ICD-10
Getting There…..
Pulmonary 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.
•
ICD-9-CM codes must continue to be used for all dates of services on or before
9/30/2015.
•
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….
•
•
•
•
•
•
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
Patient received via ambulance,
multi stab wounds torso & hands.
Stabbed repeatedly by husband at
school.
Patient received via ambulance, multi
stab wounds bilateral anterior &
posterior torso & both hands. Stabbed
repeatedly with hunting knife by
husband at school where she worked.
Hemopneumothorax &
subcutaneous emphysema. Chest
tube placement.
Bilateral hemopneumothorax &
subcutaneous emphysema. Bilateral
chest tube placement.
Stabilized to OR.
Stabilized, to OR.
Inadequate vs. Adequate Documentation
Example 1: Pneumothorax
Inadequate Documentation
Required ICD-10 Documentation
38-year-old female presented with
fever, dyspnea, toothache & chest
pain. Oral exam reveals significant
periodontal disease.
38-year-old female presented with fever,
dyspnea, toothache & chest pain. Oral
exam reveals significant periodontal
disease.
Elevated C-reactive protein &
WBC. CT demonstrates large PE.
Elevated C-reactive protein & WBC. CT
demonstrates large PE.
Dx: Pulmonary Embolism
Dx: Acute septic pulmonary embolism
secondary to cytomegalovirus. No cor
pulmonale.
Inadequate vs. Adequate Documentation
Example 2: Pulmonary Embolism
Inadequate Documentation
Required ICD-10 Documentation
78-year-old male admitted with
respiratory failure. ABGs showed
respiratory acidosis. Long-standing
history of COPD & asthma with
exacerbation. Hx tobacco abuse. O2
use.
78-year-old male admitted with acute
on chronic respiratory failure. ABGs
showed hypoxia & hypercapnia.
Long-standing history of COPD &
moderate persistent asthma with
exacerbation of both. Nicotine
dependent, smokes 3 PPD despite
O2 use.
Found to be in atrial flutter.
Found to be in atypical atrial flutter.
Inadequate vs. Adequate Documentation
Example 3: Respiratory Failure
Inadequate Documentation
Required ICD-10 Documentation
Admit for left total knee replacement.
Pneumonia. Now septic. Blood
cultures positive.
Admit for left total knee replacement.
Post op day #6. Staph aureus
pneumonia. Now septic with shock.
Blood cultures positive for Staph
aureus.
Adult respiratory distress syndrome
requiring vent support with increased
PEEP.
B/P down to 73/45, Swan placed.
Adult respiratory distress syndrome
secondary to sepsis requiring vent
support with increased PEEP.
B/P down to 73/45, Swan placed.
Inadequate vs. Adequate Documentation
Example 4: Sepsis
Inadequate Documentation
Required ICD-10 Documentation
42-year-old with chronic kidney
disease, HTN, & diabetes.
42-year-old on transplant list with
ESRD on dialysis, HTN, IDDM type
2 with nephropathy & neuropathy.
Hbg & Hct decreased, transfuse 2 units
PRBCs.
Chronic kidney disease related iron
deficiency anemia, transfuse 2 units
PRBCs.
I12.9 Needed
Hypertensive
Chronic Kidney Disease, NOS
improvements:
E11.9
Type
2 Diabetes
Mellitus
Stage,
transplant
status,
and Without Complications
N18.9
Chronic
Kidney Disease,
related
or contributing
disease.Unspecified (Stage)
E11.21
I112.0
N18.6
Z99.2
E11.40
D63.1
Z76.82
Type 2 diabetes mellitus with diabetic nephropathy
Hypertensive End Stage Renal Disease
Chronic Kidney Disease requiring chronic dialysis
Dependence on Renal Dialysis
Type 2 diabetes mellitus with diabetic neuropathy, unspecified
Anemia in chronic kidney disease
Awaiting Organ Transplant Status
Inadequate vs. Adequate Documentation
Example 5: Chronic Kidney Disease
• 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 – Feb 2015 Dept. Meetings
ICD-10 Introduction/Overview
Feb 2015 – Mar 2015
On-line/Classroom
Future Order Entry
Diagnosis Assistant
Feb 2015 – Jul 2015
Web-based
ICD-10-CM Overview &
Service Specific Documentation
Mar 2015 – Jun 2015
Classroom
Physician Playbooks/
Documenting for ICD10 using
the Electronic Health Record
Jul 2015 – Sep 2015
Web-based
Documenting Operative and
Procedure Notes for ICD-10-PCS
Training for Physicians
Demonstration
Future Orders & Diagnosis Assistant