Download - ICD-10 Wisconsin - Clean - WPMA Podiatrists
11/15/2013
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ICD-10-CM: No More Baby Steps
October 1, 2014 Tick-Tock, Tick-Tock
Presented by Harry Goldsmith, DPM
DisclaimerThis presentation is brought to you by Harry Goldsmith, DPM who is solely responsible for its content and delivery so don’t complain to or blame WSPM about any demonstrated insensitivity, poor judgment, unfunny jokes, puns that aren’t punny, or lack of taste.
The APMA Coding Resource Center
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The APMA Coding Resource Center
Making Your Life Easier
ICD-9 to ICD-10Crosswalk
The APMA Coding Resource Center
New low price: $249 per year
for APMA Members
www.apmacodingrc.org
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Codingline-APMA’s “Coding in Paradise” Seminar
Right after the APMA Hawaii Seminar (July 28-31)
www.codingline.com/events-hawaii.htm
Questions? [email protected]
ICD-10-CM: October 1, 2014
Believe it
ICD-10-CM WatchMedical Group Management Association’s (MGMA) survey found in mid-June that 4.8% of medical practices have made significant progress in their readiness of ICD-10.
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ICD-10-CM Watch2013 National Physician Practice ICD-10 Readiness Survey notes
• 62% of medical practices surveyed said they have no ICD-10 implementation plany p p
• More than 33% said they did not know any of their vendors’ ICD-10 plans or timelines
• 22.4% of medical practices said they do not expect to be ready by October 1, 2014
What’s the Worst that Can Happen?
No dough
ICD-10-CM ConcernsOther Issues
• ‘Same old, same old’ mentality• Coding complexity • Documentation details• Documentation details• 2014: The perfect storm
• Meaningful use, stage 2• PQRS • eRx• HIPAA – Security, privacy
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ICD-10-CM
What is the ICD-10-CM code for when the sky (or things from the sky) falls on you?
W21.220- Hockey puck T75.0- Lightning
Y36.22- Guided missileV95.41- Spacecraft
X39.8xxA Dorothy’s house falling on the witch
ICD-10-CMICD-10 will be implemented October 1, 2014. There is no grace period.
A sensible transition program can alleviate a scramble as the implementation date approaches;scramble as the implementation date approaches; and avoid costly mistakes.
ICD-10-CMTransition Preparation Timeline
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ICD-10-CMTransition Preparation Timeline
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ICD-10-CMTransition Preparation Timeline
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ICD-10-CMTransition Preparation Timeline
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New Insurance Claim Form (02 12)
New Insurance Claim Form (02 12)
ICD-10-CMTransition Preparation Timeline
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ICD-10-CMTransition Preparation Timeline
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ICD-10-CMTransition Preparation Timeline
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ICD-10-CMTransition Preparation Timeline
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ICD-10-CMTransition Preparation Timeline
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ICD-10-CMTransition Preparation Timeline
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ICD-10-CMTransition Preparation Timeline
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ICD-10-CMTransition Preparation Timeline
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ICD-10-CMTransition Preparation Timeline
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ICD
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What Is ICD-10-CM?It is an alphanumeric code used to translate words identifying diagnoses of diseases, circumstances, symptoms, other health problems, etc. into a universal, workable system that can be read by computer software, analyzed, “acted upon”, stored, and retrieved as needed.
So, why should we care?
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ICD-10-CM Q/As• WHO owns ICD-10-CM?• Why not skip ICD-10-CM and go to ICD-11-CM
way, way down the road?
ICD-10-CM Q/As• What does the “CM” stand for in ICD-10-CM?• Come October 1, 2014, will I only be dealing
with ICD-10?• What will be the biggest problem/issueWhat will be the biggest problem/issue
association with ICD-10-CM implementation?
