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AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 1 2015 AQ-IQ LLChttp://aq-iq.com11-877-976-6677Slide 2DisclaimerThe information contained in this presentation is provided to assist the attendee inunderstanding the reimbursement process. It is intended to assist healthcareproviders in accurately obtaining reimbursement for health care services. It is notintended to increase or maximize reimbursement inappropriately by any payer. It isstrongly recommended that attendees consult their payer organizations with regardto local reimbursement policies. The information contained in the presentation isprovided for information purposes only and represents no statement, promise orguarantee concerning levels of reimbursement, payment or charge. The material isdesigned to provide accurate information on the subject matter covered and is forguidance and reference purposes only. Although prepared for use by professionals,the presentation information should not be utilized as a substitute for professionalservices in specific situations. If legal advice is required, the services of a professionalshould be sought.All CPT codes discussed are used with permission of the American Medical Association. Current Procedural Terminology (CPT) is copyright 2013 AmericanMedical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liabilityfor the data contained herein. Applicable FARS/DFARS restrictions apply to government use. 2015 AQ-IQ LLChttp://aq-iq.com21-877-976-6677 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 3Cramming for ICD-10 (IRF) Paula Digby, CDIP, CCS, CPC, CPCIAHIMA Approved ICD-10-CM/PCS InstructorAQC Consulting LLC/AQ-IQ.com 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 4Test Prep Understanding Key Vocabulary What codes look, feel and act like Myth versus Fact – Overcoming Test Anxiety Process/Payment considerations How ICD-10 will impact IRFs New Documentation Requirements Shortcuts to preparedness Where to focus efforts and who to include. 2015 AQ-IQAQ-IQ LLCLLC 1-877-976-6677 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 5ICD-CM Code StructureICD-9-CM Approx 13,000 Diagnosis Codes Alphanumeric CodesICD-10-CM Approx 68,000 Diagnosis Codes Alphanumeric Codes– Only a few start with a letter 3 – 5 charactersNew Options andthinking patternsrequired for IRFs.– ALL start with a letter 3 – 7 charactersAdded LateralityExpanded InjuriesAdded episodes of careRevised definitions for somediagnoses. 2015 AQ-IQ LLC http://aq-iq.com 2015 AQ-IQ LLC1-877-976-6677http://aq-iq.com1-877-976-66775 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 6PREPARATION IS THE KEY TO SUCCESSCoding and 7th Character SAlpha(Except U)MXAS X0 X2Category2 Numeric3-7 Numeric or Alpha.X6 X5 XxEtiology, anatomicsite, severityAdditionalCharactersAXAdded 7th character forobstetrics, injuries, andexternal causes of injury3–7 Characters 2012 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 7Yes, the Leading Letters Mean Something! 2015 AQ-IQ LLChttp://aq-iq.com1-877-976-66777 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 8ICD-9-CM to ICD-10-CM / GEMS Available CD-10CM-and-GEMs.html Many are fairly close between code sets:– Infectious diseases, neoplasms, eye & ear codes Many are NOT close:– Obstetrics – reorganized– Not direct 1-to-1 relationships 2015 AQ-IQ LLChttp://aq-iq.com1-877-976-66778 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 9What I-10 Codes Look Feel and Act LikeOh My! It feels like I just got a new cell phoneand have to find all my apps again! Myth #1: There are so many changes physicians will have todocument novels for compliance. Myth #2: There are no more unspecified diagnosis codes. Myth #3: Coding rules have all changed. Myth #4: All Diagnosis Codes are 7 digits long. Myth #5: All ICD-9-CM’s Crosswalk to Multiple ICD-10’s. 2015 AQ-IQAQ-IQ LLCLLC 1-877-976-6677 