ICD-10 Training for
Otolaryngologists
Sponsored by:
Alabama Society of Otolaryngology
June 12, 2014
Destin, Florida
Presented by:
Joy McKusick, RHIA
www.karenzupko.com
2
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Attention
3
©KarenZupko & Associates, Inc. 2014
All Rights Reserved
No part of this presentation (including slides and
handout materials) may be copied, modified, re-used,
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entirety without the express written consent of
KarenZupko & Associates, Inc.
Agenda
4

Format and Structure

Other Coding Conventions and Guidelines

Diseases of the Ear and Mastoid Process (H60 – H95)

Diseases of the Digestive System (K00 – K95)

Diseases of the Respiratory System (J00 – J99)

Neoplasms (C00 – D49)

Congenital Malformations, Deformations and Chromosomal Abnormalities (Q00 – Q99)

Diseases of the Skin and Subcutaneous Tissue (L00 – L99)

Symptoms, Signs and Abnormal Clinical and Laboratory Findings (R00 – R99)

Injury, Poisoning and Certain other Consequences of External Causes (S00 – T88)

Getting Ready
Learning Objectives
5
At the conclusion of this activity, participants will be able to:


Understand ICD-10 code structure and concepts.
Use relevant ICD-10 chapters and codes as they relate
to ENT.

Identify and address documentation deficiencies.

Map current ICD-9 codes to ICD-10 codes.
Resources
ICD10data.com
commerce.ama-assn.org
ICD-10 Delay…AGAIN
7
October
2013
October
2014
October
2015
Implementation
9
Take a breath!
Implementation
10
Now is not the time to
put off preparation!
Be proactive!
Make changes now to
lessen problems later!
11
Format and Structure
Format and Structure
12
What’s the same and what’s different?
Format and Structure
13
Alphabetic
Index
Contains:
-Index to Diseases
and Injuries
Also includes:
-Neoplasm Table
-Table of Drugs
and Chemicals
-Index to External
Cause of Injuries
Tabular
List
List of
alphanumeric
codes divided into
chapters based on
condition and/or
body system
Contains
categories,
subcategories and
valid codes
Finding the Code
14
Look up the main
term
Index
instructions
Locate
code in
Tabular List
Finding the Code
15
Read all
instructional
material
Review
guidelines
Confirm
and assign
code
Finding the Code
16
A
Fracture, mandible
Finding the Code
17
B
Complication,
postmastoidectomy,
granulation
*Granulation tissue-see Complications,
postmastoidectomy, granulation
Finding the Code
18
C
Wound, open, nose
Finding the Code
19
D
Pain, ear
Index directs user to see
subcategory H92.0-
Finding the Code
20
E
Foreign body,
pharynx
Differences?
21
Chapters
Titles
Injury codes
Postoperative Complications
Comparison of ICD-9 and ICD-10
22
ICD-9
ICD-10

Diagnosis codes 3-5 characters
in length

Diagnosis codes are 3-7
characters in length

First character may be alpha or
numeric; characters 2-5 are
numeric

Character 1 is alpha; 2 is
numeric; characters 3-7 are
alpha or numeric

Limited space for new codes

Utilizes every letter except “U”

Lacks detail

Flexible for adding new codes

Lacks laterality

Very specific

Has laterality
What makes up the code?
23
ICD-9-CM
ICD-10-CM
Code
S00.531A
Subcategory
S00.53Category
S00
Superficial Injury
of the head
Contusion of lip
and oral cavity
Contusion of lip,
initial encounter
25
7th Character Extension and
“X” Placeholder



Applies only to certain
categories of codes.
7th character must
always be in the 7th
data field.
“X” placeholder is
used to fill in empty
characters when the
code is not 6
characters.
th
7
26
Character Extension
27
7th Character Extension and
“X” Placeholder
28
7th Character Extension and
“X” Placeholder
Foreign body in right ear
T16.1Incorrect code assignment:
T16.1A
Correct code assignment:
T16.1XXA
th
7
Character Definitions
29

Initial encounter = A
 This
extension is used when the patient is receiving
active treatment for the condition.
 Examples
include: surgical treatment, emergency department
encounter and evaluation and treatment by a new physician.
th
7
Character Definitions
30

Subsequent encounter = D
 This
extension is used for encounters after the patient
has received active treatment and is now in the healing
phase receiving routine care for the condition.
 Examples
include: cast change or removal, removal of
external or internal fixation device, medication adjustment,
other aftercare and follow up visits following treatment of the
injury or condition
th
7
Character Definitions
31

Sequela = S
ICD-10-CM no longer has late effect codes. To indicate a
condition is the result of a previous injury, the 7th character
extension “S” is used on the active injury code.
 When using this extension it is necessary to use both the
injury code that is the cause of the sequela and the code
for the sequela itself.


