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Building Blocks of ICD-10-CM
Norma A. Panther, CPC, CPC-I, CIRCC, CEMC, CCS-P, ICDCT-
CM, ICDCT-PCS, CHC
Objectives
Comparison of ICD-9 & ICD-1Ø 5 digits vs. 7 Alphanumeric New conventions, such as:
Excludes 2 Placeholder x
General coding rules Coding
We’ll use pages from the Ingenix® 2013 ICD-1Ø- CM Draft to code using building blocks. The example codes will include at least one placeholder x.
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The same!
Alphabetic Index & Tabular Index External Causes Index Codes arranged by chapter, now 21 in the tabular index Neoplasm and Drugs and Chemicals Tables Brackets, Code First, Colon, Excludes, Includes, In diseases classified elsewhere, Parentheses, See, See Also, Use Additional Code
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I-9 vs. I-10 Diseases of the Musculoskeletal System and Connective Tissue
M84. Disorder of continuity of bone
M84.5 Pathological fracture in neoplastic disease
M84.56 Pathological fracture in neoplastic disease, tibia and fibula
M84.561 Pathological fracture in neoplastic disease, right tibia
M84.561A Pathological fracture in neoplastic disease, right tibia, initial encounter for fracture
Musculoskeletal System and Connective Tissue
733. Other disorders of bone and cartilage
733.1 Pathologic fracture
733.16 Pathologic fracture of tibia or fibula
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Steps to coding: 1. Review conventions and guidelines 2. Locate and look up mainterm in the Alphabetic Index 3. Note nonessential modifiers 4. Follow instructions such as: see, see also, see
category, with/without, omit code, due to 5. Verify code choice in the Tabular Index 6. Review instructions in the Tabular Index, such as:
includes, excludes, code also, character requirements 7. Are there guidelines for the chapter you are coding? 8. Confirm and assign code
General Coding Guidelines Medical Necessity
Reasonable and necessary for the diagnosis and/or treatment of an illness or injury, or to improve function of a deformed member
Borderline Diagnosis
Code as confirmed unless classification provides specific entry (e.g., borderline diabetes)
First Listed Diagnosis The most important reason for the care provided to the patient
Specificity
Assignment of 4th. 5th, 6th or 7th character to further specify or classify a diagnosis Special Characters Use of placeholder x
General Coding Guidelines Impending or Threatened Condition
At discharge if diagnosis occurred code it otherwise refer to impending or threatened in the index
Laterality
If no bilateral code for bilateral condition assign both left and right
Signs & Symptoms What prompts a patient to seek treatment. Code when diagnosis is not confirmed. Also code when not routinely associated with disease process.
I-10- CM Differences
Point dash - Excludes 2 notes Extensions- Alphabetic and Numeric Placeholder x
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Point dash - Placeholder for additional digits
Alphabetic Index
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Point dash - Placeholder for additional digits
Tabular List
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Excludes 2
“Code this 2”
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Alphabetic Extensions
A through S No: I, L, O Most common:
A- initial encounter D- subsequent encounter S- sequela plural se·quel·ae
Definition of SEQUELA \si-ˈkwe-lə\ 1: an aftereffect of disease, condition, or injury 2: a secondary result Origin of SEQUELA New Latin, from Latin, sequel First Known Use: circa 1793 14
Alphabetic Extensions
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Numeric Extensions
Number of fetuses Stage of disease Time frame
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Placeholder x
Used as 4th, 5th and/or 6th character Must be used or code is invalid Use when you see this symbol
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x7th
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DETERMINATION
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Coding Exercise
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Disclaimer: The information provided in this presentation was obtained from third party sources and is subject to change without notice. It is intended to provide general information for illustrative purposes only. Presenter specifically disclaims liability or responsibility for the results or consequences of any misapplication(s)
of the statements, opinions, or suggestions, in this presentation. Sources:
Principles of ICD-10-CM Coding; AMA; Deborah J. Grider ICD-10-CM, The Complete Official Draft Code Set; Ingenix Understanding ICD-10-CM and ICD-10-PCS A Worktext; Mary Jo Bowie & Regina Schaffer CMS; various web sources and presentations
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