coded to root operation C-Extirpation  No guidelines have been published yet but presumably, if both angioplasty and atherectomy take place within the same vessel, both are coded Copyright 2011 Medtronic 52

CABG  Device refers to grafts obtained from patients (eg. SVG) or cadavers, or as products; no device is direct anastomosis  The qualifier refers to the origin of the bypass, ie. source of the new blood flow Aorta-coronary bypass, one site, with SVG: W  Separate codes are assigned for each bypass that uses a different device or qualifier RIMA-coronary artery bypass, one site: Z8 Copyright 2011 Medtronic 53

Valve Replacement  This is a true replacement for coding purposes because the new valve physically takes over the place and the function of the native valve Replacement of aortic valve with porcine valve: 02RF08Z Replacement of mitral valve with mechanical valve: 02RG0JZ Copyright 2011 Medtronic 54

Greater Specificity ICD-10-PCS has far more procedure codes than ICD-9-CM. System # Procedure Codes ICD-9-CM 3,824 ICD-10-PCS 72,589 The sheer volume of codes can be daunting at first but some constructs are far less likely than others. The structure of ICD-10-PCS has key consequences in:  ease of expansion for new procedures and technologies  greater depth of clinical documentation and knowledge required to assign codes Copyright 2011 Medtronic 55

ICD-10-PCS Coding Guidelines
 The ICD-10-PCS Reference Manual contains an appendix with draft procedure coding guidelines  Guideline use is mandatory under HIPAA  The ICD-10-PCS Reference Manual also contains many helpful examples  An ICD-10-PCS Body Part Key is available to help users choose the correct value for specific anatomic structures  CMS is developing an ICD-10-PCS Device Key with trade names to help users choose the correct device value  Coding Clinic® will address procedure code issues as well Copyright 2011 Medtronic 56

MS-DRG Conversion CMS’s stated objective in the MS-DRG conversion is:
“for data coded in ICD-10, the ICD-10 MS-DRGs would assign the same MS-DRG had the same case been coded using ICD-9-CM codes” (See the Appendix for the link) In other words, CMS is not taking advantage of the ICD-10 transition to make changes to MS-DRG assignments. DRG titles and concepts are unchanged. The conversion is strictly about the codes used, not about the MS-DRG structure itself. Copyright 2011 Medtronic 58

DRG Grouper Version CMS has gone through two iterations of the MS-DRG Grouper using ICD-10 codes:  V26 (FY 2009) was released for public comment in 2009  V28 (FY 2011) was released in February 2011 and comments are currently being taken Although ICD-10 codes will be final in October 2011, the MS-DRG Grouper for ICD-10 is still in draft form.  V29 (FY 2012) is expected to be released in October 2011  The final version of the MS-DRG Grouper with ICD-10 codes is subject to the formal rule-making process Copyright 2011 Medtronic 59

CC/MCC Lists In keeping with the objective of assigning the same DRGs, all conditions that are CCs/MCCs in ICD-9-CM are also CCs/MCCs in ICD-10-CM.  In some cases where ICD-10-CM codes reflect combined conditions, an automatic CC or MCC DRG is assigned Example: I Atherosclerotic heart disease of native coronary artery with unstable angina pectoris  In conflicts where an ICD-10-CM code could be either a CC or an MCC, designation was based on frequency data  New codes were factored into the CC Exclusion List Example: I22.~, subsequent AMI, is excluded as an MCC when I21.~, initial AMI, is the principal diagnosis Copyright 2011 Medtronic 60

Qualifier Z for Lead Insertion
 Don’t default to qualifier Z!  Pacemaker DRGs are assigned when qualifier Z is used  Be sure to assign qualifier A for all pacemaker and CRT-P leads and qualifier E for all defibrillator and CRT-D leads Copyright 2011 Medtronic 64

Different DRGs? Be alert to unexpected DRGs.
If the ICD-10 DRG assigned to a particular case is different from the ICD-9-CM DRG, either the codes are incorrect or the DRG structure is flawed.  Check the ICD-10 codes assigned, with attention to the value for each character and the need for multiple codes  Verify the DRG assignment manually Medtronic can assist in DRG verification and in notifying CMS about discrepant DRG logic. Copyright 2011 Medtronic 66

Key Websites The CDC and CMS have a wealth of educational materials and resources available on-line, both for implementation of ICD-10 and the MS-DRG conversion. ICD-10-CM Diagnosis Codes draft ICD-10-CM coding guidelines ICD-10-CM tabular and index diagnosis code GEMS Copyright 2011 Medtronic 68

Key Websites ICD-10-PCS Procedure Codes
ICD-10-PCS tables and index ICD-10-PCS Reference Manual procedure code GEMS Copyright 2011 Medtronic 69

Table 02K: Mapping  Table 02K is used for cardiac mapping, eg. 02K83ZZ  This does not represent a full electrophysiologic study  For EPS plus cardiac mapping, two codes must be used:  one from table 4A0 for the electrophysiologic study  one from table 02K for mapping Copyright 2011 Medtronic 71

Table 025: Electrophysiologic Ablation
Endovascular EP ablation of arrhythmogenic focus in LA: ZZ Endovascular EP ablation of atrioventricular node: 02583ZZ Copyright 2011 Medtronic 72

Table B21: Heart Angiography
Arteriography of native coronary arteries with high osmolar contrast: B2110ZZ Left ventriculography with low osmolar contrast: B2150ZZ  When performed with a cardiac catheterization, these codes are assigned separately Copyright 2011 Medtronic 73

Coding Hotlines You can contact Medtronic for assistance with coding and reimbursement issues. Cardiac Rhythm Disease Management (866) , option 1 Vascular (877) Structural Heart (866) Copyright 2011 Medtronic 75

Thanks for Participating!
We hope this was informative. If you have any comments or questions, please send us an at: Medtronic Inc. Minneapolis, MN Copyright 2011 Medtronic

Preparing for ICD-10 for Hospitals May 2011 Copyright 2011 Medtronic.

Similar presentations

Presentation on theme: "Preparing for ICD-10 for Hospitals May 2011 Copyright 2011 Medtronic."— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

Preparing for ICD-10 for Hospitals May 2011 Copyright 2011 Medtronic.

Similar presentations

Presentation on theme: "Preparing for ICD-10 for Hospitals May 2011 Copyright 2011 Medtronic."— Presentation transcript:

Similar presentations

About project

Feedback