Example: L91.0 Hypertrophic scar
S01.411S Laceration without foreign body of right
temporomandibular area, sequela
Practice
Questions
Practice Questions
33
Practice 1.1
Answer: A initial encounter
Practice 1.2
Answer: True
Practice Questions
34
Practice 1.3
Answer: Chapter 7 eye/adnexa and Chapter 8 Ear
and Mastoid process
Practice 1.4
Answer: False
Practice Questions
35
Practice 1.5
Answer: A, D, S
Practice 1.6
Answer: A, B, D, G, K, S
Practice Questions
36
Practice 1.7
Answer: False
Practice 1.8
S02.3XXD
Practice Questions
37
Practice 1.9
Answer: T17.1XXA
Practice 1.10
“U”
38
Other Coding Conventions and
Guidelines
39
Other Coding Conventions and
Guidelines

Abbreviations and Punctuation
40
Other Coding Conventions and
Guidelines

Instructional Notes,
sequencing and new
concepts
Info
“NEC” and “NOS”
“Other”
“Unspecified”
41
Other Coding Conventions and
Guidelines
Punctuation

Brackets [ ]

Parentheses ( )

Colons :

Dash –
42
Other Coding Conventions and
Guidelines

Excludes 1
 Code
should not be
used at the same time
as the code above the
Excludes 1 note.
Excludes 1

Excludes 2
 Acceptable
to use both
the excluded code and
the code above the
Excludes 2 note.
Excludes 2
43
Other Coding Conventions and
Guidelines

Etiology and manifestation
 Underlying
condition is sequenced first, followed by
the manifestation
 “code
first”
 Noted
 “use
at manifestation
additional code”
 Noted
at etiology code
44
Other Coding Conventions and
Guidelines
“And”
“With”
“See” and “See Also”
“Code also”
45
Other Coding Conventions and
Guidelines

Acute and Chronic conditions
 If
separate entries exist, code both sequencing the acute
condition first.

Laterality
 Codes
available for right, left and bilateral conditions.
 If a condition is bilateral, but a bilateral code is not
available, assign a code for both the right and left side.
Complications of Care
46



Some complications have been moved to specific
body system chapters.
Cause-and-effect relationship.
Documentation must support that there is a
relationship between the care provided and the
condition.
Practice
Questions
Practice Questions
48
Practice 2.1
Answer: False
Practice 2.2
Answer: not coded here/code can’t be used at the
same time as code above the excludes 1 note
Practice Questions
49
Practice 2.3
Answer: right, left, bilateral, unspecified
Practice 2.4
Answer: True
Practice Questions
50
Practice 2.5
Answer: Not otherwise specified, unspecified
codes
Practice 2.6
Answer: A code for both the right and left side
should be assigned
51
Chapter Specifics
52
Chapter 8
Diseases of the Ear and Mastoid Process
(H60 – H95)
Chapter 8
Diseases of the Ear and Mastoid Process
53

Highlights


Laterality
Conventions

Code first underlying
disease

Use additional code
Instructional Notes


Excludes 1 and 2
Chapter 8
Diseases of the Ear and Mastoid Process
54
Abscess
Cellulitis
Infective NOS
Circumscribed
Infective
Otitis
Externa
380.10
Hemorrhagica
Diffuse
NOS
Chapter 8
Diseases of the Ear and Mastoid Process
55
Specified
type, NEC
Actinic
Chemical
Other
acute
otitis
externa
380.22
Contact
Reactive
Eczematoid
Chapter 8
Disease of the Ear and Mastoid Process
56

Cerumen removal
 Laterality

Acquired stenosis of external ear canal
 Changed
some of the code titles
Chapter 8
Diseases of the Ear and Mastoid Process
57