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 10Example: Non-Traumatic SAHICD9430I60 Nontraumatic subarachnoid hemorrhageI60.0 Nontraumatic subarachnoid hemorrhage from carotid siphon and bifurcationI60.00Nontraumatic subarachnoid hemorrhage from unspecified carotid siphon and bifurcationI60.01Nontraumatic subarachnoid hemorrhage from right carotid siphon and bifurcationI60.02Nontraumatic subarachnoid hemorrhage from left carotid siphon and bifurcationI60.1 Nontraumatic subarachnoid hemorrhage from middle cerebral arteryI60.10Nontraumatic subarachnoid hemorrhage from unspecified middle cerebral arteryI60.11Nontraumatic subarachnoid hemorrhage from right middle cerebral arteryI60.12Nontraumatic subarachnoid hemorrhage from left middle cerebral arteryI60.2 Nontraumatic subarachnoid hemorrhage from anterior communicating arteryI60.20Nontraumatic subarachnoid hemorrhage from unspecified anterior communicating arteryI60.21Nontraumatic subarachnoid hemorrhage from right anterior communicating arteryI60.22Nontraumatic subarachnoid hemorrhage from left anterior communicating arteryI60.3 Nontraumatic subarachnoid hemorrhage from posterior communicating arteryI60.30Nontraumatic subarachnoid hemorrhage from unspecified posterior communicating arteryI60.31Nontraumatic subarachnoid hemorrhage from right posterior communicating arteryI60.32Nontraumatic subarachnoid hemorrhage from left posterior communicating arteryI60.4Nontraumatic subarachnoid hemorrhage from basilar arteryI60.5 Nontraumatic subarachnoid hemorrhage from vertebral arteryI60.50Nontraumatic subarachnoid hemorrhage from unspecified vertebral arteryI60.51Nontraumatic subarachnoid hemorrhage from right vertebral arteryI60.52Nontraumatic subarachnoid hemorrhage from left vertebral arteryI60.6Nontraumatic subarachnoid hemorrhage from other intracranial arteriesI60.7Nontraumatic subarachnoid hemorrhage from unspecified intracranial arteryI60.8Other nontraumatic subarachnoid hemorrhageI60.9Nontraumatic subarachnoid hemorrhage, unspecified 2015 AQ-IQ LLC 2015 AQ-IQ -877-976-6677 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 11CHF ICD-9 vs. ICD-10ICD-10DescriptionI50.1Left heart failureI50.20Unspec. systolic (congestive) heart failureI50.21Acute systolic (congestive) heart failureI50.22Chronic systolic (congestive) heart failureSystolic heart failure, chronicI50.23Acute on chronic systolic (congestive) heart failureSystolic heart failure, acute on chronicI50.30Unspec. diastolic (congestive) heart failure428.30Diastolic heart failure, unspecifiedI50.31Acute diastolic (congestive) heart failure428.31Diastolic heart failure, acuteI50.32Chronic diastolic (congestive) heart failure428.32Diastolic heart failure, chronicI50.33Acute on chronic diastolic systolic (congestive) heart failure428.33Diastolic heart failure, acute on chronic428.40Combined systolic & diastolic heart failure, unspecifiedI50.40Unspec. combined systolic/diastolic heart failureI50.41428.41Combined systolic & diastolic heart failure, acuteAcute combined systolic(congestive) & diastolic(congestive)heart failure428.42Combined systolic & diastolic heart failure, chronicI50.42Chronic combined systolic (congestive) & diastolic (congestive)heart failure428.43Combined systolic & diastolic heart failure, acute onchronicI50.43Acute on chronic combined systolic (congestive) & diastolic(congestive) heart failure428.9Heart failure, unspecifiedI50.9Heart failure, riptionCHF, unspecifiedLeft heart failureSystolic heart failure, unspecifiedSystolic heart failure, acute 2015 AQ-IQAQ-IQ LLCLLC 1-877-976-667711 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 12EXAMPLES OF ICD-9 TO ICD-10ICD-10ICD-9E10.36Type 1 diabetes mellitus with diabetic cataractNo additional code necessary.250.51Diabetes type 1 with ophthalmic manifestations366.41Diabetic cataractE10.630Type 1 diabetes mellitus with periodontal diseaseNo additional code necessary.250.81Diabetes type 1 with