1. ICD-10
Getting There…..
Pediatrics

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
Known dextrocardia, found to also have an arterial malformation and septal defect.
Congenital situs inversus with dextrocardia, found to also have patent ductus arteriosus and atrial septal defect.
Needed improvements:
Congenital vs. acquired and specificity regarding the site and type of anomalies.
Inadequate vs. Adequate Documentation Example 1: Congenital Anomalies of the Circulatory System

7. Inadequate vs. Adequate Documentation Example 2: Asthma
Inadequate Documentation
Required ICD-10 Documentation
Seven-year-old female with asthma presents to ER in resp distress. Tachycardic and tachypneic, audible in and out wheeze, O2 sat 63% on room air.
Mother reports home inhaler and nebulizers used but didn’t help.
Seven-year-old female with moderate, persistent asthma presents to ER in resp distress d/t status asthmaticus. Tachycardic and tachypneic, audible in and out wheeze, O2 sat 63% on room air.
Mother reports home inhaler and nebulizers used but didn’t help. Dad smokes near child.
Needed improvements:
Type, severity, exacerbation(s), complication(s), and precipitating factor(s).
Inadequate vs. Adequate Documentation Example 2: Asthma

8. Location, type, and presence of complicating factors.
Inadequate Documentation
Required ICD-10 Documentation
Spina bifida with paralysis.
Previous ventriculoperitoneal shunt placement.
Lumbar spina bifida cystica, bilateral lower limb paralysis and hydrocephalus with previous ventriculoperitoneal shunt placement.
Needed improvements:
Location, type, and presence of complicating factors.
Inadequate vs. Adequate Documentation Example 3: Spina Bifida

9. Inadequate vs. Adequate Documentation Example 4: Respiratory Failure
Inadequate Documentation
Required ICD-10 Documentation
One-day-old newborn received in transfer with aspiration and pulmonary hypertension. Tachypnea, tachycardia, and grunting. ABGs show respiratory acidosis.
Dx: Respiratory distress syndrome.
One-day-old newborn received in transfer with blood aspiration, pneumonia, and secondary pulmonary hypertension. Tachypnea, tachycardia, and grunting. ABGs show respiratory acidosis.
Dx: Hyaline membrane disease.
Needed improvements:
Type, substance aspirated, respiratory symptoms, and secondary condition(s).
Inadequate vs. Adequate Documentation Example 4: Respiratory Failure

10. Stage, transplant status, and related or contributing disease.
Inadequate Documentation
Required ICD-10 Documentation
42-year-old with chronic kidney disease, HTN, & diabetes.
Hbg & Hct decreased, transfuse 2 units PRBCs.
42-year-old on transplant list with ESRD on dialysis, HTN, IDDM type 2 with nephropathy & neuropathy.
Chronic kidney disease related iron deficiency anemia, transfuse 2 units PRBCs.
I Hypertensive Chronic Kidney Disease, NOS
E Type 2 Diabetes Mellitus Without Complications
N Chronic Kidney Disease, Unspecified (Stage)
Needed improvements:
Stage, transplant status, and related or contributing disease.
E Type 2 diabetes mellitus with diabetic nephropathy
I Hypertensive End Stage Renal Disease
N Chronic Kidney Disease requiring chronic dialysis
Z Dependence on Renal Dialysis
E Type 2 diabetes mellitus with diabetic neuropathy, unspecified
D Anemia in chronic kidney disease
Z Awaiting Organ Transplant Status
Inadequate vs. Adequate Documentation Example 3: Chronic Kidney Disease

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