Nonsuppurative otitis media
 Inflammation

without the production of pus.
Instructional notes
 Tympanic
membrane perforation.
 Smoking use/dependence/exposure
Otitis Media
58

Acute otitis media (AOM)


Recurrent AOM


The rapid onset of signs and symptoms of inflammation of
the middle ear.
Three or more well-documented and separate AOM
episodes in the past 6 months or at least 4 well-documented
and separate AOM episodes in the past 12 months with at
lease 1 in the past 6 months.
Chronic otitis media with effusion (OME)

OME persisting for 3 months or longer from the date of
onset or from the date of diagnosis.
Otitis Media
59

Suppurative
 Purulent


(pus) fluid in the middle ear
Excludes 1 for tympanic membrane perforation for
subcategory H66.01Use additional code for smoking use/dependence or
exposure.
Chapter 8
Diseases of the Ear and Mastoid Process
60
Hearing Loss
Unilateral
Right or left
Types of loss
Conductive
Sensorineural
Mixed
Complications
Documentation Examples
62
What code(s) are assigned for the clinic encounter?
H65.91
Unspecified nonsuppurative otitis media,
right ear
H72.01
Central perforation of tympanic
membrane, right ear
Documentation Examples
63
Potential documentation gaps:
1.
Laterality is noted for specific code selection.
2.
Mucoid fluid is noted in exam, but impression and plan
only state otitis media. Be as specific as possible when
describing the diagnosis using ICD-10 code language
when possible.
3.
Acute/chronic is not documented. Forced to use an
unspecified OM code. Inclusion terms under the
unspecified category list mucoid OM, NOS.
Other issues for code selection:
Documentation Examples
64
What code(s) are assigned for the clinic encounter?
H91.90
Unspecified hearing loss, unspecified ear
H93.19
Tinnitus, unspecified ear
R42
Dizziness
Potential documentation gaps:
Laterality-Specify which ear or if bilateral ears have hearing loss
and/or tinnitus
Specific type of hearing loss if known.
Other issues for code selection:
Unilateral/bilateral issue for hearing loss code selection.
65
Chapter 11
Diseases of the Digestive System
(K00 – K95)
Chapter 11
Diseases of the Digestive System
66

Highlights


Conditions reclassified
Instructional notes


Alcohol use/dependence
Smoking
Chapter 11
Diseases of the Digestive System
67
Salivary glands
→
→
1-1 mapping
Sialoadenitis
acute
recurrent
chronic
Image Source:
http://upload.wikimedia.org/wikipedia/commons/d/df/Blausen_0780_SalivaryGlands.png
Chapter 11
Diseases of the Digestive System
68
Mouth
Lips
Tongue
Image Source: http://upload.wikimedia.org/wikipedia/commons/6/6a/Illu03_mouth.jpg
Chapter 11
Diseases of the Digestive System
69
Gastro-Esophageal Reflux
Disease
HEARTBURN
Practice
Questions
Practice Questions
71
Practice 3.11.1
Answer: Biting
Answer: K13.1
Practice 3.11.2
Answer: K21.9
Practice 3.11.3
Answer: T45.1X5 A, D, S
Answer: Y84.2
Practice Questions
72
Practice 3.11.4
Answer: K11.21
Practice 3.11.5
Answer: K11.22
Practice Questions
73
Practice 3.11.6
Answer: K14.5
Practice 3.11.7
Answer: K22.711
74
Chapter 10
Diseases of the Respiratory System
(J00 – J99)
Chapter 10
Diseases of the Respiratory System
75

Highlights

Instructional notes

Excludes 1 and 2
76
Chapter 10
Diseases of the Respiratory System

Infectious agent code assignment.
 Use
code for “in diseases classified elsewhere”
 A49.02

Methicillin resistant staphylococcus aureus
Excludes 1 note indicating not to use with bacterial agent as
cause of disease classified elsewhere.
 B95.62
MRSA as cause of disease classified elsewhere
Watch for correct code assignment!
Sinusitis
77


Acute
 Lasts up to four weeks
Recurrent
 Several attacks in a year
 Three or more episodes in a year with each
lasting two weeks.
Sinusitis
78


Chronic
 Last more than 12 weeks
 Three months or more
 Longer than 8 weeks
Pansinusitis
 All four sinuses are infected
Chapter 10
Diseases of the Respiratory System
79

