ICD10 Whats The Big Deal SOHN Sept 2012 083012 Kim

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8/31/2012ICD-10: WHAT’S THEBIG DEAL?Presented to:Society of Otorhinolaryngology andHead-Neck NursesAnnual MeetingSeptember 10, 2012Washington, DCPresented by: Kim Pollock, RN, MBA, CPCKarenZupko & Associates, Inc.www.karenzupko.comConnectwith KZASign-up forour freeKZA AlertsOtolaryngologyCoding CoachWould You Like The Slides?1.Go to www.karenzupko.com2.Click on Workshops3.Click on Course Alumni4.5.6.Look at SOHN-Society of Otorhinolaryngologyand Head-Neck NursesCourse: ICD-10: What’s the Big Deal?Username: ICD10Password: ICD102012 AOA What You Need to Know About ICD‐10 (KP) 083012v21

8/31/2012First Things First: What is ICD? ICD is the international standard of diagnosticclassification for all general epidemiological purposes,many health management purposes, and for clinical use.ICD-9 codes have been in use since 1979 with annualrevisions. The World Health Organization (WHO) Statesstarted using ICD-10 in May 1994 except the USA.International Classification of Diseases, 9th Edition,Clinical ModificationVolumes I & I diagnosis codes used by all healthcareproviders Volume III procedural coding system (not used for physicianservices, just for facility billing) Same volumes for ICD-10-CMIntroduction to ICD-10-CMWorld Health Organization (WHO)ICD-10USAUSICD-10-CMCooperating parties – AHA, AHIMA, CMS, NCHSVolume 1: Tabular list, chronological list by body system or conditionVolume 2: Alphabetic index including neoplasm tableVolume 3: Procedural coding system (PCS)Countries That Have Adopted ICD-102012 AOA What You Need to Know About ICD‐10 (KP) 083012v22

8/31/2012Introduction to ICD-10-CMWho is Affected? Any provider or facility covered by HIPAAThis does not just apply to MedicareclaimsRight now, auto and Work Comp payorsare exempt because they are not coveredby HIPAAImplementation Timeline CMS originally stated implementation date of October 1, 2013June 30, 2012: 5010 electronic file format conversion requiredICD-10 implementation delay requested by AMA and other groupsFebruary 2012: CMS proposed 1 year delay (30-day commentperiod)i d)August 24, 2012: CMS extends implementation by1 year to October1, 2014Outpatient/physician/ASC claims: Must use ICD-10 codes forservices performed on date of implementation or later (presumed10/1/14)Inpatient hospital: Must use ICD-10 codes for claims with dischargedates on or after 10/11/14Implementation Timeline – Now 10/1/142012 AOA What You Need to Know About ICD‐10 (KP) 083012v23

8/31/2012Where Do We Use Diagnosis Codes? Claims using diagnosis codes Superbills, encounter forms with pre-printed diagnosis codes Practice management information system Electronic medical record Pre-certification of surgery and testing Policies that include diagnosis codes Clinical trials contracts that include diagnosis codesOther areas in your practice where diagnosis codes arerequired/utilized. Preparation for ICD-10-CM hasAlready StartedConversion to 5010 Standards HIPAA 5010 was a new set of standards to regulateelectronic transactions such as claims, eligibility, referralsand remittancesCritical technical requisite for ICD-10 implementationbecause it accommodates the ICD-10 code structureClaims will be rejected if not compliant and will need tobe resubmitted in 5010 formatDeadline for conversion was June 30, 2012ICD-9 vs ICD-10ICD-9ICD-103-5 characters3-7 charactersFirst character is numeric or alpha (E or V)First character is alpha (all letters except U are listed)Characters 2-5 are numericUse of decimal after 3rd characterUse of decimal after 3rd character7th character used in certain chapters, injuries andexternal cause of injury codesOver 14,000 codesAlmost 70,000 codesLacks lateralityHas laterality (i.e., codes identifying right vs. left)Example: 470 Deviated nasal septumExample J34.2 Deviated nasal septum2012 AOA What You Need to Know About ICD‐10 (KP) 083012v24

