Introducing ICD10 CM John A Mc Greal Jr

Introducing ICD-10 -CM John A. Mc. Greal Jr. , O. D. Missouri Eye Associates Mc. Greal Educational Institute Excellence in Optometric Education

John A. Mc. Greal Jr. , O. D. Missouri Eye Associates n 11710 Old Ballas Rd. n St. Louis, MO. 63141 n 314. 569. 2020 n 314. 569. 1596 FAX n mcgrealjohn@gmail. com n JAM

Understanding the Basics & Getting Ready Differences between ICD-9 & ICD-10 n How the ICD-10 CM is laid out n How to Use the Alphabetic Index n How to Use the Tabular List n How to Use the Index of injuries n How to Use the Table of Drugs & Chemicals n How to Understand new Abbreviations n How to Use Placeholders n How to Use Code Extensions n Understand laterality n JAM

The Lilliputians Take Control of the Healthcare Giant n n n n ICD-9 has 13, 000 codes ICD-10 has 140, 000 Effective date – October 1, 2014 Transition will be difficult as there is little in common with our current coding paradigms Requires doctors, not staff to do the specific coding Every artery and nerve has been issued a number Number of physicians = 800, 000/ 35% own their own practice (Source Accenture with data from Medical Group management Assoc and AMA) JAM

Introduction to ICD-10 -CM n Clinical modification of WHO’s ICD-10 – Clinical emphasizes the intent to serve as a tool in classification of morbidity data for indexing, medical records care review, medical & ambulatory care programs, health statistics n Better understand complications n Better design robust algorithms n Track outcomes – – – To describe the “clinical” picture the codes must be more precise Far exceeds ICD-9 in number of concepts and codes Disease classification expanded to include health related conditions and provides greater specificity JAM

Improvements Over ICD-9 n Index MUCH longer – Ex 28 pterygium, 69 conjunctivitis, 12 astigmatism codes Adds information relevant to ambulatory & MC encounters n Expanded injury codes n Combination diagnosis/symptom codes n Addition of 6 th & 7 th characters n Incorporates common 4 th & 5 th digit subclassification n Laterality n Allows further expansion n JAM

Organization of ICD-10 -CM n Alphabetical Index – – – n Alphabetical list of terms and corresponding codes Index of Diseases & Injury Table of Neoplasm Table of Drugs & Chemicals Index of External causes of injury Tabular List – – – Chronological list of codes Divided into chapters Based on body systems JAM

Tabular List Detail n n n Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Infectious and parasitic diseases Neoplasms Diseases of Blood and blood forms Endocrine, nutritional, metabolic Mental & behavioral Nervous system Eye & adnexa Ear and mastoid Circulatory system Respiratory system Digestive system JAM

Tabular List Detail n Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Chapter 18 n Chapter 19 n Chapter 20 Chapter 21 n n n n Skin & subcutaneous Musculoskeletal Gastrointestinal Pregnancy & childbirth Conditions of perinatal period Congenital / Malformations Signs/Symptoms/abnormal clinical laboratory findings Injury, Poisoning, consequences of external causes External causes of morbidity Factors influencing health status & contact JAM with health services

Chapter 7: Diseases of Eye/Adnexa Detail n n n H 00 -H 05 H 10 -11 H 15 -H 22 H 25 -H 28 H 30 -H 36 H 40 -H 42 H 43 -H 44 H 46 -H 47 H 49 -H 52 H 53 -H 54 H 55 -H 57 H 59 Eyelid, lacrimal, orbit Conjunctiva Sclera, cornea, iris, ciliary body Lens Choroid/retina Glaucoma Vitreous & globe Optic nerve & pathways Ocular muscles, accomodation, refraction Visual disturbances and blindness Other disorders eye & adnexa Intra-operative & post-procedural complications. JAM

Format & Structure Tabular list contains categories, subcategories & codes n Characters may be letter or numbers n Categories are 3 characters n – Character 1 is alpha n All – – – letter used except U Character 2 is numeric Character 3 -7 are alpha or numeric Use decimal after 3 characters Subcategories are 4 or 5 characters n Codes may be 3, 4, 5, 6 or 7 characters n Laterality specific n JAM

Placeholder Characters n Character “X” used as a placeholder – – – Allows for future expansion Where it exists it must be used to be valid Ex S 05. 8 x 1 A JAM

Placeholder Characters n Code extensions (seventh character) have been added for injuries and consequences of external causes (S 00 -T 88), to identify the encounter – – – “A” Initial encounter – receiving active treatment “D” Subsequent encounter-use after Pt received active treamt “S” Sequelae-used for complications/conditions arise as result of injury n. S only added to injury code, not sequela code n Sequela code first, followed by injury code – Ex: S 30 superficial injury of abdomen n S 30. 810, code requires extension to indicate episode of care n S 30. 810 A JAM

7 th Character Certain ICD-10 -CM categories have 7 th digit characters n Applicable 7 th character is required within the category n If code requires 7 th character and is not 6 characters, a placeholder “X” must be used to fill empty character n Ex: S 05 Injury of eye and orbit, subsequent visit n – S 05. 00 n Looking it up you find “x 7 th” meaning no 6 th character exists but there is a 7 th character mandatory – S 05. 00 x. D JAM

