ICD-10-CM/PCS Preparing for ICD-10

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Preparing for ICD-10CM/PCS: What does a coder
need to do now?
Presented by:
Jennifer McManis, RHIT
ICD-10-CM/PCS
 Compliance
Timeline
 Training Timeline
 Continuing Education Requirements
 Myth Busters
 Code Structure
 Coding Fundamentals
 Case
Studies
 Resources
Implementation Date
 ICD-10-CM/PCS
 October
Compliance Deadline
1, 2013
 Claims for services provided on or after
this date must use ICD-10 codes
 CPT codes will continue to be used for
outpatient services
Compliance Timeline
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January 1, 2010
 Internal testing of Version 5010 for electronic claims
December 31, 2010
 Internal testing must be complete
January 1, 2011
 External Testing of Version 5010 claims
 CMS begins accepting Version 5010
 Version 4010 continue to be accepted
January 1, 2012
 All claims must use Version 5010
 Version 4010 no longer accepted
Outpatient Coder Training

Outpatient Coder Training


Approximately 16 hours
2011-2012

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Review code Structure & Coding Conventions.
Learn the fundamentals
Analyze & practice applying the ICD-10-CM
guidelines
Review and refresh knowledge of A & P
concepts
Outpatient Coding Training

2012-2013
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Become an expert in applying ICD-10-CM codes
to outpatient cases in the six to nine months
preceding October 1, 2013.
Practice using ICD-10-CM codes each week
leading into “go live” on October 1, 2013.
Network with peers to seek answers to cases
and confirm application of ICD-10-CM codes.
Take advantage of component MHIMA training
opportunities
Inpatient Coder Training

Approximately 50 hours
 2011-12





Review code structure and coding conventions
for ICD-10-CM and ICD-10-PCS.
Learn the fundamentals of the ICD-10-CM and
ICD-10-PCS systems.
Analyze and practice applying the ICD-10-CM
and ICD-10-PCS Coding Guidelines.
Continue to study ICD-10-PCS definitions
(memorize the definitions of approaches and
root operations).
Continue to review and refresh knowledge of
anatomy and physiology concepts
Inpatient Coder Training

2012-13




Become an expert in applying ICD-10-CM and
ICD-10-PCS codes to inpatient cases in the 6 to
9 months preceding October 1, 2013
Practice using ICD-10-CM and ICD-10-PCS
codes each week leading into “go live” on
October 1, 2013
Network with peers to seek answers to cases
and confirm application of ICD-10-CM/PCS
codes
Take advantage of MHIMA training opportunities
Continuing Education Unit
(CEU) Requirements
 Required
to participate in a
predetermined number of mandatory
baseline educational experiences
specific to ICD-10-CM/PCS.
 *Can Begin Earning CEU’s January 1,
2011 thru December 31, 2013
 2009
or 2010 ICD-10 –CM Academy
CEU Requirements
 Total
number of ICD-10-cm/PCS CEU
required, by AHIMA Credential
 CHPS-
1 CEU
 CHDA; RHIT;RHIA- 6 CEUs
 CCS-P- 12 CEUs
 CCS; CCA- 18 CEUs
 If
you hold more than one credential,
only report the highest number of CEUs
CEU Requirements

CEU requirements will be included within the
total number of CEUs required for a given
CEU Cycle. For example, if you hold an RHIA
credential, you will obtain 6 CEUs that are in
relation to ICD-10-CM/PCS along with the
additional 24 CEUs to complete your
recertification cycle.
 Reporting
of the CEUs will be made
available by Fall of 2011
Myths
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October 1, 2013 is considered a flexible date
Implementation planning should be undertaken with an
assumption that DPHHS will grant an extension
Worker’s comp & auto insurance companies may choose not to
implement ICD-10-CM/PCS
State Medicaid Programs will not be required to update their
systems in order to utilize ICD-10-CM/PCS
The increased number of codes will make the new coding
system impossible to use
Developed without any clinical input
There will no hard copy of ICD-10-CM/PCS
 All coding will be done electronically
Myths
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Developed a number of years ago, so it is out of date
Unnecessarily detailed medical record documentation will be
required
Implementation can wait until after electronic health records and
other health care initiatives have been established
ICD-10-CM based super bills will be too long or too complex
The GEMs are intended to facilitate the process of coding
medical records
Each payer will be required to develop their own mappings,
GEM have been developed for CMS use only
Medically unnecessary diagnostic tests will need to be
performed in order to assign an ICD-10-CM code
CPT will be replaced by ICD-10-CM/PCS
ICD 10-CM Code Structure

ICD 10-CM

Contains more than 68,000 codes
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Compare this to ICD-9-CM which contains 13,000 codes
Consists of 3-7 characters
First digit is alpha
All Letters are used except U
4th,5th,6th & 7th Digits can be numeric
Decimal placed after the 1st three characters
ICD-10-CM Code Structure

