Medical Group Business
Services
Brown Bag Series
April 12, 2007
CCA/CPC Review
UCSF Clinical Enterprise
Compliance Program
CECP Education Series
Wanda T. Ziemba MFA RHIT
CHCC CHCO CPC
Associate Compliance Officer
& CECP Educator
CCA/CPC Review
ICD-10-CM
“Catching Up With The Rest of
The World”
CCA/CPC Review
The National Library of Medicine (NLM)
has begun a project to develop,
review and test mappings between
SNOMED CT, ICD-9-CM and HIPAA
standards. This is one of the priority
efforts for HHS to align clinical
vocabulary and messaging standards
in order to move forward with the
national electronic health record.
CCA/CPC Review
While the final decision regarding the
replacement of the ICD-9-CM coding
system with ICD-10 is eminent, preparatory
planning now is advised. While there are
some similarities between the coding
systems, the differences are more striking.
The ICD-10 codes will have up to 6 alpha
numeric characters with 3 to the right of the
decimal point. Codes will be expanded to
include underlying and combination
conditions, laterality, timeframes, causes
and complications.
CCA/CPC Review
The ICD-10 is copyrighted by the World
Health Organization (WHO), which owns
and publishes the classification. WHO has
authorized the development of an
adaptation of ICD-10 for use in the United
States for U.S. government purposes. As
agreed, all modifications to the ICD-10
must conform to WHO conventions for the
ICD. Except in rare instances, no
modifications have been made to existing
three-digit categories and four-digit codes,
with the exception of title changes that did
not change the meaning of the category or
code.
CCA/CPC Review
ICD-10-CM was developed following a
thorough evaluation by a Technical
Advisory Panel and extensive additional
consultation with physician groups,
clinical coders, and others to assure
clinical accuracy and utility. We believe
the clinical modification represents a
significant improvement over ICD-9-CM
and ICD-10. The current draft of ICD10-CM contains a significant increase in
codes over ICD-10 and ICD-9-CM.
CCA/CPC Review
ICD-10-CM
ICD-10-CM scheduled to replace
ICD-9-CM
 Target implementation date 2010

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Anticipated timeline for adoption of ICD10-CM was originally 2008.
 Canada and Australia have converted to
ICD-10 already (Note: both countries
have single payor systems)
 ICD-10 has been implemented in the
U.S. for the coding of death certificates
since January 1999

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Benefits of ICD-10-CM


More accurate payment for new
procedures – flexibility in
nomenclature will improve support of
medical innovations
Fewer miscoded, rejected and
improper claims – expanded coding
schema reinforces structured and
complete physician documentation
CCA/CPC Review
Better understanding of the value of
new procedures
 Improved disease management –
consistency with coding conventions will
support world-wide research
 Better understanding of healthcare
outcomes

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CCA/CPC Review
Improvements in ICD-10-CM
More relevant ambulatory and managed
care encounter codes
 Expanded injury codes
 Combination diagnosis/symptom codes
 Six digits, maximum

(Cont’d…)
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Improvements
(…Cont’d)
More fourth and fifth digits added
 Updated diabetes codes
 Greater overall specificity

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ICD-10-CM Structure
21 Chapters
 V and E codes incorporated
 Addition of chapters for

– Eye and Adnexa
– Ear and Mastoid Process
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Crosswalk
Figure: 15.7

ICD-9-CM code cross-walked to new ICD-10-CM code
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Index

Main terms and subterms
Figure: 15.8
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Tabular
Figure: 15.9

Each section begins with unique letter and
codes arranged in numerical
order
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ICD-10-PCS
Will replace Volume 3, Procedures of
ICD-9-CM
 Currently being piloted

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Advanced Planning
Mitigate impact to Accounts Receivable
 Secure training and additional coding
resources
 Demonstrate organization commitment
to coder retention with commitment to
training and support needed

CCA/CPC Review
Implementation Requirements



Higher level of expertise in anatomy and
physiology than for current ICD-9-CM coding
Database and information processing
systems must be able to accommodate a 7
character field for alphanumeric codes
(compared to 5 character field size for
ICD-9-CM
CCA/CPC Review
Training Requirements



NCVHS Field Testing projects conclude that a
minimum of 16 hours of introductory training
is needed for each experienced coder
3-6 weeks required for experienced coders to
become comfortable with the ICD-10-CM
schema
it takes 6 months until the productivity level
reaches current ICD-9-CM levels
CCA/CPC Review
Concerns
Coding schema is significantly different
with a combination of numeric digits 0-9
and alphabetic characters A-H, J-N, P-Z
 26% of current coders surveyed
indicated personal plans to retire or
change careers before ICD-10-CM is
implemented

