Transcript ICD-10

ICD-10
Getting There…..
Cardiology
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Claims for ambulatory and physician services provided on or after 10/1/2015 must
use ICD-10-CM diagnosis codes.
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Hospital inpatient claims for discharges occurring on or after 10/1/2015 must use
ICD-10-CM diagnosis codes.
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CPT Codes will continue to be used for physician inpatient and outpatient services
and for hospital outpatient procedures.
•
ICD-10-PCS – a NEW procedure coding classification system, must be used to
code all inpatient procedures on Facility Claims for discharges on or after 10/1/15.
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ICD-9-CM codes must continue to be used for all dates of services on or before
9/30/2015.
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Further delays are not likely.
What Physicians Need To Know
ICD-9-CM Diagnosis Codes
3 to 5 digits
Alpha “E” & “V” – 1st Character
No place holder characters
ICD-10-CM Diagnosis Codes
7 digits
Alpha or numeric for any character
Include place holder characters (“x”)
Terminology
Similar
Index and Tabular Structure
Similar
Coding Guidelines
Somewhat similar
Approximately 14,000 codes
Approximately 69,000 codes
Severity parameters limited
Extensive severity parameters
Does not include laterality
Common definition of laterality
Combination codes limited
Combination codes common
ICD-9 vs ICD-10 Diagnosis Codes
Clinical Area
ICD-9 Codes
ICD-10 Codes
Fractures
747
17,099
Poisoning and Toxic Effects
244
4,662
1,104
2,155
292
574
Diabetes
69
239
Migraine
40
44
Bleeding Disorders
26
29
Mood Related Disorders
78
71
Hypertensive Disease
33
14
End Stage Renal Disease
11
5
7
4
Pregnancy Related Conditions
Brain Injury
Chronic Respiratory Failure
Number of Codes by Clinical Area
• The role of the provider is to accurately and specifically
document the nature of the patient’s condition and treatment.
• The role of the Clinical Documentation Specialist is to query
the provider for clarification, ensuring the documentation
accurately reflects the severity of illness and risk of mortality.
• The role of the coder is to ensure that coding is consistent with
the documentation.
• Good documentation….
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Supports proper payment and reduces denials
Assures accurate measures of quality and efficiency
Captures the level of risk and severity
Supports clinical research
Enhances communication with hospital and other providers
It’s just good care!
The Importance of Good Documentation
Inadequate Documentation
Required ICD-10 Documentation
Received in transfer from Medical
Center A with AMI. Hx tobacco use
and obesity.
Received in transfer from Medical
Center A with LAD STEMI. Hx
tobacco dependence with cessation x
6 months, morbid obesity d/t excess
calories, BMI of 42.5.
Received Alteplase prior to transfer.
Coded upon arrival.
Received Alteplase 6 hrs prior to
transfer.
Cardiac arrest on arrival secondary
to MI.
Inadequate vs. Adequate Documentation
Example 1: Acute Myocardial Infarction
Inadequate Documentation
Required ICD-10 Documentation
Coronary artery disease with angina,
tobacco dependence, abnormal
exercise eval.
Coronary artery disease with unstable
angina, cigarette dependence,
abnormal exercise eval.
Cardiac cath reveals partial occlusion
Cardiac cath reveals atherosclerotic
prox left anterior descending artery.
partial occlusion native prox left
Successful PCI with drug eluting stent. anterior descending artery with lipid
rich plaque. Successful PCI with
drug eluting stent.
Inadequate vs. Adequate Documentation
Example 2: Atherosclerosis of Coronary Vessels
Inadequate Documentation
Required ICD-10 Documentation
CARDIOVASCULAR:
Cardiomyopathy
CARDIOVASCULAR:
Congenital cardiomyopathy
OTHER PROBLEMS:
Thyroid, hepatitis
OTHER PROBLEMS:
Thyrotoxicosis with uninodular
goiter, no crisis or storm, chronic
hepatitis B with delta-agent.
Inadequate vs. Adequate Documentation
Example 3: Cardiomyopathy
Inadequate Documentation
Required ICD-10 Documentation
BRIEF HISTORY:
BRIEF HISTORY:
43 year old positive for tobacco use
and markedly positive family history
of coronary artery disease. EKG
showing old MI and atrial flutter. He
has had episodes of angina and
coronary angiography has been
recommended.
43 year old with chewing tobacco
dependence currently having
withdrawal and markedly positive
family history of coronary artery
disease. EKG showing old anterior
septal MI and atypical atrial flutter.
He has had episodes of unstable
angina and coronary angiography has
been recommended.
Inadequate vs. Adequate Documentation
Example 4: Dysrhythmias
Key Requirements for Documenting Cardiovascular Diseases
• The acuity of the disease (e.g.,
acute, chronic)
• Disease specificity and granularity
(e.g., cardiomyopathy – dilated,
obstructive, or hypertrophic)
• The causal disease, contributory
drug, chemical or non-medical
substance (e.g., cardiac tamponade
due to radiation therapy)
• The manifestation of the disease
(e.g. obstruction of vessels, angina,
heart failure, or renal disease)
• The site of the manifestation (e.g.
the specific coronary vessel
affected by atherosclerosis and
whether or not a bypass or stent
has occurred at this site in the
past.)
• Alcohol, tobacco, or drug use,
abuse, or dependence and their
impact on other disease processes
that are being treated.
With ICD-10, the need for specific and accurate
documentation is increased significantly.
• Sign/symptom and “unspecified” codes have acceptable,
even necessary, uses.
• If a definitive diagnosis has not been established by the
end of the encounter, it is appropriate to report codes for
signs and/or symptoms in lieu of a definitive diagnosis.
• When sufficient clinical information is not known or
available about a particular health condition, it is
acceptable to report the appropriate “unspecified” code.
• It is inappropriate to select a SPECIFIC code that is not
supported by the medical record documentation.
Using Sign/Symptom and Unspecified Codes
Dates
Method
Content
Nov 2014 – Jan 2015
Department
Meetings
Introduction/Overview
Jan 2015 – Mar 2015
Web-based
Overview
Service Specific Documentation
Future Order Entry
Diagnosis Assistant
Mar 2015 – Jun 2015
Classroom
Documenting for ICD10 using
the Electronic Health Record
Jun 2015 – Sep 2015
Web-based
Overview
Documenting Operative and
Procedure Notes for ICD-10-PCS
Training for Physicians
Demonstration
Future Orders & Diagnosis Assistant