general surgery, vascular, thoracic, and plastic … surgery, vascular, thoracic, and plastic...

General surgery, vascular, thoracic, and plastic surgery

ICD-10 CM: Focus on documentation

ICD-10 CM: Focus on documentation - General surgery, vascular, thoracic, and plastic surgery 1

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ICD-10 CM: Focus on documentation - General surgery, vascular, thoracic, and plastic surgery 2

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ICD-10 CM: Focus on documentation - General surgery, vascular, thoracic, and plastic surgery

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Part 1 Introduction to ICD-10 ICD-10 timeline & billing dates of service

Part 2 Specialty specific documentation examples

Part 3 Next steps and wrap up

Agenda


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Identify the “What,” “Why” and “When” of ICD- 10 implementation

Recognize the format of ICD-10 codes

Apply documentation tips for the most common diagnoses in a given specialty

Value the benefits of ICD-10 documentation

Objectives


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Introduction to ICD-10

ICD-10 Timeline & billing dates of service

Part 1


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International Classification of Diseases- 10th Revision-Clinical Modification Listed by the World Health Organization (WHO) and the National Center for Health Statistics (NCHS)

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What is ICD-10-CM ?

The Centers for Medicare and Medicaid Services (CMS) announced on July 31, 2014 that the new deadline for ICD-10 Implementation will be October 1, 2015 ICD-9 codes provide limited data about patients’ medical

conditions and hospital inpatient procedures ICD-10 codes allow for greater specificity and accuracy in

describing a patient’s diagnosis and in classifying inpatient procedures

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Why are we implementing ICD-10 ?

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ICD-10 world adoption

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How will ICD-10 impact me?

The required specificity of ICD-10 documentation will have a positive provider impact in the areas listed to the right.

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Implementation Delays

ICD-10 implementation has been delayed several times but the current implementation date is October 1, 2015 Why so many delays? The most common reason cited for delaying ICD-10 is the complexity and cost involved on the health care provider side Another reason is the possibility of rejected claims due to noncompliance and the impact on health care providers and cash flow

Everyone agrees that disruption to the claims processing system is the greatest danger of ICD-10 implementation

It could lead to cash flow problems and disruptions It could also increase inquiries and resources straining health

plans resources (i.e., longer hold times, response times, etc.) We need to work together to ensure that all stakeholders are ready to minimize disruption

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Provider & Payer Concerns

“It can cost (a provider office) $80k to transition from ICD-9 to ICD-10”

We too have heard “facts” like this, but believe that this figure assumes implementation, planning, and costs that will not be seen by the majority of health care providers. For most specialties, cost are much lower. -United HC findings http://www.medscape.com/viewarticle/839670

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Fact or Fiction?

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What provider documentation will be impacted by ICD-10?

Impacted Not Impacted

Diagnosis documentation for inpatients Diagnosis documentation for outpatients

Procedure documentation for outpatient services Procedure documentation for certain professional services and medical supplies

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What are some key differences between ICD-9 and ICD-10?

ICD-9 Diagnosis codes ICD-10 Diagnosis codes

3-5 characters in length 3-7 characters in length

Approximately 14,000 codes Approximately 69,000 codes

First digit may be alpha (E or V) or numeric; Digits 2-5 are numeric

Character 1 is alpha; character 2 is numeric; characters 3-7 are alphanumeric

Limited space for expansion Room for expansion

Lacks detail and laterality Very specific and added laterality

Difficult to analyze data due to non specific codes

Specificity improved coding accuracy/richness for data analysis/medical research

Date of service Code set billed Prior to October 1, 2015 ICD-9-CM

October 1, 2015 and later ICD-10-CM

Provider outpatient AND inpatient claims are based on date of service. (DOS)

Note: Overlapping dates require separate claims.

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Is ICD-10 required on calendar date or date

of service Oct. 1, 2015?