Comparing ICD-9 to ICD-10
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Comparing ICD-9 to ICD-10ICD-9
• Numeric characters(with exception of some codes beginning with V, E, M)
ICD-10• Alphanumeric
characters(always begin with an alpha [except U] character
Alphanumeric Character Issue
Alphanumeric Character Issue
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Comparing ICD-9 to ICD-10ICD-9
• Numeric characters(with exception of some codes beginning with V, E, M)
ICD-10• Alphanumeric
characters(always begin with an alpha
• 3-5 characters in length
• About 13,000 codes
[except U] character
• 3-7 characters in length
• About 68,000 codes
Comparing ICD-9 to ICD-10
ICD-9 Formatting ICD-10
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ICD-9 Structure - Format3-5 character examples
700 Corn and callosities735.0 Hallux valgus (acquired)733.82 Nonunion of fractureV49.71 Lower limb amputation status, great
toe
ICD-10 Structure - Format3-7 character examples
L84 Corn and callositiesB95.5 Staphylococcus aureus as the cause
of diseases classified elsewhereM20.11 Hallux valgus (acquired), right foot S98.111A Complete traumatic amputation of
right great toe (initial encounter)
ICD-10 to ICD-9 Differences
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ICD-10 to ICD-9 DifferencesLaterality (side of the body affected – right/left) has been added to relevant codes
Expanded use of combination codes– Certain conditions and associated commonCertain conditions and associated common
symptoms or manifestations
Combination Code ExamplesE11.52 Type 2 diabetes mellitus with diabetic
peripheral angiopathy with gangreneE11.621 Type 2 diabetes mellitus with foot ulcerI69.144 Monoplegia of lower limb followingI69.144 Monoplegia of lower limb following
nontraumatic intracerebral hemorrhage affecting left non-dominant side
I70.235 Atherosclerosis of native arteries of right leg with ulceration of other part of foot
Other ICD-10 to ICD-9 Differences
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It’s In the Details
ICD-9 ICD-10V49.71 - Lower limb
amputation status,great toe
Z89 – Acquired absence of limb
Z89.4 – Acquired absence of toe(s), foot, &
klankleZ89.41 – Acquired
absence of great toe
Z89.411 - Acquiredabsence of right greattoe
Other ICD-10 to ICD-9 Differences
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Meet the7th Character
(when required)
ICD-10: The 7th CharacterExample: Fracture codes The fracture codes require a 7th character:
A - Initial encounter for closed fracture B - Initial encounter for open fracture D - Subsequent encounter for fracture with routineD - Subsequent encounter for fracture with routine
healing G - Subsequent encounter for fracture with delayed
healing K - Subsequent encounter for fracture with nonunion P - Subsequent encounter for fracture with malunionS - Sequelae
ICD-10: The 7th CharacterAnother example…
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How Are ICD-10 & ICD-9 Similar?
ICD-9 & ICD-10 SimilaritiesBoth ICD-9 and ICD-10 Alphabetic Indexes include
• The Index of Diseases and Injury• The Index of External Causes of InjuryThe Index of External Causes of Injury• The Tables of Neoplasm; and• The Table of Drugs and Chemicals
ICD-9 & ICD-10 SimilaritiesBoth ICD-9 and ICD-10 use an indented format
Hallux 735.9rigidus (acquired) 735 2rigidus (acquired) 735.2
congenital 755.66
The main term is listed in bold font with subordinate terms are listed beneath the main term in an indented format.
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ICD-9 & ICD-10 SimilaritiesMany of the terms along with their
• Definitions/applications• Symbols• Guidelines and• Guidelines, and • Conventions
are the same in both ICD-9 and ICD-10.
ICD-10 HoweverDoes have several new conventions that we will discuss today through examples.
ICD-10 HoweverProvides greater specificity through the expansion of the 3-5 ICD-9 code to a 3-7 ICD-10 codes.
Which has resulted inA d ti i i th b f• A dramatic increase in the number of available codes
• A need for more accurate, detailed medical records
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Any questions before I move on?
ICD-10 Clue
The Game of ClueA man has been murdered in a large mansion by one of six guests. It is up to the game players to find out which of the six guests, i.e., suspects, did the deed, which of the six weapons was used, and in which of nine possible rooms it was done.
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The Game of ClueA man has been murdered in a large mansion by one of six guests. It is up to the game players to find out which of the six guests, i.e., suspects, did the deed, which of the six weapons was used, and in which of nine possible rooms it was done.
The Game of ClueA man has been murdered in a large mansion by one of six guests. It is up to the game players to find out which of the six guests, i.e., suspects, did the deed, which of the six weapons was used, and in which of nine possible rooms it was done.
The Game of ClueA man has been murdered in a large mansion by one of six guests. It is up to the game players to find out which of the six guests, i.e., suspects, did the deed, which of the six weapons was used, and in which of nine possible rooms it was done.
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The ICD-10 Clue Game
The suspect is…
The ICD-10 Clue Game
Alyssa Stephenson, DPM
The ICD-10 Clue Game
Her weapon…
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The ICD-10 Clue Game
Revolver
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The ICD-10 Clue Game
X93
The ICD-10 Clue Game
The ICD-10 Clue GameSummary
You are given a 3 character codeX93
That requires a 7th characterThat requires a 7 character A – initial encounterD – subsequent encounterS - sequela
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The ICD-10 Clue GameWe have the first 3 characters and a 7 character (A), and nothing in between.
