ICD-10 Fundamentals and Navigation
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ICD-10 Fundamentals and Navigation
- 3. ICD-10 Boot Camp Part 1 – Fundamentals and Navigation 3 Presented by Evan M. Gwilliam, DC MBA BS CPC CCPC NCICS CCCPC CPC-I MCS-P CPMA Chief Product Officer
- 4. Dr. Evan Gwilliam • Education • Bachelor’s of Science, Accounting - Brigham Young University • Master’s of Business Administration - Broadview University • Doctor of Chiropractic, Valedictorian - Palmer College of Chiropractic • Certifications • Certified Professional Coder (CPC) - AAPC • Nationally Certified Insurance Coding Specialist (NCICS) - NCCT • Certified Chiropractic Professional Coder (CCPC) - AAPC • ChiroCode Certified Chiropractic Professional Coder (CCCPC) - ChiroCode • Certified Professional Coder – Instructor (CPC-I) - AAPC • Medical Compliance Specialist – Physician (MCS-P) - MCS • Certified Professional Medical Auditor (CPMA) – AAPC, NAMAS • Certified ICD-10 Trainer - AAPC 4
- 5. Overview • Part 1 - ICD-10 fundamentals and navigation • Part 2 - Coding conventions and guidelines • Part 3 - ICD-10 code selection strategies • Part 4 - Documentation improvement Note: ICD-10-PCS are procedure codes which replace ICD-9-CM volume 3. They are used for inpatient hospital facility billing only and not discussed in this program. 5
- 6. 6
- 7. 7 Similarities I. Official Guidelines (about 30 pages) II. Indexes (about 350 pages) i. Diseases and Injuries i. Neoplasms ii. Drugs and Chemicals iii. External Causes ICD-9
- 8. 8 I. Official Guidelines (about 30 pages) II. Indexes (about 420 pages) i. Diseases and Injuries ii. Neoplasms iii. Drugs and Chemicals iv. External Causes ICD-10 Similarities
- 9. 9 III.Tabular list (340 pages) 1. Infectious Diseases 2. Neoplasms 3. Endocrine 4. Blood 5. Mental 6. Nervous 7. Circulatory 8. Respiratory 9. Digestive 10.Genitourinary 11.Pregnancy 12.Skin 13.Musculoskeletal 14.Congenital malformations 15.Perinatal 16.Signs and Symptoms 17.Injuries and Poisoning E-codes. External Causes V-codes. Health Status ICD-9 Similarities
- 10. 10 III.Tabular list (660 pages) 1. Infectious Diseases 2. Neoplasms 3. Blood 4. Endocrine 5. Mental 6. Nervous 7. Eye 8. Ear 9. Circulatory 10.Respiratory 11.Digestive 12.Skin 13.Musculoskeletal 14.Genitourinary 15.Pregnancy 16.Perinatal 17.Congenital malformations 18.Signs and Symptoms 19.Injuries and Poisoning 20.External Causes 21.Health Status ICD-10 Similarities
- 12. Tabular list layout Chapter 21 of them from A to Z (body system or condition) Block Ranges of categories (related conditions) Categories 3 characters (more specific condition) Subcategories 4th or 5th characters (etiology, location, etc.) Codes 6th or 7th characters (laterality, encounter, etc.) 12
- 13. 13 Tabular List Chapter: 8, Diseases of the ear and mastoid process (H6Ø-H95) (always white font in a black box)
- 14. Tabular list layout Chapter 21 of them from A to Z (body system or condition) Block Ranges of categories (related conditions) Categories 3 characters (more specific condition) Subcategories 4th or 5th characters (etiology, location, etc.) Codes 6th or 7th characters (laterality, encounter, etc.) 14
- 15. Tabular List 15 Block: Diseases of Middle Ear and Mastoid (H65-H75) (Always bold CAPS, lined above and below)
- 16. Tabular list layout Chapter 21 of them from A to Z (body system or condition) Block Ranges of categories (related conditions) Categories 3 characters (more specific condition) Subcategories 4th or 5th characters (etiology, location, etc.) Codes 6th or 7th characters (laterality, encounter, etc.) 16
- 17. Tabular List 17 Category: H65.- Nonsuppurative Otitis Media (Always all CAPS, with a line above. A hyphen indicates an incomplete code)
- 18. Tabular list layout Chapter 21 of them from A to Z (body system or condition) Block Ranges of categories (related conditions) Categories 3 characters (more specific condition) Subcategories 4th or 5th characters (etiology, location, etc.) Codes 6th or 7th characters (laterality, encounter, etc.) 18
- 19. Tabular List Subcategory: H65.0-Acute serous otitis media Acute & subacute secretory otitis (Codes with a hyphen are incomplete) 19
- 20. Tabular list layout Chapter 21 of them from A to Z (body system or condition) Block Ranges of categories (related conditions) Categories 3 characters (more specific condition) Subcategories 4th or 5th characters (etiology, location, etc.) Codes 6th or 7th characters (laterality, encounter, etc.) 20 Note: Codes may be complete with fewer than 6 characters. Some codes only have 3.
