ICD-10 Impact on Coding and Billing ICD-10-CM Complete

ICD-10 Impact on Coding and Billing ICD-10-CM Complete

ICD-10 Impact on Coding and Billing ICD-10-CM Complete Official Draft Code Set 2014 Ingenix All Rights Reserved. Use of this handout is for informational purposes only Refer to current updated version of ICD-10 manual at the time of implementation to confirm coding accuracy! Paul Cadorette CPC, CPC-H, CPC-P, CASCC, COSC AAPC ICD-10 Proficiency Certified Director of Education

[email protected] ICD-10-CM Complete Official Draft Code Set 2014 Ingenix All Rights Reserved Why the Need for ICD-10? ICD-10 A98.4 Ebola virus disease ICD-9 Other specified diseases due to viruses Arthropod-borne hemorrhagic fever Codes lack specificity which is necessary for identifying Ebola patients Makes the process of monitoring and tracking the disease more difficult

ICD-10-CM Complete Official Draft Code Set 2014 Ingenix All Rights Reserved 21 Chapters with alphanumeric codes ICD-9 14,000 codes vs. ICD-10 68,000 Diseases of nervous system and sense organs E codes V codes ICD-10-CM Complete Official Draft Code Set 2014 Ingenix.

All Rights Reserved. ICD-10 Guidelines For ambulatory surgery, code the diagnosis for which the surgery was performed. If the postoperative diagnosis is known to be different from the preoperative diagnosis at the time the diagnosis is confirmed, select the postoperative diagnosis for coding, since it is the most definitive ICD-10-CM Complete Official Draft Code Set 2014 Ingenix. All Rights Reserved. ICD-10 CONVENTIONS

General rules for the use of the classification system with instructional notes that are applicable regardless of the health care setting ICD-10-CM Complete Official Draft Code Set 2014 Ingenix All Rights Reserved ICD-10 Conventions See - another term should be referenced, it is necessary for the coder to go to the main term indicated by the see note Arthritis, arthritic spine rheumatoid see Spondylitis, ankylosing

See Also another main term can be referenced that may have additional index entries that may be useful. When the main term provides an appropriate code, it is not necessary to follow the see also note Stricture (see also Stenosis) bladder N32.89 neck N32.0 nasolacrimal duct (see also Stenosis, lacrimal duct) congenital Q10.5 ICD-10-CM Complete Official Draft Code Set 2014 Ingenix. All Rights Reserved.

Excludes Notes EXCLUDES 1 The two conditions cannot be reported together When present, the EXCLUCDED code/condition should be reported instead of the code listed above it It may be appropriate to use both the code listed along with the excluded code when supported by the medical documentation EXCLUDES 2

S92 Fracture of foot and toe, except ankle EXCLUDES 1 EXCLUDES 2 traumatic amputation of ankle and foot (S98.-) fracture of ankle (S82.-) fracture of malleolus (82.-) ICD-10-CM Complete Official Draft Code Set 2014 Ingenix All Rights Reserved. .

Anatomy and Terminology Spondylo- (vertebra or spinal column) -pathy (disease process) Atlanto-occipital Expansion of diagnosis code sets Atlanto-axial - C7-T1 - T12-L1 - L5-S1

ICD-10-CM Complete Official Draft Code Set 2014 Ingenix All Rights Reserved. . Anatomy and Terminology Enthesopathy Enthesis the point where a tendon or ligament inserts into a bone Enthesopathy disease process in the zones of attachment for ligaments or tendons to bone, a disorder of

entheses (bone attachments) ICD-10-CM Complete Official Draft Code Set 2014 Ingenix All Rights Reserved. Anatomy and Terminology Spondylopathies (M45-M49) spondylo (vertebra) pathy (disease process) Spondylosis - a term referring to degenerative osteoarthritis of the joints between the center of the spinal vertebra and/or neural foramina ICD-10-CM Complete Official Draft Code Set 2014 Ingenix All Rights Reserved.