other specified manifestations523.8Other specified periodontal diseaseICD-10ICD-9E11.341Type 2 diabetes mellitus with severe non proliferative diabetic retinopathy with macularedema250.50Diabetes type II with ophthalmic manifestations362.06Severe nonproliferative diabetic retinopathy362.07Diabetic macular edemaE11.43Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy250.60Diabetes type 2 with neurological manifestations536.3Gastroparesis 2015 AQ-IQAQ-IQ LLCLLC 1-877-976-6677 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 13What I-10 Codes Look Feel and Act LikeOh Wow! That was easier than anticipated! Fact #1: Success is in the Details! Quality NOT Quantity! Fact #2: ICD-10 is like real estate – LOCATION MATTERS! Fact #3: Radiologist, Neurologist, Cardiovascular andOrthopedics are key to success! Fact #4: Most Coding rules remain consistent with ICD-9-CM. Fact #5: Payment & Process/Considerations to achieveappropriate payment is anticipated to be impacted. 2015 AQ-IQAQ-IQ LLCLLC 1-877-976-6677 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 14ICD-10 Impact on IRFs!Success is in the DetailsProcess Considerations Changes to IRF-PAI – Coding Implications What about ICD-10 PCS? Diagnosis Codes & Documentation Changes Presumptive Compliance Options Reduced Potential Tier Diagnoses – Will options Reduce? Quality Measures Pressures Ulcers PVD/PAD; DM w/Certain Manifestations Therapy Time Tracking 2015AQ-IQLLCLLC 6771-877-976-66771-14 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 15Best Practice Processes – IRF Revenue CyclePreAdmissionsScreeningSTOP!Its takes allplayers forsuccess .EDUCATE ALL!CaseManagement/ uticPatientManagement(Team) 2015 AQ-IQ LLChttp://aq-iq.com1-877-976-667715 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 16Making Reimbursement Happen(Remains the Same)CMG 2015 AQ-IQ LLChttp://aq-iq.com1-877-976-6677 2015 AQ-IQ LLChttp://aq-iq.com877-976-66771-16 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 17Calculation Logic the SameCoding ImpactsDischargeStatusChanged–Consistentwith NUBCGuidelines(UB-04 codes– SOMEEXCEPTIONS)Not Changing – Diagnosis Codes Look Different However! 2015 AQ-IQ LLChttp://aq-iq.com877-976-66771-17 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 18Basic Coding Nuances – NOT CHANGING Etiologic: Underlying Reason for Impairment NOT the Impairment if something more definitive! NOT a Surgery! NOT CABG but CAD; NOT Lumbar Lami but Spinal Stenosis. Comorbidities Exist at time of admission Treated Impact treatment/length ofstay Complications Occur or are Diagnosesidentified during the admissiondocumented on the last two days of the stay are notreported. Conditions that are Possible, Probable, or Suspected are notreported. 2015 AQ-IQ LLChttp://aq-iq.com1-877-976-667718 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015IRF-PAI CHANGES p1Slide 19NEWIMPORTANTFOCUS AREAS 2015 AQ-IQ LLChttp://aq-iq.com1-877-976-6677 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015IRF-PAI CHANGES p3Slide 20NEWIMPORTANTFOCUS AREAS 2015 AQ-IQ LLChttp://aq-iq.com1-877-976-6677 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015IRF-PAI CHANGES p7Slide 21IMPORTANTFOCUS AREAS 2015 AQ-IQ LLChttp://aq-iq.com1-877-976-6677 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 22Achieving Presumption – Same Logic– Different CodesUnilateral HIP FractureMeets with Specific Etiologic IGC 8.11 Fails if IGC Alone– Achieves or Doesn’t IGC Etiologic 820.8 820.9– May Make or Break Comorbidity/Complication mayimpactUnspecified Part ofNeck, Open/Closed S72.001A, B or C S72.002A, B or C S27.009A, B or C 2015 AQ-IQAQ-IQ LLCLLC 1-877-976-6677Unspecified Part ofFemur Neck, Right or Left, Open Type I, II, IIIA,IIIB, IIIC (or) Closed, Initial Encounter22 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 23IRF Patients – Changes to all Categories(60% Rule – Presumptive Diagnoses) StrokeCongenital DeformitySpinal Cord InjuryAmputationBrain InjuryMajor Multiple TraumaHip FractureNeurological Disorders Burns Polyarthritis (includingRheumatoid) Severe or AdvancedOsteoarthritis Certain Knee or HipReplacements Systemic Vasculidities withJoint Inflammation 2015 AQ-IQAQ-IQ LLCLLC 1-877-976-667723 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 24Presumptive List Changes (60%)In anticipation of ICD-10 Unspecified Codes Removed as Qualifiers– Exception Stroke Arthritis Removed (Well Maybe?)