X93._ _ _A
The “x” PlaceholderBecause no specific character(s) exist in the 4th, 5th, and 6th position, the letter “x” serves as a placeholder filling in character ‘holes’ in the code when, in this case, it requires a 7th character.
X93.xxxAAssault (murder) by revolver, initial encounter
The “x” PlaceholderThe “x” placeholder also allows for future code expansion. In those cases, you may see a single “x” within a code.
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The “x” PlaceholderAnother example:
When placeholder character applies, it must be used in order for the code to be considered valid.
By the Way, “X” is NOT an “x” Placeholder
The ICD-10 Clue Game
Back to the game…
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The ICD-10 Clue Game
The ICD-10 Clue Game
EXCLUDES1 - Very Pistol
EXCLUDES1Indicates mutually exclusive codes - two conditions that cannot be reported together.
Excludes1 note indicates that the code is excluded from the main code and should never beexcluded from the main code, and should never be used at the same time as the code above it.
Example:A congenital condition and an acquired condition
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EXCLUDES1Example:
EXCLUDES2Indicates the excluded condition is not part of or defined by the condition it is excluded from, butboth conditions can be present at the same time in the patient.
When an Excludes2 note appears below a code, it is okay to use both that code and the Excludes2 code at the same time.
EXCLUDES2Example:
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The ICD-10 Clue Game
Back to the game…again
The ICD-10 Clue Game
What if it wasn’t murder, but an accident?
The ICD-10 Clue GameW32.0 - Accidental handgun discharge
W32.1 - Accidental handgun malfunction
Both codes require the appropriate 7th character:
A initial encounterD subsequent encounterS sequela
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The ICD-10 Clue GameW32.0 - Accidental handgun discharge
W32.1 - Accidental handgun malfunction
E l W32 0 AExample: W32.0xxA
The ICD-10 Clue Game
What if the murder was done with one of the other
‘ ’?‘weapons’?
Y00.xxxA
Y00.xxxA
Y00.xxxA
T71.193AX99.1xxA
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The ICD-10 Clue Game
What if the victim was pecked by a bird?
Pecked or bitten by a…W61.01 – parrotW61.11 – macaw
W61.21 – cockatooW61.33 – chickenW61.43 – turkeyW61.51 – gooseW61.61 – duck
W61.91 – all other birds* All need a 7th character
Brief InterludeHistory of Present Illness: The patient was waterskiing on Lake Meade at a company outing. The temperature was in the low 100s. Suddenly, without warning, her skis burst in flames and she
t i d 1st d 2nd d b h lsustained 1st and 2nd degree burns on her lower legs…
How does this happen?How do you code this?
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Brief Interlude
V91.07xA“burn due to water skis on fire”
The real question is…
Is this work related?
The ICD-10 Clue Game
Back to the game…
The ICD-10 Clue Game
Where did the murder occur?occur?
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The ICD-10 Clue Game
Kitchen
The ICD-10 Clue GameY92.010 - Kitchen of single-family house
Excludes: mobile home
The ICD-10 Clue Game
What if it was done in a different room?different room?
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The ICD-10 Clue GameY92.018 - Other place in single-family house as
the place of occurrence of the externalcause
Y92.019 - Unspecified place in single-family house as the place of occurrence of external cause
Other & UnspecifiedY92.018 - Other place in single-family house as
the place of occurrence of the externalcause
Y92.019 - Unspecified place in single-family house as the place of occurrence of external cause
OtherOther means the medical record details a condition
or, in this case, place of occurrence that doesn’t have an existing ICD-9 or 10 code
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UnspecifiedUnspecified means there is not enough information
in the medical record to assign a more specificcode
Would You Like to Play Again?
No.
Back to ICD-9 and ICD-10 Similarities
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Searching for a Code
With both ICD-9 and ICD-10, you begin your code search in the alphabetic index, then verify the code in the tabular list
ICD-10 ExampleAlphabetic Index
hallux valgus (acquired), left foot
M20.1-
ICD-10 Coding FormatM20.1–
“code ending in a hyphen”An ICD-10 code ending in a hyphen means the code is not detailed enough to bill.
When a hyphen-ending code is seen in the alphabetic index of ICD-10, you must go to the tabular coding listing to look for a more specific description/more specific code.
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Tabular ListM20.1 Hallux valgus (acquired), left foot
Tabular ListM20.1 Hallux valgus (acquired), left foot
Another Example?Your turn…
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Ready?
