Mooresville AAPC Chapter ICD-10 Review Class Registrant Information

Mooresville AAPC Chapter ICD-10 Review Class Registrant Information
Name: _______________________________________________________________________________________________________ Address:________________________________________________________________________________________________________ _ __________________________________________________________________________________________________________________ Contact Number:_____________________________________________________________________________________________ _____________________________________________________________________________ Registrant Information: ICD-10 Review Class (6CEUs) Saturday, April 11, am-4pm $60.00 Payment Information: Please make checks/money orders payable to Mooresville AAPC Chapter Send Payments to: Sylvia Hale 192 Crystal Circle Mooresville, NC 28117 Phone: (704) Payments must be postmarked no later than 4/1/15 and will be deposited on that date. Only cash payments will be accepted the day of the class, and registration is first come first serve. Cash payments should be confirmed by to no later than 4/1/15. All payments are non-refundable, your check will serve as your registration confirmation. Receipts and CEU certificates will be given out at the conclusion of the class. All attendees will be responsible for providing their own ICD-10 books for this class, Materials will be provided for the class ***Sign in starts at 8:30- Please arrive no later than 8:45, as the class will start promptly at 9am***

ICD-10-CM Diagnosis Coding: Let’s Get Ready. Taught by Nancy G
ICD-10-CM Diagnosis Coding: Let’s Get Ready! Taught by Nancy G. Higgins, CPC, CPC-I, CIRCC, CPMA, CEMC © Nancy G. Higgins

What we are going to cover:
Introduction to ICD-10-CM The benefits of the new system and how it differs from ICD-9-CM ICD-10-CM code format Code selection process ICD-10-CM book format and how it differs from ICD-9-CM General ICD-10-CM diagnosis coding guidelines Chapter-specific ICD-10-CM diagnosis coding guidelines that differ from ICD-9-CM How to get your providers ready for ICD-10-CM

Introduction to ICD-10-CM
ICD-10-CM = International Classification of Diseases, 10th Revision, Clinical Modification World Health Organization (WHO) developed the International Classification of Diseases Used worldwide Clinical Modification was developed by the National Center for Health Statistics Used only in the United States Implementation date is October 1, 2015 Beginning with this date, all HIPAA covered entities will be required to use ICD-10-CM codes to report diagnoses HIPAA covered entities includes physicians, hospitals, outpatient hospital departments, etc. and most payers Exception is Workers’ Compensation

Benefits of ICD-10-CM Significant increase in number of codes allows for greater specificity in code definition ICD-9-CM has approximately 14,000 codes ICD-10-CM has approximately 68,000 codes!! New code format allows for addition of future codes in appropriate category and location Updated terminology and disease classifications More detailed data for analysis of disease patterns Possibility of new reimbursement methods that recognize the complexity of treating more severe conditions

Differences between ICD-10-CM and ICD-9-CM
Codes consist of up to 5 numbers (except V and E codes – letter and up to 4 numbers) Codes consist of up to 7 characters (combination of letters and numbers) 17 chapters plus sections for V codes and E codes 21 chapters Approximately 14,000 codes Approximately 68,000 codes

ICD-10-CM code format… Codes have up to 7 characters
1st is always a LETTER 2nd and 3rd are usually NUMBERS First three characters determine the category of the medical condition 4th through 7th can be a LETTER OR A NUMBER 4th, 5th and 6th characters provide subclassifications with more specificity 7th character is reserved for additional info when needed, e.g., trimester of pregnancy, episode of care, etc. It’s important to know the first character is always a letter because the letter O is used. It is the letter O, not the number 0 (zero). Only letter not used is U.

How to select a code … Determine the main term related to the disease, condition, or symptom you want to code Look it up in the Alphabetic Index Review all possible options listed Identify a potential code selection DO NOT STOP HERE!!! Turn to that code in the Tabular Listing and read all the instructional notes, alternative listings, etc. Determine whether that is the correct code Determine whether additional codes are needed Be sure you have read all of the guidelines before you start using the ICD-10-CM book!