ICD-10-CM Code Structure
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XXX.XXX X
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1st 3 Characters- Category
4th 5th 6th Characters-Etiology, Anatomic Site, Severity
7th Character-Extension (Visit Encounter, Sequelae,
External Causes)
ICD-9-CM Code Structure

XXX.XX
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
1st 3 Characters-Category
4th 5th Characters- Etiology, Anatomic Site, Manifestation
ICD-10-CM

Structure

Index & Tabular List

Two Parts of the Index


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Coding Guidelines

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Disease & Injury
 Table of Drugs & Chemicals
 Neoplasm Table
External Causes
Some changes from ICD-9
Fractures- Default Displaced
2 Categories for Acute MI
 Acute MI is 4 weeks instead of 8 weeks
Osteoporosis with current pathological fracture
V codes are now Z Codes
ICD-10-CM

New Features
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Combination codes for conditions & common
symptoms
Combination codes for poisonings & external
causes
Added laterality
Added extensions for episode of care
Expanded codes
Inclusion of trimester in obstetric codes and
elimination of fifth digits for episode of care
External cause codes no longer a supplementary
classification
ICD-10-CM
 Diabetes
Mellitus Codes
No Longer Classified as uncontrolled/controlled
 Includes diabetes & the complication

 Injuries
Grouped by Anatomical site rather than type of
injury
 Code Extension to identify (7th Character)




A- Initial encounter
D-Subsequent encounter
S-Sequelae
ICD-10-CM


Code Examples
 I10- Hypertension
 Hypertension Table Removed
Combination codes Certain Conditions and Associated
Symptoms
 K57.21-Diverticulitis of large intestine with perforation and
abscess with bleeding
 I25.110- Arteriosclerotic Heart Disease of native coronary
artery with unstable angina pectoris
 K571.51- Toxic Liver disease with chronic active hepatitis
with ascites
 E10.610- Type 1 diabetes mellitus with diabetic neuropathic
arthropathy
ICD-10-CM


Combination codes for poisonings and their external
cause
 T42.3x2S- Poisoning by barbituates, intentional
self-harm, sequela
Laterality
 C50.212- Malignant neoplasm of upper-inner
quadrant of left female breast
 L89.213- Pressure ulcer of right hip, stage III
ICD-10-CM


Codes for clinical concepts that do not exist in ICD-9-CM
 T45.526D-Underdosing of antithrombotic drugs, subsequent
encounter
 Z67.40- Type O Blood, RH positive
Codes for postoperative complications, intraoperative, and postprocedural disorders



D78.01- Intraoperative hemorrhage and hematoma of spleen complicating a
procedure on the spleen
D78.21- Post-procedural hemorrhage and hematoma of spleen following a
procedure on the spleen
Obstetric codes identify trimester instead of episode of care

026.02- Excessive weight gain in pregnancy, second trimester
ICD-10-CM Coding Guidelines


Chapter 1: Certain Infectious and Parasitic
Diseases (A00-B99)
 d. Sepsis, Severe Sepsis, and Septic Shock
Case Study:


Patient was taken to the emergency department and
admitted to the hospital after being found semi-conscious
with markedly abnormal vital signs, a fever of over 39
degrees C, a heart rate of 110, and a respiratory rate of
22/min. Final diagnoses included sepsis and septic shock
with acute respiratory failure
Answer:



A41.9
R65.21
J96.0
Sepsis (generalized)
Shock, septic (due to severe sepsis)
Failure, respiration, respiratory, acute
ICD-10-CM Coding Guidelines

Chapter 4: Endocrine, Nutritional, and Metabolic Diseases
(E00-E89) a. Diabetes mellitus


Case Study
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6) Secondary Diabetes Mellitus
This 34-year-old patient is being seen for ongoing management of steroidinduced diabetes mellitus which was due to the prolonged use of
corticosteroids, which have been discontinued. The patient’s diabetes is
managed with insulin which he has been taking for the last two years
Answer:



T38.0x5S
effect
E09.9
Z79.4
Refer to Drug and Chemical Table, Corticosteroid, adverse
Diabetes, diabetic, (mellitus) (sugar), due to drug or chemical
Long-term (current) drug therapy (use of), insulin
ICD-10-CM Coding Guidelines


Chapter 9 Diseases of Circulatory System (I00-I99)
Case Study


Patient is seen for treatment of unstable angina. The patient has a history
of atherosclerotic heart disease and underwent a 3-vessel coronary bypass
approximately 2 years ago. The patient recently underwent a cardiac
catheterization of all three coronary bypass grafts which showed them
patent
Answer:


