WHAT IS NEW IN ICD10 CM 2017 REBECCA

WHAT IS NEW IN ICD-10 -CM 2017 REBECCA H WARTMAN OD HEART OF AMERICA CONTACT LENS SOCIETY FEBRUARY 2017

DISCLAIMERS FOR PRESENTATION 1. All information was current at time it was prepared 2. Drawn from national policies, with links included in the presentation for your use 3. Prepared as a tool to assist doctors and staff and is not intended to grant rights or impose obligations 4. Prepared and presented carefully to ensure the information is accurate, current and relevant 5. No conflicts of interest exist for presenters- financial or otherwise. However, Rebecca is a paid consultant for Eye Care Center OD PA and writes articles

DISCLAIMERS FOR PRESENTATION 6. Of course the ultimate responsibility for the correct submission of claims and compliance with provider contracts lies with the provider of services 7. AOA, AOA-TPC, NCOS, its presenters, agents, and staff make no representation, warranty, or guarantee that this presentation and/or its contents are error-free and will bear no responsibility or liability for the results or consequences of the information contained herein 8. The content of the COPE Accredited CE activity was prepared with assistance from Kara Webb (AOA Staff), Harvey Richman OD, and Doug Morrow OD

AOA THIRD PARTY CENTER CODING EXPERTS Rebecca Wartman OD Douglas Morrow OD Harvey Richman OD

WHAT WE WILL COVER • Overview of ICD-10 -CM • Review of important definitions • Updates for 2017 • Diabetes Codes • ARMD Codes • Glaucoma Codes • Suggested approaches for review of 2017 changes • New Resources of 2017

DO NOT FALL ASLEEP Too important - CMS leniency ended October 2016 Coding MUST be exact

OVERVIEW OF ICD-10 -CM • ICD-10 -CM/PCS 1 st • (International Classification of Diseases, 10 th Edition, Clinical Modification /Procedure Coding System) • ICD-10 -CM for diagnosis coding 2 nd • ICD-10 -PCS for inpatient procedure coding (Hospitals only) • ICD-10 -CM replaces ICD-9 -CM 3 rd D C I f o t ar p y l n O • Does not change use of CPT® in any way ed e n e -10 w

US VERSION OF ICD-10 -CM NOT WORLD HEALTH VERSION ICD-10 -CM owned by World Health Organization BUT ICD-10 -CM code set for use in the United States is maintained by the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC) Thus some different rules will apply for US vs World Health Organization versions of code set www. cdc. gov/nchs/icd 10 cm. htm

ICD-10 -CM STRUCTURE ICD-10 -CM =68, 000 + 3 -7 characters Character 1= alpha (except U) Character 2 = numbers Characters 3 -7=alpha or # Decimal after 3 characters Alpha characters not case-sensitive ICD-10: Dummy placeholder “x” used when need 7 th character

ICD-10 -CM Determine conditions for coding from medical documentation following ICD rules Use Alphabetical Index to locate condition and allocate code Use Tabular Listing to review all coding instructions related to code (e. g. inclusion, exclusion) Use Instruction Manual for any rules regarding selection for reporting mortality/morbidity

OVERVIEW OF ICD-10 -CM ALPHABETICAL INDEX This is where you begin! Can make errors if you do not start here! Alphabetical list of codes from the Tabular List Alphabetical list of terms and corresponding code 1. Index of Diseases and Injury 2. -. . . Index of External Causes of Injury 3. Table of Neoplasms 4. Table of Drugs and Chemicals

OVERVIEW OF ICD-10 -CM ALPHABETICAL INDEX Helpful Hint ØSyndromes under “syndrome” listing • Dry eye syndrome • Not under corneal • Not under lacrimal • Not under ocular • UNDER SYNDROME ØDysfunctions under “dysfunctions” listing ØDegenerations under “degeneration” listing • Macular degeneration • Not under retinal • Not under macula • UNDER DEGENERATION

ICD-10 -CM TERMINOLOGY AND CONVENTIONS ALPHABETIC INDEX EXAMPLE Macula - cornea, corneal —see Opacity, cornea - degeneration (atrophic) (exudative) (senile) —see also Degeneration, macula - - hereditary —see Dystrophy, retina Degeneration, degenerative - macula, macular (acquired) (age-related) (senile) H 35. 30 - - angioid streaks H 35. 33 - - atrophic age-related H 35. 31 - - congenital or hereditary —see Dystrophy, retina

