1. Guidelines Most Significantly Affected Under ICD-10-CM
Kay Potter, RHIT, CPC, CPC-I, PCS

2. ICD – 10
Keep Calm
And
Code On!
Tips And Resources

3. Official ICD 10 Guidelines
Objectives:
In this section you will learn
Review the basic structure of ICD-10-CM and differences/similarities to ICD-9-CM.
Describe updates to the ICD-10-CM system
Analyze changes to ICD-10-CM Official Guidelines for Coding and Reporting
Official ICD 10 Guidelines

4. NCHS is responsible for developing the diagnostic portion of the ICD-10 coding system, ICD-10-CM.
CMS is responsible for developing the procedure portion of the ICD-10 coding system, ICD-10-PCS.
Who is NCHS? National Center for Health Statistics compiles statistical information used to guide actions and policies to improve the public health U.S. citizens.
Key Point

5. ICD-10 Code Set Draft Format
Implementation date October 1, 2014
Partial Code Freeze
October 1, 2011 – Last regular update to ICD-9-CM
October 1, 2012 – 2013 – Limited updates to both ICD-(-CM and ICD-10-CM
October 1, 2014 – Limited updates to ICD-10-CM, ICD-9-CM no longer used.
October 1, 2015 – Regular Updates to ICD-10- CM/PCS.
ICD-10 Code Set Draft Format

6. ICD-10-CM Diagnosis Codes
To be used in all settings
Hospital inpatients
Hospital outpatients
Physicians offices
Emergency offices
Home Health
Long Term Care
Rehabilitation Facilities
For ANY diagnosis anywhere
ICD-10-CM Diagnosis Codes

7. As additional detail is to be reported with ICD-10- CM, more detail will be required in the medical records from which the data for coding are extracted.
For payers, the clarity afforded by the ICD-10-CM coding system is likely to greatly enhance and assist in supporting medical necessity.
With ICD-10-CM, the diagnosis comes significantly closer to being “married” to the procedure; further, it intrinsically gives a more complex description of the condition, thereby leaving less room for denials.
Advantages of ICD-10

8. A Review of the Basics 21 chapters and expanded codes
Some chapters reorganized, some conditions put in to different chapters
Alphanumeric – first character is always a letter
Addition of up to 7 characters
7th character code extensions in some cases
Injuries
Initial encounter
Subsequent encounter
Sequela
Obstetrics
Glaucoma
A Review of the Basics

9. Why so Many More Codes? Laterality
__ Example: Acute angle closure glaucoma
ICD-9-CM
ICD-10-CM H Right eye
H Left eye
H Bilateral
H Unspecified eye
Increased Specificity
External Cause Codes
Why so Many More Codes?

11. What is Different in ICD-10-CM
Alphanumeric
Alpha characters are not case sensitive
I and O are used but only as the 1st character
U is not used – saved for the International version
Restructured chapters
E.g. injuries by site and then by type
Increased specificity and detail
E.g. laterality – as described
Combination codes
E.g. – Diabetes, Angina, and CAD
What is Different in ICD-10-CM

14. The Good News – What is the SAME in ICD-10-CM
Many of the guidelines are exactly the same between ICD-9-CM and ICD-10-CM
Conventions
Format of the Index and Tabular List
Abbreviations and Punctuation
NEC, NOS, brackets, and colons etc.
Steps in assigning codes
Includes notes
General coding guidelines
The Good News – What is the SAME in ICD-10-CM

15. Some Differences – Conventions and General Guidelines
Conventions, general coding guidelines and chapter specific guidelines
X as a placeholder
7th character
Excludes Notes
-- Excludes 1 – not coded
-- Excludes 2 – not included here
General Coding Guidelines
Late Effects is now a Sequela
Laterality
Some Differences – Conventions and General Guidelines

16. The diagnosis coding system (ICD-10-CM) will affect both hospital and physician providers .
In creating the clinical modification for ICD-10 in this country, the National Center for Hospital Statistics has made significant changes.
The number of diagnostic codes available for use in the ICD-10-CM coding system is larger than the number available in ICD-9-CM by thousands.
Documentation Needs

17. The documentation principles and concepts, may apply to documentation considerations created by the impact of both systems.
ICD-10-CM will pose certain significant challenges to coders in both physician and facility settings.
As additional detail is to be reported with ICD- 10-CM, more detail will be required in the medical records from which the data for coding are extracted.
Documentation Needs

18. Never code strictly from the alphabetical index, always confirm your code choice in the tabular list to insure the most appropriate code choice selection.
ICD 10 has 21 Chapters
Coding Tip

19. The alphabetic Index is divided into sections and is organized by main terms
Index of Diseases and Injury
Index of External Causes of Injury
Table of Neoplasms
Table o Drugs and Chemicals
Alphabetic Index

20. Terms Data Granularity
Degree or detail contained in data; the fineness in which data fields are subdivided.
The increased granularity, or in other words, the greater level of detail afforded by ICD-10 provides the quality data needed to support the medical necessity of rendering patient care, improving clinical outcomes, and improve cost- effective disease management.
Terms

21. Combination Code – The term represents a single code used to classify: two diagnoses, either a diagnosis with an associated sign or symptom or a diagnosis with an associated complication.
IMPORTANT—Multiple codes should not be used when the classification provides a combination code that clearly identifies all of the elements documented in the diagnosis.
Terms

22. Granularity – The term refers to the level of hierarchy and the amount of information the increased hierarchy provides to the diagnostic description
Laterality – ICD-10 code description include right or left designation.
The right side is usually character 1,
Left side character 2.
Bilateral character is usually 3.
Unspecified side is either a character 0 or 9, depending on whether it is a fifth or sixth character.
Terms

23. New – placeholder “X” if the code only has 4 or 5 characters, but needs a 7th character (e.g., initial/subsequent/sequela to injury), use an “X” in the blank spaces
Different – Exclude 1 (never code it here) and Exclude 2 (not included, if he has that code it separately
New – Laterality
New – Coding pregnancy trimesters
New – Glasgow coma scale
New – Functional quadriplegia

24. What you can do Be detailed in your diagnostic documentation:
Identify laterality
Identify specific site, anatomical location.
What you can do

25. ICD-10-CM Specific Guidelines for Selected Chapters

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