Go!
Stage III Decubitus Ulcer of Left Heel
How do you begin?
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Stage III Decubitus Ulcer of Left Heel
You look up the “main” term
Stage III Decubitus Ulcer of Left Heel
Stage III Decubitus Ulcer of Left HeelGo to the Alphabetic Index
Ulcer, ulcerated, ulcerating, ulcerationSee ulcer by site
lower limb (atrophic) (chronic) (neurogenic) ( p ) ( ) ( g )(perforating) (pyogenic) (trophic) (topical)
pressure/decubitus (pressure area) L89-heel L89.6-
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Stage III Decubitus Ulcer of Left Heel
Decubitus ulcer heelL89.6-
Time to go to the Tabular Listing
Stage III Decubitus Ulcer of Left HeelIn the Tabular: L89-
Stage III Decubitus Ulcer of Left HeelLook for a 4 character code beginning with L89
L89.6 Pressure ulcer of heel
L89.62 Pressure ulcer of left heel
L89.623 Pressure ulcer of left heel,stage III
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Stage III Decubitus Ulcer of Left Heel
L89.623
Stop!
Eight Hours, Not Bad
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Another Example
Patient is seen with a painful bunion on the left foot. The exam reveals reduced ROM with pain reported with movement of MTPJ. X-rays confirm degenerative changes in MTPJ. ICD-9 diagnoses:
ICD-9 727.1 - bunionICD-9 735.8 - hallux limitusICD-9 715.17 - osteoarthritis, localized, primary, footICD-9 729.5 - pain in limb (or ICD-9 719.47 –
pain in joint, foot)
Ready?
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Go!
ICD-10 Coding StepsBunion (left foot)
1) Go to ICD-10 Index to Diseases & Injuries2) Under “B”, find
“bunion”bunion
Bunion – see Deformity, toe, hallux valgus
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ICD-10 Coding StepsBunion – see Deformity, toe, hallux valgus
1) Go to “D” 2) Look under “Deformity”3) Find “toe”3) Find toe4) Find “hallux valgus”
ICD-10 Coding StepsBunion – see Deformity, toe, hallux rigidus
1) Look above “hallux valgus”and there is “hallux rigidus”
M20.2- hallux rigidus
ICD-10 Coding StepsWe now have 2 of the 4 base codes we are looking for:
M20.1- Hallux valgus, acquiredM20 2 H ll i id i dM20.2- Hallux rigidus, acquired
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Moving to the Tabular Listing
M20.1- and M20.2-
ICD-10 Coding StepsM20.1
1) Go to ICD-10 Tabular List of Diseases & Injuries
2) In the list look up “M” (Chapter 13 – Diseases2) In the list, look up M (Chapter 13 Diseases of the Musculoskeletal System and Connective Tissue)
3) Under “M” find M20.1
ICD-10 Coding StepsM20.1 Hallux valgus (acquired), left
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ICD-10 Coding StepsM20.1 Hallux valgus (acquired), left
ICD-10 Coding StepsM20.2 Hallux rigidus, left
ICD-10 Coding StepsM20.2 - Hallux rigidus, left
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ICD-10 Coding Steps
So far we have…M20.12 – Hallux valgus (acquired), left foot
M20 22 Hallux rigidus left footM20.22 – Hallux rigidus, left foot
That leaves two to go: Osteoarthritis
Local pain
ICD-10 Coding StepsOsteoarthritis, primary, foot
1) Go to ICD-10 Index to Diseases & Injuries2) Under “O”, find
“osteoarthritis”osteoarthritis
ICD-10 Coding Steps
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ICD-10 Coding StepsChoices:
M19.07-, M19.17-, or M19.27-
ICD-10 Coding StepsTheir common code root is
M19
Moving to the Tabular Listing
M19
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ICD-10 Coding StepsM19
1) Go to ICD-10 Tabular List of Diseases & Injuries2) In the list, look up “M” (Chapter 13 – Diseases of
the Musculoskeletal System and Connectivethe Musculoskeletal System and Connective Tissue)
3) Under “M” find M19
ICD-10 Coding Steps
ICD-10 Coding StepsOur choices were:
M19.07-M19.17-M19.27-
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ICD-10 Coding StepsOsteoarthritis, foot, left
ICD-10 Coding StepsOsteoarthritis, foot (primary), left foot
ICD-10 Coding Steps
So far we have…M20.12 – Hallux valgus (acquired), left footM20.22 – Hallux rigidus, left footgM19.072 – Primary osteoarthritis, left foot
That leaves one to go: Pain
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ICD-10 Coding StepsPain
1) Go to ICD-10 Index to Diseases & Injuries2) Under “P”, find
“pain”pain
see Pain, lower limb
ICD-10 Coding StepsPain, limb, lower
1) Go to “Pain, limb, lower”2) Find “foot” or “toe”
M79.67-
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Moving to the Tabular Listing
M79.67
ICD-10 Coding StepsM79.67
1) Go to the ICD-10 Tabular List of Diseases & Injuries
2) In the list look up “M” (Chapter 13 – Diseases2) In the list, look up M (Chapter 13 Diseases of the Musculoskeletal System and Connective Tissue)
3) Under “M” find M79.67
ICD-10 Coding StepsPain, foot (or is pain in the “toe”?)