ICD-10-CM book … Introductory material
ICD-10-CM Draft Official Guidelines for Coding and Reporting YOU MUST READ THESE AND UNDERSTAND THE INFORMATION CONTAINED IN THIS SECTION!!! Volume 2 – Alphabetic Index to Diseases Main terms are in bold Subterms (variations of main terms) are indented and in regular font Look for condition, disease, symptom or problem Do NOT look under body location or part … not usually there Notice there’s no hypertension table in ICD-10-CM

ICD-10-CM book … Volume 2 – Alphabetic Index to Diseases
Neoplasm table – moved to the end of the Alphabetical Index in ICD-10-CM Neoplasm = new growth Malignant = cancer Benign = NOT cancer Uncertain behavior = pathology report specifies that the specimen is not clearly malignant or clearly benign; the specimen is of “uncertain behavior” Unspecified = the physician’s documentation in the chart or EMR does not state whether the growth is malignant or benign

ICD-10-CM book … Volume 2 – Table of Drugs and Chemicals
Immediately after the Neoplasm Table Contains a list of all the drugs and other chemical substances that can poison a person Series of options for each drug or substance Poisoning, Accidental (Unintentional) Poisoning, Intentional Self-Harm Poisoning, Assault Poisoning, Undetermined Adverse Effect – allergic reaction Underdosing – patient did not take correct dosage (took less than instructed) and became sick or sicker as a result  new in ICD-10-CM

ICD-10-CM book … Volume 2 – Alphabetic Index to External Causes of Injury and Poisoning Immediately after the Table of Drugs and Chemicals Contains an alphabetic listing of all the ways a person could be injured Volume 1 – Tabular Listing Codes are listed in order beginning with A00 through Z99.8 Organized by chapter 21 chapters (ICD-9-CM only had 19 chapters) Some chapters renamed Some chapters moved Some chapters reorganized so that sections have been moved to other chapters Codes for eye conditions and ear conditions have been moved out of the Nervous System chapter into separate chapters

ICD-10-CM book … Chapter Title 1
Certain infectious and parasitic diseases 2 Neoplasms 3 Diseases of the blood and blood-forming organs and certain disorders involving the immune system 4 Endocrine, nutritional and metabolic diseases 5 Mental, behavioral, and neurodevelopmental disorders 6 Diseases of the nervous system 7 Diseases of the eye and adnexa 8 Diseases of the ear and mastoid process 9 Diseases of the circulatory system 10 Diseases of the respiratory system 11 Diseases of the digestive system 12 Diseases of the skin and subcutaneous tissue

ICD-10-CM book … Chapter Title 13
Diseases of the musculoskeletal system and connective tissue 14 Diseases of the genitourinary system 15 Pregnancy, childbirth and the puerperium 16 Certain conditions originating in the perinatal period 17 Congenital malformations, deformations and chromosomal abnormalities 18 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified 19 Injury, poisoning and certain other consequences of external causes 20 External causes of morbidity 21 Factors influencing health status and contact with health services

Basic coding conventions …
Codes can be 3 to 7 characters in length Letter X is used as dummy placeholder to allow for future expansion of codes  new in ICD-10-CM Example: S52.91 Unspecified fracture of right forearm requires a 7th character to specify the episode of care so letter “X” is used to hold the 6th place so that the 7th character will be in the correct position If the encounter is the initial encounter for a closed fracture, the code would be: S52.91xA Unspecified fracture of right forearm, initial encounter for closed fracture

ICD-10-CM has two types of Excludes notes Excludes1 identifies two conditions that cannot be reported together Example: Category G43 Migraine has an Excludes1 note for Headache NOS (R51). These two codes should never be reported together Headache is a symptom commonly associated with a migraine Excludes2 indicates that the excluded condition is not part of the condition defined by the code you are viewing but the patient may have both conditions at the same time The excluded condition is simply not part of the definition for the code you are viewing These two codes CAN be reported together Example: Category G47 Sleep disorders includes insomnia, hypersomnia, Circadian rhythm sleep disorders, sleep apnea, narcolepsy, etc. The category has an Excludes2 note for nightmares, sleep terrors, and sleep walking. The patient CAN have insomnia and nightmares (for example) so both can be coded. The Excludes2 note indicates that nightmares are not part of the insomnia definitions.

