1. Barbara Parker, CMA (AAMA), CPC, CCS-P

3.  ICD-10 Implementation  Format  Differences between ICD-9 and ICD-10  Resources

4.  October 1, 2013 –NOT flexible  All HIPAA covered entities must transition  NO grace period  ICD-9-CM not accepted after this date  January 1, 2012 – electronic transmission changes to Version 5010 which accomodates ICD-10 format  Proposed freeze on ICD-9-CM on October 1, 20ll  CPT and HCPCS continue

5. January 1, 2010  Payers and providers should begin internal testing of Version 5010 standards for electronic claims December 31, 2010  Internal testing of Version 5010 must be complete to achieve Level I Version 5010 compliance January 1, 2011  Payers and providers should begin external testing of Version 5010 for electronic claims  CMS begins accepting Version 5010 claims  Version 4010 claims continue to be accepted December 31, 2011  External testing of Version 5010 for electronic claims must be complete to achieve Level II Version 5010 compliance January 1, 2012  All electronic claims must use Version 5010  Version 4010 claims are no longer accepted October 1, 2013  Claims for services provided on or after this date must use ICD-10 codes for medical diagnosis and inpatient procedures  CPT codes will continue to be used for outpatient services

6.  General Equivalence Mapping files  ICD-9 to ICD-10  ICD-10 to ICD-9  Not set in stone – just the general idea

7. ICD-10-CM From 14,315 to 69,099 codes Added right, left, bilateral ICD-10-PCS From 3,838 to 71,957

8.  Longer... Uses more alpha characters  3 to 7 characters 1 st character is a letter (except U) 2 nd character is a number 3 rd – 7 th can be a letter or number  Decimal after third character

9. A78Q fever A69.21 Meningitis due to Lyme disease O9A311Physical abuse complicating pregnancy, first trimester S52.131ADisplace fracture of neck of right radius, initial encounter for closed fracture Reference: MLN Matters, SE 109

10. Laterality is added (left, right, bilateral) C50.511Malignant neoplasm of the lower-outer quadrant of right female breast H16.013Central corneal ulcer, bilateral L89.022Pressure ulcer of left elbow, stage II

11. Combination codes for conditions and commonly associated symptoms and manifestations K57.21Diverticulitis of large intestine with perforation and abscess with bleeding E11.341Type 2 diabetes mellitus with severe nonproliferating diabetic retinopathy with macular edema I25.110Atherosclerotic heart disease of native coronary artery with unstable angina pectoris

12. Combination codes for poisoning and associated external cause T42.3x2S Poisoning by barbiturates, intentional self-harm, sequela

13. Obstetric codes to identify trimester instead of episode of care O26.02Excessive weight gain in pregnancy, second trimester

14. Character “x” used as 5 th or 6 th character placeholder to fill in empty space when a code is less than 6 characters and requires a 7 th character T15.02xDForeign body in cornea, left eye, subsequent encounter T46.1x5AAdverse effect of calcium- channel blockers, initial encounter

15. Excludes1: Code excluded should NEVER be reported with the code where the note is located Q03Congenital hydrocephalus Excludes1: Acquired hydrocephalus (G91.0-)

16. Excludes2: Condition excluded is NOT part of the condition represented by the code but a patient may have both conditions at the same time in which case both codes are assigned L27.2 Dermatitis due to ingested food Excludes2: Dermatitis due to food in contact with skin (L23.6, L24.6, L25.4)

17.  Underdosing T45.526D Underdosing of antithrombotic drugs, subsequent encounter  Blood type Z67.40Type O blood, Rh positive  Blood alcohol level Y90.6 Blood alcohol level of 120-199 mg/100 ml

18.  Injury S75.121A Major laceration of femoral vein at hip and thigh level, right leg, initial encounter  Diabetes E10.610 Type 1 diabetes mellitus with diabetic neuropathic arthropathy

19.  Substance abuse F10.182Alcohol abuse with alcohol- induced sleep disorder  Postoperative complications T82.02xADisplacement of heart valve prosthesis, initial encounter

20.  The appropriate 7 th character must be added to each code from category S01 A initial encounter D subsequent encounter S sequela (from prior disease or injury)

21. M84.6 Pathological fracture in other disease The appropriate 7 th character is to be added to each code from subcategory M84.6 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

22.  Distinction made between intraoperative complications and post operative disorders D78.01 Intraoperative hemorrhage and hematoma of spleen complicating a procedure of the spleen D78.21 Postprocedural hemorrhage and hematoma of spleen complicating a procedure of the spleen

23.  Injuries grouped by anatomical site rather than injury type Example: S25.411A Minor laceration of right pulmonary blood vessel, initial encounter  New code definitions Example: Acute myocardial infarction is defined as 4 weeks rather than 8 weeks  V and E codes incorporated into main classification rather than separate classifications

25.  www.cms.gov (Choose Medicare, then coding, then ICD10) www.cms.gov Medicare has many, many resources  www.cdc.gov/nchs/icd/icd10cm.htm www.cdc.gov/nchs/icd/icd10cm.htm New ICD10 draft guidelines available here  www.aapc.org www.aapc.org  American Academy of Professional Coders has webinars, online courses, and a wealth of other resources