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ICD-10 Coding StepsFinally…
ICD-10 M20.12 – Hallux valgus (acquired), left foot
ICD-10 M20 22 – Hallux rigidus left footICD-10 M20.22 Hallux rigidus, left foot
ICD-10 M19.072 – Primary osteoarthritis, left foot
and either
ICD-10 M79.672 – Pain, left foot or
ICD-10 M79.675 – Pain, left toe
Stop!
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Let’s Play with ICD-10
Clinical Example: Plantar SpurPre-Op Diagnosis: painful plantar fasciitis with
heel spur, left footPost-Op Diagnosis: sameProcedure: endoscopic plantar fasciotomy, left p p y
ICD-10 Code(s)?
Painful Plantar Fasciitis withHeel Spur, Left Foot
Key term(s)?
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Painful Plantar Fasciitis withHeel Spur, Left Foot
Key term(s)?
Fasciitis
Painful Plantar Fasciitis withHeel Spur, Left Foot
Key term(s)?
FasciitisSpur
Painful Plantar Fasciitis withHeel Spur, Left Foot
Begin by looking up fasciitis in the Alphabetic Index
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Painful Plantar Fasciitis withHeel Spur, Left Foot
1) Go to ICD-10 Index to Diseases & Injuries2) Under “F” find “fasciitis”3) Under “fasciitis” find3) Under fasciitis find
“plantar”
Painful Plantar Fasciitis withHeel Spur, Left Foot
Plantar fasciitis:
M72.2
Moving to the Tabular Listing
M72.2
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Painful Plantar Fasciitis withHeel Spur, Left Foot
M72.2 Plantar fasciitis
1) In the Tabular List, look up M72.2(Chapter 13 – Diseases of MusculoskeletalSystem and Connective Tissue)
Painful Plantar Fasciitis withHeel Spur, Left Foot
M72.2 Plantar fasciitis
Painful Plantar Fasciitis withHeel Spur, Left Foot
M72.2 Plantar fasciitis
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Painful Plantar Fasciitis withHeel Spur, Left Foot
M72.2 Plantar fasciitis
Need next main term spurNeed next main term…spur
Painful Plantar Fasciitis withHeel Spur, Left Foot
Go to Alphabetic Index and look up spur
Painful Plantar Fasciitis withHeel Spur, Left Foot
1) Go to ICD-10 Index to Diseases & Injuries2) Under “S” find “spur”
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Painful Plantar Fasciitis withHeel Spur, Left Foot
1) Go to ICD-10 Index to Diseases & Injuries2) Under “S” find “spur”3) Under “spur” find3) Under spur find
“heel”
What? No Heel?
Painful Plantar Fasciitis withHeel Spur, Left Foot
1) Think “calcaneal”
M77.3-
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Painful Plantar Fasciitis withHeel Spur, Left Foot
But look…there’s an instruction: “see also Enthesopathy”
Let’s follow that instruction and see where it takes us, shall we?
