David J. Freedman, DPM,
FASPS, CPC, CPMA,CSFAC
● Certified Professional coder
● Certified Professional Medical Auditor
● Certified Surgical Foot & Ankle Coder
● www.ICDTENHELP.com
● APMA Coding Committee, member
●
●
●
●
●
since 2005
ICD 10 Team Manager APMA
Past President, Maryland Board of
Podiatric Medical Examiners
CAC member Maryland
Maryland Podiatric Medical
Association Coding Tips.
26 years of Coding and Billing
Experience
POTENTIAL SPEAKER CONFLICTS:
1) Volunteer as CAC representative with Medicare
and APMA
2) Own and authored www.icdtenhelp.com
3) Provide consulting services to doctors and
medical company’s
Disclaimer:
Don’t blame the speaker, me for
the coding suggestions, jokes, or information for
this presentation as its represents only the opinion
of the lecturer. So, no consequences or liability
incurred using information contained in this
presentation. CPT, ICD-9-CM, ICD-10-CM and
HCPCS code descriptors and coding policies do
not determine coverage and payment policies,
and do not ensure payment for any service.
Coding coverage and payment policies of
governmental and commercial payers may vary,
so questions regarding coding coverage and
payment for a specific item or service should be
directed to the particular payer involved.
ICD-10 CM Is Just Around the
Corner
 Need to understand the concept of ICD-10
 Implementation date is Oct, 1 2014
 This applies to CMS and private insurance
Companies but there is an EXCEPTION TO
THE RULE
 Workers Compensation and Auto Insurance
are NOT mandated to switch, what does this
mean to you?
ICD-10 CM Is Just Around the
Corner
First The Bad News
ICD-10 CM Is Just Around the
Corner-Potential negative impacts
 Decreased productivity
 Interrupted cash flow
 Increased amount of rejections
 Incompatible systems
 Increased volumes of work
 Incorrect mapping
 Increased risk of payer audits
Discussion Points
1.
2.
3.
4.
5.
6.
7.
History of ICD and WHO?
Why are we changing?
What is ICD-10?
What is the difference between CM and
PCS?
Examples
What’s it going to cost?
What do I do to get ready?
CMS links
1.
2.
3.
www.cms.gov/ICD10/17_ICD10_MS_DRG_Conver
sion_Project.asp
http://www.codingbooks.com/catalogsearch/result/
?q=icd+10
http://www.cms.gov/Outreach-andEducation/Medicare-Learning-NetworkMLN/MLNMattersArticles/downloads/SE1239.pdf
CDC links
1.
http://www.cdc.gov/nchs/icd/icd10cm.htm
There’s an app for that:
https://itunes.apple.com/us/app/icd10
ICDTENHELP.com
 Resource made simple
 Instruction Page is 1st tab
Now lets proceed
 2nd tab ICD 9 to ICD 10 Tabular Only
ICDTENHELP.com
 3rd Tab is ICD 10 Tabular Coding Only
ICDTENHELP.com
 4th Tab is ICD9 to ICD10 Index &
Tabular
ICDTENHELP.com
 Rules of ICD 10
“CM”
Clinical Modifications
The CM part of ICD-10 can vary from country
to country
The US version of ICD-10 is different from the
Canadian and the Mexican versions
Direct Comparison
ICD-9 (five digits)
X X X . X X
Category
etiology
anatomic site, manifestation
ICD-10 (seven digits)
X X X . X X X
X
Category
etiology extension
anatomic site, severity
3 Character Categories
Characters 1-3
1st Character Alpha A-Z
2nd Character Numeric 0-9
3rd Character Numeric 0-9
Describes system or disease
process
ICD-10 Terms
Chapters
22 Chapters identifying categories
Blocks
Subchapters
Etiology, anatomical site, severity
Rubrics
Identify closely related conditions
Extensions
ICD-10 Chapters
Chapter 1 A00-B99 Infectious and Parasitic
diseases
Chapter 2 C00-D49 Neoplasms
Chapter 3 D50-D89 Hematological and Immune
Systems
Chapter 4 E00-E90 Endocrine, Nutritional and
Metabolic Diseases
Chapter 5 F01-F99 Mental and Behavioral Disorders
Chapter 6 G00-G99 Diseases of the Nervous System
Chapter 7 H00-H59 Diseases of the Eye and Adnexa
ICD-10 Chapters
Chapter 8 H-60-H95 Diseases of the Ear and Mastoid
Process
Chapter 9 I01-I99 Diseases of the Circulatory System
Chapter 10 J00-J99 Diseases of the Repiratory System
Chapter 11 K00-K94 Diseases of the Digestive System
Chapter 12 L00-L99 Diseases of the Skin and
Subcutaneous Tissue
Chapter 13 M00-M99 Disease of the Musculoskeletal
System and Connective Tissue
Chapter 14 N00-N99 Diseases of the Genitourinary
System
ICD-10 Chapters