Default codes In the Alphabetic Index, the default code is the code listed next to the main term Represents condition most commonly associated with main term Assign this code when the documentation does not provide enough information to assign a more specific code AND The term “and” should be interpreted as “and/or”!!! I IMPORTANT!!!

NEC “Not elsewhere classifiable” Use when a specific code is not available for a condition NOS “Not otherwise specified” Equivalent of unspecified Etiology/manifestation convention Certain conditions have an underlying cause (etiology) and manifestations due to that underlying cause Code underlying condition first and manifestation following that unless otherwise instructed by notes in book Look for “use additional code” to identify manifestations Look for “code first” to identify etiology

WITH Should be interpreted to mean “associated with” or “due to” Do not code any condition described in the physician’s documentation as “probable,” “suspected” or “rule out” If a diagnosis has not been confirmed, code the patient’s symptoms Once a diagnosis has been confirmed, do NOT code the symptoms routinely associated with that diagnosis Sequela = late effects Residual effect after the acute phase of an illness or injury has terminated May be apparent early or may occur months or years later

General coding guidelines…
The majority of the general coding guidelines in ICD-10-CM are similar to those in ICD-9-CM Concept of laterality is addressed in ICD-10-CM because it has a huge impact on the code definitions throughout the book In general, the final character of the codes specifies the side of the body affected 1 = right side 2 = left side 3 = bilateral (note that this option is not always available) 0 or 9 = unspecified depending on whether it is in the 5th or 6th character position Documentation associated with complications is addressed in ICD-10-CM To be classified as a complication, the documentation must establish a cause-and-effect relationship between the care provided and the condition Not all conditions that occur during or following medical care or surgery are classified as complications

General coding guidelines…
Example of documentation of complications Documentation states: Patient suffers from severe lymphedema resulting from the mastectomy she underwent six months ago I97.2 Postmastectomy lymphedema syndrome The cause and effect relationship is clear Documentation states: Patient suffers from severe lymphedema. Past medical history significant for mastectomy six months ago. I89.0 Lymphedema, not elsewhere classified  The cause and effect relationship is not documented

General coding guidelines: same or similar in ICD-9-CM and ICD-10-CM …
Selection of first-listed diagnosis code The diagnosis documented first in the assessment and plan section (or impression and plan section) should indicate the main reason for the encounter and this condition typically should be coded first Always follow any instructional notes about sequencing at the code classification If two or more confirmed diagnoses meet the criteria for first-listed diagnosis, the order does not matter Selection of additional diagnosis codes Do not code conditions that no longer exist (except a code for the history of a previous condition if it affects patient care or indicates the need for the patient encounter) For a surgical procedure, code the postoperative diagnosis Always code to the highest level of specificity

General coding guidelines: same or similar in ICD-9-CM and ICD-10-CM …
When a definitive diagnosis has not been established by the provider, code the signs and symptoms experienced by the patient Signs and symptoms commonly associated with an established or confirmed diagnosis should not be coded unless the instructions in ICD-10-CM direct you to do so Signs and symptoms that are not commonly associated with an established or confirmed diagnosis should be coded when described in the documentation Acute and chronic conditions If the same condition is documented as acute or subacute and chronic and there are separate codes for these conditions, report both codes and list the acute or subacute code first

