Puerto Rico
ICD 10: The Road Forward
Agenda
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ICD-10 Overview
ICD-10 Documentation
Examples
Implementation
Putting into Practice
Resources
2
Overview
Final Rule Issued
 On July 31st, 2014, The U.S. Department of
Health and Human Services (HHS) issued a
rule finalizing Oct. 1, 2015 as the new
compliance date.
4
Now is the Time to Prepare
Compliance Date – Oct. 1, 2015
ICD-10 Go Live
October 1, 2015
Jan 2015
End-to-End Testing
Jul 1 – Dec 31, 2014
Build and Maintain
Momentum
Jul
2014
Aug
Sep
Oct
Nov
Apr 2015
End-to-End Testing
Jul 2015
End-to-End Testing
Oct 1, 2015 – Feb 29, 2016
Post-Implementation
Activities
Training
Dec
Jan
2015
Feb
Mar
Apr
May
Jul 1, 2014 – Sep 30, 2015
Acknowledgement Testing
with Stakeholders
Jun
Jul
Aug
Apr 1 – Sep 30, 2015
Operational Readiness
5
Sep
Oct
Nov
Dec
Jan
2016
Feb
ICD10 Quick Facts

ICD-10 international version
– Adopted by WHO in 1990
– Most countries other than the US currently use ICD10
– ICD-10 (International version) ~ 12,500 diagnostic
codes
– ICD-10 used for mortality reporting in the US - 1999
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ICD-10-CM (US version)
– ~ 69,000 diagnostic codes
– Final rule published – 2009
ICD-10-PCS
– ~72,000 codes
– Not part of an international standard
– Inpatient procedures only
6
The “Anatomy” of ICD-10
structure
Alpha (not
U)
Numeric
1st
character
2nd
character
<Can be any combination of alpha or numeric
characters>
3rd
character
4th
character
Category
5th
character
6th
character
Etiology, Anatomical Site, Severity
• 3 character codes ONLY if not further subdivided
• Codes without all required characters are invalid
• Alpha characters are NOT case specific (e.g., s93.401A)
7
7th
character
Extension
ICD-10 codes have UP TO 7
characters
The following are examples of the many possible alpha
and numeric characters that are used in the 7th
character position:
7th character
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A = Initial Encounter
D = Subsequent Encounter
S = Sequelae
3 = Fetus #3 in multiple
gestation, complication of
Often seen in: Obstetrics, Musculoskeletal conditions such
as fractures, injuries, and many others
8
ICD9 Comparison to ICD10-CM
Diagnosis Codes – Clinical Example
A patient is seen in the emergency room with an acute
exacerbation of her severe persistent asthma.
ICD-9 only captures part of the information available for
this patient.
ICD9 Code
49312
Description
Intrinsic asthma with (acute) exacerbation
9
ICD9 Comparison to ICD10-CM
Diagnosis Codes – Clinical Example
A patient is seen in the emergency room with an acute
exacerbation of her severe persistent asthma.
ICD-10 provides a more complete description of this
patient’s condition compared to the limited information
available in ICD-9
ICD10 Code
J4551
Description
Severe persistent asthma with (acute) exacerbation
ICD9 Code
49312
Description
Intrinsic asthma with (acute) exacerbation
10
Each Physician Will Use a
Small Subset of ICD-10 Codes
 34,250 (50%) of all ICD-10-CM codes are related to
the musculoskeletal system
 17,045 (25%) of all ICD-10-CM codes are related to
fractures
 ~25,000(36%) of all ICD-10-CM codes to distinguish
‘right’ vs. ‘left’
 Only a very small percentage of the codes will
be used by most providers
Source: Health Data Consulting
11
Varying Code Volume
By Clinical Area
Clinical Area
ICD-9 Codes
ICD-10 Codes
Fractures
747
17099
Poisoning and toxic effects
244
4662
Pregnancy related conditions
1104
2155
Brain Injury
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
Chronic respiratory failure
7
4
Source: Health Data Consulting
12
Current Distribution of
ICD-9 Diagnosis Codes
3 Years of Data – All claims – 1 Million Lives
 Over 72% of all charges
involve only 5% of codes
Total Charges by Code
3 years - $10 Bill
 Almost 85% of all charges
are covered by 10% of
codes
80.0%
70.0%
60.0%
50.0%
40.0%
Charge %
30.0%
20.0%
10.0%
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…
…
…
…
…
…
…
…
…
…
…
…
…
…
…
…
…
…
5%
next 5%
0.0%
 Over 95% of all charges
are covered by 15% of
codes
 Similar results are
expected with ICD-10
codes
Coding Specificity
No Place for “Unspecified” Codes
 If there is sufficient information available to more
accurately define the condition
 For basic concepts such as:
–
–
–
–
–
–
Laterality (Right, Left, Bilateral, Unilateral)
Anatomical locations
Source: Health Data Consulting
Trimester
Type of diabetes
Known complications or comorbidities
Description of severity, acute or chronic or other known parameters…
 Where care is implemented that demands a more