8/31/2012Comparing Coding Conventionsin ICD-9 to ICD-10Comparing Coding Conventionsin ICD-9 to ICD-10 ICD-9 uses slanted brackets [ ]ICD-10 uses square brackets [ ]; the presence orabsence of the phrase in the bracket does not affectthe code Example B01 Varicella [chickenpox]“Code Also” is used to show that two codes may beneeded to fully code a diagnostic phraseThere are “combination codes” M05.571 Rheumatoid polyneuropathy arthritis of rightankle and footComparing Coding Conventionsin ICD-9 to ICD-10 Two types of “Excludes” notes:1. “Excludes1” indicates that the code excluded should never beused at the same time as the code above the note. The twoconditions cannot occur together.Example: B06 Rubella [German measles]Excludes1 of congenital rubella (P35.0)2. “Excludes2” indicates that the condition excluded is not partof the condition represented by the code. It is acceptable touse both codes together if the patient has both conditions.Example: J04.0, Acute laryngitisExcludes2 of chronic laryngitis (J37.0)Point Dash (.--) means that the code contains a list of options ata level of specificity past the three character category2012 AOA What You Need to Know About ICD‐10 (KP) 083012v25

8/31/2012ICD-10 7th CharacterCertain ICD-10 categories have applicable 7thcharactersA Initial encounterD Subsequent encounterS Sequela (a pathological condition resulting from aprior disease, injury, or attack)ICD-10 7th Character: FracturesTo code a fracture, you must know: Open vs closed Displaced vs. non-displaced Location of fracture on the bone Type of fracture Episode of careA Initial encounter for closed fractureB Initial encounter for open fractureD Subsequent encounter for fracture with routine healingG Subsequent encounter for fracture with delayed healingK Subsequent encounter for fracture with nonunion (no union of thefragments of a fracture bone)P Subsequent encounter for fracture with malunion (union of the fragments ofa fractured bone in a faulty position)S Sequela Any complications associated with the healing of the fracture (nonunion,malunion)ICD-10 Placeholder “X”Some codes have a placeholder of “X” to: Allow for future expansion of codes Fill out empty character when a code contains fewerthan 6 character and a 7th character applies When placeholder character applies, it must be usedin order for the code to be considered validExample: Foreign body in right earT16.1XXA Initial encounterT16.1XXD Subsequent encounterT16.1XXS Sequela2012 AOA What You Need to Know About ICD‐10 (KP) 083012v26

8/31/2012ICD-10 LateralityMost codes require designation of right vs. leftS04.51- - Injury of facial nerve, right sideS04.52- - Injury of facial nerve, left sideH60.331 Swimmer’s ear, right earH60.332 Swimmer’s ear, left earH60.333 Swimmer’s ear, bilateralH60.339 Swimmer’s ear, unspecified earBeware! Reportedly, payors will not accept “unspecified”diagnosis codes in ICD-10.ICD-10 Laterality: Cerumen RemovalICD-9380.4 Impacted cerumenICDICD-1010H61.20 Impacted cerumen, unspecified earH61.21 Impacted cerumen, right earH61.22 Impacted cerumen, left earH61.23 Impacted cerumen, bilateralOrganization of ICD-10 Order of chapters is somewhat like ICD-9.Order of topics within the chapters is also like ICD-9.Ch.1234567891011DescriptionCertain Infectious and Parasitic DiseasesNeoplasmsDiseases of the BloodEndocrine, Nutritional and Metabolic DiseasesMental and Behavioral DisordersDiseases of the Nervous SystemDisorder of the Eye and AdnexaDiseases of the Ear and Mastoid ProcessDiseases of the Circulatory SystemDiseases of the Respiratory SystemDiseases of the Digestive SystemCode H00-H59H60-H95I00-I99J00-J99K00-K942012 AOA What You Need to Know About ICD‐10 (KP) 083012v27

8/31/2012Organization of ICD-10Ch.12131415131415161718192021DescriptionCode CategoryDiseases of the Skin and Subcutaneous TissueDiseases of the Musculoskeletal System and Connective TissueDiseases of the Genitourinary SystemPregnancy, Childbirth and the PuerperiumDiseases of the Musculoskeletal System and Connective TissueDiseases of the Genitourinary SystemPregnancy, Childbirth and the PuerperiumCertain Conditions Originating in the Perinatal PeriodCongenital Malformations, Deformations and ChromosomalAbnormalitiesSymptoms, Signs and Abnormal Clinical and LaboratoryFindingsInjury, Poisoning and Certain Other Consequences of ExternalCauseExternal Causes of MorbidityFactors Influencing Health Status and Contact with -Y98Z00-Z99Chapter 2: Neoplasm (C00-D49) C00-C14 Malignant neoplasms of lip, oral cavity and pharynxC30-C39 Malignant neoplasms of respiratory and intrathoracic organsC43-C44 Malignant neoplasms of skinC773-C75 Malignant neoplasms of thyroid and other endocrine glandsD10-D36 Benign neoplasms, except benign neuroendocrine tumorsD37D37-D48D48 Neoplasms of uncertain behaviorD49 Neoplasms of unspecified behaviorMalignant neoplasm of lip, oral cavity and pharynx:instructed to use additional code to identify:alcohol abuse and dependence (F10-)history of tobacco use (Z87.891)tobacco dependence (F17-)tobacco use (Z72.0)Image source: wikipedia.orgChapter 4: Endocrine, Nutritional andMetabolic Diseases (E00-D89)E00-E07 Disorders of thyroid glandE04.1 Nontoxic single thyroid nodule2012 AOA What You Need to Know About ICD‐10 (KP) 083012v28