Chapter specific guidelines …
Some chapters have similar guidelines in ICD-10-CM and ICD-9-CM but some have very different guidelines and should be reviewed carefully prior to coding We will now begin our review of the chapter-specific guidelines focusing on what is different in ICD-9-CM and ICD-10-CM

Chapter 1: Certain infectious and parasitic diseases (A00 – B99) …
This chapter includes diseases typically recognized as communicable or transmissible The guidelines in ICD-10-CM are similar to those in ICD-9-CM with the following exceptions: Term “septicemia” is no longer used because it has been used to describe multiple conditions by different providers and has no clear definition Term “urosepsis” should not be used because it is nonspecific and is not the same thing as sepsis If a patient develops sepsis due to a postprocedural infection, the relationship between the infection and the procedure must be clearly documented Because many bacterial infections have become resistant to antibiotics, if the infection code does not specify drug resistance in its definition, use the following code in addition to the infection code: Z16 Infection with drug resistant microorganisms

Chapter 2: Neoplasms (C00 – D49) …
This chapter includes malignant neoplasms, carcinoma in situ, benign neoplasms, neoplasms of uncertain behavior, and neoplasms of unspecified behavior Some benign neoplasms have been moved to the specific body system chapters in ICD-10-CM Note that this chapter has a significant expansion of codes in ICD-10-CM due to the incorporation of laterality, more detail regarding anatomic location, and more detail regarding neoplasm type or histology ICD-9-CM contains approximately 1000 codes in this chapter while ICD-10-CM contains over 1500 codes Some of the malignancy code series now have an option for primary malignant neoplasm with overlapping sites The malignancy must overlap two or more contiguous sites (next to each other) specified by different codes

The guideline for Anemia associated with malignancy is different in ICD-10-CM! If the encounter is for evaluation and management of anemia associated with a malignancy and the treatment is only for the anemia, sequence the codes as follows: 1. Code for the malignancy 2. Code for the anemia (D63.0 Anemia in neoplastic disease) The guidelines for anemia associated with chemotherapy, immunotherapy, or radiation therapy are expanded in ICD-10-CM Code as follows: 1. Code for the anemia 2. Code for the malignancy 3. One of the following codes depending on the treatment that caused the anemia: T45.1x5_ Adverse effect of antineoplastic and immunosuppressive drugs, OR Y84.2 Radiological procedure and radiotherapy as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure

ICD-10-CM contains a new guideline for Malignant neoplasm in a pregnant patient that states the following codes should be assigned: Code from O9A.1_ Malignant neoplasm complicating pregnancy, childbirth and the puerperium Code for the malignancy ICD-10-CM also contains a new guideline that states that if a patient encounter is solely for treatment of a complication associated with a neoplasm, the following codes should be reported: Code for complication Code for malignancy Remember that the guideline for anemia associated with a malignancy is an exception to this guideline.

ICD-10-CM contains guidelines about two new codes and their use: C80.0 Disseminated malignant neoplasm, unspecified should be used when the patient has advanced metastatic disease and no primary or secondary sites are documented C80.1 Malignant (primary) neoplasm, unspecified is the equivalent of “Cancer, unspecified” There are more chapter-specific guidelines for chapter 2 but they are unchanged from those in ICD-9-CM

Chapter 3: Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50 – D89) … This chapter has been moved and now includes the immunity disorders Chapter 3 in ICD-9-CM included Immunity Disorders with Endocrine, Nutritional and Metabolic Diseases Chapter 4 in ICD-9-CM contained Diseases of the Blood and Blood-Forming Organs This chapter now has categories of codes while the chapter in ICD-9-CM had no specific categories Codes for lymphadenitis were previously included in this chapter but in ICD-10-CM can now be found in Chapter 9 – Diseases of the circulatory system This chapter, like the others in ICD-10-CM, contains a significant expansion of codes ICD-10-CM contains no chapter-specific guidelines for this chapter

