Title: International%20Classification%20of%20Disease,%2010th%20Revision,%20Clinical%20Module%20(ICD-10-CM)
1International Classification of Disease, 10th
Revision, Clinical Module (ICD-10-CM)
- Steven M. Verno, CMBS, CMSCS, CEMCS, CPM-MCS
2Disclaimer
- I am not a Lawyer. I am a practice manager,
medical coder and medical biller. I do not
provide any legal advice. This presentation
contains no legal advice. The contents are
provided for training purposes only!
3Its true!!
- There is No Longer any Rumor!
- ICD-10-CM BECOMES OUR CURRENT DIAGNOSIS CODE SET
AS OF OCTOBER 1, 2013
4What I wont be Discussing!
- I will not be discussing ICD-10-PCS
5When is ICD-10-CM Effective?
6What Changes with ICD-10-CM?
- The disease remains the same
- Chicken Pox is still chicken pox
- Measles is still measles
- Chest pain is still chest pain.
- The numbers change!
7Comparing ICD-9 to ICD-10 Codes
- Chicken Pox
- ICD-9-CM
- V05.4 Varicella
- Chicken pox
- ICD-10-CM
- B01.9 - Varicella without complication
8Comparing ICD-9 to ICD-10 Codes
- Measles
- ICD-9-CM
- 055 Measles
- 056 Rubella
- ICD-10-CM
- B05.9 - Measles without complication
- B06.9 - Rubella without complication
9Comparing ICD-9 to ICD-10 Codes
- Chest pain
- ICD-9-CM
- 786.50 Chest pain, unspecified
- ICD-10-CM
- R07.9 - Chest pain, unspecified
10What doesnt change?
- Coding Conventions dont change
- ICD-9-CM
- 370.2 Superficial keratitis without
conjunctivitis - Excludes dendritic herpes simplex keratitis
(054.42) - 370.20 Superficial keratitis, unspecified
- ICD-10
- H10 Conjunctivitis
- Excludes keratoconjunctivitis ( H16.2 )
- H10.0 Mucopurulent conjunctivitis
- H10.3 Acute conjunctivitis, unspecified
- Excludes ophthalmia neonatorum
- NOS ( P39.1 )
11What doesnt change?
- NEC Not elsewhere classifiable
- This abbreviation in the Index represents other
specified. When a specific code is not available
for a condition, the Index directs the coder to
the other specified code in the Tabular. - NOS Not otherwise specified
- This abbreviation is the equivalent of
unspecified.
12What doesnt change?
- Brackets are used in the tabular list to
enclose synonyms, alternative wording or
explanatory phrases. Brackets are used in the
Index to identify manifestation codes. - ( ) Parentheses are used in both the Index and
Tabular to enclose supplementary words that may
be present or absent in the statement of a
disease or procedure without affecting the code
number to which it is assigned. The terms within
the parentheses are referred to as nonessential
modifiers. - Colons are used in the Tabular List after an
incomplete term which needs one or more of the
modifiers following the colon to make it
assignable to a given category.
13- Unspecified codes
- Codes (usually a code with a 4th digit 9 or 5th
digit 0 for diagnosis codes) titled unspecified
are for use when the information in the medical
record is insufficient to assign a more specific
code. For those categories for which an
unspecified code is not provided, the other
specified code may represent both other and
unspecified. - Includes Notes
- This note appears immediately under a three-digit
code title to further define, or give examples
of, the content of the category.
14- Inclusion terms
- List of terms is included under some codes. These
terms are the conditions for which that code is
to be used. The terms may be synonyms of the code
title, or, in the case of other specified
codes, the terms are a list of the various
conditions assigned to that code. The inclusion
terms are not necessarily exhaustive. Additional
terms found only in the Index may also be
assigned to a code. - Excludes Notes
- ICD-10-CM has two types of excludes notes. Each
type of note has a different definition for use
but they are all similar in that they indicate
that codes excluded from each other are
independent of each other.
15Many Guidelines remain the same
- ICD-9
- Signs and symptoms
- Codes that describe symptoms and signs, as
opposed to diagnoses, are acceptable for
reporting purposes when a related definitive
diagnosis has not been established (confirmed) by
the physician. Chapter 16 of ICD-9-CM, Symptoms,
Signs, and Ill-defined conditions (codes 780.0
-799.9) contain many, but not all codes for
symptoms. - ICD-10
- Codes for symptoms, signs, and ill-defined
conditions - Codes for symptoms, signs, and ill-defined
conditions from Chapter 18 are not to be used as
principal diagnosis when a related definitive
diagnosis has been established.
