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Briefing: ICD-10-CM (International Classification of Diseases – 10 th Revision – Clinical Modifications) A Piece of Cake. Date: 23 March 2010 Time: 1400–1450 . Pre-Quiz. Quiz – jot down your answers 1. ICD- 10 -CM is

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slide1

Briefing: ICD-10-CM(International Classification of Diseases – 10th Revision – Clinical Modifications)A Piece of Cake

Date: 23 March 2010

Time: 1400–1450

pre quiz
Pre-Quiz

Quiz – jot down your answers

  • 1. ICD-10-CM is
    • a. ICD-9-CM where they replaced the three digit categories with three digit alpha-numeric categories to have more space
    • b. Pretty much volumes 1 and 2 of ICD-9-CM (volume 3 is now ICD-10-PCS)
    • c. Mapped to ICD-9-CM with about 95% of the codes being a one-to-one mapping
    • d. All of the above
pre quiz3
Pre-Quiz
  • 2. When you think “Personal History of” you think –
    • a. V10 – Personal History of malignant neoplasm, through V15 Other Personal History Presenting Hazard to Health
    • b. V86 Estrogen Receptor Status
    • c. V87 Other specified personal exposures and history presenting hazards to health
    • d. V88 Acquired absence of other organs and tissue
    • e. Both a and c even though they are not in the same place – this just makes coding more challenging!
pre quiz4
Pre-Quiz
  • 3. The coding guidelines for ICD-10-CM (e.g., assign all the digits available) are
    • a. Are pretty much the same as for ICD-9-CM.
    • b. Are pretty much the same as for ICD-8-A.
    • c. Are pretty much the same as for ICD-7.
    • d. Are pretty much the same as for ICD-6.
    • e. All of the above.
pre quiz5
Pre-Quiz
  • 4. The ICD-9-CM codes are being “frozen” (will not change, no additions/deletions) in 2012 because
    • a. There is so much automation and all those programs need to have all the code numbers for the various conditions changed, tested, fixed, tested…
    • b. To give coders an entire year to goof off claiming they were studying VERY hard to understand the ICD-10-CM.
    • c. Because the cost of gasoline had gone up to $5/gallon and those of us driving up from Washington to Baltimore for the Coordination and Maintenance Meetings wanted a break for an entire year.
    • d. Because we knew Washington DC was going to get 30+ inches of snow in one week and we wanted all the coders to know how to spell “frozen” before December 2009 and February 2010.
pre quiz6
Pre-Quiz
  • 5. The General Equivalency Mappings (GEMs) don’t have a one-for-one mapping because
    • a. Some few medical concepts have changed so the ICD-10-CM reflects the thought process of the current medical understanding.
    • b. ICD-10-CM has expanded some concepts so it may have five codes while ICD-9-CM only has one code.
    • c. If there was a one-for-one mapping to ICD-9-CM from ICD-10-CM, and a one-for-one mapping to 10 from 9, why bother with ICD-10?
    • d. All of the above.
    • e. None of the above.
pre quiz7
Pre-Quiz
  • 6. I plan to get ready for the new codes:
    • a. On 1 Oct 2013 and not a second before.
    • b. When I take the Oct 2013 AHIMA CCS-P quiz I will borrow a book and hope for the best.
    • c. I’d be willing to attend teleclasses for a few weeks prior so long as they let me do it from work
    • d. What – you silly goose, who actually believes the MHS will be ready on 1 Oct 2013, they can’t even get the new codes out until Jan/Feb/Mar on a normal year – I’m sticking with the MHS and plan never to have to learn the new codes
    • e. Other:
objectives
Objectives