Chapter 4: Endocrine, Nutritional and Metabolic Diseases (E00 – E89) …
All of the chapter-specific guidelines in ICD-10-CM are for the diabetes codes and are similar to those found in ICD-9-CM The diabetes codes are now combination codes that include the following: Type of diabetes mellitus (Type 1, Type 2, Secondary) The body system affected, and Complications affecting that body system The guidelines state to use as many codes within a particular category as are necessary to describe all of the complications experienced by the patient Codes should be sequenced based on the reason for the encounter ICD-10-CM does include guidelines for overdose or underdose of insulin due to insulin pump failure

Chapter 4: Endocrine, Nutritional and Metabolic Diseases (E00 – E89) …
Example of combination code found in ICD-10-CM: Patient is seen and evaluated for Type 2 diabetes with moderate nonproliferative diabetic retinopathy with macular edema ICD-10-CM Code Description E11.331 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema ICD-9-CM Codes Description 250.50 362.05 362.07 Diabetes, type II, with opthalmic manifestations Moderate nonproliferative diabetic retinopathy Diabetic macular edema

This chapter is similar to the chapter in ICD-9-CM
Chapter 5: Mental, Behavioral, and Neuro-developmental Disorders (F01 – F99) … This chapter is similar to the chapter in ICD-9-CM The biggest change is the incorporation of guidelines and codes for mental disorders due to drug use, abuse or dependence Guidelines for mental and behavioral disorders due to psychoactive substance use – new in ICD-10-CM Codes should be used only when the drug use is associated with a mental or behavioral disorder AND the relationship between the two is documented by the provider Hierarchy exists for determining what to code: If use and abuse are documented  assign code for abuse If use and/or abuse AND dependence are documented  assign code for dependence

Chapter 6: Diseases of the Nervous System (G00 – G99) …
The ICD-10-CM chapter set-up differs significantly from the ICD-9-CM chapter Diseases of the eye and ear have been moved to their own chapters (chapters 7 and 8) New categories of codes have been developed based on the type of disease or disorder The codes are slightly rearranged because of the new categories This chapter also has a significant expansion of the number of codes For example, ICD-9-CM has 10 codes that can be used to report Migraines while ICD-10-CM has 44 codes in this category. Codes are also expanded due to the incorporation of laterality (left versus right)

Chapter 6: Diseases of the Nervous System (G00 – G99) …
The guidelines in ICD-10-CM are the same as those in ICD-9-CM except for a new section that addresses dominant versus nondominant side Some code categories incorporate code descriptions that describe the affected side as dominant or nondominant If the documentation does not indicate whether the affected side is dominant or nondominant, the code should be selected as follows: If the patient is ambidextrous, default = dominant If the right side is affected, default = dominant If the left side is affected, default = nondominant

Chapter 7: Diseases of the Eye and Adnexa (H00 – H59) …
Codes for these conditions are included in the Nervous System chapter in ICD-9-CM ICD-10-CM has extensive additions to the codes because of the addition of laterality and increased specificity Most of the codes have four subcategories as follows: Right eye Left eye Bilateral Unspecified eye All chapter-specific guidelines relate to glaucoma coding Assign as many codes from category H40 Glaucoma as needed to identify: Type of glaucoma Affected eye Stage of glaucoma

Chapter 8: Diseases of the Ear and Mastoid Process (H60 – H95) …
Codes for these conditions are included in the Nervous System chapter in ICD-9-CM ICD-10-CM has extensive additions to the codes because of the addition of laterality and increased specificity Most of the codes have four subcategories as follows: Right ear Left ear Bilateral Unspecified ear There are no chapter-specific guidelines for this chapter

Chapter 9: Diseases of the Circulatory System (I00 – I99) …
The ICD-10-CM chapter set-up is similar to that in ICD-9-CM Codes are expanded significantly in some areas A new code category exists for Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarctions Many code series have been expanded to account for laterality Many guidelines remain the same as those in ICD-9-CM New or modified guidelines in ICD-10-CM relate to: Atherosclerotic coronary artery disease and angina Acute myocardial infarctions (AMI) Subsequent acute myocardial infarctions The chapter also contains many additional instructional notes regarding use of additional codes to identify tobacco use and exposure