Painful Plantar Fasciitis withHeel Spur, Left Foot
1) In the Index, under “E” find “enthesopathy”
Painful Plantar Fasciitis withHeel Spur, Left Foot
1) Under “enthesopathy” find “calcaneal spur”
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Painful Plantar Fasciitis withHeel Spur, Left Foot
Instruction #1: M77.3- Spur, bone, calcaneal – see also Enthesopathy
Instruction #2: Enthesopathy, calcaneal spur – see Spur, bone, calcaneal
Back to Calaneal Spur
Painful Plantar Fasciitis withHeel Spur, Left Foot
1) Going back to “spur” stick with “calcaneal”
M77.3-
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Moving to the Tabular Listing
M77.3-
Painful Plantar Fasciitis withHeel Spur, Left FootM77.3- Bone Spur, calcaneal
1) In the Tabular List, look up M77.3(Chapter 13 – Diseases of MusculoskeletalSystem and Connective Tissue)
Painful Plantar Fasciitis withHeel Spur, Left Foot
M77.3- Calcaneal spur
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Painful Plantar Fasciitis withHeel Spur, Left Foot
M77.3- Calcaneal spur
Painful Plantar Fasciitis withHeel Spur, Left Foot
M77.32 Calcaneal spur, left foot
Painful Plantar Fasciitis withHeel Spur, Left Foot
M72.2 Plantar fasciitisM77.32 Calcaneal spur, left foot
One term left…pain, painful
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Painful Plantar Fasciitis withHeel Spur, Left Foot
Question: Do you need to add “pain”?
Painful Plantar Fasciitis withHeel Spur, Left Foot
Go to Alphabetic Index and look up pain
Painful Plantar Fasciitis withHeel Spur, Left Foot
1) Go to ICD-10 Index to Diseases & Injuries2) Under “p” find “pain”
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Painful Plantar Fasciitis withHeel Spur, Left Foot
1) Go to ICD-10 Index to Diseases & Injuries2) Under “pain” find “foot”
Go to “Pain, lower limb”
Painful Plantar Fasciitis withHeel Spur, Left Foot
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Painful Plantar Fasciitis withHeel Spur, Left Foot
M79.67-
Moving to the Tabular Listing
M79.67-
Painful Plantar Fasciitis withHeel Spur, Left Foot
M79.67- Pain, lower limb, foot
1) In the Tabular List, look up M79.67(Chapter 13 – Diseases of MusculoskeletalSystem and Connective Tissue)
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Painful Plantar Fasciitis withHeel Spur, Left Foot
M79.67- Pain, lower limb, foot
Painful Plantar Fasciitis withHeel Spur, Left Foot
M79.67- Pain, lower limb, foot
Painful Plantar Fasciitis withHeel Spur, Left Foot
M72.2 Plantar fasciitisM77.32 Calcaneal spur, left footp ,M79.672 Pain, lower limb, foot (optional)
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Ta da
Clinical Example: Skin LesionPre-Op Diagnosis: skin lesion, sub4th metatarsal
head, right foot; plantar verruca, right foot
Post-Op Diagnosis: sameProcedure: excision and ablation of verruca, right
foot with CO2 laser; biopsy skin lesion, sub4th metatarsal, right foot
ICD-10 Code(s)?
Plantar Verruca, Right Foot andSkin Lesion, Right Foot
Key term(s)?
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Plantar Verruca, Right Foot andSkin Lesion, Right Foot
Key term(s)?
VVerruca
Plantar Verruca, Right Foot andSkin Lesion, Right Foot
Key term(s)?
VVerrucaLesion
Plantar Verruca, Right Foot andSkin Lesion, Right Foot
Begin by looking up verruca in the Alphabetic Index
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Plantar Verruca, Right Foot andSkin Lesion, Right Foot
1) Go to ICD-10 Index to Diseases & Injuries2) Under “V” find “verruca”3) Under “verruca” find3) Under verruca find
“plantar” or “plantaris”
Moving to the Tabular Listing
B07.0
Plantar Verruca, Right Foot andSkin Lesion, Right Foot
B07.0 Verruca plantaris
1) In the Tabular List, look up B07.0(Chapter 1 – Certain Infectious and Parasitic Diseases)
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Plantar Verruca, Right Foot andSkin Lesion, Right Foot
B07.0 Verruca plantaris
lantar Verruca, Right Foot andSkin Lesion, Right Foot
B07.0 Verruca plantaris
Need next main term lesionNeed next main term…lesion
Plantar Verruca, Right Foot andSkin Lesion, Right Foot
Go to the Alphabetic Index
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Plantar Verruca, Right Foot andSkin Lesion, Right Foot
1) Go to ICD-10 Index to Diseases & Injuries2) Under “L” find “lesion”3) Under “lesion” find3) Under lesion find
“skin”
Moving to the Tabular Listing
L98.9
Plantar Verruca, Right Foot andSkin Lesion, Right Foot
L98.9 Lesion, skin
1) In the Tabular List, look up L98.9(Chapter 12 – Diseases of the Skin and Subcutaneous Tissue)
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Plantar Verruca, Right Foot andSkin Lesion, Right Foot
L98.9 Lesion, skin
Plantar Verruca, Right Foot andSkin Lesion, Right Foot
B07.0 Verruca plantarisL98 9 Lesion skinL98.9 Lesion, skin
Plantar Verruca, Right Foot andSkin Lesion, Right Foot
B07.0 Verruca plantarisL98 9 Lesion skinL98.9 Lesion, skin
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Plantar Verruca andSkin Lesion
B07.0 Verruca plantarisL98 9 Lesion skinL98.9 Lesion, skin
Ta da
Educational Moment
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NEOPLASMS OF UNCERTAIN BEHAVIOR
NEOPLASMS OF UNCERTAIN BEHAVIOR
What is a neoplasm of uncertain behavior?