Chapter 15 O00-O99 Pregnancy, Childbirth and
Puerperium
Chapter 16 P00-P96 Certain Conditions Originating in
the Perinatal Period
Chapter 17 Q00-Q99 Congenital Malformations,
Deformations and Chromosomal Abnormalities
Chapter 18 R00-R99 Symptoms, Signs and Abnormal
Clinical and Laboratory findings, not classified
elsewhere
Chapter 19 S00-T88 Injury, Poisoning and Certain other
Consequences of External Causes
ICD-10 Chapters
Chapter 20 V00-Y98 External Causes of Disease or
Morbidity
Chapter 21 Z00-Z99 Factors Influencing Health Status
and Contact with Health Services
Chapter 22 – Special Purposes
ICD-10 Example
Index
There is a period after the 3rd character and often a dash
Example Pain
M79. –
Define the site, etiology, manifestation or state of the disease
or condition
Numeric
Example Pain
M79. -
ICD-10 Example
4th Character
Define the site, etiology, manifestation or state of the
disease or condition
Numeric
Example Pain
M79. M79.6 pain in limb, hand, foot, fingers, toes
ICD-10 Example
5th Character
5th character identifies a level of specificity
Letter or Number (0-9)
Example
M79. Pain
M79.6 pain in limb, hand, foot, fingers, toes
M79.60 Pain in limb
ICD-10 Example
6th character is even more specific
Numeric (0-9)
Describes specific location or cause
For laterality
1 is right
2 is left
3 is unspecified
Example Pain
M79.M79.6 pain in limb, hand, foot, fingers, toes
M79.60 Pain in limb unspecified
• M79.671 Pain in right foot
ICD-10 Example
6th character is even more specific
Numeric (0-9)
Describes specific location or cause
For laterality
1 is right
2 is left
3 is unspecified
Example Pain
M79.M79.6 pain in limb, hand, foot, fingers, toes
M79.60 Pain in limb unspecified
• M79.671 Pain in right foot
ICD-10 Example
Dummy 5th Character
Just to confuse you even more 
To allow for further expansion some codes have a “dummy”
5th place character so that the 6 character structure will not
be disrupted when changes are added
Report these codes as they are in the book including the
“dummy”5th character “x”
ICD-10 Example
Dummy 5th Character
Example Poisoning
T45.T45.7 poisoning by, adverse effect of, and under
dosing of anticoagulant antagonists, Vitamin K, and
other coagulants
T45.7x the x is holding a space for a future 5th
place character
T45.7x1 accidental
T45.7x2 intentional, self harm
T45.7x3 assault
T34.7x4 undetermined
ICD-10 Example
7th Character
Some codes have a so-called character extension
Typically letters, that describe conditions/timing of the visit
Used to give more information about the events related to
the reason for the visit or service
• Non-fracture care
th
• A- initial encounter
• D- subsequent
encounter
• S- sequela
• Fracture care
• A- initial encounter (for
closed fracture)
• B – initial encounter for
open fracture
• D- subsequent encounter
for normal healing fracture
• G- subsequent encounter
for delayed healing
fracture
• K- subsequent encounter
for fracture with non-union
• P- subsequent encounter
for fracture with mal-union
• S- sequela of fracture
NEW ICD-10 Features
Laterality
C76.51
Malignant neoplasm of right lower limb
Combination of certain conditions and common
associated symptoms
E11.42
Type 2 diabetes mellitus with diabetic
polyneuropathy
NEW ICD-10 Features
Combination codes for poisonings and their associated
external cause
T36.1x2S Poisoning by cephalosporins and other betalactam antibiotics, intentional self-harm, sequela
Character “x” is used as a 5th character placeholder
T45.7x1A Poisoning by anticoagulant antagonists,
vitamin K and other coagulants,accidental (unintentional),
initial encounter
NEW ICD-10 Features
 Obstetric codes identify trimester instead of episode
of care
 O26.020 – excessive weight gain in pregnancy,
second trimester
 Inclusion of clinical concepts that do not exist in ICD-
9 (e.g., underdosing, blood type, blood alcohol level)
 T45.526D – underdosing of antithrombotic drugs,
subsequent encounter
NEW ICD-10 Features
 Significantly expanded codes (e.g., injuries, diabetes,
substance abuse, postoperative complications)
 E10.610 – type 1 diabetes mellitus with diabetic
neuropathic arthropathy
 Distinction between intraoperative complications and