Tonsillitis
 Acute
 Acute
recurrent
 Chronic
 Streptococcal
 Other

Tonsillitis and Adenoiditis
 Chronic
 Hypertrophy
Image Source:
http://upload.wikimedia.org/wikipedia/commons/thumb/8/89/Blausen_0861_Tonsils%26Thr
oat_Anatomy2.png/600px-Blausen_0861_Tonsils%26Throat_Anatomy2.png
80
Chapter 10
Tonsillitis

Acute
Fever, sore throat, foul breath, tender cervical lymph nodes.
 Airway obstruction due to swollen tonsils
 Symptoms usually resolve in three to four days, may last up
to two weeks.


Recurrent


Multiple episodes of acute tonsillitis in a year.
Chronic

Individuals have chronic sore throat, halitosis, tonsillitis and
persistently tender cervical nodes.
Rhinitis
81

Vasomotor
 Rhinitis
not caused by hay fever or allergies
 Non-allergic rhinitis

Allergic
 Similar
code titles
 1-1 mapping
1-1 mapping!!!!!
82
Chapter 10
Diseases of the Respiratory System
83

Asthma
Mild
Intermittent
Mild
Persistent
Moderate
Persistent
Severe
Persistent
84
Chapter 10
Diseases of the Respiratory System

Asthma
 Intermittent
 Wheezing/coughing
 Nighttime
 Mild
no more than 2 days/week
flare-ups occur twice a month at most
persistent
 Symptoms
occur more than twice a week, but less than one
per day
 Nighttime
flare-ups occur more than twice/month, but less
than once/week
85
Chapter 10
Diseases of the Respiratory System

Asthma
 Moderate
persistent
 Symptoms
 Flare-ups
 Severe
occur and usually last several days
persistent
 Symptoms
 Curtails
 Lung
occur daily
occur daily and often
activities and disrupts sleep
function less than 60% without treatment
www.healthychildren.org
Chapter 10
Diseases of the Respiratory System
86

Intraoperative and Postprocedural Complications
 Documentation
requirements
Documentation Examples
87
What code(s) are assigned for the clinic encounter?
J03.01 Acute recurrent streptococcal tonsillitis
Potential documentation gaps:
1.
2.
Acute vs. recurrent-Documentation states patient has had 6 plus
infections in the last year. Documentation in plan states acute strep,
but would advise physician to use term recurrent to code more
specifically to show severity of rate of infections.
Would also code for enlarged lymph nodes. R59.0 Localized
enlarged lymph nodes.
Other issues for code selection:
Documentation Examples
88
What code(s) are assigned for the clinic encounter?
J32.4 Pansinusitis NOS
J33.0 Polyp of nasal cavity
J34.2 Deviated septum
Potential documentation gaps:
Chronic vs. NOS. If acute or chronic isn’t documented, sinusitis codes
default to chronic.
Asthma is noted in HPI, but isn’t addressed in plan and impression.
Asthma should be addressed in the plan and impression if it
influences the care of the patient. Also, added as an additional
diagnosis.
Documentation Examples
89
Other issues for code selection:
Acute sinusitis codes now have options for recurrent acute
infections.
ICD-10- has specific codes available for pansinusitis.
New guideline for coding more than one sinus infected, but less
than 4. Use other specified sinusitis codes per the guideline.
90
Chapter 2
Neoplasms
(C00 – D49)
Chapter 2 Neoplasms
91

Neoplasm Table
 Reference
first unless a histologic term is documented
 Malignant
 Benign
 In
situ
 Uncertain
histologic behavior
 Unspecified
behavior
Chapter 2 Neoplasms
92

Overlapping sites
 Separate

code within the category.
History of vs. active neoplasm
 Primary
malignancy is excised/eradicated and no
further treatment is directed to the site, use code from
category Z85.
Chapter 2 Neoplasms (C00 – C49)
93

Use additional code

Includes and Excludes

NOS

Laterality
Chapter 2 Neoplasms (C00 – C49)
94

Malignant neoplasms
1
– 1 mapping
 141.0
1
= C01 Malignant neoplasm of base of tongue
– many mapping
 146.8
Malignant neoplasm other specified sites of
oropharynx