I25.110
Angina (attack) (cardiac) (chest) (heart) (pectoris) (syndrome)
(vasomotor), with atherosclerotic heart disease – see Arteriosclerosis,
coronary (artery), native vessel with angina pectoris, unstable
Z95.1
Status (post), aortocoronary bypass
ICD-10-CM Coding Guidelines

Chapter 12: Diseases of Skin and Subcutaneous Tissue
(L00-L99)
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
Case Study
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a. Pressure ulcer stage codes
This patient has a gangrenous pressure ulcer of the right hip and a pressure
ulcer of the sacrum documented by the physician. The nursing assessment
indicates a stage II pressure ulcer of the sacrum with a stage III decubitus
ulcer of the right hip.
Answer:
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
I96 Ulcer, gangrenous – see Gangrene. Gangrene, gangrenous (connective
tissue) (dropsical) (dry) (moist) (skin) (ulcer) (see also necrosis), Necrosis,
skin or subcutaneous tissue NEC
L89.213
Ulcer, ulcerated, ulcerating, ulceration, ulcerative, pressure
(pressure area) stage III, (healing) (full thickness skin loss involving damage
or necrosis of subcutaneous tissue)
L89.152
Ulcer, ulcerated, ulcerating, ulceration, ulcerative, pressure
(pressure area) stage II, (healing) (abrasion, blister, partial thickness skin
loss involving epidermis and/or dermis) sacral region (tailbone
ICD-10-CM Coding Guidelines


Chapter 9: Diseases of Circulatory System (I00-I99)
a. Hypertension
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
Case Study
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1) Hypertension with Heart Disease
3) Hypertensive Heart and Chronic Kidney Disease
This patient is hospitalized with a diagnosis of congestive heart failure due
to hypertensive heart disease. Patient also has Stage 5 chronic kidney
failure. The patient has been prescribed Lasix previously but admits he
forgets to take his medication every day. This is due to his advanced age.
ICD-10-CM Coding Guidelines

Answer:
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I13.2
Disease, diseased, heart (organic), hypertensive – see
Hypertension, heart. Hypertension, hypertensive (accelerated) (benign)
(essential) (idiopathic) (malignant) (systemic), heart (disease) with kidney
disease (chronic) – see Hypertension, cardiorenal (disease), with heart
failure, with stage 5 or end stage renal disease
I50.9
Failure, heart (acute) (sudden), congestive (compensated)
(decompensated). The “use additional code” statement under code I13.2
indicates the use of this code to identify the type of heart failure
N18.5
Disease, diseased, kidney (functional) (pelvis), chronic, stage 5.
The “use additional code” statement under code I13.2 indicates the use of
this code to identify the stage of the chronic kidney disease
T50.1x6A Refer to Table of Drugs and Chemicals, Lasix, underdosing
Z91.130
Noncompliance, medication regimen, underdosing,
unintentional, due to patient’s age-related debility
ICD-10-CM Coding Guidelines
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Chapter 20: Chapter 20: External Causes of Morbidity (V01Y99)
Case Study
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An 18 year-old driver of a car that collided with a pickup truck on the
interstate highway. The driver confessed to using his cell phone to send a
text message to his girlfriend.
Assign the external cause codes only
Answer:



V43.53xA Index to External Causes. Accident, car – see Accident,
transport, car occupant, Accident, transport, car occupant, driver, collision
(with) pickup truck (traffic)
Y92.411
Index to External Causes, Place of occurrence, highway
(interstate)
Y93.c2
Index to External Causes, Activity (involving) (of victim at time
of event), cellular, telephone
ICD-9-CM Coding Guidelines


Chapter 21: Factors influencing health status and contact
with health services (Z00-Z99)
Case Study

This patient had a lateral wall STEMI and was brought by ambulance to the
emergency room. He received tPA and was transferred to a tertiary care
center for continued care. The patient was received with tPA infusion
continuing, and immediately taken to the cardiac cath lab.
Answer:


I21.29
Infarct, infarction, myocardium, myocardial (acute) (with stated
duration of 4 weeks or less), ST elevation (STEMI), lateral (apical-lateral)
(basal-lateral) (high)
Z92.82
Status(post) – see also Presence (of), administration of tPA
(rtPA) in a different facility within the last 24 hours prior to admission to
current facility
ICD-10-PCS
 ICD-10-PCS
 Inpatient
Procedures
 Contains

7
Over 72,000 codes
Character-alphanumeric code structure

Each character contains up to 34 possible
values
 The
letter O is not used
 No Decimals
ICD-10-PCS

Structure

Index
Codes found based on type of procedure- No diagnostic
information in the description
 One you know the tables; you can go directly to the
tables the index does not need to be used first
 First Three values in the index direct you to the table
Tables
 Each page in the section is composed of rows that
specify valid combinations of code values
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
Root Operations
Approach
ICD-10-PCS