specific level of detail
 At specialty level that should be able to define the detail
required
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Coding Specificity
A place for “Unspecified” Codes
 Sometimes unspecified makes sense…
– The patient may be early in the course of
evaluation
– The claim may be coming from a provider who
is not directly related to diagnosing the patient’s
condition and unfamiliar with all the details
– The clinician seeing the patient may be more of
a generalist and not able to define the condition
at a level of detail expected by a specialist
15
Leveraging ICD10
Better Information
 Greater detail
 Enhanced categorization models
 Greater severity and risk definition
 Greater precision of definition
 Greater forward flexibility
 Greater ability to integrate clinical information
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ICD-10 Documentation
ICD-10 Clinical Documentation
Impacts
Timing of
Timing
ofcare
care
Combination codes
with Symptoms
and/or Manifestations
Anatomical site
specificity
Complications
Laterality
Status codes, personal
and family history
codes
Disease acuity
General – BMI, tobacco
use/smoking exposure,
health status
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Clinical Documentation
Know Your Role
 The role of the clinician is to document as
accurately as possible the nature of the patient’s
conditions and services provide to maintain or
improve those conditions
 The role of the coding professional is to assure that
coding is consistent with the documentation
 The role of the business manager is to assure that
all billing is accurately coded and supported by the
documented facts
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Clinical Documentation –The Patient Interface
Where It All Begins
Physical Exam
History
Internal Record Review
External Record Review
Studies
Assessment/Diagnosis
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Good Patient Data
It’s all About Good Patient Care…
 Observation of all objective and subjective facts
relevant to the patient condition
 Documentation of all of the key medical
concepts relevant to patient care currently and in
the future
 Coding that includes all of the key medical
concepts supported by the coding standard and
guidelines
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Clinical Documentation
What They Taught Us in Medical School
Type of Condition
Onset
Etiology / Cause
Anatomical Location
Laterality
Severity
Environmental Factors
Time Parameters
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Comorbidities
Complications
Manifestations
Healing Level
Findings & Symptoms
External Causes
Type of Encounter
Documentation
Why Is It Important?
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Supports proper payment and reduces denials
Assures accurate measures of quality and efficiency
Addresses the issue of accountability and transparency
Creates a competitive advantage
Provides better business intelligence
Supports clinical research
Supports interoperable sharing of data
It’s just good care!
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How documentation Impacts The Practice
A Changing World of Cost Containment
Accurate and complete documentation and coding provides
opportunities to support the transition into a “value-based”,
“accountable care” reimbursement environment.
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Better representation of severity and risk
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Opportunities to reduce audit risk exposure
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More accurate measures of quality and efficiency
Recognition of varying levels of complexity
Better claim information to support automated
processing and more rapid reimbursement
Improved business intelligence to support population risk
management
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Examples
Exercise 1
Asthma
Current History
8 year old female here for follow up to ER visit 2 days ago for shortness of breath.
The patient was discharged with a diagnosis of asthma and Albuterol inhaler
prescription. Patient is stable on inhaler.
History
 Patient has seasonal allergies with rhinorrhea and a history of wheezing during
physical exertion. Last episode occurred during PE at school and the patient
was taken to the ER for assessment and treatment.
 Patient has been exposed to second hand cigarette smoke since infancy; father
is a pack-a-day smoke
 The patient has a history of moderately severe episodes of awakening at night
approximately 2 times a week requiring the use of an inhaler.