– Some may be approved on review.– Will unspecified CCs be removed?” 2015 AQ-IQAQ-IQ LLCLLC 1-877-976-6677 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 25Presumptive Compliance IGC and DiagnosesUNTIL 10/1/15 IGCs w/o Etiologic Dx Exclusions––––––––Stroke 01.1- 01.9Brain Dysfunction 02.21 and 02.22 ONLYNeuro 03.1, 03.2, 03.5 and 03.8 ONLYAmputation 05.1, 05.3, 05.5, 05.6, and05.7 ONLYArthritis 06.1 ONLYOrtho 08.11, 08.12, 08.51*, 08.52, 08.61*,08.62, 08.71*, 08.72 ONLYBurns 11Congenital Deformities 12.1 and 12.9* Age must be 85 ON/AFTER 10/1/15 IGCs w/o Etiologic Dx Exclusions– Stroke 01.1- 01.4 ONLY (NOT 1.9)– Neuro 03.1, 03.2 ONLY (NOT 03.5 & 03.8)– Amputation 05.3, 05.5, 05.6, and 05.7ONLY (NOT 05.1,)– Ortho 08.51*, 08.52, 08.61*, 08.62,08.71*, 08.72 ONLY 2015 AQ-IQAQ-IQ LLCLLC 1-877-976-667725 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 26Presumptive Compliance IGC and DiagnosesON/AFTER 10/1/15 IGCs w/o Etiologic Dx Exclusions– Stroke 01.1- 01.4 ONLY (NOT 1.9)– Neuro 03.1, 03.2 ONLY (NOT 03.5 & 03.8)– Amputation 05.3, 05.5, 05.6, and 05.7ONLY (NOT 05.1)– Ortho 08.51*, 08.52, 08.61*, 08.62,08.71*, 08.72 ONLY IGCs w/ Etiologic Dx Exclusions–––––– Age must be 85 –NEVER MEET w/o Qualifying Diagnosis–2.9, 3.3, 3.4, 3.9, 5.1, 5.2, 5.9, 6.1-6.9, 7.1–7.9, 8.2, 8.3, 8.4, 8.9, 09, 10.1-10.9,13, 15,–16, 17.1-17.9 2015 AQ-IQ LLC – 2015 AQ-IQ rain Dysfunction 02.1TBI 02.21 - 02.22Cerebral Palsy 03.5Neuromuscular 03.8NTSC Dysfunction 04.110 -04.130 (ALL)Traumatic SCI 04.210 – 04.230 (ALL)Amputation 05.4 (BKA)Unilateral/Bilateral Hip Fx 08.11, 08.12Burns 11Congenital 12.1 & 12.9Brain/Spine 14.1, 14.2, 14.3, 14.91-877-976-667726 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 27Presumptive Compliance 7th character.pdf 2015 AQ-IQ LLChttp://aq-iq.com1-877-976-6677 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 287th Character Rules for Injuries(including Fractures)/Complications Most 7th Characters (Exception Fractures – more options):– A - Initial Encounter “Active Treatment”– D - Subsequent Encounter– S - Sequela“While a patient may be seen by a new or different provider overthe course of treatment for an injury, assignment of the 7thcharacter is based on whether the patient is undergoing activetreatment and not whether the provider is seeing the patient forthe first time.” ICD-10 Guidelines 2015 AQ-IQAQ-IQ LLCLLC 1-877-976-6677 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 29Specificity & Presumption (Hip Fracture)I-9 820.8 Fracture Femur (closed),NOS (HIP, NOS)I-10 S72.009D Unspecified Part of the Neck of theFemur, Unspecified Leg, Subsequent encounter forclosed fracture with routine healing.80 codes to report various femur neck fracturesbased on:– Location (Bone - Femur/Part of Bone – base,midcervical, subtrochanteric .)– Laterality (Side of the Body)– Type of fracture (Traumatic/Pathologic/Stress,Open/Closed.)– Type of Healing– Type of visit/encounter– Association to other conditions(Osteoporosis/Neoplasm .)– Sequela/Residuals 18 codes to report variousfractures of the femur neck Unspecified not 60% Unspecified Codes not on Presumptive List for –FY2016. 