ICD-10 Here it comes – like it or not… © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. Brian D. Loftus,

ICD-10Here it comes – like it or not…

© 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc.

Brian D. Loftus, MDBellaire Neurology

iHeadacheSouthern Headache Society, Vice President

Disclosures:

Nothing relevant regarding ICD-10 except … I am really fed up with meaningless use and have stopped

participatingI am really fed up with PQRS and have stopped participatingPlanning to drop medicare completelyI am very computer literate (former programmer, iHeadache

developer)


Objectives

Identify ICD10 coding

Understand the Structure of the International Classification of Headache Diseases Version 2

Recognize accurate disease coding of headache and facial pain in ICD10


ICD10 Why Bother

ICD-10 allows for more codes for more specific diagnosis, better ability to determine comorbid conditions, severity of illness, etc

We are the only major country not using ICD-10

External injury codes are particularly more detailed and may improve injury surveillance


AHIMA (American HIM Assoc)

ICD10 Why Bother

Improve monitoring

Fewer rejected and improper reimbursed claims?

Reduced coding errors?

Reduced labor costs and increased productivity?


AHIMA (American HIM Assoc)

ICD10 Cons

Track record has been so good with this sort of thing…

Meaningful use has been debacle

PQRS – very little quality being measured in my practice

MOC – I see no value to practice for all the extra expense

Multiple Boards – increasingly common – increasing cost


One more thing to deal with

ICD10 Cons

ICD11 is just 2 years away


One more thing to deal with

ICD10 Here it Comes

From the physician viewpoint – at least in my practice – it has been actually painless.


The Best Thing I can Say!!

ICD 10 in My Practice

There exists a government approved ICD10 to ICD9 conversion (General Equivalence Mapping)

More than 1 ICD10 code for each ICD9 code but only 1 ICD9 code for each ICD10 Code


Your experience may vary…


I can search for words in either the ICD9 code names or ICD10 code names or both

I have not encountered any initial or subsequent subcodes in my practice to date




I can search for words in either the ICD9 code names or ICD10 code names or both

I have not encountered any patient in my practice where I had to worry about an initial encounter, subsequent, or sequelae code




7 characters

1st 3 – category

2nd 3 – etiology, anatomic site, severity

7th digit extension A (Initial) D (Subsequent), or S (Sequalae)


Structure


1st character is an alpha.

O and I will only be in the 1st character, otherwise they are 0 (zero) or 1 (one).

7th character for injuries and external causes


Structure

Headaches

ihs-classification.org/en/

This classification gives you the ICD10 codes for each disease. There are cases when they do not match exactly.


ICHD-2 is your friend

http://www.ihs-classification.org/en/

IHS Classification ICHD-2

Part One – Primary Headaches

Part Two – Secondary Headaches

Part Three – Cranial Neuralgias, Facial pain and other

Appendix


Structure

Headaches – Part I ICHD-2

Periodic Headache Syndromes in Adult/child

Opthalmoplegic migraine

Abdominal migraine

All of the above can be intractable or not intractable


Migraine – ICD10 additions

Headaches – Part 2 ICHD-2

No changes (tension unspecified, episodic, chronic) except



Tension – ICD10 additions


No changes – Cluster (unspecified, episodic, intractable) and paroxysmal hemicrania (episodic, chronic), SUNCT, and Other Trigeminal Autonomic Cephalgias are unchanged



Cluster and TACs – ICD10 additions


No additions –

Reminder – Primary Stabbing Headache, Primary Cough Headache, Primary Exertional Headache, Primary headache associated with sexual activity, Hypnic Headache, Primary Thunderclap Headache, Hemicrania Continua, New Daily Persistant Headache


Other Primary HA – ICD10 additions


No changes - Post traumatic headache (unspecified, acute, chronic)



Head Trauma– ICD10 additions

Concussion – S06.0X

Digit 6 of Code is based upon length or loss of consciousness, (none, <30, 31-59, 1 hour - <6 hr, 6-24 hr, >24 hr with full recovery of consciousness, non recovery, death due to brain injury, death but not due to brain injury)

Digit 7 of Code is initial encounter (end with A), subsequent encounter(end in D), or sequelae (end in S)



Concussion

Initial eval for concussion lasting a few minutes

All concussions are S06.0X

Next digit - – time <30 minutes – 1

Initial encounter A

S06.0X1A



Concussion

The coding of the extension – is from the patient’s perspective. It is not – your first visit to see the patient.

In our example, the ED physician, consulting neurologist/neurosurgeon, radiologist would all use the same code during the initial evaluation time frame.

Other acute care would use subsequent extension D



Concussion

If you saw the patient post-discharge from the hospital for evaluation of seizures that you felt that were related to the concussion – you would code the extension as sequelae even though is was your initial visit with the patient



Stroke and TIAs

Cerebral infarction is now broken down by –

1) Basilar, Carotid, Vertebral, Cerebellar, Precerebral, ACA, PCA, MCA, PCA

2) Thrombosis, Embolism, or Unspecified

3) Left, Right, or Unspecified


ICD10 Additions

Stroke and TIAs

Common stroke syndromes added

MCA Syndrome, ACA Syndrome, PCA syndrome

Pure Sensory Lacunar Syndrome

Pure Motor Lacunar Syndrome


ICD10 Additions

Multiple Sclerosis

Optic Neuritis gets unspecified, left, right, bilateral

No changes to MS, NMO, Transverse Myelitis


ICD10 Additions

Dementia

Alzheimer’s disease gets early onset, late onset other, and unspecified

No changes in other dementia diagnosis or MCI


ICD10 Additions

Parkinsonism

Vascular

Neuroleptic induced

Other drug induced

Other external agents

Postencephalitis

Other secondary

Unspecified© 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc.

ICD10 Additions

Partial Seizures

Simple Partial, Complex Partial, or unspecified

Idiopathic or Symptomatic

Intractable or not intractable

With or without status epilepticus


ICD10 Additions

Generalized Seizures

Idiopathic, JME, Absence, Lennox-Gastaut or Other

Intractable or not Intractable

With or Without Status epilepticus


ICD10 Additions

Radiculopathies

15 ICD10 codes that map to cervical stenosis (724.00)

3 by location (occipito-allanto-axial region, cervical, cervicothoracic)

Cause of stenosis – subluxation, osseous, connective tissue, intervertebral disk

Head vs cervical


ICD10 Additions

Radiculopathies

7 ICD10 codes for brachial neuritis (723.4)

9 ICD10 codes for lumbar stenosis (724.02)

8 ICD10 codes for thoracic stenosis (724.01)

8 ICD10 codes for thoracic or lumbar radiculopathy (724.4)

6 ICD10 codes for Sciatica


ICD10 Additions

Radiculopathies

25 ICD10 codes for other unspecified back disorders (724.9)

7 ICD10 codes for disorders of sacrum (724.6)


ICD10 Additions

Brian D. Loftus, MD

[email protected]


Thank you for your attention

Documents

ICD-10 Here it comes – like it or not… © 2014 Better QOL, Inc. All Rights Reserved. iHeadache is a registered trademark of Better QOL, Inc. Brian D. Loftus,