8/31/2012Chapter 8: Diseases of the Ear andMastoid Process (H60-H95)H60-H62 Diseases of external earH65-H75 Diseases of middle ear and mastoidH80-H83 Diseases of inner earH90-H94 Other disorders of earH95Intraoperative and postprocedural complications and disordersoff ear andd mastoidt id process, nott elsewherel hclassifiedl ifi dImage source: wikipedia.orgChapter 10: Diseases of theRespiratory System (J00-J99)J00-J06 Acute upper respiratory infectionsJ30-J39 Other diseases of upper respiratory tractAcute vs. chronic conditions (sinusitis, laryngitis, bronchitis, rhinitis)J32.0 Chronic maxillary sinusitisJ32.1 Chronic frontal sinusitisJ32.2 Chronic ethmoidal sinusitisJ32.3 Chronic sphenoidal sinusitisJ32.4 Chronic pansinusitisJ32.8 Other chronic sinusitisSinusitis (chronic) involving more than one sinus but not pansinusitisJ32.9 Chronic sinusitis, unspecifiedImage source: http://www.aaaai.org/Chapter 11: Disease of the DigestiveSystem (K00-K94)K00-K14 Diseases of oral cavity and salivary glandsK20-K31 Diseases of esophagus, stomach andduodenumImage source: wikipedia.org2012 AOA What You Need to Know About ICD‐10 (KP) 083012v29

8/31/2012Chapter 17: Congenital Malformations, Deformationsand Chromosomal Abnormalities (Q00-Q99)Q10-Q18 Congenital malformations of eye, ear, face and neckQ30-Q34 Congenital malformations of the respiratory systemQ35-Q37 Cleft lip and cleft palateChapter 18: Symptoms, Signs and Abnormal ClinicalLaboratory Findings, Nor Elsewhere Classified (R00-R99)R00-R09 Symptoms and signs involving the circulatory andrespiratory systemsR10-R19 Symptoms and signs involving the digestivesystem and abdomenR47R47-R49R49 Symptoms and signs involving speech and voiceExamples:R04.0 EpistaxisR05 CoughR42 Dizziness and giddiness(Light-headedness, Vertigo NOS)Chapter 19: Injury, Poisoning and Certain OtherConsequences of External Causes (S00-T88)S00-S09 Injuries to the headS10-S19 Injuries to the neckT15-T199 Effectsffoff fforeign bbodyd entering throughhhnatural orificeT80-T88 Complications of surgical and medical care,not elsewhere classified2012 AOA What You Need to Know About ICD‐10 (KP) 083012v210

8/31/2012Chapter 20: External Causes ofMorbidity (V00-Y99)Not like the V codes you now know! Classifies environmental events and circumstances asthe cause of injury, and other adverse effects.These codes are intended to be used as secondarydiagnosis codes; the primary diagnosis is the injuryitself (e.g., nasal bone fracture) in Chapter 19.Do a Lot of Trauma?Injuries – mandatory reporting of additional codes fromChapters 19 and 20 when the primary diagnosis is aninjury for a total of 5 diagnosis codes on the first claim. Injury (medical condition) – pathologic vs. traumaticHow it happened – external causePlace of occurrence (Y92.xxx)Activity being performed (Y93.xx)Who patient is (Y99.x)Trauma ExampleExample:Required #1) S02.2xxA Fracture of nasal bones, initial encounter for close fractureRequired #2) How it happened: V00.211A Fall from ice skatesRRequiredi d #3) PlPlace iit hhappened:d Y92Y92.331331 IIce skatingk i rinki k (i(indoor)d ) ((outdoor)d )Required #4) Activity performed: Y93.21 Activity, ice skatingRequired #5) Who the patient is: Y99.0 Civilian activity donefor income or pay[patient works in an ice skating rink]2012 AOA What You Need to Know About ICD‐10 (KP) 083012v211