Assessment
 Moderate persistent asthma
 Seasonal allergic rhinitis
 Second hand smoke exposure
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Answer 1
Asthma
CODING
ICD-9-CM Diagnosis Codes
493.02 – Asthma, extrinsic, acute exacerbation
477.0 – Allergic rhinitis, due to pollen
ANALYSIS
•
•
•
•
•
•
ICD-10-CM Diagnosis Codes
J45.41– Moderate persistent asthma with
(acute) exacerbation
J30.1 – Allergic rhinitis, due to pollen
Z77.22 – Contact with and (suspected)
exposure to environmental tobacco smoke
(acute) (chronic)
ICD-10 does not include the concept of extrinsic, but does include whether asthma is mild
intermittent or persistent or moderate and severe persistent.
ICD-10 guidelines now require the use of an additional code to indicate if a patient is exposed
to tobacco smoke.
Moderate Persistent Asthma
Symptoms occur daily, and the disease severity warrants regular use of medications for
control.
Patients are constantly aware of their disease, require medications on a daily basis, have
their sleep interrupted at least weekly, and have to accommodate their life style to the
disease.
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Pulmonary function is moderately abnormal, with the FEV1 being 60-80
Exercise 2
Breast Cancer with Chemotherapy Induced Anemia
Current History:
The patient is a 44 year old female with Estrogen positive, Stage II
invasive ductal carcinoma in the lower inner quadrant of the left breast.
She has been receiving chemotherapy and complains of extreme fatigue,
headaches, dizziness and rapid heart rate. Hematology studies indicate
aplastic anemia consistent with chemotherapy treatment.
History
 Patient has completed first round of chemotherapy.
Assessment
 Malignancy left breast; estrogen positive
 Drug induced aplastic anemia
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Exercise 2 Answer
Breast Cancer with Chemotherapy Induced
Anemia
CODING
ICD-9-CM Diagnosis Codes
284.89 – Other specified aplastic anemias
ICD-10-CM Diagnosis Codes
D61.1 - Drug-induced aplastic anemia
E933.1 Therapeutic use of Antineoplastic
agents
174.3 – Malignant neoplasm of female breast,
lower-inner quadrant
V86.0 Estrogen receptor positive
T45.1X5D - Adverse effect of antineoplastic
and immunosuppressive drugs
C50.312 - Malignant neoplasm of lower-inner
quadrant of left female breast
Z17.0 - Estrogen receptor positive status
[ER+]
ANALYSIS
• ICD-10 includes a new guideline that requires the reporting of an adverse effect code
when anemia is associated with chemotherapy.
• ICD-10 has codes for Estrogen receptor positive or negative status codes.
• Adverse effect codes are found in the Table of Drugs and Chemicals in ICD-10-CM.
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Exercise 3
Musculoskeletal
Current History
Patient’s neck hurts and I have a tingling pain sensation going down my right arm.
History
 Patient is a 68 year-old male with history of neck pain that has been worsening
over the last two years. Recently, he has experienced some numbness and a
painful tingling sensation in his right arm going down to his thumb. No other
symptoms or pertinent medical history.
Assessment
 Review of systems is negative except for the neck pain and sensations in his
right arm described above. No history of acute injury to neck or arm.
 Physical exam is normal except for neurological exam of the right upper
extremity, which reveals slight decrease to sensation in the thumb and
forefinger region of the hand in the C6 nerve root distribution. No evidence of
weakness in the muscles of the arm or hand.
 MRI scan of the neck shows degenerative changes of the C5-6 disc with lateral
protrusion of disc material. No other abnormalities noted.
 Cervical transforaminal injection at C5-6.
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Exercise 3 Answer
Musculoskeletal
CODING
ICD-9-CM Diagnosis Codes
722.0 Cervical disc displacement without
myelopathy
722.4 Degeneration of cervical intervertebral disc
ICD-10-CM Diagnosis Codes
M50.12 Cervical disc disorder with
radiculopathy, mid-cervical region
Analysis
• The code category M50.12 Cervical disc disease includes degeneration of the disc as a combination
code.
• Subcategory M50.1 describes cervical disc disorders.
• The 5th character differentiates various regions of the cervical spine (high cervical C2-3 and C3-4;
mid-cervical C4-5, C5-6, and C6-7; cervicothoracic C7-T1 and the associated radiculopathies at each
level).
