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ICD-10 Physician Education
Internal Medicine/Family Medicine
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Training Objectives
• ICD-9 to ICD-10 Comparison
• Documentation Tips
• Additional Educational Opportunities
• Questions
ICD-9 to ICD-10 Comparison
3
Reference: CMS
X X X X X
ICD-9 ICD-10-CM
X X X X X X X
Category Category Etiology, anatomic site,
manifestation Etiology, anatomic
site, manifestation Extension
Diagnosis Code Structural Change
. .
What Will Change What Remains the Same
Code
Structure
Up to 7 characters DRGs
Alpha-numeric codes CPT, HCPCS, E&M Codes
Diagnosis
Code Volume 14,025 to 69,823
Reimbursement methodology
(awaiting finalization)
Coders can only assign codes based
on provider documentation
Neoplasms
• Type
• Detailed location(s)
– Overlapping sites vs
different, distinct locations
– Laterality (where
applicable) new concept
• Primary
– Still active primary site
– Previously removed/treated
• Metastatic
– Location
– Symptomatic
– Current treatment course
• Manifestations
– Mucositis
– Anemia
– Link to etiology (neoplasm,
chemotherapy)
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Endocrine & Blood Disorders • Diabetes
– Type
– Documentation concept of “controlled” vs “uncontrolled” is no longer applicable in ICD-10
– Manifestations
– Long-term use of insulin
– Insulin pump
– Gestational (clearly define if condition is gestational or pre-dates the pregnancy)
• Nutritional deficiencies – Specify substance
• Overweight, obesity, morbid obesity – Specify BMI
• Malnutrition
– Type (mild, moderate, severe)
– BMI
– Complications/Manifestations
• Lipid Disorders
• Thyroid Diseases
– Toxic vs non-toxic
– Crisis or storm
– Drug induced
• Anemia
– Etiology/Type
– Due to chronic disease
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Mental & Behavioral Disorders • Anxiety
– Type
• Bipolar Disorder – Description of most recent
episode
• Depression – Major depressive disorder
verbiage change
– Single vs recurrent episode
– Type
– Remission
• Dementia – Presence of behavioral
disturbances
• Intellectual Disabilities expansion – Specify category
• Schizophrenia – Type
• Phobias expansion
– Multiple phobias with specific diagnosis codes in ICD-10
• ADD/ADHD
• Smoking – Use or dependence
– Specify product new concept
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Nervous System • Alzheimer’s Disease
– Onset new concept
– Behavioral disturbances
• Cerebral Palsy
– Type
• CVA
– Artery impacted
– Laterality new concept
– Infarction vs hemorrhagic
– Occlusion vs stenosis
• Hemiplegia/Hemiparesis
– Type
– Laterality new concept
– Underlying etiology
– Hand dominance
• Restless Leg Syndrome
• Migraine
– Aura
– Intractable
– Status migrainosus
• Parkinson’s Disease
– Type
– Due to adverse effect
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Eye & Adnexa
Ear & Mastoid Process Eye & Adnexa
• Laterality, upper vs lower eyelids new concepts
• Blindness
– Type
– Etiology
• Cataract
– Age related, traumatic, drug induced
– Anterior vs posterior
– Complicated vs uncomplicated
• Glaucoma – Staging (mild, moderate, severe,
indeterminate)
Ear & Mastoid Process
• Anatomic specificity and
laterality new concept
• Hearing loss
– Type
• Otitis Media
– Type
• Impacted Cerumen
• Otalgia
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Acute Myocardial Infarction
• New time period is 4 weeks
– From the time of incident
• Initial MI vs subsequent MI
– Each AMI begins a new 4 week time period and would be
considered current/acute event
– Documentation must clearly state onset of acute MI event
• STEMI vs NSTEMI
• Impacted artery
• Impacted wall
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Circulatory System, cont… • Angina
– Stable, unstable, new onset
– Supply vs Demand causes
– Documented spasm new
concept
• Atherosclerosis
– Native artery or vein vs graft
• Cerebral Hemorrhage vs
Infarction
– Traumatic vs nontraumatic
– Etiology
– Artery blocked/ruptured
– Laterality new concept
• Hypertension concept change
• Heart Failure
– Acute, chronic or both
– Systolic, diastolic or both
• Embolism and Thrombosis
– Acute vs chronic
– Location/laterality new concept
• Valve Disorders
– Identify valve
– Insufficiency, prolapse, stenosis
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Respiratory System • Allergic Rhinitis
– Type
– Due to…
– With asthma
• Asthma – Intermittent vs persistent
– Mild, moderate or severe
• Bronchitis – Acute, subacute, chronic
– Underlying etiology
• COPD – Identify underlying condition(s)
– Exacerbation/decompensation
– Identify acute infections
• Respiratory Failure – Acute, chronic both