postprocedural disorders
 G97.31 Intraoperative hemorrhage and hematoma of a
nervous system organ or structure complicating a
nervous system procedure
 G97.51 Postprocedural hemorrhage and hematoma of
a nervous system organ or structure following a
nervous system procedure
Costs of ICD-10 Implementation
 Overall health care industry $8 Billion
 Average small practice upgrade $84,000
 Average large practice upgrade $3 Million
 Average health plan upgrade $14 Million
 Most costs are associated with monies aimed at training,
software upgrades and contract negotiations
Costs of ICD-10 ImplementationCollateral issues
Your practice must have 5010 activated
 Problems with 5010 implementation will forecast ICD10 implementation issues
 All NCD’s and LCD’s have to be updated CMS has set
this to be completed in April 2014
 EHR usage should make it easier
 Expect income lapse when implementation starts
 Payment issues may continue for 3-6 months
afterwards
Strategies for Success
 The first place to begin in preparing for ICD-10
implementation is with communication
 Keep everyone updated on what is happening
 No delay, we need to continue to prepare for
the transition
 If you take it seriously, so will the people you
are leading
 What form of communication will be most
effective in your office/institution
Impact analysis
 Create a flow chart to:






Demonstrate how the action of each individual
impacts the entire process
Identify areas of weakness and quickly create a
process to strengthen it
Clearly illustrates the need for interaction between
departments, clinical or business areas
Make impacts visible to all areas
Generate ownership of each process
Provides a clear picture of how things work today and
can outline how things should work in the future
Impact analysis
 Determine any area in the practice that currently
utilizes an ICD-9-CM code
 Ask for input from the various departments to
ensure that nothing is overlooked
 How are performance measures captured
 Prior authorizations
 Research
 Tracking and trending
Build an action plan
 Build an action plan based on the results of the
impact analysis
 Create a preliminary needs assessment
 Establish timeline parameters to create a
roadmap
 Adhere to the timeline, but be open-minded to
allow for unexpected circumstances
 Begin discussion early with vendors to
understand their timelines
Measure productivity
 Understand where productivity is at prior to the
implementation of ICD-10
 Use this as a “goal” to get back to after the
official implementation date
 Canada indicates that their productivity has not
recovered since implementation
 Different reimbursement system
 Implemented EMR at same time as ICD-10
 Went from DOS system to an electronic world
Questions for Consideration:

Have you identified all internal systems and
processes that will be impacted by the change to ICD10?

Has your office performed a cost analysis to
understand the financial impact for your organization?
For example, revenue impacts that could result from
improperly coded claims
Questions for Consideration:
1.
Have you identified all inter-dependencies on
external partners such as coding vendors,
clearinghouses, etc.? Have you confirmed that all
remediation and testing dates are mutually
acceptable?
2.
Do you know if you will be utilizing the CMS
crosswalks and if so, what impact those may have on
expected outcomes?
3.
Will you be trying to realize any benefit or value from
this new code set?
TIME PLAN THAT HAS BEEN
PUBLISHED:
“Give your practice at least
18 months prior to the
implementation date of Oct 1, 2014
to make sure you are ready.”
Wait you have only 9 months to go is
that a problem?
What Are Insurance
Companies Doing To Get
Ready?
 United Health Care related they will be
ready
 Aetna relates they will be ready
 CMS says their contractors will be ready
and national testing is week 3/5/2014
 Not sure about others
https://www.aapc.com
/ICD-10/icd-10mapping.aspx
New CMS
FORM 1500
02-12
 Effective date
1/1/2014
 Transition
1/1/14-4/1/2014
 Drop dead date
4/1/2014
To Know ICD 10 CM You
need to know 2 things, #1
#2
Let’s look at Heel Ulcer example