• This is a combination code that includes the disc degeneration and radiculopathy
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Exercise 4
Diabetes
Current History
A 55 year old male with type 2 diabetes mellitus complains of numbness and
tingling in feet x 2 months. Patient also states that he did not feel pain in his left
foot after striking his big toe against the driveway while barefoot about a month
ago. Injury resulted in superficial abrasion that is still visibly healing. The blood
sugar recorded in the office today was 200 mg/dL with only a light breakfast 3
hours earlier. On further discussion with the patient it is apparent that he is
intentionally not taking his insulin dosage on an appropriate basis.
History
 Patient has been on insulin x 5 years with poor control x 6 months.
 Patient has hypertension and is taking an ACE inhibitor. x 3 years. Blood
pressure is stable.
Assessment
 Type 2 diabetes with diabetic polyneuropathy
 Hyperglycemia
 Hypertension
 Ongoing insulin use
32
Exercise 4 Answer
Diabetes
CODING
ICD-9-CM Diagnosis Codes
250.62 - Diabetes mellitus with peripheral
neurological disorders, type II, uncontrolled
357.2 - Polyneuropathy
401.9 – Hypertension ,unspecified
V58.67 - Long term (current) insulin use
V15.81 - History of noncompliance
ICD-10-CM Diagnosis Codes
E11.42 - Type 2 diabetes mellitus with diabetic
polyneuropathy
E11.65 - Type 2 diabetes mellitus with
hyperglycemia
I10 - Essential (primary) hypertension
Z79.4 - Long term (current) insulin use
T38.3X6D - Underdosing of insulin and oral
hypoglycemic [antidiabetic] drugs, subsequent
encounter
Z91.112 - Patient’s intentional underdosing of
medication regimen for other reason
Analysis
• Diabetes which is poorly controlled is not a concept that is carried over to ICD-10.
• Unlike ICD-9, ICD-10 provides codes to indicate hyper or hypoglycemia.
• Manifestations in diabetes are not generally reported separately, but rather as part of the ICD-10
diabetes mellitus code.
• Unlike ICD-9, ICD-10 supports the reporting underdosing of medication by the patient. Note found
33
at the beginning of category T36 – T50 referencing
the use of underdosing with codes Z91.12-, or
Endocrine - Diabetes
Diabetes
Mellitus
Diabetes found at E08 thru E13
E08 Diabetes mellitus due to underlying
condition
E09 Drug or chemical induced diabetes
mellitus
E10 Type 1 diabetes mellitus
E11 Type 2 diabetes mellitus
E13 Other specified diabetes mellitus
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Documenting Diabetes (continued)
 If there are complications/manifestations of the
diabetes, additional details may be necessary
for the following conditions:
Arthropathy
Severity of
retinopathy
Site of ulcer
Stage of CKD
Gangrene
With/without
macular edema
Hyperglycemia
Each manifestation documented should be
coded separately
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35 35
MANIFESTATIONS OF DIABETES
E08.621
Diabetes mellitus due to underlying condition
with foot ulcer
E09.621
Drug or chemical induced diabetes mellitus with
foot ulcer
E10.621
Type 1 diabetes mellitus with foot ulcer
E11.621
Type 2 diabetes mellitus with foot ulcer
E13.621
Other specified diabetes mellitus with foot ulcer
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JOINT PAIN
M25.511
M25.512
M25.519
M25.521
M25.522
M25.529
M25.531
M25.532
M25.539
Pain in right shoulder
Pain in left shoulder
Pain in unspecified shoulder
Pain in right elbow
Pain in left elbow
Pain in unspecified elbow
Pain in right wrist
Pain in left wrist
Pain in unspecified wrist
37
M25.411 thru M25.48
Effusion of Joint
By joint, left versus right
M25.411 Effusion, right shoulder
M25.412 Effusion, left shoulder
M25.419 Effusion, unspecified shoulder
M25.421 Effusion, right elbow
M25.422 Effusion, left elbow
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CREATING TOOLS
M25.5 __ __ Pain, joint______location [ ]right [
]left
M24.4__ __ Effusion, joint,__location [ ]right [
]left
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Z CODES REPLACE V CODES
Z CODES
 In the absence of disease or injury, it is still necessary to
"match" an ICD-10-CM code to a service or procedure code
(CPT).
 Z codes state the reason for your patient's visit in just such
circumstances.