16- ICD-9
- Conditions that are an integral part of a disease
process - Signs and symptoms that are integral to the
disease process should not be assigned as
additional codes. - ICD-10
- Conditions that are an integral part of a disease
process - Signs and symptoms that are associated routinely
with a disease process should not be assigned as
additional codes, unless otherwise instructed by
the classification.
17- ICD-9 Level of Detail in Coding
- Diagnosis and procedure codes are to be used at
their highest number of digits available. - ICD-9-CM diagnosis codes are composed of codes
with either 3, 4, or 5 digits. Codes with three
digits are included in ICD-9-CM as the heading of
a category of codes that may be further
subdivided by the use of fourth and/or fifth
digits, which provide greater detail. - A three-digit code is to be used only if it is
not further subdivided. Where fourth-digit
subcategories and/or fifth-digit
subclassifications are provided, they must be
assigned. A code is invalid if it has not been
coded to the full number of digits required for
that code. For example, Acute myocardial
infarction, code 410, has fourth digits that
describe the location of the infarction (e.g.,
410.2, Of inferolateral wall), and fifth digits
that identify the episode of care. It would be
incorrect to report a code in category 410
without a fourth and fifth digit. - ICD-9-CM Volume 3 procedure codes are composed of
codes with either 3 or 4 digits. Codes with two
digits are included in ICD-9-CM as the heading of
a category of codes that may be further
subdivided by the use of third and/or fourth
digits, which provide greater detail. - ICD-10 Level of Detail in Coding
- Diagnosis codes are to be used and reported at
their highest number of digits available. - ICD-10-CM diagnosis codes are composed of codes
with 3, 4, 5, 6 or 7 digits. Codes with three
digits are included in ICD-10-CM as the heading
of a category of codes that may be further
subdivided by the use of fourth and/or fifth
digits, which provide greater detail. - A three-digit code is to be used only if it is
not further subdivided. A code is invalid if it
has not been coded to the full number of
characters required for that code, including the
7th character, if applicable.
18Some guidelines changed or do not exist in ICD-10
- ICD-9
- 15. Admissions/Encounters for Rehabilitation
- When the purpose for the admission/encounter is
rehabilitation, sequence the appropriate V code
from category V57, Care involving use of
rehabilitation procedures, as the
principal/first-listed diagnosis. The code for
the condition for which the service is being
performed should be reported as an additional
diagnosis. - Only one code from category V57 is required. Code
V57.89, Other specified rehabilitation
procedures, should be assigned if more than one
type of rehabilitation is performed during a
single encounter. A procedure code should be
reported to identify each type of rehabilitation
therapy actually performed. - ICD-10
- Does not exist in ICD-10
19How do I look up a code?
- ICD-9-CM
- 1. Use of Both Alphabetic Index and Tabular List
- Use both the Alphabetic Index and the Tabular
List when locating and assigning a code. Reliance
on only the Alphabetic Index or the Tabular List
leads to errors in code assignments and less
specificity in code selection. - 2. Locate each term in the Alphabetic Index
- Locate each term in the Alphabetic Index and
verify the code selected in the Tabular List.
Read and be guided by instructional notations
that appear in both the Alphabetic Index and the
Tabular List. - Locating a code in the ICD-10-CM
- It is essential to use both the Index and Tabular
List when locating and assigning a code. The
Index does not always provide the full code.
Selection of the full code, including laterality
and any applicable 7th character can only be done
in the Tabular list. A dash (-) at the end of an
Index entry indicates that additional characters
are required. Even if a dash is not included at
the Index entry, it is necessary to refer to the
Tabular list to verify that no 7th character is
required.