S96.2 Injury of Intrinsic Muscle at Ankle and Foot Level Dorsal Interossei C B A A B

A Flexor digitorum brevis B Abductor digiti minimi C Abductor hallucis A - Quadratus plantae B - Lumbricales C A B B A Flexor hallucis brevis B Adductor hallucis

C Flexor digiti minimi ICD-10-CM Complete Official Draft Code Set 2014 Ingenix All Rights Reserved. . Plantar Interossei Diagnosis Code Structure S52.551A Type of Encounter Laterality Other extra-articular fracture lower end of radius

Fracture lower end of radius Base code - Fracture of forearm Fracture of right distal radius, extra-articular ICD-10-CM Complete Official Draft Code Set 2014 Ingenix. All Rights Reserved. Diagnosis Code Structure - Base Codes ICD-10-CM Complete Official Draft Code Set 2014 Ingenix All Rights Reserved. Diagnosis Code Structure

ICD-10-CM Complete Official Draft Code Set 2014 Ingenix. All Rights Reserved. Fractures of Femur (23 Different Classifications plus 9 Other/Unspecified codes) Current Procedural Terminology 2014 American Medical Association. All Rights Reserved. ICD-10 Laterality RT is usually indicated with 1 LT is usually indicated with 2 Bilateral is usually indicated with 3

(When no bilateral code exists, report both the RT and LT code) (Bilateral refers to paired organs) M20.40 Other hammertoe(s) (acquired), unspecified foot M20.41 Other hammertoe(s) (acquired), right foot M20.42 Other hammertoe(s) (acquired), left foot Unspecified character is 0 if in the fifth position or 9 when it is in the sixth position M20.011 Mallet finger of right finger(s) M20.012 Mallet finger of left finger(s) M20.019 Mallet finger of unspecified finger(s) ICD-10-CM Complete Official Draft Code Set 2014 Ingenix.

All Rights Reserved. ICD-10 Laterality NOTE: Although toes are identified by proximal, medial or distal phalanx the specific toe (second, third, fourth or fifth) is not mentioned ICD-10-CM Complete Official Draft Code Set 2014 Ingenix All Rights Reserved. .

CPT Code Sections Forearm, Wrist Hand, Finger Select CPT code based on the anatomical site where at which the procedure was performed Hand or Wrist Wrist and Hand Level For categories where no multiple site code is provided and more than one bone, joint or muscle is involved, multiple codes should be used to indicate the different sites involved ICD-10-CM Complete Official Draft Code Set 2014 Ingenix

All Rights Reserved. . ICD-10 Laterality Exceptions Other and Unspecified ICD-10-CM Complete Official Draft Code Set 2014 Ingenix. All Rights Reserved. ICD-10 Laterality ICD-10-CM Complete Official Draft Code Set 2014 Ingenix.

All Rights Reserved. Eyelid Characters . CPT Code Modifiers ICD-10-CM Complete Official Draft Code Set 2014 Ingenix All Rights Reserved. Seventh Character Extensions Additional digits required ICD-10-CM Complete Official Draft Code Set 2014 Ingenix. All Rights Reserved.

Seventh Character Extension 7th vs. X7th When a diagnosis code requires a 7th character - that character must always be the 7th character in the data field, which sometimes necessitates the use of placeholder X Some codes may be only 4 characters long, but they require a 7th character extension - so placeholder x is used twice S46.011 Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder The appropriate 7 character is to be added to each code S46.011A from category S00 th

S43.50 Sprain of acromioclavicular joint S43.50XA A D S initial encounter subsequent encounter sequela S33.0 Traumatic rupture of lumbar intervertebral disc S33.0XXA

ICD-10-CM Complete Official Draft Code Set 2014 Ingenix All Rights Reserved. Encounters (7th Character Extensions) A - Initial encounter Active treatment (surgical treatment, emergency department encounter or evaluation and treatment by new physician) D - Subsequent encounter Routine care during healing or recovery phase (cast change/removal, removal of internal/external fixation device, medication adjustment, follow-up visits)

S - Sequela - Late effect from initial injury Condition that occurs after the acute phase of an injury No time limit to identify a late effect ICD-10-CM Complete Official Draft Code Set 2014 Ingenix All Rights Reserved. Fracture Encounters Defaults No open fx code ICD-10-CM Complete Official Draft Code Set 2014 Ingenix. All Rights Reserved.

