Transcript ICD10

ICD-10-CM
What Do These Items Have
In Common?
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Killer Bees
1984
Y2k
Ice-Free Polar Cap by 2013
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Predictions That Never Came True
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Killer Bees
Expected to reach the U.S. in the 1980s, but delayed
10 years.
"The Swarm": A huge swarm of deadly African bees
spreads terror over American cities by killing
thousands of people.
Weekly Reader.
By 2013, the number of deaths is minuscule. The
Centers for Disease Control doesn’t find enough to
make a separate category for killer-bee-related
deaths. 2013: 1 death in Central Texas.
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1984
Orwell’s vision of a post-atomic dictatorship in which
every individual would be monitored ceaselessly by
means of the telescreen.
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Y2k
Predictions of a Y2K computer bug; it was to crash
many computers, and malfunctions would cause major
catastrophes worldwide and society would cease to
function.
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Ice-Free Polar Cap in 2013
In 2007, British Broadcasting Corporation reported the
Arctic would be ice-free in summer 2013, citing U.S.
scientist Wieslaw Maslowski. (Naval Post Graduate School)
Al Gore cited Maslowski's analysis in his acceptance
speech at the Nobel Peace Prize ceremony in 2007.
In summer 2013, the Arctic had 533,000 more square
miles of ice than the same time in 2012 – a 29%
increase.
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ICD-10 Predictions
"The implementation of ICD-10 will be the most
significant, costly event that we will experience"
(J.Rumpakis, Review of Optometry 1/15/09)
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ICD-10 Predictions
"To upgrade to ICD-10 will cost a small
practice (3 docs) $83,290”
(Nachimson Advisors)
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ICD-10 Predictions
"The cost will be up to 10 times more than the $600
per physician that the U.S Dept. of Health & Human
Services has assumed"
(American Academy of Professional Coders)
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ICD-10 Predictions
"The cost of switching to ICD-10 will be about $20"
(Alan Homestead OD)
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What Is ICD-10-CM
International Classification of Diseases,
Tenth Revision,
Clinical Modification
General information:
www.cdc.gov/nchs/icd/icd10cm.htm
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Who Created
National Center for Health Statistics
(under Centers for Disease Control and Prevention)
developed & maintains ICD-10-CM
Who created & owns CPT?
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Who Affected
Everyone covered by HIPAA, including providers and
payers who do not deal with Medicare claims.
Claims submitted electronically to any payer.
HIPAA = Health Insurance Portability and Accountability Act
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Why
Better data for:
– Measuring quality, safety, and efficacy of care
– Designing payment systems & processing claims for payment
– Conducting research, epidemiological studies, and clinical trials
– Setting health policy
– Operational & strategic planning & designing healthcare
delivery systems
– Monitoring resource utilization
– Improving clinical, financial, and administrative performance
– Preventing and detecting healthcare fraud and abuse
– Tracking public health and risks
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Why
In 2012, AMA advocated to halt of implementation of
ICD-10.
AMA CEO James Madara:
the move will "create significant burdens on the practice
of medicine with no direct benefit to individual patient
care."
What was the AOA position?
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When
In 2009, Dept of Health and Human Services
published regulation requiring replacement of ICD-9CM with ICD-10-CM.
Implementation Date: Oct 1, 2014
What does “Implementation Date” mean?
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When
IMPORTANT
Claims with Date Of Service before Oct 1, 2014 must
use ICD-9.
Claims with Date Of Service Oct 1, 2014 (or later)
must use ICD-10.
Claims for services provided before October 1, 2014
must use ICD-9 even if they are submitted after the
compliance date.
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When
"After the compliance date, ICD-9 codes will not be
accepted and any transactions with ICD-9 codes will
be rejected."
American Medical Association
False.
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ICD-9 vs. ICD-10
ICD-10 code can contain more than one diagnosis –
called combination codes.
Example:
E11.311
Type 2 diabetes mellitus with unspecified diabetic
retinopathy with macular edema
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ICD-9 vs. ICD-10
Combined diagnosis/symptom codes.
More specificity (longer code) to identify etiology,
anatomic site, severity.
Laterality.
3 - 7 characters (ICD-9 = 3 to 5 characters).