Specialty specific documentation examples

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Part 2

ICD-9 562.10 Diverticulosis of colon (without mention of hemorrhage) 562.11 Diverticulitis of colon (without mention of hemorrhage) 562.12 Diverticulosis of colon with hemorrhage 562.13 Diverticulitis of colon with hemorrhage

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Diverticular disease: Codes at a glance

ICD-10 K57.30 Diverticulosis of large intestine without perforation or abscess without bleeding K57.31 Diverticulosis of large intestine without perforation or abscess with bleeding K57.32 Diverticulitis of large intestine without perforation or abscess without bleeding K57.33 Diverticulitis of large intestine without perforation or abscess with bleeding

Patient was referred by his PCP for colonoscopy due to frequent bouts of constipation and diarrhea accompanied by lower abdominal discomfort. Colonoscopy revealed diverticulosis. Recommended that he change his diet, drink plenty of fluids, increase exercise, take fiber supplement as needed, and avoid foods that cause gas, bloating or pain. The diagnosis is documented as diverticulosis K57.90 Diverticulosis of intestine, part unspecified, without perforation or abscess without bleeding

NOT ICD-10 SPECIFIC

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Documentation: Diverticula disease

Patient was referred by his PCP for colonoscopy due to frequent bouts of constipation and diarrhea accompanied by lower abdominal discomfort. Colonoscopy revealed diverticulosis of the large intestine. Recommended that he change his diet, drink plenty of fluids, increase exercise, take fiber supplement as needed, and avoid foods that cause gas, bloating or pain. The diagnosis is documented as diverticulosis of large intestine K57.30 Diverticulosis of large intestine without perforation or abscess without bleeding ICD-10 SPECIFIC

ICD-9

707.13 Ulcer of ankle

Code, if applicable, any causal condition first:

Diabetes mellitus

(249.8x, 250.8x)

Atherosclerosis of the extremities with ulcerations (440.23)

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Chronic skin ulcers: Codes at a glance

ICD-10 L97.311 Non-pressure chronic ulcer of right ankle limited to breakdown of skin L97.312 Non-pressure chronic ulcer of right ankle with fat layer exposed L97.313 Non-pressure chronic ulcer of right ankle with necrosis of muscle L97.314 Non-pressure chronic ulcer of right ankle with necrosis of bone L97.319 Non-pressure chronic ulcer of right ankle with unspecified severity

Patient presents with a painful, non-healing ulcer on his right ankle. It is pale, red and shallow. The leg and foot skin are shiny and with little hair present. The diagnosis is documented as ulcer, ankle L97.309 Non-pressure chronic ulcer of unspecified ankle with unspecified severity

NOT ICD-10 SPECIFIC

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Documentation: Chronic skin ulcers

Patient presents with a painful, non-healing ulcer on his right ankle. It is pale, red and shallow and limited to the breakdown of the skin. The leg and foot skin are shiny and with little hair present. Popliteal and dorsalis pedis pulses cannot be identified. Patient does not recall any injury to the ankle and since he has atherosclerosis it appears to be related to the poor leg circulation. The diagnosis is documented as atherosclerosis with ulcer, ankle L70.233 Atherosclerosis of native arteries of right leg with ulceration of ankle. I97.311 Non-pressure chronic ulcer of right ankle limited to breakdown of skin ICD-10 SPECIFIC

ICD-9

996.54 Mechanical complication of other specified prosthetic device, implant, and graft, due to breast prosthesis

NOTE: If documentation indicates capsular contracture of breast implant, see instead code 611.83.

611.83 Other specified disorders of breast, capsular contracture of breast implant

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Complications of breast implants: Codes at a glance

ICD-10 T85.4 (√ 5th) Mechanical complication of breast prosthesis and implant T85.41 (√ 7th) Breakdown (mechanical) of breast prosthesis and implant T85.42 (√ 7th) Displacement of breast prosthesis and implant T85.43 (√ 7th) Leakage of breast prosthesis and implant T85.44 (√ 7th) Capsular contracture of breast implant T85.49 (√ 7th) Other mechanical complication of other ocular prosthesis and implant

This patient had breast implants placed 5 months ago and her breasts have gotten progressively harder. Her breast have become painful and look distorted. An open procedure was recommended. Patient agreed to surgery. The diagnosis is documented as complication, breast implant T85.49xA Mechanical complication of breast prosthesis and implant, Other mechanical complication of breast prosthesis and implant

NOT ICD-10 SPECIFIC

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Documentation: Complications of breast implants

This patient had breast implants placed 5 months ago and her breasts have gotten progressively harder. Her breasts have become painful and look distorted. Patient has capsular contracture of breast implants. Open capsulectomy was recommended. Patient agreed to surgery. The diagnosis is documented as complication, breast implant, capsular contracture T85.44xA Mechanical complication of breast prosthesis and implant, Capsular contracture of breast implant ICD-10 SPECIFIC