20Chapter ICD-9-CM Descriptor ICD-10-CM Descriptor Codes
1 001-139 Infectious and Parasitic Diseases A00-B99 Certain infectious and parasitic diseases 455
2 140-239 Neoplasms C00-D48 Neoplasms 622
3 240-279 Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders D50-D89 Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism 696
4 289-289 Diseases of Blood and Blood Forming Organs E00-E90 Endocrine, nutritional and metabolic diseases 2,230
5 230-319 Mental Disorders F00-F99 Mental and behavioural disorders 1,163
6 320-389 Diseases of Nervous System and Sense Organs G00-G99 Diseases of the nervous system 792
7 390-459 Diseases of Circulatory System H00-H59 Diseases of the eye and adnexa 296
8 460-519 Diseases of Respiratory System H60-H95 Diseases of the ear and mastoid process 214
9 520-579 Diseases of Digestive System I00-I99 Diseases of the circulatory system 3,885
10 580-629 Diseases of Genitourinary System J00-J99 Diseases of the respiratory system 1,439
11 630-677 Complications of Pregnancy, Childbirth, and the Puerperium K00-K93 Diseases of the digestive system 1,560
12 680-709 Diseases Skin and Subcutaneous Tissue L00-L99 Diseases of the skin and subcutaneous tissue 322
13 710-739 Diseases of Musculoskeletal and Connective Tissue M00-M99 Diseases of the musculoskeletal system and connective tissue 1,374
14 740-759 Congenital Anomalies N00-N99 Diseases of the genitourinary system 1,046
15 760-799 Newborn (Perinatal) Guidelines O00-O99 Pregnancy, childbirth and the puerperium 600
16 780-799 Signs, Symptoms and Ill-Defined Conditions P00-P96 Certain conditions originating in the perinatal period 213
17 800-999 Injury and Poisoning Q00-Q99 Congenital malformations, deformations and chromosomal abnormalities 240
18 V01-V89 Classification of Factors Influencing Health Status and Contact with Health Service R00-R99 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified 1,585
19 E800-E999 Supplemental Classification of External Causes of Injury and Poisoning S00-T98 Injury, poisoning and certain other consequences of external causes 1,235
20 V01-98 External causes of morbidity and mortality 714
21 Z00-Z98 Factors influencing health status and contact with health services 2,441
22 U00-U99 Codes for special purposes
Total Codes 23,122
Note Information Obtained from data compiled by AHA AHIMA Note Information Obtained from data compiled by AHA AHIMA
21ICD-9 Table of Drugs and Biologicals
Substance Poisoning Accident Therapeutic Use Suicide Attempt Assault Undetermined
1-propanol 980.3 E860.4 - E950.9 E962.1 E980.9
2-propanol 980.2 E860.3 - E950.9 E962.1 E980.9
2, 4-D (dichlorophen-oxyacetic acid) 989.4 E863.5 - E950.6 E962.1 E980.7
2, 4-toluene diisocyanate 983.0 E864.0 - E950.7 E962.1 E980.6
2, 4, 5-T (trichloro-phenoxyacetic acid) 989.2 E863.5 - E950.6 E962.1 E980.7
14-hydroxydihydro-morphinone 965.09 E850.2 E935.2 E950.0 E962.0 E980.0
ABOB 961.7 E857 E931.7 E950.4 E962.0 E980.4
Abrus (seed) 988.2 E865.3 - E950.9 E962.1 E980.9
Absinthe 980.0 E860.1 - E950.9 E962.1 E980.9
22ICD-10 Table of Drugs and Biologicals
Substance Poisoning Poisoning Acicidental I
ntentional Poisoning Poisoning Adverse
Underdosing Unintentional Self
harm Assault undetermined effect 1-propanol
T51.3x1 T51.3x2 T51.3x3 T51.3x4 -- --
2-propanol T51.2x1 T51.2x2 T51.2x3
T51.2x4 -- -- 2,4-D (dichlorophen-oxyacetic
acid) T60.3x1 T60.3x2 T60.3x3 T60.3x4 -- --
2,4-toluene diisocyanate T65.0x1 T65.0x2
T65.0x3 T65.0x4 -- -- 2,4,5-T
(trichloro-phenoxyacetic acid) T60.1x1 T60.1x2
T60.1x3 T60.1x4 -- -- 14-hydroxydihydro-morp
hinone T40.2x1 T40.2x2 T40.2x3 T40.2x4
T40.2x5 T40.2x6 ABOB T37.5x1 T37.5x2
T37.5x3 T37.5x4 T37.5x5 T37.5x6 Abrine
T62.2x1 T62.2x2 T62.2x3 T62.2x4 -- --
Abrus (seed) T62.2x1 T62.2x2 T62.2x3
T62.2x4 -- -- Absinthe T51.0x1 T51.0x2
T51.0x3 T51.0x4 -- -- - beverage T51.0x1
T51.0x2 T51.0x3 T51.0x4 -- --
Under ICD-9, Accidental poisoning by Absinthe
would be 980.0 . Under ICD-10, this code would be
T51.0x1 When looking at T51.0, you find
this T51.0 Toxic effect of ethanol Toxic effect
of ethyl alcohol Excludes2 acute alcohol
intoxication or "hangover" effects drunkenness
pathological alcohol intoxication T51.0x Toxic
effect of ethanol T51.0x1 Toxic effect of
ethanol, accidental (unintentional) Toxic effect
of ethanol NOS
23Getting Ready for ICD-10-CM
24Documentation
- ICD-10 takes a disease down to the Nth degree,
due to the availability of more codes to select.
