Barbara Parker, CMA (AAMA), CPC, CCS-P

ICD-10 ImplementationFormatDifferences between ICD-9 and ICD-10

Resources

October 1, 2013 –NOT flexible All HIPAA covered entities must transition NO grace period ICD-9-CM not accepted after this date January 1, 2012 – electronic transmission

changes to Version 5010 which accomodates ICD-10 format

Proposed freeze on ICD-9-CM on October 1, 20ll

CPT and HCPCS continue

January 1, 2010 Payers and providers should begin internal testing of Version 5010 standards

for electronic claimsDecember 31, 2010 Internal testing of Version 5010 must be complete to achieve Level I Version

5010 complianceJanuary 1, 2011 •         Payers and providers should begin external testing of Version 5010 for

electronic claims •         CMS begins accepting Version 5010 claims •         Version 4010 claims continue to be acceptedDecember 31, 2011 External testing of Version 5010 for electronic claims must be complete to

achieve Level II Version 5010 complianceJanuary 1, 2012 •         All electronic claims must use Version 5010 •         Version 4010 claims are no longer acceptedOctober 1, 2013 •         Claims for services provided on or after this date must use ICD-10 codes

for medical diagnosis and inpatient procedures •         CPT codes will continue to be used for outpatient services

General Equivalence Mapping files

ICD-9 to ICD-10

ICD-10 to ICD-9

Not set in stone – just thegeneral idea

ICD-10-CMFrom 14,315 to 69,099 codesAdded right, left, bilateral

ICD-10-PCSFrom 3,838 to 71,957

Longer . . . Uses more alpha characters 3 to 7 characters

1st character is a letter (except U)2nd character is a number3rd – 7th can be a letter or number

Decimal after third character

A78 Q fever

A69.21 Meningitis due to Lyme disease

O9A311 Physical abuse complicating pregnancy, first trimester

S52.131A Displace fracture of neck of right radius, initial encounter for

closed fractureReference: MLN Matters, SE 109

Laterality is added(left, right, bilateral)

C50.511 Malignant neoplasm of the lower-outer quadrant of right female breast

H16.013 Central corneal ulcer, bilateral

L89.022 Pressure ulcer of left elbow, stage II

Combination codes for conditions and commonly associated symptoms and manifestations

K57.21 Diverticulitis of large intestine with perforation and abscess with bleeding

E11.341 Type 2 diabetes mellitus with severe nonproliferating diabetic retinopathy with macular edema

I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris

Combination codes for poisoning and associated external cause

T42.3x2S Poisoning by barbiturates, intentional self-harm, sequela

Obstetric codes to identify trimester instead of episode of care

O26.02 Excessive weight gain in pregnancy, second

trimester

Character “x” used as 5th or 6th character placeholder to fill in empty space when a code is less than 6 characters and requires a 7th character

T15.02xD Foreign body in cornea, left eye, subsequent encounter

T46.1x5A Adverse effect of calcium-channel blockers, initial encounter

Excludes1: Code excluded should NEVER be reported with the code where the note is located

Q03 Congenital hydrocephalusExcludes1: Acquired hydrocephalus (G91.0-)

Excludes2: Condition excluded is NOT part of the condition represented by the code but a patient may have both conditions at the same time in which case both codes are assigned

L27.2 Dermatitis due to ingested foodExcludes2: Dermatitis due to

food in contact with skin (L23.6, L24.6, L25.4)

UnderdosingT45.526D Underdosing of

antithrombotic drugs, subsequent encounter

Blood typeZ67.40 Type O blood, Rh positive

Blood alcohol levelY90.6 Blood alcohol level of

120-199 mg/100 ml

InjuryS75.121A Major laceration of femoral

vein at hip and thigh level, right leg, initial encounter

DiabetesE10.610 Type 1 diabetes mellitus

with diabetic neuropathic arthropathy

Substance abuseF10.182 Alcohol abuse with alcohol-

induced sleep disorder

Postoperative complicationsT82.02xA Displacement of heart valve

prosthesis, initial encounter

The appropriate 7th character must be added to each code from category S01

A initial encounterD subsequent encounterS sequela (from prior

disease or injury)

M84.6 Pathological fracture in other diseaseThe appropriate 7th character is to be added to each code from subcategory M84.6

A initial encounter for fracture

D subsequent encounter for fracture with routine healing

G subsequent encounter for fracture with delayed healing

K subsequent encounter for fracture with nonunionP subsequent encounter for fracture with malunionS sequela

Distinction made between intraoperative complications and post operative disorders

D78.01 Intraoperative hemorrhage and hematoma of spleen complicating a procedure of the spleen

D78.21 Postprocedural hemorrhage and hematoma of spleen complicating a procedure of the spleen

Injuries grouped by anatomical site rather than injury type

Example: S25.411A Minor laceration of right pulmonary blood vessel, initial encounter

New code definitionsExample: Acute myocardial infarction

is defined as 4 weeks rather than 8 weeks

V and E codes incorporated into main classification rather than separate classifications

www.cms.gov (Choose Medicare, then coding, then ICD10)

Medicare has many, many resources

www.cdc.gov/nchs/icd/icd10cm.htmNew ICD10 draft guidelines available

here www.aapc.org American Academy of Professional

Coders has webinars, online courses, and a wealth of other resources