ICD-9

727.03 Trigger Finger (acquired)

756.89 Other specified anomalies of muscle, tendon, fascia, and connective tissue, other (congenital)

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Trigger finger: Codes at a glance

ICD-10 M65.30 Trigger finger, unspecified finger M65.31x Trigger Thumb M65.32x Trigger Finger, index finger M65.321 Trigger finger, right index finger M65.322 Trigger finger, left index finger M65.329 Trigger finger, unspecified index finger M65.33x Trigger finger, middle finger M65.34x Trigger finger, ring finger M65.35x Trigger finger, little finger Q74.0 Other congenital malformations of upper limb(s), including shoulder girdle

This female patient is complaining of her joint of her finger locking/popping and also pain at the base of her finger. Treatment with ice, anti-inflammatories and even steroid injections has not relieved the pain. The finger cannot be straightened all the way and the joint exhibits a popping as her hand is opened or closed. Surgical treatment for trigger finger was explained. The diagnosis is documented as trigger finger M65.30 Trigger finger, unspecified

NOT ICD-10 SPECIFIC

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Documentation: Trigger finger

This female patient is complaining of her joint of her left middle finger locking/popping and also pain at the base of her finger. Treatment with ice, anti-inflammatories and even steroid injections has not relieved the pain. The finger cannot be straightened all the way and the joint exhibits a popping as her hand is opened or closed. Surgical treatment for trigger finger was explained. The diagnosis is documented as trigger finger, left middle finger M65.332 Trigger finger, left middle finger

ICD-10 SPECIFIC

ICD-9

414.00 Coronary Atherosclerosis of unspecified type of vessel, native or graft 414.01 Coronary Atherosclerosis of native coronary artery 411.1 Intermediate coronary syndrome (Unstable angina) 413.9 Other and unspecified angina pectoris

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Heart disease: Codes at a glance

ICD-10 I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris I25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris I25.119 Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris

Patient was consulted for chest pain radiating down her left arm with dyspnea. EKG showed non-specific T-wave changes, Troponin levels were normal. Cardiology felt she had angina and proceeded with cardiac catheterization and coronary angiography. The left anterior descending coronary artery showed 80% narrowing shortly after takeoff from the left main and with 40% narrowing of the diagonal and circumflex. CABG was planned. Diagnosis is documented as atherosclerosis with angina I25.119 Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris

NOT ICD-10 SPECIFIC

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Documentation: Heart disease

Patient was consulted for chest pain radiating down her left arm with dyspnea. EKG showed non-specific T-wave changes, Troponin levels were normal. Cardiology felt she had unstable angina and proceeded with cardiac catheterization and coronary angiography. The left anterior descending coronary artery showed 80% narrowing shortly after takeoff from the left main and with 40% narrowing of the diagonal and circumflex. CABG was planned. Diagnosis is documented as atherosclerosis with unstable angina I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris ICD-10 SPECIFIC

ICD-9

786.50 Chest pain, unspecified 786.51 Precordial pain 786.52 Painful respiration 786.59 Chest pain, other

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Chest pain: Codes at a glance

ICD-10

R07.1 Chest pain on breathing

R07.2 Precordial pain

R07.81 Pleurodynia

R07.82 Intercostal pain

R07.89 Other chest pain

R07.9 Chest pain, unspecified

This 22 y/o male was seen for recurring, chest pain, lasting several weeks with duration of less than a minute and unrelated to activity, eating, or body position. There is no dyspnea, cough, sputum, hemoptysis or fever. Physical exam was normal with no pleural or pericardial rubs. His chest X-ray, EKG and lab tests were normal, D-Dimer was normal. Diagnosis is documented as chest pain. R07.9 Chest pain, unspecified

NOT ICD-10 SPECIFIC

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Documentation: Chest pain This 22 y/o male was seen for recurring, stabbing chest pain, for last several weeks with duration of less than a minute and unrelated to activity, eating, or body position. Pain located to the right of the sternum, does not radiate and is not related to respiration. There is no dyspnea, cough, sputum, hemoptysis or fever. His physical exam was normal with no pleural or pericardial rubs. There was tenderness of the right costochondral junctions. His chest X-ray, EKG and lab tests were normal, D-Dimer was normal. Diagnosis is documented as cardiac- pulmonary chest pain. R07.89 Other chest pain