Implant Removal Previous Injury Fracture of 1st metatarsal bone right foot S92.311D (Subsequent encounter D defaulted to displaced) Previous Surgery Austin bunionectomy for hallux valgus Z47.2 (Acquired deformity) ICD-10-CM Complete Official Draft Code Set 2014 Ingenix All Rights Reserved. .

Acute vs. Chronic Chapter 13. Diseases of the Musculoskeletal System and Connective Tissue Chapter 19. Injury, Poisoning and Certain Other Consequences of External Causes ICD-10-CM Complete Official Draft Code Set 2014 Ingenix. All Rights Reserved. Strains and Sprains Strain injury to a muscle or tendon Tendons connect muscle to bone Quadriceps tendon to superior pole of patella S76.119A Strain of unspecified quadriceps muscle, fascia and tendon, initial encounter

Sprain stretching or tearing of a ligament Ligaments connect bone to bone Anterior cruciate ligament S83.519A Sprain of anterior cruciate ligament of unspecified knee, initial encounter ICD-10-CM Complete Official Draft Code Set 2014 Ingenix All Rights Reserved. . Herniated Disk 722.10 Chapter 13 - Old/Chronic Chapter 19 - Acute/Current

ICD-10-CM Complete Official Draft Code Set 2014 Ingenix All Rights Reserved. Barretts Esophagus ICD-9 Same ICD-9 code Different codes in ICD-10 Precancerous changes Severe precancerous changes ICD-10-CM Complete Official Draft Code Set 2014 Ingenix

All Rights Reserved K22.70 Barretts esophagus without dysplasia Barretts esophagus NOS NOS Not Otherwise Specified ICD-10-CM Complete Official Draft Code Set 2014 Ingenix All Rights Reserved Carrier Policy Treatment of Barretts Radiofrequency ablation is considered investigational as a treatment of Barretts esophagus in the absence of dysplasia

(Nondysplastic Barretts) Radiofrequency ablation may be considered medically necessary for treatment of Barretts esophagus with low-grade dysplasia, when the initial diagnosis of low-grade dysplasia is confirmed by a second pathologist who is an expert in GI [gastrointestinal] pathology Radiofrequency ablation may be considered medically necessary for treatment of Barretts esophagus with high-grade dysplasia The diagnosis of high-grade dysplasia should be confirmed by two pathologists prior to radiofrequency ablation BCBS of NC Current Procedural Terminology 2014 American Medical Association.

All Rights Reserved. Colon Polyps 211.3 Hyperplastic polyps code to K63.5 Adenomatous polyps are site specific and code to benign neoplasms Hyperplastic polyps of anus/rectum ICD-10-CM Complete Official Draft Code Set 2014 Ingenix All Rights Reserved Screening

Testing for disease in seemingly well individuals Testing to rule out or confirm a sign or symptom is a diagnostic exam and not a screening List the screening code as the primary diagnosis Conditions found during screening exam should be listed as additional diagnoses ICD-10-CM Complete Official Draft Code Set 2014 Ingenix All Rights Reserved Accidental Dural Puncture 998.2

ICD-9 Diagnosis Coding 1. 2. 1. 2. 3. 4. 5.