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Examples
Most eye codes start with
“H”
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Examples
367.9 Unspecified disorder of refraction & accomodation
comparable to
H52.7 Unspecified disorder of refraction
(no laterality)
(myopia, hyperopia, astigmatism: all have laterality)
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Examples
365.00 Preglaucoma, unspecified
comparable to
H40.001
H40.002
H40.003
H40.009
Preglaucoma,
Preglaucoma,
Preglaucoma,
Preglaucoma,
unspecified,
unspecified,
unspecified,
unspecified,
(1 = right, 2 = left, 3 = bilateral)
(9 is not "unspecified" as general rule)
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right eye
left eye
bilateral
unspecified eye
Examples
366.10 Senile cataract
comparable to
H25.9 Unspecified age-related cataract
(no laterality)
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Examples
366.16 Nuclear sclerosis
comparable to
H25.10
H25.11
H25.12
H25.13
Age-related
Age-related
Age-related
Age-related
nuclear
nuclear
nuclear
nuclear
cataract,
cataract,
cataract,
cataract,
(1 = right, 2 = left, 3 = bilateral)
(0 is not "unspecified" as general rule)
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unspecified eye
right eye
left eye
bilateral
Examples
362.51 Nonexudative senile macular degeneration, dry
comparable to
H35.31 Nonexudative age-related macular degeneration
(no laterality)
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Examples
Symptoms
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Examples
379.91 Pain in or around eye
comparable to
H57.10
H57.11
H57.12
H57.13
Ocular
Ocular
Ocular
Ocular
pain,
pain,
pain,
pain,
unspecified eye
right eye
left eye
bilateral
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Examples
784.0 Headache
comparable to
R51 Headache
(no laterality)
(R = Symptoms, Signs, Abnormal Findings)
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Examples
250.00 Diabetes mellitus without mention of
complication, type 2 or unspecified type, not stated as
uncontrolled
comparable to
E13.9 Other specified diabetes mellitus without
complications
(E = Endocrine, nutritional, metabolic disease)
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Examples
250.50 Diabetes with opthalmic manifestations, type 2 or
unspecified type, not stated as uncontrolled
comparable to
E13.8 Other diabetes mellitus with unspecified
complications
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Examples
362.01 Background diabetic retinopathy
comparable to
E13.39 Other specified diabetes mellitus with other
diabetic ophthalmic complication
(many many choices)
(was in eye section, now in diabetes section)
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Examples
918.1 Abrasion, cornea
comparable to
S05.00XA Injury of conjunctiva and corneal abrasion
without foreign body, unspecified eye, initial encounter
or
S05.00XD Injury of conjunctiva and corneal abrasion
without foreign body, unspecified eye, subsequent
encounter
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Examples
S = Injury, poisoning and certain other consequences of
external causes
”5th” character:
0 = unspecified eye
1 = right eye
2 = left eye
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Examples
“6th” character:
X – space saver
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Examples
“7th” character is to be added to S05 codes
A - initial encounter
D - subsequent encounter
S – sequela
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Examples
930.0 Foreign body, cornea
comparable to
T15.00XA Foreign body in cornea, unspecified eye, initial
encounter
or
T15.00XD Foreign body in cornea, unspecified eye,
subsequent encounter
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Examples
T = Injury, poisoning & certain other consequences of
external causes
”5th” character:
0 = unspecified eye
1 = right eye
2 = left eye
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Examples
“6th” character:
X = space saver
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Examples
“7th” character is to be added to T15 codes
A - initial encounter
D - subsequent encounter
S – sequela
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Examples
V58.69 Long term use of other medications
comparable to
Z79.899 Other long term drug therapy
(Z = Factors influencing health status and contact with health
services
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How To Find a Code
Crosswalking with:
General Equivalency Mappings (GEMs)
Maps ICD-9 to ICD-10 & vice versa.
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How To Find a Code
GEMs “attempt to find corresponding codes between
the two code sets”.
GEMs do not provide an exact crosswalk between
codes.
An exact one-to-one match of ICD-9 and ICD-10 codes
cannot be made.
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How To Find a Code
GEM:
www.cdc.gov/nchs/icd/icd10cm.htm
File w/ 2 columns
Other sources:
www.aapc.com/icd-10/codes
Enter ICD-9 or ICD-10 code, it finds comparable code
www.icd10data.com
Alphabetical and numeric converter.
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How To Find a Code
Or
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How To Find a Code
Stat ICD-10 app
Free
$20
Alphabetical search
Save frequently used codes
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How To Find a Code
Create document w/commonly used ICD-9s
Cross reference ICD-9’s w/
GEMs or AAPC website.
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Where To Get ICD-10-CM
www.cdc.gov/nchs/icd/icd10cm.htm
Download
ICD-10-CM PDF Format
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