ICD-9 to ICD 10 Coding
1) Ulceration right heel. ICD9=707.14
1) Ulceration Right Heel. ICD-10=L97.412
Non-pressure chronic ulcer of right heel
and midfoot with fat layer exposed
ICD-9 to ICD 10 Coding
2) Type 2 DM with neuropathy. ICD9=250.60 and 357.2
2) E11.42 Type 2 diabetes mellitus with
diabetic polyneuropathy
ICD-9 to ICD 10 Coding
2) Type 2 DM with neuropathy. ICD9=250.60 and 357.2
3) E11.621 Type 2 diabetes mellitus with
foot ulcer
Use additional code to identify site of
ulcer (L97.4-, L97.5-)
In Summary based on ICD-10
Rules the following are coded:
1) E11.621 Type 2 diabetes mellitus with foot ulcer
Use additional code to identify site of ulcer (L97.4-, L97.5-)
2) Ulceration Right Heel. ICD-10=L97.412
Non-pressure chronic ulcer of right heel and midfoot with fat
layer exposed
3) E11.42 Type 2 diabetes mellitus with diabetic
polyneuropathy
Cellulitis/Abscess Example
10060
10061
Incision and drainage of abscess
(eg, carbuncle, suppurative
hidradenitis, cutaneous or
subcutaneous abscess, cyst,
furuncle, or paronychia); simple
or single
MC=$134.97
10
ICD9:
Global 681.10 toe
Incision and drainage of abscess
(eg, carbuncle, suppurative
hidradenitis, cutaneous or
subcutaneous abscess, cyst,
furuncle, or paronychia);
complicated or multiple
MC=$236.33
10
ICD9:
Global 681.10 toe
681.11ony/par
682.7 foot
682.6 ankle/leg
998.59 Post-op
681.11ony/par
682.7 foot
682.6 ankle/leg
998.59 Post-op
I&D Abscess (NOT DEEP)
10060
10061
Incision and drainage of abscess
(eg, carbuncle, suppurative
hidradenitis, cutaneous or
subcutaneous abscess, cyst,
furuncle, or paronychia); simple
or single
MC=$134.97
10
ICD9:
Global 681.10 toe
Incision and drainage of abscess
(eg, carbuncle, suppurative
hidradenitis, cutaneous or
subcutaneous abscess, cyst,
furuncle, or paronychia);
complicated or multiple
MC=$236.33
10
ICD9:
Global 681.10 toe
681.11ony/par
682.7 foot
682.6 ankle/leg
998.59 Post-op
681.11ony/par
682.7 foot
682.6 ankle/leg
998.59 Post-op
ICD-9 to ICD 10 Coding
1) Cellulitis toe ICD9=681.10
2) Onychia/Paronychia ICD9= 681.11
3) Cellulitis ankle/leg ICD9= 682.6
4) Cellulitis Foot ICD0= 682.7
5) Post-op ICD9= 998.59
ICD-9 to ICD 10 Coding
1) Cellulitis toe ICD9=681.10
2) Onychia/Paronychia ICD9= 681.11
1) L03.031 Cellulitis of right toe
2) L03.032 Cellulitis of left toe
ICD-9 to ICD 10 Coding
1) 682.6 Cellulitis ankle/leg
2) 682.7 Cellulitis Foot
1) L03.115 Cellulitis of right lower limb
2) L03.116 Cellulitis of left lower limb
3) L03.125 Acute lymphangitis of right lower
limb
4) L03.126 Acute lymphangitis of left lower
limb
ICD-9 to ICD 10 Coding
1)998.59 Post-op
1) T81.4XXA Infection following a procedure
“Initial Encounter”
Osteomyelitis Example
ICD-9 to ICD 10 Coding
1) 730.07 Bone-Acute
1) M86.071 Acute hematogenous
osteomyelitis, right ankle and foot
2) M86.072 Acute hematogenous
osteomyelitis, left ankle and foot
3) M86.171 Other acute osteomyelitis, right
ankle and foot
4) M86.172 Other acute osteomyelitis, left
ankle and foot
ICD-9 to ICD 10 Coding
1) 730.17 Bone-Chronic
1) M86.371 Chronic multifocal osteomyelitis,
right ankle and foot
2) M86.372 Chronic multifocal osteomyelitis,
left ankle and foot
3) M86.471 Chronic osteomyelitis with
draining sinus, right ankle and foot
4) M86.472 Chronic osteomyelitis with
draining sinus, left ankle and foot
ICD-9 to ICD 10 Coding
1) 730.07 Bone-Acute
1) M86.071 Acute hematogenous
osteomyelitis, right ankle and foot
2) M86.072 Acute hematogenous
osteomyelitis, left ankle and foot
3) M86.171 Other acute osteomyelitis, right
ankle and foot
4) M86.172 Other acute osteomyelitis, left
ankle and foot
ICD-9 to ICD 10 Coding
1) 730.17 Bone-Chronic
1) M86.371 Chronic multifocal osteomyelitis,
right ankle and foot
2) M86.372 Chronic multifocal osteomyelitis,
left ankle and foot
3) M86.471 Chronic osteomyelitis with
draining sinus, right ankle and foot
4) M86.472 Chronic osteomyelitis with
draining sinus, left ankle and foot
Infection
Infection
Infection
ICD-9 to ICD 10 Coding
1) 707.06 Decubitus ulcer, ankle
2) 707.07 Decubitus ulcer, heel
3) 707.09 Decubitus ulcer, other site
1)
2)
3)
4)
5)
L89.511- L89.514
L89.521-L89.524
L89.611-L89.614
L89.621-L89.624
L89.891-L89.894