8/31/2012Chapter 21: Factors Influencing Health Statusand Contact with Health Services (Z00-Z99) Similar to the V codes in ICD-9-CMEncounter for exam (e.g., hearing screening, allergytesting)Genetic susceptibility to diseaseRetained foreign bodyPotential health hazards (e.g., exposure to smoke)Other specific health care (e.g., tracheostomy, encounterfor cosmetic procedure, implanted devices)Do not resuscitate status (Z66)Blood type, body mass indexFamily and personal history (e.g., malignancy)Mapping ICD-9 to ICD-10Beware of “crosswalks” – many codes do not have a1:1 relationshipUUse officialff l resourcesGeneral Equivalence Mappings (GEMS) CMS created General Equivalence Mappings (GEM) to ensureconsistency in national data is maintained.GEMs are a tool to convert data from ICD-9-CM to ICD-10CM and vice versa. Coders refer to this as forward and backward mapping. You can look up an ICD-9-CM code and “map forward” to an ICD10-CM code You can look up an ICD-10-CM code and “map backward” to anICD-9-CM code.GEMs will be updated annually during the transition periodfrom ICD-9-CM to ICD-10-CM.CMS will maintain the GEMs for at least three years afterOctober 1, 2013GEMs are not “crosswalks” but a translator or convertor2012 AOA What You Need to Know About ICD‐10 (KP) 083012v212

8/31/2012ICD-9 to ICD-10 Mapping for ENTICD-9Description381.81 Dysfunction ofEustachiantubeICD-10H69.80 Other specifieddisorders of Eustachiantube, unspecified ear;H6981 Other specifiedH69.81disorders of Eustachiantube, right ear;H69.82 Other specifieddisorders of Eustachiantube, left ear;H69.83 Other specifieddisorders of Eustachiantube, bilateralDocumentation/EducationNeededICD-10 identifies anEustachian tube salpingitis orobstruction. Otherwise allother dysfunctions fall intoother and unspecified codes.In ALL cases the laterality ofthe affected side needs to beidentified for the specificcode.ICD-9 to ICD-10 Mapping for ENTICD-9 Description477.0 Allergic rhinitis,due to pollen;477.9 Allergic tion NeededJ30.0 Vasomotor rhinitis;Specificity as to causeJ30.1 Allergic rhinitis due topollen;J30J30.22 Other seasonal allergicrhinitisJ30.5 Allergic rhinitis due tofood;J30.81 Allergic rhinitis due toanimal (cat) (dog) hair anddanderJ30.9 Allergic rhinitis,unspecifiedICD-9 to ICD-10 Mapping for ENTICD-9Description388.30 Tinnitus,unspecified388.31 SubjectivetinnitusICD-10H93.11 Tinnitus, right ear;H93.12 Tinnitus, left ear;H93.13 Tinnitus, bilateral;H93.19 Tinnitus,unspecified earDocumentation/EducationNeededThe laterality of the affectedside must be documentedand coded.2012 AOA What You Need to Know About ICD‐10 (KP) 083012v213

8/31/2012ICD-9 to ICD-10 Mapping for ENTICD-9Description381.10 Chronic serousotitis media,simple .04 Acute serous otitis, Recurrent acute otitis mediarecurrent, right ear;now has ICD-9 codes – we noH65.05 Acute serous otitis longer have to use “chronicmedia, recurrent, left ear; otitis media”.H65.06 Acute serous otitismedia, recurrent, bilateral; The laterality of the affectedH65.07 Acute serous otitis side must be documentedmedia, recurrent,and coded.unspecified earALERT: Instructional notes exist to use additional code to identify: exposure to environmentaltobacco smoke (Z77.22); exposure to tobacco smoke in the perinatal period (P96.81);history of tobacco use (Z87.891); occupational exposure to environmental tobacco smoke(Z57.31) or tobacco use (Z72.0).ICD-9 to ICD-10 Mapping for ENTICD-9 DescriptionICD-10478.0 Hypertrophy ofnasal turbinatesJ34.3 Hypertrophy ofnasal turbinatesDocumentation/EducationNeededNo further specificityneeded.No separate ICD-10 codefor concha bullosaICD-9 to ICD-10 Mapping for ENTICD-9 DescriptionICD-10476.0 ChroniclaryngitisJ37.0 Chronic laryngitisDocumentation/EducationNeededNo further specificityneeded.2012 AOA What You Need to Know About ICD‐10 (KP) 083012v214