ICD-10 Structure
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XXXXXXX
1st- Section (Medical & Surgical; OB; Imaging)
2nd- Body System
3rd- Root Operation ( Resection, Transfusion)
4th- Body Part
5th- Approach
6th- Device
7th- Qualifier
ICD-10-PCS

Code Examples
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0HTT0ZZ- Right Total Mastectomy
0X6C0ZZ- Amputation at left elbow level
0FT44ZZ- Lap Chole
0HBT0ZX- Right Breast Biopsy
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0- Medical Surgical
H- Skin & Breast
B-Excision
T- body Part
0- Approach
Z-Device
X-Qualifier
ICD-10-PCS
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Root Operations
30 Root Operations
Identifies the objective of the procedure
 In order to determine the appropriate root operation, the full
definition of the root operation as contained in the PCS
Tables must be applied.
Components of a procedure specified in the root operation
definition and explanation are not coded separately. Procedural
steps necessary to reach the operative site and close the
operative site are also not coded separately.

Example: Resection of a joint as part of a joint replacement procedure is
included in the root operation definition of Replacement and is not coded
separately. Laparotomy performed to reach the site of an open liver biopsy
is not coded separately.
ICD-10-PCS: Root Operations


Excision vs. Resection
 PCS contains specific body parts for anatomical subdivisions
of a body part, such as lobes of the lungs or liver and
regions of the intestine. Resection of the specific body part is
coded whenever all of the body part is cut out or off, rather
than coding Excision of a less specific body part.
Example: Left upper lung lobectomy is coded to Resection of
Upper Lung Lobe, Left rather than Excision of Lung, Left.
ICD-10-PCS: Root Operations

Biopsy followed by more definitive treatment
If a diagnostic Excision, Extraction, or Drainage procedure (biopsy)
is followed by a more definitive procedure, such as Destruction,
Excision or Resection at the same procedure site, both the biopsy
and the more definitive treatment are coded.
 Example: Biopsy of breast followed by partial mastectomy at the same
procedure site, both the biopsy and the partial mastectomy procedure
are coded.
 Control vs. more definitive root operations



The root operation Control is defined as, “Stopping, or attempting to stop,
postprocedural bleeding.” If an attempt to stop postprocedural bleeding is
initially unsuccessful, and to stop the bleeding requires performing any of
the definitive root operations Bypass, Detachment, Excision, Extraction,
Reposition, Replacement, or Resection, then that root operation is coded
instead of Control.
Example: Resection of spleen to stop postprocedural bleeding is coded
to Resection instead of Control
ICD-10-PCS: Root Operations

Release procedures



Example: Lysis of intestinal adhesions is coded to the specific
intestine body part value.
Release vs. Division


In the root operation Release, the body part value coded is the body part
being freed and not the tissue being manipulated or cut to free the body
part.
If the sole objective of the procedure is freeing a body part without cutting
the body part, the root operation is Release. If the sole objective of the
procedure is separating or transecting a body part, the root operation is
Division.
Examples: Freeing a nerve root from surrounding scar tissue to
relieve pain is coded to the root operation Release. Severing a
nerve root to relieve pain is coded to the root operation Division.
ICD-10-PCS

Approach


Technique used to reach the site of the procedure
7 Different Approaches

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

Open
Percutaneous
Percutaneous Endoscopic
Via Natural or Artificial Opening
Open with Percutaneous endoscopic assistance
External
ICD-10-PCS
 Device
A
device is coded only if a device remains
after the procedure is completed. If no
device remains, the device value No
Device is coded.
ICD-10-PCS
 Obstetrics

Products of conception



Procedures performed on the products of conception are coded to the
Obstetrics section. Procedures performed on the pregnant female other
than the products of conception are coded to the appropriate root
operation in the Medical and Surgical section.
Example: Amniocentesis is coded to the products of conception body
part in the Obstetrics section. Repair of obstetric urethral laceration is
coded to the urethra body part in the Medical and Surgical section.
Procedures following delivery or abortion

Procedures performed following a delivery or abortion for curettage of
the endometrium or evacuation of retained products of conception are
all coded in the Obstetrics section, to the root operation Extraction and
the body part Products of Conception, Retained. Diagnostic or
therapeutic dilation and curettage performed during times other than
the postpartum or post-abortion period are all coded in the Medical and
Surgical section, to the root operation Extraction and the body part
Endometrium
ICD-10-CM/PCS Resources
 http://www.cms.gov/ICD10/
 Download
the Index & Tabular
 Compliance Dates
 Quick Reference Guide
 www.ahima.org
 ICD-10-CM/PCS
Resource Page
ICD-10-CM/PCS Resources
 Subscribe
and read the monthly ICDTEN free newsletter from AHIMA
 Complete exercises in the CodeWrite
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 Network with peers in the ICD-10
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