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

Organization impact is widespread:
HIMS/inpatient coding, IT, Patient Billing
Services, Physicians/Providers, Quality
Management, Decision Support, Department
Management, Medical Research, etc.
Comparative trends with historical data not
feasible for many codes due to combining
nomenclature
CCA/CPC Review
Example Chapter-Infectious &
Parasitic Diseases





A00-A09 Intestinal infectious diseases
A15-A19 Tuberculosis
A20-A28 Certain zoonotic bacterial diseases
A30-A49 Other bacterial diseases
A50-A64 Infections with a predominantly
sexual mode of transmission
A65-A69 Other spirochetal diseases
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A70-A74 Other diseases caused by
chlamydiae
 A75-A79 Rickettsioses
 A80-A89 Viral infections of the central
nervous system
 A90-A99Arthropod-borne viral fevers
and viral hemorrhagic fevers

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
B00-B09 Viral infections characterized
by skin and mucous membrane lesions

B15-B19 Viral hepatitis B20 Human
immunodeficiency virus [HIV] disease

B25-B34 Other viral diseases

B35-B49 Mycoses

B50-B64 Protozoal diseases

B65-B83 Helminthiases
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
B85-B89 Pediculosis, acariasis and
other infestations

B90-B94 Sequelae of infectious and
parasitic diseases

B95-B97 Bacterial, viral and other
infectious agents

B99 Other infectious diseases Intestinal
infectious diseases
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Example Alpha – Tuberculosis
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





T
Tabacism, tabacosis, tabagism
- meaning dependence (without remission)
F17.200
- - with
- - - disorder F17.299
- - - - remission F17.211
- - - - specified disorder NEC F17.298
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




Tuberculosis, tubercular, tuberculous
(calcification) (calcified) (caseous)
(chromogenic acid-fast bacilli)
(degeneration) (fibrocaseous) (fistula)
(interstitial) (isolated circumscribed lesions)
(necrosis)
(parenchymatous) (ulcerative) A15.9
- with pneumoconiosis (any condition in J60J64) J65
- abdomen (lymph gland) A18.39
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












- abscess (respiratory) A15.9
- - bone A18.03
- - - hip A18.02
- - - knee A18.02
- - - sacrum A18.01
- - - specified site NEC A18.03
- - - spinal A18.01
- - - vertebra A18.01
- - brain A17.81
- - breast A18.89
- - Cowper's gland A18.15
- - dura (mater) (cerebral) (spinal) A17.81
- - epidural (cerebral) (spinal) A17.81
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






- - female pelvis A18.17
- - frontal sinus A15.8
- - genital organs NEC A18.10
- - genitourinary A18.10
- - gland (lymphatic) - see Tuberculosis,
lymph gland
- - hip A18.02
- - intestine A18.32
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










- - ischiorectal A18.32
- - joint NEC A18.02
- - - hip A18.02
- - - knee A18.02
- - - specified NEC A18.02
- - - vertebral A18.01
- - kidney A18.11
- - knee A18.02
- - lumbar (spine) A18.01
- - lung - see Tuberculosis, pulmonary
- - meninges (cerebral) (spinal) A17.0
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








- - muscle A18.09
- - perianal (fistula) A18.32
- - perinephritic A18.11
- - perirectal A18.32
- - rectum A18.32
- - retropharyngeal A15.8
- - sacrum A18.01
- - scrofulous A18.2
- - scrotum A18.15
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









- - skin (primary) A18.4
- - spinal cord A17.81
- - spine or vertebra (column) A18.01
- - subdiaphragmatic A18.31
- - testis A18.15
- - urinary A18.13
- - uterus A18.17
- accessory sinus - see Tuberculosis, sinus
- Addison's disease A18.7
- adenitis - see Tuberculosis, lymph gland
CCA/CPC Review







- adenoids A15.8
- adenopathy - see Tuberculosis, lymph gland
- adherent pericardium A18.84
- adnexa (uteri) A18.17
- adrenal (capsule) (gland) A18.7
- alimentary canal A18.32
- anemia A18.89
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






- ankle (joint) (bone) A18.02
- anus A18.32
- apex, apical - see Tuberculosis, pulmonary
- appendicitis, appendix A18.32
- arachnoid A17.0
- artery, arteritis A18.89
- - cerebral A18.89
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







- arthritis (chronic) (synovial) A18.02
- - spine or vertebra (column) A18.01
- articular - see Tuberculosis, joint
- ascites A18.31
- asthma - see Tuberculosis, pulmonary
- axilla, axillary (gland) A18.2
- bilateral - see Tuberculosis, pulmonary
- bladder A18.12
CCA/CPC Review