ICD-10 -CM TERMINOLOGY AND CONVENTIONS TABULAR LIST Tabular list →chapters ►body system/condition Divided into categories, subcategories and codes Can ONLY report codes Categories-3 characters • If has no further subdivision is equivalent to code Subcategories - 4 or 5 characters • Each level of subdivision after a category is a subcategory • If no further subdivision is equivalent to a code Codes- 3, 4, 5, 6 or 7 characters • Final level of subdivision • If 7 th character is required invalid without 7 th character • If placeholder needed-X used for code to be valid code

ICD-10 -CM TERMINOLOGY AND CONVENTIONS TABULAR LIST Category Subcategory NOT a code These are final codes Subcategory that is Code

ICD-10 -CM TERMINOLOGY AND CONVENTIONS 7 TH CHARACTERS Certain ICD-10 -CM categories need 7 th character When 7 th character is required →used for all codes within category or as noted in Tabular List instructions The 7 th character must be 7 th character in data field If code requires 7 th character but is not 6 characters long THEN must use placeholder X to fill in empty characters

ICD-10 -CM TERMINOLOGY AND CONVENTIONS INCLUDES NOTES Includes Notes: immediately under three character code title further define or give examples of category content Inclusion terms are list of terms included under some codes Defines when code is to be used May be synonyms of the code title For “other specified” codes is list of various conditions assigned to code BUT not necessarily exhaustive Additional terms found only in Alphabetic Index may also be assigned to a code

ICD-10 -CM TERMINOLOGY AND CONVENTIONS EXCLUDES NOTES Excludes 1 Pure excludes note- meaning “NOT CODED HERE!” Excluded code should never be used at same time as code above Excludes 1 note Used when two conditions cannot occur together (Example: congenital versus acquired form of same condition Excludes 2 Means “Not included here” Excluded condition is not part of condition represented by code, BUT patient may have both conditions at the same time Excludes 2 code acceptable to use when both the code and excluded code occur together

ICD-10 -CM TERMINOLOGY AND CONVENTIONS EXAMPLES Excludes 1 note Excludes 2 note

ICD-10 -CM SEQUENCING ORDER TABULAR NOTES • “In diseases classified elsewhere” codes: • Never permitted to be used as first-listed diagnosis code • Must be used with underlying condition code • Must be listed following the underlying condition • Some manifestation codes do not have “in diseases classified elsewhere” in title • “use additional code” note for the etiology code • “code first” note at the manifestation code • Rules for sequencing apply→ etiology code then manifestation code

ICD-10 -CM TERMINOLOGY AND CONVENTIONS OTHER NOMENCLATURE “Code also” note Instructs that two codes may be required to fully describe condition, but this note does not provide sequencing direction Default codes Listed next to a main term in Alphabetic Index The default code represents condition most commonly associated with main term or is the unspecified code for the condition If condition is documented in medical record (for example, appendicitis) without any additional information, such as acute or chronic, the default code should be assigned

WE ARE READY TO CONQUER THIS 2017 ICD-10 -CM MOUNTAIN!!

CHANGES TO THE DIABETES CODES 2017 2016 g n i rd 2017 More 2º code s All DM patients on DM medication must use 2º code: Z 79. 4 or Z 79. 84 Note: does not apply to E 10 only Ne o W w

CHANGES TO THE DIABETES CODES 2017 2016 2017 NEW: 7 th character Per Eye

CHANGES TO THE DIABETES CODES 2017 Diabetic coding changes are for all the categories No medication code for Type 1 only

CHANGES TO THE DIABETES CODES 2017 2016 2017 Long term Insulin use – No change New code for oral DM medications Both used when appropriate In addition to DM diagnosis

CHANGES TO THE DIABETES CODES 2017 2016 2017 Several other description were added to E 11. 35 subcategory. HOWEVER These changes were originally omitted from the initial recorded webinar