2015 AQ-IQ LLC 2015 AQ-IQ -877-976-667729 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 30Coding Hip Fractures in ICD-10(Presumption)CATEGORIES (Examples):Unsp Intracapsular Fractures,S72.011A, B, CR/L/Unsp, Open (Type I, II, IIIA,IIIB, IIIC)/Closed, InitialS72.012A, B, CEncounterS72.019A, B, CDisplaced Epiphysis FracturesS72.021A, B, C(separation/upper) R/L/Unsp,Open (Type I, II, IIIA, IIIB,S72.022A, B, CIIIC)/Closed, Initial EncounterS72.023A, B, CNONdisplaced EpiphysisS72.021A, B, CFractures (separation/upper)R/L/Unsp, Open (Type I, II, IIIA,S72.022A, B, CIIIB, IIIC)/Closed, InitialEncounterS72.023A, B, CNOT PRESUMPTIVE S72.001A, B or C Unspecified Part of the Neck ofthe RIGHT Femur, Initial encounterfor:‒ (A) closed fracture‒ (B) Open Type I or II‒ (C) Open Type IIIA, IIIB, IIIC S72.002A, B or C Unspecified Part of the Neck ofthe LEFT Femur S72.009A, B or C Unspecified Part of the Neck ofUNSPECIFIED Femur 2015 AQ-IQ -877-976-6677 2015 AQ-IQ LLC30 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 31How Will ICD-10 Affect Clinical Documentation? “Concepts that are new to ICD-10 are not new to clinicians,who are already documenting a patient's chart with moreclinical information than an ICD-9 codes can capture.”-CMSDon’t worry about the codes, CONTINUE to paint the story with your words! 2015 AQ-IQAQ-IQ LLCLLC 1-877-976-6677 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 32Can You Just Tell Me What to Say?Why Yes, State the Obvious!Coders rules: No clinical decisions; No leading to an answer; No guessing conditions based on symptoms ortreatment/medications; Must use only PHYSICIAN documentation and physicianvalidated diagnoses.– Labs, x-rays, therapy, nursing not utilized.We & the Payers Are Detail Junkies! 2015 AQ-IQAQ-IQ LLCLLC 1-877-976-6677 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 33FY 2014ICD9CM LabelRICTier ExclusionICD-10FY 2015ICD10CM LabelTierParalysis of vocal cords and larynx, unilateralParalysis of vocal cords and larynx, bilateralEdema of larynxJ38.4478.32115Vocal paral unilat totalEncounter for attention to tracheostomyZ43.0478.33115Vocal paral bilat partTracheostomy statusZ93.0478.34Dependence on renal dialysis115Vocal paral bilat totalZ99.2Enterocolitis due to Clostridium difficileA04.7478.6115Edema of larynxOther specified bacterial intestinal infectionsA04.8V44.01Tracheostomy statusPseudomonas (aeruginosa) (mallei) (pseudomallei) as cause ofV45.111Renal dialysis statusdisease classified elsewhereB96.5V55.01Atten to tracheostomyI69.091 Dysphagia following nontraumatic subarachnoid hemorrhageDysphagia following nontraumatic intracerebral hemorrhageI69.191008.422Pseudomonas enteritisI69.291 Dysphagia following other nontraumatic intracranial hemorrhage008.452Int inf clostridium difficileI69.391 Dysphagia following cerebral infarction041.72Pseudomonas infect NOSI69.891 Dysphagia following other cerebrovascular disease438.82I69.991 Dysphagia following unspecified cerebrovascular disease201Late eff CV dis dysphagiaPostsurgical malabsorption, not elsewhere classifiedK91.2579.32Intest postop nonabsorbAphagiaR13.0787.20201Dysphagia NOSR13.10 Dysphagia, unspecified787.21201Dysphagia, oral phaseR13.11 Dysphagia, oral phase787.22201Dysphagia, oropharyngealR13.12 Dysphagia, oropharyngeal phase787.23R13.13 Dysphagia, pharyngeal phase201Dysphagia, pharyngealR13.14 Dysphagia, pharyngoesophageal phase787.24201Dysphagia, pharyngoesophR13.19 Other dysphagia787.29201Dysphagia NECSalmonella sepsisA02.1011.00315TB lung infiltr-unspecTuberculosis of lungA15.0Appendix C – List of Comorbidities 2015 AQ-IQ LLChttp://aq-iq.com(Unchanged From the List That Was Updated August 20, 2011)1-877-976-6677ICD9Vocal paral unilat part115J38.01J38.02Tier lusion1515150101010101010101010101010115(Effective for Discharges Occurring on or After October 1, 2014) 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 34All Diagnoses are Not the Same 2015 AQ-IQAQ-IQ LLCLLC 1-877-976-6677 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 35ICD-9ICD-10682.6Cellulitis andabscess of leg,except footL02.415- Cutaneous abscess of right lower limbL02.416- Cutaneous abscess of left lower limbL02.419 Cutaneous abscess of limb, unspecifiedL03.115- Cellulitis