Chapter 9: Diseases of the Circulatory System (I00 – I99) …
Atherosclerotic heart disease and angina ICD-10-CM contains combination codes for these conditions I Atherosclerotic heart disease of native coronary artery with angina pectoris I25.7 Atherosclerosis of coronary artery bypass graft(s) and coronary artery of transplanted heart with angina pectoris A causal relationship is assumed and does not have to be documented Acute myocardial infarctions (MIs) This section contains significant differences from ICD-9-CM The acute phase was designed as eight weeks or less in ICD-9-CM but is defined as four weeks (28 days) or less in ICD-10-CM Episode of care concept has been eliminated in ICD-10-CM Two categories of codes exist – initial MI and subsequent MI Codes for STEMIs have been significantly expanded Subsequent MI is defined as occurring with in 4-week acute phase

Chapter 10: Diseases of the Respiratory System (J00 – J99) …
The chapter set-up is similar to that found in ICD-9-CM ICD-10-CM contains numerous combination codes that describe a condition and the infection that is its underlying cause Example: J20.2 Acute bronchitis due to streptococcus Guidelines in ICD-10-CM address the following: Acute exacerbation of chronic obstructive bronchitis and asthma – An acute exacerbation is a worsening or a decompensation of a chronic condition, not an infection superimposed on a chronic condition. Sequencing of acute respiratory failure codes List first if it is the reason chiefly responsible for admission to the hospital Asthma codes contain options for Mild Moderate Severe This chapter contains significant instructional notes to use additional codes to report tobacco use or exposure

Chapter 11: Diseases of the Digestive System (K00 – K95) …
The chapter set-up is similar to that found in ICD-9-CM although three additional sub-categories have been added allowing for more specificity of category title Combination codes also exist in some cases that include the drug, nature of the condition (e.g., adverse effect), and external cause  eliminates the need for E-codes Example: Fran was a healthy 30 year old female diagnosed with a UTI and prescribed a course of Doxycycline. Approximately one week after beginning to take her antibiotics, Fran’s UTI had resolved but she returned to the office with odynophagia, chest pain and dysphagia. After diagnostic testing, Fran was diagnosed with an esophageal ulcer. Her physician determined her ulcer was caused by the antibiotic. K22.10 Ulcer of esophagus without bleeding T36.4x5A Adverse effect of tetracyclines, initial encounter

Chapter 11: Diseases of the Digestive System (K00 – K95) …
One major change in this chapter is that the ulcer code definitions no longer mention obstruction This has eliminated approximately 50% of the ulcer codes since ICD-9-CM typically had options for “with obstruction” and “without obstruction” Codes in ICD-9-CM for dentofacial anomalies have been moved to the chapter for Diseases of the Musculoskeletal System in ICD-10-CM

Chapter 12: Diseases of the Skin and Subcutaneous Tissue (L00 – L99) …
ICD-10-CM has many more subcategories than ICD-9-CM but the conditions are generally in the same order as in ICD-9-CM There is a significant expansion in the number of codes for Laterality (left versus right) Upper limb versus lower limb The pressure ulcer codes have been significantly expanded in ICD-10-CM (almost 6 pages while ICD-9-CM had less than one page) All chapter-specific guidelines in ICD-10-CM relate to the pressure ulcer codes

Chapter 12: Diseases of the Skin and Subcutaneous Tissue (L00 – L99) …
Pressure ulcer guidelines state: Assign as many codes as needed from the L89 Pressure ulcer series to identify multiple pressure ulcers by anatomic site and stage Code first any associated Gangrene (I96) No code should be assigned for a pressure ulcer described as “healed” Information needed to code a pressure ulcer Body area or anatomic site (4th digit) Laterality (5th digit) Stage of ulcer / depth (6th digit) Note that the dermatitis codes have also been expanded significantly reflecting the cause of the dermatitis Providers may need to add more specific information to their documentation so that the cause of the dermatitis can be used to determine the appropriate code

Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00 – M99) …
The chapter in ICD-10-CM again has a significant expansion of codes due to the addition of laterality and other specificity The chapter includes all diseases typically associated with the musculoskeletal system and connected tissue as well as the following: Bone, joint or muscle conditions that are the result of a healed injury Recurrent bone, joint or muscle conditions Pathological fractures Stress fractures Current, acute injuries should be coded using codes form Chapter 19 – Injury, Poisoning and Certain Other Consequences of External Causes The majority of the guidelines in ICD-10-CM relate to coding pathological fractures

Pathological fractures are also known as “spontaneous fractures”
Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00 – M99) … A pathological fracture occurs in a diseased or weakened bone when either no trauma or only minor trauma that would not normally break a healthy bone has occurred Pathological fractures are also known as “spontaneous fractures” Bones can become weakened as the result of many conditions including Malignancies Osteoporosis Osteomyelitis Hyperparathyroidism Pathologic fractures also include instructions to code the underlying condition The 7th character specifies the episode of care and is different from what is seen in ICD-9-CM

7th characters for pathological fractures:
Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00 – M99) … 7th characters for pathological fractures: 7th Character Description A Initial encounter for fracture D Subsequent encounter for fracture with routine healing G Subsequent encounter for fracture with delayed healing K Subsequent encounter for fracture with nonunion P Subsequent encounter for fracture with malunion S Sequela

Stress fracture codes are in this chapter Stress fractures
Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00 – M99) … Stress fracture codes are in this chapter Stress fractures Occur in weight-bearing bones Are caused by repeated minimal stresses to the bone Should be coded using category M84.3 Stress fracture Note that when you code a stress fracture, you must also select an external cause code to identify the cause of the stress fracture

Chapter 14: Diseases of the Genitourinary System (N00 – N99) …
In ICD-10-CM, renal manifestations of systemic diseases classified in other chapters have been moved to those chapters Example: Nephrotic syndromes, nephritis, and nephropathies associated with diabetes have been moved to chapter 4, Endocrine, Nutritional and Metabolic Diseases The codes in many categories again are significantly expanded due to the increased specificity of the definitions Some of the terminology used to describe conditions in this chapter has changed Example: Benign prostatic hypertrophy (BPH) is called enlargement of the prostate in ICD-10-CM This chapter includes Disorders of the Breast (N60 – N65) – codes are expanded due to the addition of laterality The dysplasia codes for the cervix and vagina have been redefined to differentiate the severity of the condition (mild, moderate, or unspecified; severe is in chapter 2)

Chapter 15: Pregnancy, Childbirth and the Puerperium (O00 – O9a) …
In ICD-10-CM, the categories and codes are more detailed ICD-10-CM eliminates the concept of antepartum, delivery, etc. in the code definition and instead incorporates the trimester of the pregnancy into many of the codes including those for supervision of the pregnancy The trimesters are defined as follows: First trimester – less than 14 weeks Second trimester – 14 weeks 0 days to less than 28 weeks Third trimester – 28 weeks 0 days until delivery The guidelines address the importance of knowing whether a condition developed due to the pregnancy or if it was a pre-existing condition  this will impact the code selection

Chapter 16: Certain Conditions Originating in the Perinatal Period (P00 – P96) …
In ICD-10-CM, the codes have been structured to bring together related conditions into distinct code blocks while ICD-9-CM grouped the conditions into two subchapters Remember these codes are used only on the newborn’s record (birth to 28 days of age)