- bone A18.03
- - hip A18.02
- - knee A18.02
- - limb NEC A18.03
- - sacrum A18.01
- - spine or vertebral column A18.01
- bowel (miliary) A18.32
- brain A17.81
- breast A18.89
- broad ligament A18.17
CCA/CPC Review








- bronchi, bronchial, bronchus A15.5
- - ectasia, ectasis (bronchiectasis) - see
Tuberculosis, pulmonary
- - fistula A15.5
- - - primary (progressive) A15.7
- - gland or node A15.4
- - - primary (progressive) A15.7
- - lymph gland or node A15.4
- - - primary (progressive) A15.7
CCA/CPC Review







- bronchiectasis - see Tuberculosis,
pulmonary
- bronchitis A15.5
- bronchopleural A15.6
- bronchopneumonia, bronchopneumonic see Tuberculosis, pulmonary
- bronchorrhagia A15.5
- bronchotracheal A15.5
- bronze disease A18.7
CCA/CPC Review









- buccal cavity A18.83
- bulbourethral gland A18.15
- bursa A18.09
- cachexia A15.9
- cardiomyopathy A18.84
- caries - see Tuberculosis, bone
- cartilage A18.02
- - intervertebral A18.01
- catarrhal - see Tuberculosis, respiratory
CCA/CPC Review












- cecum A18.32
- cellulitis (primary) A18.4
- cerebellum A17.81
- cerebral, cerebrum A17.81
- cerebrospinal A17.81
- - meninges A17.0
- cervical (lymph gland or node) A18.2
- cervicitis, cervix (uteri) A18.16
- chest - see Tuberculosis, respiratory
- chorioretinitis A18.53
- choroid, choroiditis A18.53
- ciliary body A18.54
CCA/CPC Review
Example Tabular - Tuberculosis
CCA/CPC Review
Tuberculosis

Tuberculosis (A15-A19) Includes:
infections due to Mycobacterium
tuberculosis and Mycobacterium bovis
Excludes1:congenital tuberculosis
(P37.0) pneumoconiosis associated
with tuberculosis (J65) sequelae of
tuberculosis (B90.-) silicotuberculosis
CCA/CPC Review
Respiratory Tuberculosis

A15.0 Tuberculosis of lung Tuberculous
bronchiectasis Tuberculous fibrosis of lung
Tuberculous pneumonia Tuberculous
pneumothorax

A15.4 Tuberculosis of intrathoracic lymph
nodes Tuberculosis of hilar lymph nodes
Tuberculosis of mediastinal lymph nodes
Tuberculosis of tracheobronchial lymph
nodes Excludes1:tuberculosis specified as
primary (A15.7)
CCA/CPC Review

A15.5 Tuberculosis of larynx, trachea
and bronchus Tuberculosis of bronchus
Tuberculosis of glottis Tuberculosis of
larynx Tuberculosis of trachea

A15.6 Tuberculous pleurisy
Tuberculosis of pleura Tuberculous
empyema Excludes1:primary
respiratory tuberculosis (A15.7)
CCA/CPC Review

A15.7 Primary respiratory tuberculosis

A15.8 Other respiratory tuberculosis
Mediastinal tuberculosis
Nasopharyngeal tuberculosis
Tuberculosis of nose Tuberculosis of
sinus [any nasal]

A15.9 Respiratory tuberculosis
unspecified
CCA/CPC Review
Tuberculosis of the Nervous
System

A17.0 Tuberculous meningitis Tuberculosis of
meninges (cerebral)(spinal) Tuberculous
leptomeningitis Excludes1:tuberculous
meningoencephalitis (A17.82)

A17.1 Meningeal tuberculoma Tuberculoma
of meninges (cerebral) (spinal)
Excludes2:tuberculoma of brain and spinal
cord (A17.81)
CCA/CPC Review

A17.8 Other tuberculosis of nervous system

A17.81 Tuberculoma of brain and spinal cord
Tuberculous abscess of brain and spinal cord

A17.82 Tuberculous meningoencephalitis
Tuberculous myelitis

A17.83 Tuberculous neuritis Tuberculous
mononeuropathy

A17.89 Other tuberculosis of nervous system
Tuberculous polyneuropathy

A17.9 Tuberculosis of nervous system,
unspecified
CCA/CPC Review
Tuberculosis of Other Organs