C10.4 Malignant neoplasm of branchial cleft

C10.8 malignant neoplasm of overlapping sites of oropharynx
 Expanded
for greater specificity of location.
Chapter 2 Neoplasms (C00 – C49)
95

Melanoma and other skin cancers
 Malignant
 Separate
Image source: http://en.wikipedia.org/wiki/File:HumanSkinDiagram.jpg
melanoma and melanoma in situ
codes to indicate malignant melanoma or in situ.
Skin Cancer
96

Categorized by type
of skin cancer, like
ICD-9-CM.
 Basal
cell
 Squamous cell
 Merkel cell
 Other specified
malignant neoplasm
 Unspecified malignant
neoplasm
Source: http://upload.wikimedia.org/wikipedia/commons/thumb/c/c1/
Layers_of_the_skin.jpg/495px-Layers_of_the_skin.jpg
Chapter 2 Neoplasms (C00 – C49)
97

Benign neoplasms
 Similar

to malignant neoplasm with many 1-1 mapping.
Benign skin neoplasms
 Melanocytic
nevi
 Other benign neoplasm
Documentation Examples
98
What code(s) are assigned for the clinic encounter?
R22.1 Neck mass
R09.81 Nasal congestion
Z72.0 Tobacco use
Potential documentation gaps:
For current diagnoses, documentation supports most specific code
available.
Other issues for code selection:
Codes for head and neck mass now have different codes depending
on location.
Documentation Examples
99
What code(s) are assigned for the clinic encounter?
C07 Malignant neoplasm of parotid gland
C77.0 Secondary and unspecified malignant neoplasm of lymph nodes of
head, face and neck
Z72.0 Tobacco use
Potential documentation gaps:
Code fully for primary and secondary sites.
Document specific location of cancer.
Other issues for code selection:
Instructional note to add tobacco use/dependence/exposure as well as
any alcohol abuse and dependence.
100
Chapter 17
Congenital Malformations, Deformations and
Chromosomal Abnormalities
(Q00 – Q99)
Chapter 17
Congenital Malformations, Deformations and
Chromosomal Abnormalities
101



Highlights
Eye, Ear, Face and Neck
Respiratory System
 Nose
 Larynx
 Trachea


and Bronchus
Cleft lip and palate
Down Syndrome
Practice
Questions
Practice Questions
103
Practice 3.17.1
Answer: Q37.5
Practice 3.17.2
Answer: False
Practice Questions
104
Practice 3.17.3
Answer: Q17.5
Practice 3.17.4
Answer: Q32.0
Practice Questions
105
Practice 3.17.5
Answer: Q30.0
Practice 3.17.6
Answer: True
Practice Questions
106
Practice 3.17.7
Answer: Q31.0
107
Chapter 12
Diseases of the Skin and Subcutaneous Tissue
(L00 – L99)
Chapter 12
Diseases of the Skin and Subcutaneous Tissue
108

Highlights

Instructional notes
Image Source: http://upload.wikimedia.org/wikipedia/commons/5/5d/Anatomy_The_Skin__NCI_Visuals_Online.jpg
Chapter 12
Diseases of the Skin and Subcutaneous Tissue
109

Infections of the skin and subcutaneous tissue

Radiation-related disorders

Disorders of skin appendages

Complications

Other skin disorders
Practice
Questions
Practice Questions
111
Practice 3.12.1
Answer: True
Practice 3.12.2
Answer: Cyst
Practice Questions
112
Practice 3.12.3
Answer: Use additional code to
identify infectious agent
Practice 3.12.4
Answer: Additional code to indicate type of
retained foreign body
Practice Questions
113
Practice 3.12.5
Answer: Code for the condition being treated first
with the active injury code second.
Answer: S – sequela
114
Chapter 18
Symptoms, Signs and Abnormal Clinical and
Laboratory Findings
(R00 – R99)
Chapter 18
Symptoms, Signs and Abnormal Clinical and
Laboratory Findings
115

Highlights

Use of symptom codes

Instructional notes
Chapter 18
Symptoms, Signs and Abnormal Clinical and
Laboratory Findings
116


1-1 mapping
Same code titles for many conditions.
 Epistaxis
784.7 = R04.0
 Hemorrhage from throat 784.8 = R04.1
 Postnasal drip 784.91 = R09.82
 Jaw pain 784.92 = R68.84