ICD-10-CM Complete Official Draft Code Set 2014 Ingenix All Rights Reserved. . Complications (998.2 Accidental puncture or laceration) Female pelvic pain with lysis of adhesions and destruction of endometriosis. Colon is perforated during/while lysing adhesions. K91.71 Accidental puncture and laceration of a digestive system organ or structure during a digestive system procedure

K91.72 Accidental puncture and laceration of a digestive system organ or structure during other procedure Chapter 11 Diseases of the digestive system K00-K94 While placing tape during a TVT procedure, the bladder is perforated. N99.71 Accidental puncture and laceration of a genitourinary system organ or structure during a genitourinary system procedure N99.72

Accidental puncture and laceration of a genitourinary system organ or structure during other procedure Chapter 14 Diseases of the Genitourinary System N00-N99 ICD-10-CM Complete Official Draft Code Set 2014 Ingenix. All Rights Reserved. Discontinued Procedure V64.1 Surgical or other procedure not carried our because of contraindication (unacceptable primary diagnosis in ICD-9) Z53.09 Procedure and treatment not carried out because of other contraindication

DO NOT USE V64.1 (ICD-9) OR Z53.09 (ICD-10) AS A PRIMARY OR FIRST LISTED DIAGNOSIS ICD-10-CM Complete Official Draft Code Set 2014 Ingenix All Rights Reserved. Chapter 20 External Causes of Morbidity Chapter 21 Factors Influencing Health Status ICD-9 ICD-10 Daycare worker bitten by child, bleeding wound on right forearm S51.851A Open bite right forearm, initial encounter

Y04.1XXA Assault by human bite, initial encounter Y92.210 Daycare center as the place of occurrence of the external cause Y93.F9 Activity, other caregiving Y99.0 Civilian activity done for income or pay Unless a provider is subject to state-based reporting or these codes are required by a specific payer - reporting of External Causes of Morbidity codes is not required Personal and Family History codes ICD-10-CM Complete Official Draft Code Set 2014 Ingenix. All Rights Reserved.

CMS-1500 Claim Forms Z12.11 D12.3 45385 PT AB ICD-10-CM Complete Official Draft Code Set 2014 Ingenix. All Rights Reserved.

ICD-10 Testing Week: November 17-21, 2014 Test claims with ICD-10 codes must be submitted with current dates of service (i.e. October 1, 2014 through November 17, 2014), since testing does not support future dated claims. Test claims will be subject to all existing EDI front-end edits including Submitter authentication and NPI validation. Test claims will receive the 277CA or 999 acknowledgement as appropriate, to confirm that the claim was accepted or rejected in the system. Testing will not confirm claim payment or produce remittance advice. Next test dates - March 2-6, 2015, June 1-5, 2015 ICD-10-CM Complete Official Draft Code Set 2014 Ingenix. All Rights Reserved.

FUTURE: Local Coverage Determination (LCD): (L35350) UPPER GASTROINTESTINAL ENDOSCOPY (DIAGNOSTIC AND THERAPEUTIC) Effective: Oct. 1, 2015 Approximately 290 ICD-10 codes vs 234 ICD-9 codes Diagnosis Codes meeting Medical Necessity Non-Covered Diagnosis Codes ICD-10-CM Complete Official Draft Code Set 2014 Ingenix. All Rights Reserved. FUTURE: Local Coverage Determination (LCD): (L34974) Facet Joint Injections

Effective: Oct. 1, 2015 Code Comparison Approximately 264 ICD-10 LCD diagnosis codes 38 ICD-9 LCD diagnosis codes Diagnosis codes with A Encounters only ICD-10-CM Complete Official Draft Code Set 2014 Ingenix. All Rights Reserved. FUTURE: Local Coverage Determination (LCD): (L34974) Facet Joint Injections

Spondylolysis M43.00 M43.09 Aka. Pars defect Spondylolisthesis M43.10 M43.19 Pars defect-vertebra slips forward Spondylosis M47.11 M47.9 Osteoarthritis, Osteoarthrosis Osteoarthropathy ICD-10-CM Complete Official Draft Code Set 2014 Ingenix. All Rights Reserved. ICD-10 Impact on Coding and Billing Paul Cadorette CPC, CPC-H, CPC-P, CASCC, COSC AAPC ICD-10 Proficiency Certified

Director of Education [email protected] ICD-10-CM Complete Official Draft Code Set 2014 Ingenix All Rights Reserved.

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