A18.0 Tuberculosis of bones and joints
– A18.01 Tuberculosis of spine Pott's disease or
curvature of spine Tuberculous arthritis
Tuberculous osteomyelitis of spine Tuberculous
spondylitis
– A18.02 Tuberculous arthritis of other joints
Tuberculosis of hip (joint) Tuberculosis of knee
(joint)
– A18.03 Tuberculosis of other bones Tuberculous
mastoiditis Tuberculous osteomyelitis
CCA/CPC Review
– A18.09 Other musculoskeletal tuberculosis
Tuberculous myositis Tuberculous synovitis
Tuberculous tenosynovitis
– A18.1 Tuberculosis of genitourinary system
– A18.10 Tuberculosis of genitourinary
system, unspecified
– A18.11 Tuberculosis of kidney and ureter
– A18.12 Tuberculosis of bladder
CCA/CPC Review
– A18.13 Tuberculosis of other urinary
organs Tuberculous urethritis
– A18.14 Tuberculosis of prostate
– A18.15 Tuberculosis of other male genital
organs
– A18.16 Tuberculosis of cervix
CCA/CPC Review
– A18.17 Tuberculous female pelvic
inflammatory disease Tuberculous
endometritis Tuberculous oophoritis and
salpingitis
– A18.18 Tuberculosis of other female
genital organs Tuberculous ulceration of
vulva
CCA/CPC Review


A18.2 Tuberculous peripheral lymphadenopathy
Tuberculous adenitis Excludes2:tuberculosis of
bronchial and mediastinal lymph nodes (A15.4)
tuberculosis of mesenteric and retroperitoneal lymph
nodes (A18.39) tuberculous tracheobronchial
adenopathy (A15.4)
A18.3 Tuberculosis of intestines, peritoneum and
mesenteric glands
– A18.31 Tuberculous peritonitis Tuberculous ascites
– A18.32 Tuberculous enteritis Tuberculosis of anus and
rectum Tuberculosis of intestine (large) (small)
– A18.39 Retroperitoneal tuberculosis Tuberculosis of
mesenteric glands Tuberculosis of retroperitoneal (lymph
glands)
CCA/CPC Review

A18.4 Tuberculosis of skin and subcutaneous tissue
Erythema induratum, tuberculous Lupus excedens
Lupus vulgaris NOS Lupus vulgaris of eyelid
Scrofuloderma Excludes2:lupus erythematosus
(L93.-) lupus NOS (M32.9) systemic (M32.-) A18.5
Tuberculosis of eye Excludes3:lupus vulgaris of
eyelid (A18.4)
– A18.50 Tuberculosis of eye, unspecified
– A18.51 Tuberculous episcleritis
– A18.52 Tuberculous keratitis Tuberculous interstitial keratitis
Tuberculous keratoconjunctivitis (interstitial) (phlyctenular)
– A18.53 Tuberculous chorioretinitis
– A18.54 Tuberculous iridocyclitis
– A18.59 Other tuberculosis of eye Tuberculous conjunctivitis
CCA/CPC Review
A18.6 Tuberculosis of ear Tuberculous
otitis media Excludes2:tuberculous
mastoiditis (A18.03)
 A18.7 Tuberculosis of adrenal glands
Tuberculous Addison's disease

CCA/CPC Review

A18.8 Tuberculosis of other specified organs
– A18.81 Tuberculosis of thyroid gland
– A18.82 Tuberculosis of other endocrine glands
Tuberculosis of pituitary gland Tuberculosis of
thymus gland
– A18.83 Tuberculosis of digestive tract organs, not
elsewhere classified Excludes1: tuberculosis of
intestine (A18.32)
– A18.84 Tuberculosis of heart Tuberculous
cardiomyopathy Tuberculous endocarditis
Tuberculous myocarditis Tuberculous pericarditis
CCA/CPC Review
– A18.85 Tuberculosis of spleen
– A18.89 Tuberculosis of other sites
Tuberculosis of muscle Tuberculous
cerebral arteritis
CCA/CPC Review
Other Tuberculosis

A19 Miliary tuberculosis Includes:
disseminated tuberculosis generalized
tuberculosis tuberculous polyserositis
– A19.0 Acute miliary tuberculosis of a single
specified site
– A19.1 Acute miliary tuberculosis of multiple sites
– A19.2 Acute miliary tuberculosis, unspecified
– A19.8 Other miliary tuberculosis
– A19.9 Miliary tuberculosis, unspecified
CCA/CPC Review
Recommendations
Emphasize the need for increased
specificity in physician documentation
 Understand the structure of ICD-10C,/ICD-1o-PCS
 Make sure coders have adequate
knowledge and tools (particularly for
anatomy and physiology.

CCA/CPC Review