Laterality For bilateral sites, final character of code indicates laterality n Unspecified side codes if side not identified in medical record n If no bilateral code provided and condition is bilateral n – n Assign separate codes for both left and right Ex: – – H 43. 811 Vitreous degeneration, right side H 43. 812 Vitreous degeneration, left side H 43. 813 Vitreous degeneration, bilateral H 43. 819 Vitreous degeneration, unspecified JAM

Abbreviations NEC “not elsewhere classifiable” n NOS “not otherwise specified” n “and” represents and / or n “code also” instructs two codes may be required n [ ] Brackets identify manifestation codes n ( ) parenthesis terms are non essential modifiers n : Colon incomplete term needing more modifiers n JAM

Excludes Codes n Excludes 1 – pure excludes notes – – Means “NOT CODED HERE” Indicated code exclude should never be used same time as code above it n Ex n congenital vs acquired condition Exclude 2 – – “Not included here” Condition excluded is not part of the condition represented by the code JAM

Etiology / Manifestation Convention Some conditions have underlying etiology and multiple body system manifestations due to the etiology n Coding convention requires underlying condition be sequenced first, followed by manifestation n – – n “use additional code” note exists at etiology codes “code first” note at the manifestation code Ex; Dementia in Parkinson’s disease – – Code G 20 represents etiology [F 02. 80 or F 02. 81] represents manifestation of dementia n With behavioral or without behavioral disturbances JAM

General Coding Guidelines n Locating a code in ICD-10 -CM – – Locate term in Alphabetic Index Then verify code in the Tabular List Read and be guided by instructional notations appearing in both Essential to use BOTH n Alphabetic index doesn’t always provide FULL code n Need Tabular List to assign laterality and 7 th character JAM

Sign & Symptoms Codes that describe symptoms and signs, as opposed to diagnosis n Are accepted when a definitive diagnosis has not been established n Chapter 18 n JAM

Acute & Chronic Conditions n Acute & Chronic – – n Code acute or chronic If condition is both, code both with acute first Late Effects (Sequela) – – – Residual effect after acute phase of illness or injury has terminated No time limit Coding requires 2 codes sequenced in order n Condition first n Late effect code second JAM

External Cause Codes Chapter 20 n Use full range of external cause codes to completely describe: n – – – the cause, the intent, the place of occurrence, and if applicable the activity of the patient at the time of the event and the patient’s status for all injuries and other health conditions due to an external cause JAM

Z Codes Z codes are analogous to the ICD-9 CM “V” codes n Most rules of V codes transfer over to the use of Z codes n Used to describe routine examinations of many varieties n Each with different codes n Ex Z 00 Encounter for general examination without complaint, suspected or reported diagnosis n Ex Z 01 Encounter for other special examination without complaint, suspected or reported diagnosis n JAM

Steroid Responder Visit Scenario – Old Way 57 YOM with BRVO, s/p focal laser, IVDex, elevated IOP, OS n CPT 99214 n ICD: 365. 04 n JAM

Steroid Responder Visit Scenario – New Way n n n 57 YOM with BRVO, s/p focal laser, IVDex, elevated IOP, OS CPT 99204 ICD: T 38. 0 x 5 – – – n T 38. 0 x 1 = accident T 38. 0 x 2 = self harm T 38. 0 x 3 = assault T 38. 0 x 4 = undetermined T 38. 0 x 5 = adverse effect T 38. 0 x 6 = under-dosing ICD: H 40. 62 Glaucoma secondary to drugs, left eye – Note states “code first” T 36 -T 50 to identify drug JAM

Notable & Quotable “…Jonathan Swift, where are you today? The Lilliputians are tying down the healthcare giant with 140, 000 threads and calling it a “fundamental advance” MD Tucson AZ n “…this has everything to do with the government forcing more expense, inefficiency and reimbursement delays on already dispirited practitioners…many of my burned out colleagues will gladly follow me into early retirement if this continues” MD Meadville, PA n ‘…if this is a small taste of the increasing role of government involvement in healthcare, it is a wonder that any young person has any interest in a career in medicine” SDC, Pittsburgh, PA JAM n

Notable & Quotable “…this is government medicine causing the addition of more ancillary office personnel, more intrusion into the patient’s privacy, more paperwork hours for doctors and one more nail in the coffin of private practice” MD Newport OR n “. . every contact will require one of 140, 000 codes in order to submit a bill. How much time will medical providers spend choosing the right one, how much will that raise overall medical costs and why is it all worth it? MD Portland OR n “. . doctors closing their practices in droves; is there a code for that? MD Niceville FL JAM n

Notable & Quotable “…is there an app for that? ? ” OD Los Angeles, CA n “. . the Mayan Calendar says the world comes to an end the October before this becomes effective , so don’t worry about any of this. . ” OD Belize City, Belize n JAM

Thank you Missouri Eye Associates Mc. Greal Educational Institute Excellence in Optometric Education