ICD-10 SPECIFIC

ICD-9

443.0 Raynaud’s syndrome (use additional code to identify gangrene 785.4) 443.82 Erythromelalgia 443.89 Other 443.9 Peripheral vascular disease, unspecified

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Peripheral vascular disease: Codes at a glance

ICD-10

I73.00 Raynaud’s syndrome without gangrene

I73.01 Raynaud’s syndrome with gangrene

I73.81 Erythromelalgia

I73.89 Other specified peripheral vascular diseases

I73.9 Peripheral vascular disease, unspecified

The patient is seen for bilateral disabling calf cramping that occurs after 1 1/2 to 2 blocks of ambulation. Symptoms resolve with rest. Physical examination demonstrates dependent rubor of the feet and pedal pulses are palpable, but weak. Segmental lower extremity Doppler studies confirm peripheral vascular disease. Warned patient to be cautious when using a heating pad due to the risk of burns on the feet and to try and avoid any type of injury. Diagnosis is documented as peripheral vascular disease I73.9 Peripheral Vascular Disease

NOT ICD-10 SPECIFIC

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Documentation: Peripheral vascular disease

The patient is seen for discoloration of the skin after being out in the cold for a short time. Symptoms include numbness, stinging, and throbbing of fingers and toes. Explained to patient the blood is not circulating properly to the hands and feet. Cautioned patient to watch for signs of gangrene. Diagnosis is documented as Raynaud's syndrome without gangrene I73.00 Raynaud’s syndrome without gangrene

ICD-10 SPECIFIC

ICD-9

Varicose veins of lower extremities: 454.0 With ulcer 454.1 With inflammation 454.2 With ulcer and inflammation 454.8 With other complications 454.9 Asymptomatic varicose veins

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Varicose veins: Codes at a glance

ICD-10 I83 Varicose veins of lower extremities I83.0xx With ulcer I83.00x Unspecified lower extremity with ulcer I83.001 ulcer of thigh I83.002 ulcer of calf I83.003 ulcer of ankle I83.004 ulcer of heel and midfoot I83.005 ulcer of other part of foot I83.008 ulcer of part of lower leg I83.009 ulcer of unspecified site I83.01x Right lower extremity with ulcer I83.02x Left lower extremity with ulcer I83.1x Lower extremities with inflammation I83.2x Lower extremities with ulcer and inflammation


This patient has noted painful and tender enlarged veins primarily in the greater saphenous vein distribution. Tylenol has not helped, however, leg elevation has helped. These enlarged varicose veins measure 3 to 6 mm. in diameter. Patient was advised to change positions frequently, to avoid standing for long periods of time and to try foot exercises to increase blood flow. Diagnosis is documented as varicose vein with inflammation I83.10 Varicose veins of unspecified lower extremity with inflammation

NOT ICD-10 SPECIFIC

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Documentation: Varicose veins

This patient has noted painful and tender enlarged veins primarily in the right greater saphenous vein distribution. Tylenol has not helped, however, leg elevation has helped. These enlarged varicose veins measure 3 to 6 mm. in diameter. Patient was advised to change positions frequently, to avoid standing for long periods of time and to try foot exercises to increase blood flow. Diagnosis is documented as varicose vein with inflammation I83.11 Varicose veins of right lower extremity with inflammation

ICD-10 SPECIFIC

Part 3 Next steps and wrap up

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Part 3

Physician claims for outpatient and inpatient services will

transition to ICD-10 Clinical Modification (ICD-10-CM) for reporting diagnoses on October 1, 2015

Also, please note that ICD-10-PCS will NOT replace the CPT procedure codes

Remember, insurers making payment decisions, rating severity of illness or trying to predict recovery time, all need physician documentation that is at the highest level of specificity

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In summary

Obtain a list of your most commonly used ICD-9 codes

Use existing tools to develop a list of viable ICD-10 codes http://www.aapc.com/ICD-10/crosswalks/pdf-documents.aspx

Become familiar with the level of detail needed in the medical record Make sure that medical record documentation supports

ICD-10 codes Use existing content-based testing environments and

practice ICD-10 coding of those scenarios

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Start with a checklist

Give healthcare professionals (physicians, etc.) pre-defined, clinically-based medical scenarios to review and have them determine the ICD-10 codes they would use on the claim

