2010 UBO/UBU Conference Health Budgets & Financial Policy 1 Briefing: ICD-10-CM (International...
-
Upload
paulina-eleanore-golden -
Category
Documents
-
view
214 -
download
0
Transcript of 2010 UBO/UBU Conference Health Budgets & Financial Policy 1 Briefing: ICD-10-CM (International...
2010 UBO/UBU Conference
Health Budgets & Financial Policy
1
Briefing: ICD-10-CM(International Classification of Diseases – 10th Revision – Clinical Modifications)A Piece of Cake
Date: 23 March 2010
Time: 1400–1450
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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
2
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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!
3
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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.
4
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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.
5
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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.
6
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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:
7
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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
8
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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
9
2010 UBO/UBU ConferenceTurning Knowledge Into Action
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-9Based 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
10
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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
11
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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
12
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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.
13
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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
14
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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
15
2010 UBO/UBU ConferenceTurning Knowledge Into Action ICD-9-CM Comparison to ICD-10-CM
ICD-9-CM ICD-10-CMChapter
Title Category Range
Chapter Title Category Range
I Infectious and parasitic diseases 001-139 I Certain infectious and parasitic diseases A00-B99
II Neoplasms 140-239 II Neoplasms C00-D48III Endocrine, nutritional and metabolic
diseases and immunity disorders240-279 III Diseases of the blood and blood-forming
organs and certain disorders involving the immune mechanism
D50-D89
IV Diseases of blood and blood-forming organs
280-289 IV Endocrine, nutritional and metabolic diseases
E00-E90
V Mental disorders 290-319 V Mental and behavioral disorders F00-F99VI Diseases of the nervous system and
sense organs320-389 VI Diseases of the nervous system G00-G99
VII Diseases of the circulatory system 390-459 VII Diseases of the eye and adnexa H00-H59VIII Diseases of the respiratory system 460-519 VIII Diseases of the ear and mastoid process H60-H95IX Diseases of the digestive system 520-579 IX Diseases of the circulatory system I00-I99X Diseases of the genitourinary
system580-629 X Diseases of the respiratory system J00-J99
XI Complications of pregnancy, childbirth and the puerperium
630-676 XI Diseases of the digestive system K00-K99
XII Diseases of the skin and subcutaneous tissue
680-709 XII Diseases of the skin and subcutaneous tissue
L00-L99
16
2010 UBO/UBU ConferenceTurning Knowledge Into Action ICD-9-CM Comparison to ICD-10-CM
ICD-9-CM ICD-10XIII Diseases of the musculoskeletal
system and connective tissue710-739 XIII Diseases of the musculoskeletal system
and connective tissueM00-M99
XIV Congenital 740-759 XIV Diseases of the genitourinary system N00-N99XV Certain conditions originating in the
perinatal period760-779 XV Pregnancy, childbirth and the puerperium O00-O99
XVI Symptoms, signs and ill-defined conditions
780-799 XVI Certain conditions originating in the perinatal period
P00-P99
XVII Injury and Poisoning 800-999 XVII Congenital malformations, deformations and chromosomal abnormalities
Q00-Q99
No # External causes of injury and poisoning
E800-E999
XVIII Symptoms, signs and abnormal clinical and laboratory findings, NEC
R00-R99
No # Factors influencing health status and contact with health services
V01-V82 XIX Injury, poisoning and certain other consequences of external causes
S00-T98
XX External causes of morbidity and mortality V01-Y98
XXI Factors influencing health status and contact with health services
Z00-Z99
XXII Codes for special purposes U00-U99
17
2010 UBO/UBU ConferenceTurning Knowledge Into Action Sample of Downloaded Index
18
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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
19
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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
20
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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]
21
2010 UBO/UBU ConferenceTurning Knowledge Into Action ICD-10-CM
Morbidity classification – Includes potentially fatal conditions– Treatable
For use in – Hospitals; acute short-term, long-term – Provider office– Other outpatient settings
22
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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)
23
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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
24
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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
25
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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
26
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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
27
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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
28
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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
29
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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
30
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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…
31
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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
32
2010 UBO/UBU ConferenceTurning Knowledge Into Action 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
33
2010 UBO/UBU ConferenceTurning Knowledge Into Action
34
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.
2010 UBO/UBU ConferenceTurning Knowledge Into Action
35
Quiz
Take the quiz again =-)
2010 UBO/UBU ConferenceTurning Knowledge Into Action
36
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)?