Know that ICD-10-CM transition will be easy for coders

Understand the General Equivalency Mappings

Know the coding guidelines for ICD-10-CM

icd 10 cm
ICD-10-CM
  • Why
  • How – Direct Care
    • Issue: CAPER (Comprehensive Ambulatory/Professional Encounter Record) diagnosis field is only 7 characters
    • Issue: SIDR (Standard Inpatient Data Record) diagnosis field is only 8 characters
    • Issue: AHLTA (Armed Forces Healthcare Longitudinal Tracking Application)
    • Issue: CCE (Coding Compliance Editor)
    • Issue: All the other direct and purchased care MHS (Military Healthcare System) systems/programs using ICD codes
  • Training Proposal Development
    • Coders
    • Providers
    • Data Analysts
difference between icd 10 cm icd 10 pcs and icd 9 cm
Difference Between ICD-10-CM,ICD-10-PCS and ICD-9-CM
  • International Classification of Diseases – 9th Revision – Clinical Modifications (ICD-9-CM)
    • Developed in USA in 1970s based on the World Health Organization’s ICD-9
      • Based on ICD-8, and ICD-8a
    • Clinical Modifications (CM) is the United States’ version
      • Added to WHO ICD-9:
        • External Causes of Injury
        • Factors Influencing Health
        • Volume 3, Institutional Procedure Coding
icd 10 cm11
ICD-10-CM
  • ICD-10-Clinical Modifications is for use in the United States
    • Other countries use modifications specific to their country, such as ICD-10-CA for Canada and ICD-10-AM for Australia
  • ONLY:
    • Diagnoses,
    • Factors Influencing Health, and
    • External Causes of Injury
  • Does not include procedures as did ICD-9-CM
    • No third volume
    • See ICD-10-Procedure Classification System
  • Currently used for cause of death reporting in the United States
icd 10 cm12
ICD-10-CM
  • Available for download from:
    • http://www.cdc.gov/nchs/icd/icd10cm.htm#10update
  • At the bottom of the page
  • A bit easier and less expensive than going to Ingenix and buying it on disc for $119.00
  • Would recommend buying one book every other year until 2013 as they are much easier to work with
  • The downloads are nice for a quick word search
icd 10 cm is better due to
ICD-10-CM Is Better Due To
  • Addition of information relevant to ambulatory and managed care encounters
    • Expanded injury codes
  • Creation of combination diagnosis/symptom codes to reduce the number of codes needed to fully describe a condition
  • Addition of a sixth character for some codes
  • Incorporation of common 4th and 5th digit subclassifications
  • Laterality; and
  • Greater specificity in code assignment for many codes.
  • The new structure will allow further expansion than was possible with ICD-9-CM.
icd 10 cm14
ICD-10-CM
  • “Piece of Cake” for anyone who can code using ICD-9-CM
    • Same basic guidelines
    • Same basic layout/organization
    • Same basic index
    • Same basic tabular
    • Some codes are more detailed
    • Some codes indicate initial or subsequent encounter
    • Format – alpha + 2 numerics + decimal point + numeric+3 alphanumerics
      • H66.9 Otitis media, unspecified
        • Otitis media NOS
        • Acute otitis media NOS
        • Chronic otitis media NOS
      • H66.90 Otitis media, unspecified, unspecified ear
      • H66.91 Otitis media, unspecified. right ear
      • H66.92 Otitis media, unspecified, left ear
      • H66.93 Otitis media, unspecified, bilateral
review of existing code formats
Review of Existing Code Formats
  • ICD-9-CM diagnoses (look for the decimal point)
    • 3-5 numeric characters with decimal point after the 3rd
    • External cause of injury Exxx.x
    • Factors influencing health Vxx.xx
  • ICD-9-CM procedure (look for the decimal point)
    • Numeric xx.xx
  • CPT – 5 numeric, or 4 numeric with terminal F or T (no decimal point)
  • HCPCS – alpha with 4 numeric (no decimal point) – does not currently use F or T
icd 9 cm comparison to icd 10 cm