CHANGES TO DRY ARMD CODES 2017 2016 2017 Beware: 7 th character Now per eye

CHANGES TO DRY ARMD CODES: STAGING DRY ARMD No AMD: >5 small (<63 microns) drusen Mild AMD: Multiple small drusen or some intermediate (63 -124 microns) drusen Intermediate AMD: Extensive intermediate drusen, >1 large (>125 microns) drusen, or non-central geographic atrophy Advanced AMD: Central geographic atrophy or neovascularization causing vision loss (<20/32) in one eye www. retinalphysician. com

DRY ARMD CODING EXAMPLE : OD AND OS Advanced AMD OD H 35. 3122 Intermediate AMD OD 2 = OS 2 = Intermediate www. goodhopeeyeclinic. org. uk H 35. 3113 avclinic. com 1 = OD 3 = Advanced Both codes necessary to describe patient H 35. 3113 and H 35. 3122

CHANGES TO WET ARMD CODES 2017 2016 2017 BEWARE: Similar change for Wet ARMD 7 th character Now per eye

CHANGES TO WET ARMD CODING EXAMPLE H 35. 3221 2 = OS 1 = Active choroidal neo H 35. 3213 1 = OD 3 = inactive scar retinagallery. com Both codes necessary to describe patient H 35. 3213 and H 35. 3221 webeye. ophth. uiowa. edu

CHANGES TO GLAUCOMA CODING 2017 2016 2017 POAG now PER EYE!! Staging remains the same

CHANGES TO GLAUCOMA CODING 2017 2016 Code 1 st No change 201 7 2017 Removed DM from Excludes 1 Added an Excludes 2 note for glaucoma in DM

CHANGES TO CRVO CODES 2017 2016 2017 NOTE!! 7 th Character Still Per Eye

CRVO CODING EXAMPLE 1 = OD H 34. 8110 lifeinthefastlane. com 0 = With ME

CRVO CODING EXAMPLE Well compensated CRVO H 34. 8122 2 = OS 2 = Old CRVO emedicine. medscape. com

CHANGES TO BRVO CODING 2016 2017 Similar to CRVO New 7 th Character Still Per Eye

BRVO CODING EXAMPLES Left BRVO = H 34. 832 +7 th H 34. 8320 en. wikipedia. org 0 = with ME H 34. 8322 2 = Stable, old emedicine. medscape. com

CHANGES TO AMBLYOPIA CODES 2017 Brand new subcategory within Amblyopia

POSTPROCEDURAL CODE CHANGES 2017 2016 2017 ALL of these codes are per eye for 2016 and 2017 ONLY Subcategories listed here

OTHER CODE CHANGES OF NOTE 2017 2016 2017 Also for: I 69. 11… I 69. 21… I 69. 31… I 69. 81… I 69. 91…

OTHER CODE CHANGES OF NOTE 2017 2016 20 17

OTHER CODE CHANGES OF NOTE 2017 Chapter 20: Wording changes added some Excludes 1 and Excludes 2 codes Review any of these codes used for changes from 2016

ICD-10 -CM RESOURCES American Optometric Association www. aoa. org/coding AOA Coding Today http: //aoa. codingtoday. com/ CDC ICD-10 -CM Official USA site http: //www. cdc. gov/nchs/icd 10 cm. htm 2017 release of ICD-10 -CM has all the downloads CMS ICD-10 -CM information https: //www. cms. gov/Medicare/Coding/ICD 10/index. html X World Health X but Use for general training only http: //apps. who. int/classifications/apps/icd 10 training

EQUIP YOUR OFFICE FOR ICD-10 CHANGES • From AOA Marketplace • Preorder 2017 AOA Coding Bundle - available Sept. 15 • Includes: • 2017 AOA Codes for Optometry (ICD-10) • 2017 ICD-10 -CM AOA Express Mapping Card (not sold separately) • 2017 AMA CPT Professional Edition • Additional ICD-10 resources from AOA: http: //www. aoa. org/optometrists/tools-and-resources/medicalrecords-and-coding/icd-10

SUCCESS!! HAPPY CODING!!

QUESTIONS? ? ? Submit all ICD-10 -CM questions and any coding questions to: https: //www. aoa. org/ask-the-coding-experts

THANK YOU!!