Therefore, the provider must be exact with the
medical condition of the patient. Not being as
detailed as possible with the documentation can
delay the coding of the claim as well as the
possible selection of an incomplete or incorrect
code.
25Start your personnel training early
- You dont want to wait until the last minute to
train your staff on the new changes. - Be cautious of fly-by-night offers to provide
your staff with ICD-10 training. Obtain your
training guidance from a reputable organization. - The certifying agencies are working now to update
their certification tests to change from ICD-9-CM
to ICD-10-CM.
26New Manuals
- You will be left in the dust and not using
current coding manuals could be very costly to
your business, the provider and the patient. - There are some websites that currently allow you
to look up ICD-9-CM codes for free. Whether these
sites are changed or will be open is unknown at
this time. - DO NOT Rely on any association or coding forum to
do your coding for you. Your coders should be
highly trained, Certified and ready to use the
new codes the minute they are effective.
27Contact Your Billing Software Vendor
- Your billing software may have to be upgraded to
hold both ICD-9 and ICD-10 because the claims
you submit on September 30, 2013 will need the
ICD-9 Codes for all claims prior to October 1,
2011. You can expect and plan on delays in
payments while insurance companies work out the
bugs with their systems as they too will need to
keep the ICD-9 codes in their system for all pre
October 1, 2013 claims. You may have to perform
claims testing with your upgraded software so
that it does not send claims after October 1,
2013 with ICD-9-CM codes.
28HIPAA ANSI 5010
Date Compliance Step
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
http//www3.cms.gov/ICD10/03_ICD-10andVersion5010C
omplianceTimelines.aspTopOfPage
29(No Transcript)
30Contact the Insurance Companies
- Find out their coding policies as it relates to
ICD-10 and benefit restrictions based on
diagnoses. - Double check your current provider contracts
regarding coding requirements. If your provider
agreed to the carrier coding policies, you want
to ensure that the carrier and your provider are
on the same sheet of music. - Check with them to see when they are ready to
accept claims using the ICD-10. Find out what
delays may be expected with claims and payment.
This could have an affect on your current
provider contract with detailed payment
timeframes.
31Update your Compliance Plans
- Many Compliance Plans address ICD-9 coding
issues. Make sure yours is changed to reflect
the ICD-10 and any problems that may come with
it. What will you do if 90 of the charts
contain insufficient information to select the
proper code out of 25 different codes for the
condition. How will you resolve these problems?
How often will you conduct internal coding
audits? How many claims are being denied for
coding issues and how will you address this?
These should be part of your compliance plan.
32Update your appeals
- Go through your appeals that relate to any coding
issues, specifically diagnosis coding. - Make sure they are changed to reflect the new
ICD-10-CM codes. - Proofread any appeals you send to make sure the
appeal does not reference ICD-9-CM if an ICD-10
code was used.
33Updated Superbills
- Some superbills may contain a checklist of ICD-9
codes. Make sure you convert the ICD-9 code to
the appropriate ICD-10 code(s). - This may be a project that may take many days to
accomplish. Once completed, have the superbill
proof read by a trained certified coding staff
member who has been trained in ICD-10. - Dont forget to include the provider and staff in
your updated training. - www.donself.com (superbill examples)
34Fight Fraud and Abuse
- Just because there is a huge change coming in the
future, you should be on your toes to watch out
for intentional or unintentional upcoding or
downcoding using the new ICD-10 codes. You do
not want to be the subject of an audit by
Medicare, Medicaid, the OIG or any other
insurance audit. If you do what is right, you
aren't afraid of any audits.
35What does this mean for you??
- New Coding Books ICD-10-CM
- Updated Training
- Updating Billing Software
- Test Claims
- Updating Superbills
- Keeping an eye on claims denials or claims review
- Keeping your providers AR to keep it down
- Staying in close contact with the insurance
companies - Possible updating of provider contracts to
include clauses to prevent coding problems. - More Out of Pocket Expenses to get ready
36ICD-9-CM
1600 Pennsylvania Avenue
37ICD-10-CM
W01.9 Pennsylvania Avenue
38ICD-10-CM is NOT scary
39ICD-10 is friendly to a trained coder
40Helpful Websites
- Don Self www.donself.com
- AAPC www.aapc.com
- PAHCS www.pahcs.org
- POMAA www.pomaa.net
- MAB Forum http//medicalassociationofbillers.yuk
u.com/ - BC Advantage http//www.billing-coding.com/forum
/ - CDC www.cdc.gov/nchs/icd9.htm
- www.cdc.gov/nchs/about/
- major/dvs/mortdata.htm
- www.cdc.gov/nchs
41Questions?
steve_verno_at_yahoo.com
42Thank You!