ICD-9-CM

ICD-10-CM

Chapt

Title

Category

Chapter

Title

Category

er

Range

Range

I

Infectious and parasitic diseases

001-139

I

Certain infectious and parasitic diseases

A00-B99

II

Neoplasms

140-239

II

Neoplasms

C00-D48

III

Endocrine, nutritional and metabolic

240-279

III

Diseases of the blood and blood-forming

D50-D89

diseases and immunity disorders

organs and certain disorders involving the

immune mechanism

IV

Diseases of blood and blood-forming

280-289

IV

Endocrine, nutritional and metabolic

E00-E90

organs

diseases

V

Mental disorders

290-319

V

Mental and behavioral disorders

F00-F99

VI

Diseases of the nervous system and

320-389

VI

Diseases of the nervous system

G00-G99

sense organs

VII

Diseases of the circulatory system

390-459

VII

Diseases of the eye and adnexa

H00-H59

VIII

Diseases of the respiratory system

460-519

VIII

Diseases of the ear and mastoid process

H60-H95

IX

Diseases of the digestive system

520-579

IX

Diseases of the circulatory system

I00-I99

X

Diseases of the genitourinary

580-629

X

Diseases of the respiratory system

J00-J99

system

XI

Complications of pregnancy,

630-676

XI

Diseases of the digestive system

K00-K99

childbirth and the puerperium

XII

Diseases of the skin and

680-709

XII

Diseases of the skin and subcutaneous

L00-L99

subcutaneous tissue

tissue

ICD-9-CM Comparison to ICD-10-CM
the tabulars
The Tabulars
  • ICD-9-CM
  • 001 Cholera
    • 001.0 Due to Vibrio cholerae
    • 001.1 Due to Vibrio cholerae el tor
    • 001.9 Cholera, unspecified
  • 002 Typhoid and paratyphoid fevers
  • ICD-10-CM
  • A00 Cholera
    • A00.0 Cholera due to Vibrio cholerae 01, biovar cholerae (classical cholera)
    • A00.1 Cholera due to Vibrio cholerae 01, biovar eltor (cholera eltor)
    • A00.9 Cholera, unspecified
  • A01 Typhoid and paratyphoid fevers
the tabular example j00 currently 460
The Tabular – Example J00 (Currently 460)

Excludes1 = NOT CODED HERE (both conditions cannot occur at same time

Excludes2 = Not included in this diagnosis, if it is there, code them both

icd 9 cm vs icd 10 cm tabular
ICD-9-CM vs ICD-10-CM Tabular
  • ICD-9-CM

8. Diseases of the Respiratory System (460-591)

Acute Respiratory Infections (460-466)

460 Acute nasopharyngitis [common cold]

  • ICD-10-CM

Chapter X – Diseases of the Respiratory System (J00-J99)

Acute Upper Respiratory Infections (J00-J06)

J00 Acute nasopharyngitis [common cold]