 The following is a list of index words that will help you to begin
the code search in the Index to Diseases.
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WELL ADULT EXAMINATIONS
Z00.00
Z00.01
Encounter for general
adult medical
examination without
abnormal findings
Encounter for general
adult medical
examination with
abnormal findings
41
Encounter for adult health
check-up NOS
→Use additional code to
identify abnormal
findings
Implementation
Getting Started
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Establish awareness across members of your organization
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Create a realistic project plan and support it as a priority
Clearly define strategic goals
Identify internal and external dependencies
Identify and prioritize key risks
Source: Health Data Consulting
Clearly define all business requirements and implementation
tasks
Test early and often
Get started now!!
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Road to 10:
Small Physician Practice Portal
Visit: http://www.roadto10.org
44
“Road to 10” Physician Portal
http://www.roadto10.org

In collaboration with physicians, CMS
developed www.roadto10.org, a no cost
tool:
• Designed from a physician perspective
 Specialty specific
The Road to 10 Action Plan contains a
checklist of items to consider when
planning the transition to ICD-10,
organized into 5 key steps:
1
2
3
4
5
• Customizable, actionable, bite-sized,
short cuts
• Answers the key questions:
 What is ICD-10
 How do I get started
 What is the path to success
 What questions to ask
 What resources and tools are
available
Plan Your Journey
Train Your Team
Update Your Processes
Engage Your Vendors & Payers
Test Your Systems and Processes
VISIT HTTP:// WWW.ROADTO10.ORG TODAY TO GET STARTED
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1
Road to 10: Plan Your Journey
Customize Your Action Plan
1
Road to 10: Action Plan
2
Road to 10: Train Your Team
3 Road to 10: Update Your Processes
4
Road to 10: Engage
Your Vendors and Payers
Ensure that your EHR and practice management systems
are ready.
5
Road to 10: Test Your
Systems and Processes
Road to 10:
Specialty Specific Webcasts
52
Your Stories Are Important
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Moving Forward Along
the Road to 10
In the coming months,
there is opportunity to
work on several critical
activities that will help you
maximize your ICD-10
preparedness.
I encourage you to visit
http://www.roadto10.org for
tools and resources to help
you prepare for the ICD-10
transition.
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Putting ICD-10 into Practice
Clinical Documentation
Know Your Role
 The role of the clinician is to document as
accurately as possible the nature of the patient’s
conditions and services provide to maintain or
improve those conditions
 The role of the coding professional is to assure that
coding is consistent with the documentation
 The role of the business manager is to assure that
all billing is accurately coded and supported by the
documented facts
56
Clinical Documentation
Drives Code Selection
•Connect the pieces of the medical record together
for problems, assessments, procedures, and
treatments
•Support and supplement provider documentation
57
Ten for Ten for Overview ICD-10-CM
1. Concept of laterality: Right, Left, Bilateral and
Unspecified in many categories.
2. Injuries grouped by body part rather than category
of injury
3. Acute MI codes changed from 8 weeks duration to
4 weeks duration or less
58
Ten for Ten
4. New terminology for asthma from worldallergy.org
5. Infectious Diseases now spans 2 alpha characters
of A and B in Chapter 1.
6. New combination of codes for complications
commonly associated with intestinal disorders
such as Crohn’s disease, diverticulitis, etc.
59
Ten for Ten
7. Pressure and Non-pressure ulcers are classified by
site, laterality, and severity.
8. Three different categories for pathologic fractures
– due to neoplastic disease, due to osteoporosis,
and due to other specified disease
60
Ten for Ten
9. Use additional code to identify resistance to
antimicrobial drugs (Z16-) whenever infection is
documented and the resistance is documented.
10. Systemic Hypertension no longer subcategorized
by “benign” or “malignant”.
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Diagnostic Coding and Reporting
Guidelines for Outpatient Services
A. Selection of first-listed condition
In the outpatient setting, the term first-listed
diagnosis is used in lieu of principal diagnosis.
→ Chiefly responsible for today’s encounter
62
Diagnostic Coding and Reporting
Guidelines for Outpatient Services
C. Accurate reporting of ICD-10-CM diagnosis
codes
For accurate reporting of ICD-10-CM diagnosis
codes, the documentation should describe the
patient’s condition, using terminology which
includes specific diagnoses as well as symptoms,
problems, or reasons for the encounter.