- 21. Tabular List Highest specificity code: H65.06 Recurrent acute serous otitis media, bilateral (Complete codes are bolded.) Note: Approximately 40% of the new codes are due to laterality. 21
- 22. 34 specialty specific ICD-10 books • more than 70 pages which teach • Conventions • Guidelines • Implementation steps • Documentation strategies • Provider Documentation Guides • Specialty specific • GEMs mapping • Alpha Index • Abridged Tabular List
- 23. ICD-10 ICD-9 23 Differences Note: “oh = O” and “zero = 0”
- 24. ICD-10-CM code for chronic gout due to renal impairment, left shoulder, without tophus. Note: there are 11 gout codes in ICD-9 and 365 in ICD-10 24 ICD-10 example
- 25. 25 ICD-10 detail In ICD-9: E844.8 Sucked into jet without accident to aircraft; ground crew
- 26. 26 In ICD-10: V97.3 Person on ground injured in air transport accident; ICD-10 detail
- 27. 27 In ICD-10: V97.33 Person on ground injured in air transport accident; sucked into jet engine ICD-10 detail
- 28. 28 In ICD-10: V97.33& Person on ground injured in air transport accident; sucked into jet engine, male; ICD-10 detail
- 29. 29 In ICD-10: V97.33&µ Person on ground injured in air transport accident; sucked into jet engine, male; under 5’5” in height; ICD-10 detail
- 30. 30 In ICD-10: V97.33&µ# Person on ground injured in air transport accident; sucked into jet engine, male; under 5’5” in height; slightly bald; ICD-10 detail
- 31. 31 In ICD-10: V97.33&µ#$ Person on ground injured in air transport accident; sucked into jet engine, male; under 5’5” in height; slightly bald; wearing a jump suit; ICD-10 detail
- 32. 32 In ICD-10: V97.33&µ#$€ Person on ground injured in air transport accident; sucked into jet engine, male; under 5’5” in height; slightly bald; wearing a jump suit; during a full moon ICD-10 detail
- 33. Example Patient is a 47 year old Hispanic male who was involved in a car accident. Examination and x-rays reveal a displaced comminuted open Gustilo type IIIA fracture of the shaft of the right femur. Initial encounter.
- 34. 1. Find an ICD-10 category (three characters) you will frequently use 2. Look for unfamiliar terms in instructional notes in the Tabular List 3. Look for unfamiliar terms in the seventh character instructions 4. List out the fourth character descriptions and note unfamiliar terms 5. List out the fifth character description for each four-character subcategory and note unfamiliar terms 6. Do the same for the sixth character 7. Find a medical dictionary and look up all the terms you have gathered ICD-10 Anatomy and Terminology
- 35. 1. Find an ICD-10 category (three characters) you will frequently use 2. Look for unfamiliar terms in instructional notes in the Tabular List 3. Look for unfamiliar terms in the seventh character instructions 4. List out the fourth character descriptions and note unfamiliar terms 5. List out the fifth character description for each four-character subcategory and note unfamiliar terms 6. Do the same for the sixth character 7. Find a medical dictionary and look up all the terms you have gathered ICD-10 Anatomy and Terminology
- 37. Category Instructional Notes • Displaced = The bone is broken into pieces that don’t align. • Non-displaced = The bone is broken into pieces that can be aligned in place. • Open = the ends of the broken bone tear the skin • Closed = the broken bone does not break the skin
- 38. 1. Find an ICD-10 category (three characters) you will frequently use 2. Look for unfamiliar terms in instructional notes in the Tabular List 3. Look for unfamiliar terms in the seventh character instructions 4. List out the fourth character descriptions and note unfamiliar terms 5. List out the fifth character description for each four-character subcategory and note unfamiliar terms 6. Do the same for the sixth character 7. Find a medical dictionary and look up all the terms you have gathered ICD-10 Anatomy and Terminology
- 40. 7th character Seventh character = o Was it initial (A,B, C), subsequent (D-R), or sequela (S)? o Was it closed, or open? o Was it Gustilo Type I, II, or Gustilo Type III? o Was healing routine or delayed, nonunion, or malunion?
