Transcript ICD-10

ICD-10
Getting There…..
Emergency Medicine
•
Claims for ambulatory and physician services provided on or after 10/1/2015 must
use ICD-10-CM diagnosis codes.
•
Hospital inpatient claims for discharges occurring on or after 10/1/2015 must use
ICD-10-CM diagnosis codes.
•
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
Unconscious and intubated on
arrival to ED. Glasgow scores
low.
Unconscious and intubated on arrival to ED.
Glasgow scores on ED arrival:
CT scan revealed fractures and
hemorrhage.
Eyes = 1
Verbal = 1
Motor = 2
CT scan revealed displaced fracture of left
calvarium with left frontoparietal
intraparenchymal hemorrhage.
Inadequate vs. Adequate Documentation
Example 1: Altered Mental Conditions
Inadequate Documentation
Required ICD-10 Documentation
7 year old female with asthma presents
to ED in resp distress. Tachycardic &
tachypneic, audible in & out wheeze,
02 sat 63% on room air.
7 year old female with mild
intermittent asthma presents to ED in
resp distress d/t status asthmaticus.
Tachycardic & tachypneic, audible in
& out wheeze, 02 sat 63% on room
air.
Mother reports home inhaler and
nebulizers used but didn’t help.
Mother reports home inhaler and
nebulizers used but didn’t help.
Dad smokes near child.
Inadequate vs. Adequate Documentation
Example 2: Asthma
Inadequate Documentation
Required ICD-10 Documentation
IMPRESSION:
IMPRESSION:
1. Epilepsy
1. Well controlled, cryptogenic left
temporal lobe epilepsy with complex
partial seizures, no status
epilepticus.
Inadequate vs. Adequate Documentation
Example 3: Epilepsy
Inadequate Documentation
Required ICD-10 Documentation
PREGNANCY/BIRTH:
PREGNANCY/BIRTH:
Maternal depression, psychiatric
disorder, diabetes, tobacco use.
Maternal recurrent moderate
depression, borderline
schizophrenia, pre-pregnancy type I
diabetes, daily cigarette dependence
all complicating 2nd trimester
pregnancy.
Inadequate vs. Adequate Documentation
Example 4: Pre-existing Conditions
Key Requirements for Documention
• Indicate complications related to a • List any condition suspected to be
definitive diagnosis (e.g., headache
of a psychosomatic nature (e.g.,
secondary to hypertension).
anxiety-induced chest pain).
• Identify any conditions caused from • Identify signs, symptoms, or
the use of alcohol, drugs,
conditions necessitating diagnostic
medications, or other
services (e.g., syncope, chest pain,
environmental influences (e.g.,
abdominal pain).
MVA, patient with alcohol
intoxication).
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