There are ICD-10-CM codes to describe all of
these.
63
Diagnostic Coding and Reporting
Guidelines for Outpatient Services
H. Uncertain diagnosis
Do not code diagnoses documented as
“probable”, “suspected,” “questionable,” “rule out,”
or “working diagnosis” or other similar terms
indicating uncertainty.
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Table of Neoplasms
65
Drugs and Chemicals
66
67
Timing of care
SCENARIO
Patient returns for a follow up visit for a sprained
right ankle of the tibiofibular ligament. Still attending
PT for strengthening exercises.
68
Timing of care
ANSWER
KEY WORD: SPRAIN, TIBIOFIBULAR
LIGAMENT S93.43-
S93.431D
D= subsequent episode
69
Anatomical Site Specificity/ LATERALITY
Scenario
Dx: Patient has osteoarthritis of the left hip.
→M16.0 Bilateral primary osteoarthritis of hip
M16.1 Unilateral primary osteoarthritis of hip
Primary osteoarthritis of hip NOS
M16.10 Unilateral primary osteoarthritis, unspecified hip
Avoid unspecified whenever possible
M16.11 Unilateral primary osteoarthritis, right hip
→M16.12 Unilateral primary osteoarthritis, left hip
70
Combination codes with Symptoms
and/or Manifestations
K57.2 Diverticulitis of large intestine with perforation and
abscess
Diverticulitis of colon with peritonitis
→Excludes1: diverticulitis of both small and large
intestine with perforation and abscess (K57.4-)
K57.20 Diverticulitis of large intestine with perforation
and abscess without bleeding
K57.21 Diverticulitis of large intestine with perforation
and abscess with bleeding
71
Status codes, personal and family
history codes
ICD-10-CM
Z91.81 History of falling
At risk for falling
ICD-9-CM
V15.88 History of fall
At risk for falling
This code can be first listed or
secondary depending on “chiefly
responsible” for today’s encounter
This code can be first listed or
secondary depending on “chiefly
responsible” for today’s encounter
72
General – BMI, tobacco use/smoking
exposure, health status
Use additional code, if applicable, to identify:
→exposure to environmental tobacco smoke
(Z77.22)
→history of tobacco use (Z87.891)
→occupational exposure to environmental tobacco
smoke (Z57.31)
→tobacco dependence (F17.-)
→tobacco use (Z72.0)
73
New Concepts: Underdosing
The concept of underdosing has been added to the
poisoning and adverse effect classification
– Includes the ability to report why the underdosing is
occurring
T38.3X6A - Underdosing of insulin and oral hypoglycemic [antidiabetic] drugs, initial encounter
T38.3X6D - Underdosing of insulin and oral hypoglycemic [antidiabetic] drugs, subsequent
encounter
T38.3X6S - Underdosing of insulin and oral hypoglycemic [antidiabetic] drugs, sequelae
Z91.120 - Patient’s intentional underdosing of medication regimen due to financial hardship
Z91.128 - Patient’s intentional underdosing of medication regimen for other reason
Z91.130 - Patient’s unintentional underdosing of medication regimen due to age-related debility
Z91.138 - Patient’s unintentional underdosing of medication regimen for other reason
74
Free ICD -10 Resources and Tools
75
ICD-10 Resources
ICD-10 Website
• http://www.cms.gov/Medicare/Coding/ICD10/index.html
CMS Home Health Resources
• http://www.cms.gov/Medicare/Medicare-fee-for-servicePayment/HomeHealthPPS/index.html
Mapping (GEMs)
• GEMs Crosswalk documents
• http://www.cms.gov/Medicare/Coding/ICD10/2016-ICD-10CM-and-GEMs.html
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ICD-10 Resources (cont’d)
Medicare Learning Network Articles
• http://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNMattersArticles/Downloads/SE1501.pdf
ICD-10 National Provider Calls
• http://www.cms.gov/Medicare/Coding/ICD10/CMS-Sponsored-ICD-10Teleconferences.html
Provider Resources
• http://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html
77
ICD-10 Resources (cont’d)
American Health Information Management
Association (AHIMA)
• http://www.ahima.org/education/onlineed/Programs/ICD10
American Academy of Professional Coders (AAPC)
• http://www.aapc.com/medical-coding/
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Questions and Discussion
79