- 44. 1. Find an ICD-10 category (three characters) you will frequently use 2. Look for unfamiliar terms in instructional notes in the Tabular List 3. Look for unfamiliar terms in the seventh character instructions 4. List out the fourth character descriptions and note unfamiliar terms 5. List out the fifth character description for each four-character subcategory and note unfamiliar terms 6. Do the same for the sixth character 7. Find a medical dictionary and look up all the terms you have gathered ICD-10 Anatomy and Terminology
- 46. 4th character S72- Fracture of femur • S72.0- Head and neck • S72.1- Pertrochanteric • S72.2- Subtrochanteric • S72.3- Shaft of femur • S72.4- lower end of femur • S72.8- Other fracture of femur • S72.9- Unspecified 4th character = location
- 47. 1. Find an ICD-10 category (three characters) you will frequently use 2. Look for unfamiliar terms in instructional notes in the Tabular List 3. Look for unfamiliar terms in the seventh character instructions 4. List out the fourth character descriptions and note unfamiliar terms 5. List out the fifth character description for each four-character subcategory and note unfamiliar terms 6. Do the same for the sixth character 7. Find a medical dictionary and look up all the terms you have gathered ICD-10 Anatomy and Terminology
- 51. 5th character S72.3- Shaft of femur • S72.30- Unspecified • S72.32- Transverse • S72.33- Oblique • S72.34- Spiral • S72.35- Comminuted • S72.36- Segmental • S72.39- Other 5th character = type
- 52. 1. Find an ICD-10 category (three characters) you will frequently use 2. Look for unfamiliar terms in instructional notes in the Tabular List 3. Look for unfamiliar terms in the seventh character instructions 4. List out the fourth character descriptions and note unfamiliar terms 5. List out the fifth character description for each four-character subcategory and note unfamiliar terms 6. Do the same for the sixth character 7. Find a medical dictionary and look up all the terms you have gathered ICD-10 Anatomy and Terminology
- 54. 6th character S72.35- Fracture of shaft of femur, comminuted • S72.351_ Displaced right • S72.352_ Displaced left • S72.353_ Displaced unspecified • S72.354_ Nondisplaced right • S72.355_ Nondisplaced left • S72.356_ Nondisplaced unspecified 6th character = displacement and laterality
- 55. • Screenshots from ICD-10 book 55
- 56. Drawbacks of ICD-9 • Too old • Many sections are full and cannot be expanded • Not descriptive enough • Will not meet healthcare needs of the future 56
- 57. Improved efficiencies and lowered administrative costs • Fewer rejected and improper reimbursement claims • Decreased demand for submission of medical record documentation • Increased use of automated tools to facilitate the coding process • Fewer coding errors • Increased productivity • Reduced labor costs 57 Benefits of ICD-10
- 58. • Greater specificity can be achieved because the codes are: o alphanumeric o up to seven characters long 58 Benefits of ICD-10
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Notes de l'éditeur
- ICD-10 can be overwhelming, but, with some strategizing and planning it can be managed. In this presentation we will look at a few ICD-10 fundamentals, then familiarize ourselves with three methods for finding the right ICD-10 code. Each one is a different path, but all lead to the same destination: the right code.