of right lower limbL03.116- Cellulitis of left lower limbL03.119- Cellulitis of unspecified part of limbL03.125- Acute lymphangitis of right lower limbL03.126- Acute lymphangitis of left lower limbL03.129- Acute lymphangitis of unspecified part of limb 2015 AQ-IQAQ-IQ LLCLLC 1-877-976-6677 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 36CVA/TBI: ICD-10 Code Logic Tree ExampleIMPORTANT: Cause and association of residuals to condition should always be stated for brain injuries and strokes.Concussion or Traumatic Cerebral Edema Loss of consciousness/duration if knowno Greater than 24 hours did patient return to pre-existing level of consciousness?TBI (State if Diffuse or Focal) Type of Injury – Contusion/Laceration/Hemorrhage or Combination Location – Right/Left Cerebrum; Subdural; Subarachnoid; Intracerebral (Right/Left Internal Carotid; Extradural/Epidural; Cerebellum;Brainstem)) Loss of consciousness/duration if knowno Greater than 24 hours did patient return to pre-existing level of consciousness? GCS, if known speak to (required for trauma registries):o eyes open; never, to pain, to sound or spontaneouso best verbal response; incomprehensible words, inappropriate words, confused conversation, none or orientedo best motor response extension, abnormal, flexion withdrawal, localizes pain, obeys commands or noneNon-Traumatic Subarachnoid Hemorrhage Location (Vessel)o From Carotid Siphon and Bifurcation (Right or Left); Middle Cerebral Artery (Right or Left); Anterior or Posterior CommunicatingArtery (Right or Left); Vertebral (Right or Left); BasilarNon-Traumatic Subdural Hemorrhage Severity (Acute; Subacute; Chronic)Non-Traumatic Intracerebral Hemorrhage 2015 AQ-IQ LLC Location:http://aq-iq.com1-877-976-6677o Hemisphere: Cortical/Subcortical; Brainstem; Cerebellum; Intraventricular; Multiple Localized36 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 37Reimbursement Accuracy and ViablePrograms DEPEND on the TEAM!Cram Time! Don’t Forget ANYONE!–Intake/LiaisonsPPS CoordinatorsPhysiciansCase Managers/Utilization–Review– DC Planners– Nurses– Therapists––––Other Clinicians and supportstaff Radiology, Cardiology, Neurology,Orthopedics ALL KEY!Financial Services Staff Registration/Admissions CDI/Coders Billers 2015 AQ-IQAQ-IQ LLCLLC 1-877-976-667737 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 38Cramming Tips1. Teach your referral coordinators, admission screeners,physicians, case managers and others who document thepatient encounter to be THAT Southern Gossip!– Don’t forget ALL those key players.2. Identify your high risk problem diagnoses.– Focus education there first!3. Ensure open lines of communication with HealthInformation Management Coders/Clinical DocumentationImprovement Staff. 2015 AQ-IQAQ-IQ LLCLLC 1-877-976-6677 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 39Discount Offer IRF ICD-10 Training/Readiness -10-for-irfs/ 2015 AQ-IQ LLC 2015 AQ-IQ LLChttp://aq-iq.com1-877-976-6677 http://aq-iq.com1-877-976-6677Slide 40Secret OfferICD-10-CMDocumentationCues for IRFwww.aq-iq.com 2015 AQ-IQAQ-IQ LLCLLC 1-877-976-6677 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com1-877-976-6677

AQ-IQ Presents: “Cramming for ICD-10 in the IRF Setting” with Paula Digby July 28, 2015Slide 41Paula Digby, CCS, CDIP, CPC, CPC-I,AHIMA Approved ICD-10/PCS TrainerAQ Consulting, LLC & AQ-IQ.comPhone: 678-574-7184Cell: 678-858-7850Fax: om 2015 AQ-IQAQ-IQ LLCLLC 1-877-976-667741Slide 42 2015 AQ-IQ LLChttp://aq-iq.com1-877-976-6677 2015 AQ Consulting LLC and AQ-IQ LLChttp://aq-iq.com421-877-976-6677

ICD -10 ICD -9 E11.341 Type 2 diabetes mellitus with severe non proliferative diabetic retinopathy with macular edema 250.50 Diabetes type II with ophthalmic manifestations 362.06 362.07 Diabetic macular edema E11.43 Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy 250.60 Diabetes type 2 wi

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