icd 10 cm22
ICD-10-CM
  • Morbidity classification
    • Includes potentially fatal conditions
    • Treatable
  • For use in
    • Hospitals; acute short-term, long-term
    • Provider office
    • Other outpatient settings
benefit to the mhs
Benefit to the MHS
  • Ability to
    • Collect more detailed information
    • Compare morbidity data to mortality data
    • Compare to international data
    • Collect some laboratory results (e.g., blood alcohol levels and ABO blood types)
benefit to the mhs24
Benefit to the MHS
  • Ability to collect concepts such as
    • “Do Not Resuscitate”
    • Initial versus subsequent encounters
    • Right, left, bilateral
    • First, second, third trimester
    • Identification of fetus in multiple gestations
    • Classifications of fractures
    • Dominate versus non-dominate side
    • Burns separated based on heat or chemical
    • Cesarean delivery without medical indication
benefit to the mhs25
Benefit to the MHS
  • Better data on which to base decisions
  • Easier to pull records with criteria needed for a specific study
  • Expandable, more space for new conditions
  • More detailed external causes of injury
    • e.g., Y93.5B Cellular telephone usage in work-related activity
example of expanded code set
Example of Expanded Code Set
  • F10.2 Alcohol dependence
    • Excludes1: alcohol abuse (F10.1-)
    • alcohol use, unspecified (F10.9-)
    • Excludes2: toxic effect of alcohol (T51.0-)
    • F10.20 Alcohol dependence, uncomplicated
    • F10.21 Alcohol dependence, in remission
    • F10.22 Alcohol dependence with intoxication
        • Acute drunkenness (in alcoholism)
          • Excludes1: alcohol dependence with withdrawal (F10.23-)
        • F10.220 Alcohol dependence with intoxication, uncomplicated
        • F10.221 Alcohol dependence with intoxication delirium
        • F10.229 Alcohol dependence with intoxication, unspecified
    • F10.23 Alcohol dependence with withdrawal
  • Excludes1: Alcohol dependence with intoxication (F10.22-)
        • F10.230 Alcohol dependence with withdrawal, uncomplicated
        • F10.231 Alcohol dependence with withdrawal delirium
        • F10.232 Alcohol dependence with withdrawal with perceptual disturbance
        • F10.239 Alcohol dependence with withdrawal, unspecified
    • F10.24 Alcohol dependence with alcohol-induced mood disorder
    • F10.25 Alcohol dependence with alcohol-induced psychotic disorder
        • F10.250 Alcohol dependence with alcohol-induced psychotic disorder with delusions
        • F10.251 Alcohol dependence with alcohol-induced psychotic disorder with hallucinations
        • F10.259 Alcohol dependence with alcohol-induced psychotic disorder, unspecified
    • F10.26 Alcohol dependence with alcohol-induced persisting amnestic disorder
    • F10.27 Alcohol dependence with alcohol-induced persisting dementia
    • F10.28 Alcohol dependence with other alcohol-induced disorders
        • F10.280 Alcohol dependence with alcohol-induced anxiety disorder
        • F10.281 Alcohol dependence with alcohol-induced sexual dysfunction
        • F10.282 Alcohol dependence with alcohol-induced sleep disorder
        • F10.288 Alcohol dependence with other alcohol-induced disorder
    • F10.29 Alcohol dependence with unspecified alcohol-induced disorder
example of new code set
Example of New Code Set
  • O35 Maternal care for known or suspected fetal abnormality and damage
    • Includes: the listed conditions in the fetus as a reason for hospitalization or other obstetric care to the mother, or for termination of pregnancy
    • Code also any associated maternal condition
    • Excludes1: encounter for suspected maternal and fetal conditions ruled out (Z03.7-)
    • One of the following 7th characters is to be assigned to each code under category O35. 7th character 0 is for single gestations and multiple gestations where the fetus is unspecified. 7th characters 1 through 9 are for cases of multiple gestations to identify the fetus for which the code applies. The appropriate code from category O30, Multiple gestation, must also be
  • ICD-10-CM Tabular Page 1025 2010
    • assigned when assigning a code from category O35 that has a 7th character of 1 through 9.
      • 0 not applicable or unspecified
      • 1 fetus 1
      • 2 fetus 2
      • 3 fetus 3
      • 4 fetus 4
      • 5 fetus 5
      • 9 other fetus
    • O35.0 Maternal care for (suspected) central nervous system malformation in fetus
    • O35.1 Maternal care for (suspected) chromosomal abnormality in fetus
    • O35.2 Maternal care for (suspected) hereditary disease in fetus