“Certain histo-morphologically well-defined neoplasms the subsequent behavior of which cannotneoplasms, the subsequent behavior of which cannot be predicted from the present appearance.”
In English, please…
NEOPLASMS OF UNCERTAIN BEHAVIOR
1. The term "neoplasm of uncertain behavior" is a specific pathologic diagnosis.
2. This is a lesion whose behavior cannot be predicted It's currently benign but there's apredicted. It s currently benign, but there s a chance that it could undergo malignant transformation over time.
3. It is not a lesion you are waiting for a pathology report or you are not willing to make a diagnosis on.
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Next
Clinical Example: HammertoePre-Op Diagnosis: hammertoe, 2nd toe, left;
plantarflexed 2nd met, right (congential)Post-Op Diagnosis: sameProcedure: hammertoe correction 2nd toe, left;
osteotomy, 2nd metatarsal, left
ICD-10 Code(s)?
Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
Key term(s)?
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Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
Key term(s)?
Hammertoe
Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
Key term(s)?
HammertoeMetatarsal????
Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
Begin by looking up hammertoe in the Alphabetic Index
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Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
1) Go to ICD-10 Index to Diseases & Injuries2) Under “H” find “hammertoe”3) Is it acquired or3) Is it acquired or
congenital?
Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
See also Deformity, toe, hammertoe
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Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
1) Go to ICD-10 Index to Diseases & Injuries2) Under “D” find “deformity”
Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
1) Under “deformity” find “toe”2) Under “toe” find
“hammertoe”hammertoe
M20.4-
Moving to the Tabular Listing
M20.4-
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Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
M20.4 Hammertoe
1) In the Tabular List, look up M20.4(Chapter 13 – Diseases of the MusculoskeletalSystem)
Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
M20.4 Hammertoe
Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
M20.4 Hammertoe
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Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
M20.42 Hammertoe (acquired), left
Need next main term…metatarsal
Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
Look up “metatarsal” in the Alphabetic Index
Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
1) Go to ICD-10 Index to Diseases & Injuries2) Under “M” find “metatarsal”3) What now?3) What now?
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Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
And what condition might that be?And what condition might that be?Plantarflexion?
HINT: There ain’t no “plantarflexion” listing
Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
And what condition might that be?Plantarflexion?
How about…deformity, foot?
Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
Look up “deformity” in the Alphabetic Index
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Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
1) Go to ICD-10 Index to Diseases & Injuries2) Under “D” find “deformity, then find “foot”
Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
1) Go to ICD-10 Index to Diseases & Injuries2) Under “D” find “deformity, then find “foot”
Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
1) Go to ICD-10 Index to Diseases & Injuries2) Under “D” find “deformity, then find “foot”
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Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
1) Go to ICD-10 Index to Diseases & Injuries2) Under “D” find “deformity, then find “foot”
NOS & NECNOS – Not Otherwise Specified
Equivalent to “unspecified” (not enough information in the medical record to assign a more specific code)more specific code)
NEC – Not Elsewhere ClassifiedEquivalent to “other” or “other specified” (the medical record details or condition have noICD-9 or ICD-10 code that is specific for it)
Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
1) Go to ICD-10 Index to Diseases & Injuries2) Under “D” find “deformity, then find “foot”
Q66.9Q66.89
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Moving to the Tabular Listing
Q66.9 and Q66.89
Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
Q66.9 and Q66.89
1) In the Tabular List, look up Q66(Chapter 17 – Congenital Malformations, Deformations and Chromosomal Abnormalities)
Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
Q66.9 and Q66.89
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Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
Q66.9 and Q66.89
Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
Q66.9 and Q66.89
Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
Q66.89
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Hammertoe, 2nd and PlantarflexedMetatarsal (Congenital), Left
M20.42 Hammertoe (acquired), left Q66.89 Other specified congenital
deformities of feet
Ta da
Clinical Example: RFCDiagnosis: long nails x10; corn 5th bilateral;
diabetes with peripheral vascular disease
Procedure: palliative foot care
ICD-10 Code(s)?