- Let’s see how this looks in a coding manual. This is the beginning of chapter 8, which covers Diseases of the Ear and Mastoid Process. Every code in this chapter begins with the letter “H”. It spans the range of H60 to H95. Notice all of the rules listed under the chapter heading. These guidelines apply to every code in this chapter, so it is important to come back to them from time to time to make sure your code is the right one.
- A chapter is divided into blocks, or a range of three-digit categories. This one is Diseases of Middle Ear and Mastoid (H65-H75). If there were guidelines that pertained to the whole block, they would appear under this heading. The formatting here makes it easy to see when a new block begins.
- Blocks are divided into three-digit categories. This one, H65.-, is for “nonsuppurative otitis media”. Notice that the formatting here makes it easy to spot when you are at the beginning of a new category because of the line above the three-character heading. Also notice that H65.- is followed by a hyphen, which indicates that this is not a complete code. All of the complete codes on this page lack a hyphen and are in bold. Some complete codes on this page have five and six characters.
- Once you add a fourth or fifth character you have entered a subcategory. This one is ‘acute serous otitis media,’ which is a condition where fluid is trapped in the middle ear and can become infected. Notice that the subcategory is still not a complete code because it is not in bold and it has a hyphen, which tips off the reader that he or she needs to keep adding characters. However, there is a second diagnosis present under the subcategory description that indicates these codes also apply to patients diagnosed with ‘acute and subacute secretory otitis’ This is when thee fluid that has accumulated behind the eardrum, during the acute infection, remains after the infection resolves. The fifth character specifies laterality. We will come back and visit this code category in a minute.
- A complete code may contain anywhere from three to seven characters. Complete codes are listed in bold print and do not have a hyphen. When a bolded, six-character code is followed by an underscore (_) in this book, it signifies a 7th and final character is required to complete the code.
- The examples shown to you were from the InstaCode ICD-10 specialty books. There are 24 different specialties, each with their own customized ICD-10 guide and Tabular List. Come to our booth to see some examples and get a flyer. We have special pricing available for those who wish to order one today.
- Extension 7th character is for obstetrics, injuries and external causes
- Here is a real code that clearly demonstrates the additional detail available in ICD-10. The first three characters (M1A) represent the category, which is a group of related conditions. This one is chronic gout. The other gout category is M10 and it contains acute gout. The fourth character identifies the cause or etiology for this case of gout. There are actually six different digits that could go here, but we have selected the “3” for “renal impairment”. The fifth character identifies the location. Even though gout usually occurs in the big toe, there are ten choices for this character, each one a different joint where gout could occur. The sixth character is a “1” for right, “2” for left, or “9” for unspecified. This is one of the new features of ICD-10 that ICD-9 lacked: laterality. This category is one that offers a seventh character extension. It is a “0” or a “1” for without and with tophus, which is an accumulation of uric acid crystals in the joint. You can see that this seven character code tells quite the story. A third party is less likely to ask for documentation when all this detail appears on the claim form. It is interesting to note that there are 11 codes for gout in ICD-9, but 365 in ICD-10, just because of all of the extra detail available.
- To illustrate to you just how detailed ICD-10 can be, we will take this ICD-9 code and translate it so that you can see how much information can be conveyed in the new codes. This a an actual ICD-9 code.
- Here we see the first four characters of the ICD-10 equivalent. Not much new yet.
- As we add the fifth character we see some detail, but the code does not really offer anything that the ICD-9 equivalent did not.
- Now it gets interesting. The ampersand symbol offers the gender of the patient.
- The greek letter, “mew”, describes the patient’s vertical stature.
- The hashtag identifies the patient’s hair status
- The dollar sign describes his or her fashion choice.
- And the euro symbol identifies the phase of the moon at the time of the incident. So, if you have not already guessed, most of this is made up. Symbols are not used in ICD-10, just letters and numbers. And the codes can be up to seven characters long, not ten, like this silly code. However, the characters and description you see in blue, V97.33 are all part of a real code. Some ICD-10 naysayers suggest that the codes are useless because they provide detail that is not necessary. However, as you will see, much of the detail in real codes can actually be quite helpful in communicating the medical necessity of a claim to a third party payer.
- Define the unfamiliar terms: Pertrochanteric and Subtrochanteric