    • O35.3 Maternal care for (suspected) damage to fetus from viral disease in mother
    • O35.4 Maternal care for (suspected) damage to fetus from alcohol
    • O35.5 Maternal care for (suspected) damage to fetus by drugs
    • O35.6 Maternal care for (suspected) damage to fetus by radiation
    • O35.7 Maternal care for (suspected) damage to fetus by other medical procedures
    • O35.8 Maternal care for other (suspected) fetal abnormality and damage
    • O35.9 Maternal care for (suspected) fetal abnormality and damage, unspecified
example of new data collection
Example of New Data Collection
  • R40.2 Coma
    • Coma NOS; Unconsciousness NOS
    • Codes first any associated:
      • coma in fracture of skull (S02.-)
      • coma in intracranial injury (S06.-)
    • The appropriate 7th character is to be added to each code from subcategory R40.21-, R40.22-, R40.23-:
      • 0 unspecified time
      • 1 in the field [EMT or ambulance]
      • 2 at arrival to emergency department
      • 3 at hospital admission
      • 4 24 hours or more after hospital admission
    • A code from each subcategory is required to complete the coma scale
    • Note: These codes are intended primarily for trauma registry and research use but may be utilized by all users of the classification who wish to collect this information
  • R40.20 Unspecified coma
    • R40.21 Coma scale, eyes open
    • R40.211 Coma scale, eyes open, never
    • R40.212 Coma scale, eyes open, to pain
    • R40.213 Coma scale, eyes open, to sound
    • R40.214 Coma scale, eyes open, spontaneous
slide29
Coma
  • R40.22 Coma scale, best verbal response
    • R40.221 Coma scale, best verbal response, none
    • R40.222 Coma scale, best verbal response, incomprehensible words
    • R40.223 Coma scale, best verbal response, inappropriate words
    • R40.224 Coma scale, best verbal response, confused conversation
    • R40.225 Coma scale, best verbal response, oriented
  • R40.23 Coma scale, best motor response
    • R40.231 Coma scale, best motor response, none
    • R40.232 Coma scale, best motor response, extension
    • R40.233 Coma scale, best motor response, abnormal
    • R40.234 Coma scale, best motor response, flexion withdrawal
    • R40.235 Coma scale, best motor response, localizes pain
    • R40.236 Coma scale, best motor response, obeys commands
coding guidelines
Coding Guidelines
  • Same – Look it up in the alphabetic, then check in the tabular
  • Same – Abbreviations
  • Same – Punctuation
  • Same – use of “and,” “with,” “see,” “see also”
  • Same – other and unspecified codes
  • Same – includes notes and inclusion terms
  • Same – etiology/manifestation (code first, use additional code, in disease classified elsewhere)
  • Same – must use all available characters
  • Same – conditions that are or are not an integral part of the disease process
coding guidelines31
Coding Guidelines
  • Same – Acute and Chronic conditions
  • Same – Late Effects (sequela)
  • Same – Human Immunodeficiency Virus (HIV) coding
  • Same – Treatment directed at malignancy
  • Same – Treatment of secondary site of maligancy
  • Same – Primary malignancy previously excised
  • Same – Admission/Encounter for chemo
  • Same – Hypertension
  • Same – Acute myocardial infarction
  • Same – Coding Pathologic Fractures…
coding guidelines32
Coding Guidelines
  • 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 – Exclude1 (never code it here) and Exclude2 (not included, if he has that code it separately)
  • New – Laterality
  • New – Coding pregnancy trimesters
  • New – Glasgow coma scale
  • New – Functional quadriplegia
review icd 10 cm
Review ICD-10-CM
  • Diagnoses, not procedures
  • Very similar to ICD-9-CM diagnoses, volumes 1 and 2 (diagnosis index and tabular)
  • Up to 7 alphanumeric characters

BOTTOM LINE:

If you can code with ICD-9-CM, you can easily transition to ICD-10-CM

summary
Summary
  • MHS is working on the transition
  • The transition will be most difficult for the soft-ware programs
  • ICD-10-CM is much better than ICD-9-CM
  • Coders will not have a problem transitioning from ICD-9-CM to ICD-10-CM.
slide35
Quiz
  • Take the quiz again =-)
slide36
Q&A
  • Questions?
  • Training
    • Who needs ICD-10-CM training?
    • When (e.g., 2 months prior)?
    • Intensity (e.g., 1 hour teleclass a day with 1 hour a day at work to do the assigned lessons)?
    • Format (e.g., train-the-trainer to come back to work to train you, teleclasses, one REALLY large class [400 students in an auditorium], good teacher sent to each site for a week)?