Others have been expanded
 R06.5
mouth breathing
 R06.7 sneezing
Sleep Conditions
117



Most codes were reclassified to the Nervous System
chapter.
Some sleep codes fall into the Mental, Behavioral
and Neurodevelopmental disorders chapter.
Obstructive sleep apnea (adult) (pediatric)
 ICD-10-CM
= G47.33
118
Chapter 19
Injury, Poisoning and Certain Other Consequences
of External Causes
(S00 – T88)
Chapter 19
Injury, Poisoning and Certain Other Consequences of
External Causes
119

Highlights

S-section and T-section

7th character extension
definitions
Chapter 19
Injury, Poisoning and Certain Other Consequences of
External Causes
120

“X” Placeholder
 Future
code expansion
 T36.8X1A
 Fill
in empty character
positions to assign 7th
character to 7th data
field.
 S02.2XXA
Practice Questions
121
Practice
A: A initial encounter for closed fracture
B: D subsequent encounter
C: S sequela
D: A initial encounter
E: A initial encounter
Chapter 19
Injury, Poisoning and Certain Other Consequences of
External Causes
122

Coding guidelines for injuries and fractures
KNOW THE RULES!
Chapter 19
Injury, Poisoning and Certain Other Consequences of
External Causes
123

Image Source:
http://upload.wikimedia.org/wikipedia/commons/thumb/1/1a/Human_skull_front_simplified
_%28bones%29.svg/399px-Human_skull_front_simplified_%28bones%29.svg.png
Injuries to the Head and Neck

Superficial

Open wound

Fracture

Dislocation and sprain
Chapter 19
Injury, Poisoning and Certain Other Consequences of
External Causes
124

Foreign body
 Superficial
 Entering
through
natural orifice
 Respiratory
Tract
Chapter 19
Injury, Poisoning and Certain Other Consequences of
External Causes
125

Complications of Surgical and Medical Care, NEC
 Wound
infections
 Mechanical
 Disruption
 Infections
complications
of surgical wounds
due to prosthetic devices, implants, grafts
Documentation Examples
126
What code(s) are assigned for the clinic encounter?
T16.1XXA Foreign body of right ear, initial encounter
T16.2XXA Foreign body of left ear, initial encounter
What code(s) are assigned for the surgical encounter?
T16.1XXA Foreign body of right ear, initial encounter
T16.2XXA Foreign body of left ear, initial encounter
What codes(s) are assigned for the post-operative visit?
T16.1XXD Foreign body of right ear, initial encounter
T16.2XXD Foreign body of left ear, initial encounter
Documentation Examples
127
Potential documentation gaps:
Laterality is clearly documented
7th character extension-initial or subsequent
Other issues for code selection:
X placeholder
Assign two codes because there isn’t a bilateral option
Documentation Examples
128
What code(s) are assigned for the clinic encounter?
S09.22XA Traumatic rupture of left ear drum, initial encounter
H90.12
Conductive hearing loss, unilateral, left ear, with unrestricted
hearing on the contralateral side.
What code(s) would be assigned if patient required a paper patch at
the next visit and why?
S09.22XA Traumatic rupture of left ear drum, initial encounter
Surgical care is considered initial encounter. Patient is being actively
treated for the condition.
Hearing loss code if still present.
Documentation Examples
129
What code(s) would be assigned at the next visit if the patient did
not require further treatment and why?
S09.22XD Traumatic rupture of left ear drum, subsequent encounter
Patient has entered the healing/recovery phase.
Hearing loss code if still present.
Potential documentation gaps:
Laterality-Documentation addresses which ear has the condition.
7th character extension-initial or subsequent
Documentation Examples
130
Other issues for code selection:
X placeholder
Codes are assigned to the injury chapter rather than ear and
mastoid process chapter.
Traumatic ear drum ruptures are not specific to type of perforation
(e.g., marginal, central) like the codes from the H72 category in the
Ear and Mastoid Chapter.
131
Getting Ready
132
Steps to Implementation
Steps to Implementation
133
1.
Form a Team
2.
Inventory the Practice
3.
Frequency Reports
4.
Mapping
5.
Gap Analysis
Thank You
Joy McKusick, RHIA
[email protected]
312.642.5616