– Hypoxic vs hypercapnic
• Effects of tobacco use or exposure to second hand smoke
• Sinusitis – Sinus impacted
• Influenza – Causative agent
– Type
• Upper Respiratory Infection – Infectious source
– Identify organism
– Identify condition
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Digestive System • Constipation
– Slow transit/outlet dysfunction
• Crohn’s
– Location impacted
• Hernia
– Unilateral vs bilateral
• Diverticulitis
– Location
– Presence of perforation, abscess or bleeding
• Hepatitis
– Cause of disease
• Link complications to disease
– Bleeding, perforation, fistula, abscess, obstruction, gangrene
• Ulcerative Colitis
– Location impacted
• Complications of bariatric procedures
– Type of procedure
– Infection vs other complication
12
Genitourinary System • Link infectious agent/cause
• Acute Renal Failure
– Identify associated underlying
condition
– Complications (due to…)
– Due to trauma
• Benign Prostatic
Hypertrophy
– Link symptoms to syndrome
• Chronic Kidney Disease
– Stage or ESRD
– Link etiology
• Hematuria
• Urinary Obstruction
– Location
– Link symptoms
– Manifestations
• Urinary Tract Infection
– Location
• Urethral conditions
– Caruncle, diverticulum, false
passage, fistula
• Impotence
– Etiology
– Post surgical
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Skin & Subcutaneous Tissue • Cellulitis/Abscess
– Location
– Laterality new concept
– Acute vs chronic
– Manifestation
– Due to infection
• Contact Dermatitis
– Type/etiology
• Non-pressure chronic ulcer
– Etiology (diabetes, venous)
– Site
– Laterality new concept
– Severity (skin breakdown,
fat layer exposed, necrosis
of muscle and/or bone)
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Musculoskeletal System • Hand dominance
– Identify dominant side
– Identify condition
• Felty’s syndrome
– Site/laterality new concept
• Fractures (traumatic or stress)
– Open vs closed
– Anatomic site/laterality new
concept
– Displaced vs nondisplaced
– Degree of healing
– Gustilo classification for open fractures of long bones
• Injuries – identify Episode of Care (from patient’s perspective)
– Initial (presentation)
– Subsequent (routine or delayed healing)
– Sequela (late effect after initial injury/event has healed)
• Pathologic fracture
– Identify location
– Link underlying etiology
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Arthritis • Type
–Rheumatoid
•Arthritis, bursitis, nodule
•Vasculitis
•Presence of rheumatoid
factor
•Other organs/symptoms
present
–Osteoarthritis
•Primary vs secondary
•Unilateral vs bilateral
•Generalized vs localized
–Juvenile
–Other
• Site(s) impacted
• Laterality new concept
• Causal agent (when applicable)
– Staph
– Strep
– Pneumococcal
– Other
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Pregnancy & Childbirth
Newborn & Pediatrics Pregnancy & Childbirth
• Abortion – Stage
– Spontaneous vs induced
– Complications
• Clarify gestational vs pre-existing conditions
• High risk pregnancy – History of infertility,
ectopic/molar pregnancy
• List trimester and weeks gestation
• Multiple gestations – Number of fetuses
– Identify fetus with complication
Newborn & Pediatrics
• ADHD
– Type
• BMI
• Conditions brought on/affected
by pregnancy (maternal pre-
existing conditions)
• Congenital conditions
– Syndromes
– History of repaired conditions
– Identify current complications
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Symptom Diagnoses • Abnormal Gait
– Ataxic, paralytic, unsteadiness, other
• Convulsions – Type
• Disturbance of skin sensations – Anesthesia, hypoesthesia,
paresthesia, hyperesthesia, other
• Lack of coordination – Ataxic, other
• Limb pain – Site/Laterality new concept
• Muscle spasm
– Site/Laterality new concept
• Sleep Conditions
• Speech disturbances
– Aphasia, aphonia, dysphagia,
dysphonia, fluency,
hypernasality, hyponasality,
slurred speech, other
• Swelling, mass, lump
– Site/Laterality new concept
• Syncope
Z Codes (Formerly V Codes)
•Encounter for immunization new concept
– All immunizations will utilize
the same diagnosis code
•Screening examinations:
– Diabetes mellitus
– Lipoid disorders
– Other
•Routine medical examination expansion
– With or without abnormal
findings
• Long-term usage of
medications
• Screening for malignant
neoplasm
– Cervix
– Prostate
– Colon
• Personal history of
malignant neoplasm:
– Breast
– Uterus
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Additional Educational Opportunities
• Physician/Provider Foundation training
• Specialty/Service Line meetings
• ICD-10 Website
http://iuhicd10.iuhisclinicaleducation.org/
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