Chapter 17: Congenital Malformations, Deformations and Chromosomal Abnormalities (Q00 – Q96) …
The chapter title has been updated in ICD-10-CM to reflect the categories in this chapter In ICD-9-CM, the chapter title was Congenital Anomalies The chapter has also been moved so that it follows Chapter 16: Certain Conditions Originating in the Perinatal Period Many of the code definitions from ICD-9-CM have been modified or grouped as alternate listings under another code definition In ICD-10-CM, the codes are grouped into categories based on organ system or body area The guidelines state that once a congenital condition has been corrected, a personal history code should be used to identify the history of the malformation or deformity

New codes are available in ICD-10-CM for falls
Chapter 18: Symptoms, Signs and Abnormal Clinical and Laboratory Findings, NEC (R00 – R99) … Although this chapter is similar to Chapter 16 in ICD-9-CM, the categories are significantly different in ICD-10-CM Categories for symptoms and signs involving various organ systems or functions Category for General symptoms and signs Categories for abnormal findings from test results Category for Ill-defined and unknown cause of mortality This chapter also contains an expanded number of codes due to the increase in specificity of code definition New codes are available in ICD-10-CM for falls R29.6 Repeated falls Z91.81 History of falling

Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00 – T88) …
Most of the injury coding guidelines remain the same as those in ICD-9-CM ICD-10-CM includes significantly more codes due to the inclusion of greater specificity, laterality, and introduction of a new 7th character extension to indicate the episode of treatment Initial encounter – used while patient is receiving active treatment for the condition Subsequent encounter – used while patient is receiving routine care for the condition during the healing or recovery phase Sequela – used for complications or conditions that arise as a direct result of a condition (late effect) Chapter 19 of ICD-10-CM groups injuries by specific site/body part, while in ICD-9-CM injuries are grouped by types of injuries, e.g., fractures, dislocations, open wounds, etc.

Coding of traumatic fractures
Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00 – T88) … Coding of traumatic fractures Fractures are coded individually by site If the documentation does not indicate whether the fracture is open or closed, select the code for closed If the documentation does not indicate whether the fracture is displaced or nondisplaced, select the code for DISPLACED  opposite of ICD-9-CM ICD-10-CM distinguishes between burns and corrosions – guidelines are the same by codes are new and distinct Burns – thermal burns that come from a heat source, burns from electricity and radiation Corrosions – burns due to chemicals Guidelines for coding burns are the same as those in ICD-9-CM In ICD-10-CM, the poisoning codes are combination codes that include the substance that was taken and how the poisoning occurred

Underdosing – new concept in ICD-10-CM!
Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00 – T88) … Underdosing – new concept in ICD-10-CM! Used when a patient has taken less of a medication than prescribed resulting in illness Should NEVER be the first-listed code First-listed code is what is wrong with the patient as a result of the underdosing

Chapter 20: External Causes of Morbidity (V00 – Y99) …
Similar to the E codes in ICD-9-CM ICD-10-CM does contain some specific sequencing guidelines If two or more events cause separate injuries, an external cause code should be assigned for each cause Child and adult abuse take priority over all other causes Terrorism events take priority over all other causes except child and adult abuse Cataclysmic events take priority over all causes except child and adult abuse and terrorism Transport accidents take priority over all causes except child and adult abuse, terrorism, and cataclysmic events

Similar to the V codes in ICD-9-CM
Chapter 21: Factors Influencing Health Status and Contact with Health Services (Z00 – Z99) … Similar to the V codes in ICD-9-CM ICD-10-CM does contain some changes in code set-up and in guidelines Code range Z00 – Z13 is used to describe encounters related to routine examinations (general check-ups, sports physicals, pre-employment physicals) Categories now have options for Exam without abnormal findings Exam with abnormal findings If the exam results show abnormal findings, additional code(s) should be used to identify those findings Pre-operative examination codes are used only when a patient is being cleared for surgery and no treatment is rendered

Educating your providers …
Dual coding Tools you can develop – base them on your utilization reports Other ideas

Questions?

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Mooresville AAPC Chapter ICD-10 Review Class Registrant Information

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