Allow providers to enter the data in an easy, efficient manner Share the effects of their selection in the form of Peer Reports

and/or notification of the correlation of their inputs against expected codes

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Content-based testing objectives

Each Specialty has a maximum of nine Narratives available. Each Narrative defines a specific healthcare encounter Narratives are grouped into Scenarios (3 narratives per

Scenario) Providers register via a website, and will receive an email

inviting them to participate with an embedded link to the testing tool

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Content-based testing organization

Allergy/Immunology Audiologist Cardiovascular Disease Certified Nurse Midwife Chiropractic Clinical Psychologist Dermatology Emergency Medicine Endocrinology Family Practice Gastroenterology General Practice

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Content-based testing specialties General Surgeon Group Practice Hematology Hematology-Oncology Infectious Disease Internal Medicine Nephrology Neurology Nurse Practitioner Obstetrics & Gynecology Occupational Therapist Ophthalmology Optometry

Orthopedic Surgery Otolaryngology Pediatric Medicine Physical Medicine and Rehabilitation Physical Therapist Plastic and Reconstructive Surgery Podiatry Psychiatry Psychologist Pulmonary Disease Radiation Oncology Rheumatology Thoracic Surgery Urology Vascular Surgery

Humana http://hureg.providercodingimpact.com/Registration.aspx

BCBSM

http://bcbsmicd10providerregistry.highpoint-solutions.com/Registration.aspx?Test=y

Michigan Dept of Community Health http://www.michigan.gov/mdch/0,1607,7-132-2945_42542_42543_42546_42552_42696-256928--,00.html#Testing

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Content-based testing links

http://hureg.providercodingimpact.com/Registration.aspx

http://bcbsmicd10providerregistry.highpoint-solutions.com/Registration.aspx?Test=y

http://www.michigan.gov/mdch/0,1607,7-132-2945_42542_42543_42546_42552_42696-256928--,00.html#Testing












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Additional ICD-10 coding resources

Crosswalks for the Top 50 codes by specialty http://www.aapc.com/ICD-10/crosswalks/pdf-documents.aspx ICD-10 CM/PCS documentation tips http://bok.ahima.org/PdfView?oid=300621 100 Tips for ICD-10-PCS coding http://icd10monitor.com/enews/item/615-100-tips-for-icd-10-pcs-coding-tips-1-10 Free code conversion tool http://www.icd10data.com/Convert FAQs: ICD-10 transition basics http://www.cms.gov/Medicare/Coding/ICD10/downloads/ICD10FAQs.pdf

http://www.aapc.com/ICD-10/crosswalks/pdf-documents.aspx

http://bok.ahima.org/PdfView?oid=300621

http://icd10monitor.com/enews/item/615-100-tips-for-icd-10-pcs-coding-tips-1-10

http://icd10monitor.com/enews/item/615-100-tips-for-icd-10-pcs-coding-tips-1-10

http://www.icd10data.com/Convert



http://www.cms.gov/Medicare/Coding/ICD10/downloads/ICD10FAQs.pdf

http://www.cms.gov/Medicare/Coding/ICD10/downloads/ICD10FAQs.pdf

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Disclaimer

This presentation is intended only for information use accompanying a live teleconference by the Payer Collaboration (Collaboration). No copy or use of this presentation should occur without expressed permission from the Collaboration. While our best efforts are to provide accurate and useful information, the Collaboration makes no claim, promise, or guarantee of any kind about the accuracy, completeness, or adequacy of the content of the presentation and expressly disclaims liability for errors and omissions in such content. As diagnostic codes changes annually, you should reference the current version of coding guidelines for the most detailed and up-to-date information. The information contained in this presentation is intended for informational purposes only. The Collaboration has no liability or responsibility to any person or entity with respect to any loss or damage caused by the use of this seminar, including but not limited to any loss of revenue, interruption of service, loss of business or indirect damages resulting from the use of this program. The Collaboration makes no guarantee that the use of this program will prevent differences of opinion or disputes with Medicare or other third party payers as to the amount that will be paid to providers of service. The material is designed and provided to communicate information about coding and documentation in an educational format and manner. The presenter(s) are not providing or offering legal advice, but rather, practical and useful information and tools in the area of clinical documentation, data quality and coding. Every reasonable effort has been taken to ensure that the educational information provided is accurate and useful.

general surgery, vascular, thoracic, and plastic … surgery, vascular, thoracic, and plastic...

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