8/31/2012ICD-9 to ICD-10 Mapping for ENTICD-9 DescriptionICD-10780.4 Dizziness andgiddinessR42 Dizziness andgiddinessDocumentation/EducationNeededNo further specificityneeded.ICD-9 to ICD-10 Mapping for ENTICD-9 DescriptionICD-10784.7 EpistaxisR04.0 EpistaxisDocumentation/EducationNeededNo further specificityneeded.ICD-9 to ICD-10 Mapping for ENTICD-9Description389.10 Sensorineuralhearing lossICD-10H90.3 Sensorineuralhearing loss, bilateralH90.41 Sensorineuralhearing loss, unilateral,right ear with unrestrictedhearing on thecontralateral sideH90.42 Sensorineuralhearing loss, unilateral, leftear, with unrestrictedhearing on thecontralateral sideH90.5 Unspecifiedsensorineural hearingDocumentation/EducationNeededLaterality needs to bedocumented.Unilateral hearing lossrequires 5th digit2012 AOA What You Need to Know About ICD‐10 (KP) 083012v215

8/31/2012ICD-9 to ICD-10 Mapping for ENTICD-9DescriptionICD-10474.00 Chronic tonsillitis474.01 Chronic adenoiditis474.10 Hypertrophy oftonsils and adenoids474.11 Hypertrophy oftonsils alone474.12 Hypertrophy ofadenoids aloneJ35.01 ChronictonsillitisJ35.02 ChronicadenoiditisJ35.3 Hypertrophy oftonsils with hypertrophyof adenoidsJ35.1 Hypertrophy oftonsilsJ35.2 Hypertrophy ofadenoidsDocumentation/EducationNeededNo further specificityneeded.ICD-9 to ICD-10 Mapping for ENTICD-9 DescriptionICD-10470J34.2 Deviated nasalseptumDeviated nasalseptumDocumentation/EducationNeededNo further specificityneeded.ICD-9 to ICD-10 Mapping for ENTICD-9-CMICD-10-CM931 Foreignbody, earT16.1xxAForeign body in right ear, initialencounterT16T16.2xxA2 AFForeigni bbodyd iin lleftft ear, iinitialiti lencounterT16.9xxAForeign body in ear, unspecifiedear, initial encounterLocationLateralityPlaceholder “x” toallow A as 7th digit2012 AOA What You Need to Know About ICD‐10 (KP) 083012v216

8/31/2012ICD-10-CM ExamplesICD-9-CM802.0 Fractureof nasal bones,closedICD-10-CMS02.2xxAFracture of nasal bones, initialencounter for closed fractureS02.2xxDFracture of nasal bones, subsequentencounter for fracture with routinehealingS02.2xxGFracture of nasal bones, subsequentencounter for fracture with delayedhealingS02.2xxKFracture of nasal bones, subsequentencounter for fracture with nonunionS02.2xxSFracture of nasal bones, sequelaAreas of Impact in a PracticeManager Policies and proceduresWorking with vendors (EHR,PMIS)Coordinating educationWkflWorkflowInformation Technology Hardware/software upgradesMappingTestingEnsuring providers have toolsto simplify the code selectionprocessFinance BudgetsSystem upgradesEducation/trainingClinical Areas Documentation in medicalrecordABNsOrdering testsChanges to charge ticketsAreas of Impact in a PracticePhysicians Documentation in the medicalrecordIncreased level of specificityOrdering testsCode selection in EHRIdentify the elementsrequired to select specificcodeCoders/Billers May need to betterunderstand anatomy andphysiology for choosingcodesdUnderstand payor policies(eg, LCD, NCD)Workers Compensation/Autocarriers are not required tochange to ICD-10Alert: There are lots of opportunities for potential negative impacts to the practice.Plan, plan and plan again!! Learning something new takes time and effort.2012 AOA What You Need to Know About ICD‐10 (KP) 083012v217


International Classification of Diseases, 9th Edition, Clinical Modification ... Volume 1: Tabular list, chronological list by body system or condition Volume 2: Alphabetic index including neoplasm table Volume 3: Procedural coding system (PCS) Countries Th