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Nails and Corns and Diabetes with PVD, Oh My!
What’s wrong with this picture?1) “Nails”, even “long nails”, is not a
pathologypathology2) Is it type I or type II diabetes?3) Specifically, what peripheral arterial
disease does your patient have?
Nailing It: Who’yah Gonna Call?
Nailing It
ICD-9 703.8 (other specified diseases of nail)
crosswalks to
ICD 10 L60 8ICD-10 L60.8 (other nail disorders)
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Nails and Corns and Diabetes with PVD, Oh My!
L60.8 Other nail disorders
Next: Corns
Nails and Corns and Diabetes with PVD, Oh My!
1) Go to ICD-10 Index to Diseases & Injuries2) Under “C” find “corn”
L84 – infected?
Moving to the Tabular Listing
L84
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Nails and Corns and Diabetes with PVD, Oh My!
L84
1) In the Tabular List, look up L84(Chapter 12 – Diseases of the Skin and Subcutaneous Tissue)
Nails and Corns and Diabetes with PVD, Oh My!
L84
No mention of “infected”
Nails and Corns and Diabetes with PVD, Oh My!
L60.8 Other nail disordersL84 Corn
Next: Diabetes with PVD
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Nails and Corns and Diabetes with PVD, Oh My!
1) Go to ICD-10 Index to Diseases & Injuries2) Under “D” find “diabetes”
Nails and Corns and Diabetes with PVD, Oh My!
1) Go to ICD-10 Index to Diseases & Injuries2) Under “D” find “diabetes”
Then find the specific diabetic condition:Wi h i h l i h (E11 1)?• With peripheral angiopathy (E11.51)?
• Due to an underlying condition: peripheral angiopathy (E08.51)?
• Specific type with peripheral angiopathy(E13.51)?
• Type I with peripheral angiopathy (E10.51)? • Type II with peripheral angiopathy (E11.51)?
Nails and Corns and Diabetes with PVD, Oh My!
In our example, it will be
Diabetes, type II, with peripheral angiopathy
E11.51
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Moving to the Tabular Listing
E11.51
Nails and Corns and Diabetes with PVD, Oh My!
E11.51
1) In the Tabular List, look up E11.51(Chapter 4 – Endocrine, Nutritional and Metabolic Diseases)
Nails and Corns and Diabetes with PVD, Oh My!
Important to check at the beginning of the root code (E11) section for any instructions…
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Nails and Corns and Diabetes with PVD, Oh My!
E11.51
Nails and Corns and Diabetes with PVD, Oh My!
E11.51
Nails and Corns and Diabetes with PVD, Oh My!L60.8 Other nail disordersL84 CornE11.51 Diabetes, type II,
with peripheral angiopathy
Issues?
There is the Medicare Administrative Contractor’sLCD billing instructions…
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Ta da
Clinical Example: FractureA 32 year old male was sliding into 2nd base when he hit the bag. He felt a snap and instant pain in the outside of his right foot.
X-rays revealed a non-displaced, slightly oblique y p , g y q5th metatarsal base fracture
Diagnosis: closed 5th metatarsal fracture, right
ICD-10 Code(s)?
Fracture 5th Metatarsal, Closed, Right1) Go to ICD-10 Index to Diseases & Injuries2) Under “F” find “fracture”
3) Look by “site”: foot?
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Fracture 5th Metatarsal, Closed, Right
See Fracture, metatarsal
Fracture 5th Metatarsal, Closed, Right1) Go to “Fracture, metatarsal”
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Fracture 5th Metatarsal, Closed, Right1) Go to “Fracture, metatarsal”
Moving to the Tabular Listing
S92.35-
Fracture 5th Metatarsal, Closed, RightS92.35-
1) In the Tabular List, look up S92.35(Chapter 19 – Injury, Poisoning, and ExternalCauses)Causes)
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Fracture 5th Metatarsal, Closed, RightS92.35-
Fracture 5th Metatarsal, Closed, RightS92.35-
Fracture 5th Metatarsal, Closed, RightS92.354-
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Fracture 5th Metatarsal, Closed, RightS92.354-
Fracture 5th Metatarsal, Closed, RightS92.354-
Fracture 5th Metatarsal, Closed, RightS92.354A
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Fracture 5th Metatarsal, Closed, Right
S92.354A Non-placed fracture 5th metatarsal, closed, right, initial visit
Thank you, CMS
October 1, 2014™Boy Scouts of America
ICD-10: October 1, 2014