icd-10 are you ready to s.w.a.p
DESCRIPTION
ICD-10 Are You Ready to S.W.A.P. Presented by Kathy A. Montoya Senior Provider Relations Representative. Agenda. Background Volumes ICD 10 CM ICD 10 PCS General Equivalence Mappings Reimbursement Mappings Preparation Steps. Training Objectives. Increase knowledge Identify obstacles - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/1.jpg)
ICD-10 Are You Ready to S.W.A.P.
Presented byKathy A. Montoya
Senior Provider Relations Representative
![Page 2: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/2.jpg)
Agenda Background Volumes
ICD 10 CM ICD 10 PCS
General Equivalence Mappings Reimbursement Mappings Preparation Steps
![Page 3: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/3.jpg)
Training Objectives Increase knowledge Identify obstacles Get on track for implementation
October, 1 2014
![Page 4: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/4.jpg)
Health Insurance Portability and Accountability Act (HIPAA) Administrative simplification provides
standards for Electronic transmission of claims Provider identifiers Privacy Code set
![Page 5: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/5.jpg)
Why The Change ICD-9
Adopted by CMS April 1, 1989 Produces limited data
Patients’ medical conditions Hospital inpatient procedures
30 years old and outdated Limits new code creation
![Page 6: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/6.jpg)
ICD-10-CM/PCS Incorporates greater specificity and clinical
information Improves health care service measurement Helps with refining groupings and
reimbursement methodologies
![Page 7: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/7.jpg)
ICD-10-CM/PCS Enhances ability to do public health
surveillance Decreases need for claims supporting
documentation Updates medical terminology and
classification of diseases
![Page 8: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/8.jpg)
ICD-10-CM/PCS Provides better data for
Claims processing Making clinical decisions Identifying fraud and abuse Conducting research Comparison of mortality and morbidity
![Page 9: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/9.jpg)
ICD 10 Department of Health and Human Services
Final regulation January 15, 2009 October 1, 2014
Guidance available on http://www.cms.gov/ICD10/
![Page 10: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/10.jpg)
ICD-9 It’s Not Over Yet Worker’s compensation Auto insurance
Not required to convert Not planning to change
![Page 11: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/11.jpg)
ICD 10 Developed by
World Health Organization (WHO) http://www.who.int/classifications/icd/en/.
Utilized in other countries Mandated for use in U.S.
October 1, 2014
![Page 12: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/12.jpg)
ICD-10 In use in U.S.
Individual states Report cause of death on certificates
![Page 13: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/13.jpg)
ICD 10 CM National Center for Health Statistics
(NCHS) Developed ICD 10 Clinical Modification (CM) for
U.S. In conjunction with advisory group and
physicians Still in DRAFT
![Page 14: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/14.jpg)
ICD-10General Information
![Page 15: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/15.jpg)
ICD-10 Part 1 ICD-10-CM for diagnosis coding
All U.S. health care setting 3 – 7 digit alphanumeric codes 68,069 ICD-10-CM codes
Increased from 14,025 ICD-9-CM
![Page 16: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/16.jpg)
Provider ClaimsCompliance A Must No delays or grace period ICD-9-CM for dates of service < October 1,
2014 ICD-10 for dates of service ≥ October 1,
2014 Still use CPT and HCPCS
![Page 17: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/17.jpg)
ICD-10 Code Structure
AXX.XXXX
3Categories
Code
4Subcategory
Code
5/6SubclassificationCode/Placeholder
7Extention
Code
![Page 18: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/18.jpg)
ICD-10-CM Structure 3 – 7 characters
1st = alpha 2nd = numeric 3rd – 7th = alpha or numeric Decimal after 3rd character
![Page 19: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/19.jpg)
ICD-10-CM Structure Character “X”
5th or 6th position “Placeholder”
Future expansion “Fill In”
Empty characters
![Page 20: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/20.jpg)
7th Character One use is encounter type
A = Initial encounter D = Subsequent encounter S = Sequela
![Page 21: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/21.jpg)
7th Character R40.2 Coma
Coma NOSUnconsciousness NOS
The appropriate 7th character is to be added to each code from subcategory R40.21-, R40.22-, R40.23-
0 Unspecified time1 In the field [EMT or ambulance]2 At arrival to emergency department3 At hospital admission4 24 hours or more after hospital admission
![Page 22: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/22.jpg)
ICD Codes Describe medical necessity Facilitate payment Evaluate utilization patterns Study appropriateness of health care costs
![Page 23: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/23.jpg)
Incorrect Coding Lead to investigations of fraud and abuse Must be correct Must be consistent
![Page 24: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/24.jpg)
Comparison ICD-9 CM
Groups by type of injury Maximum 5 characters Most codes numeric 17 chapters
ICD-10 CM Groups by site of injury Maximum 7 characters Codes are alpha-
numeric 21 chapters
![Page 25: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/25.jpg)
Changes Found In ICD-10 CM Addition information for ambulatory and
managed care encounters Expanded injury codes Combination codes Reclassification of diseases
![Page 26: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/26.jpg)
Changes Found In ICD-10 CM New code definitions “E” and “V” codes incorporated in main
classifications Category restructuring and code
reorgaization
![Page 27: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/27.jpg)
ICD-10 CM Format Introduction Official Guidelines for Coding and
Reporting Alphabetic Index to Diseases and Injuries Neoplasm Table
![Page 28: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/28.jpg)
ICD-10 CM Format Table of Drugs and Chemicals Index of External Causes Tabular List of Diseases and Injuries
![Page 29: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/29.jpg)
Official Guidelines forCoding and Reporting ICD-9 and ICD-101. Conventions, general coding guidelines
and chapter specific guidelines2. Selection of Principle Diagnosis3. Reporting Additional Diagnosis4. Diagnostic Coding and Reporting
Guidelines for Outpatient Services
![Page 30: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/30.jpg)
Official Guidelines forCoding and Reporting ICD-10
Chapters 3, 7, 8 and 11 Not completed Specialty society involved in creation
![Page 31: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/31.jpg)
Official Guidelines forCoding and Reporting Examples
Chapter 15 Chapter 15 codes have sequencing priority over
codes from other chapters Chapter 15 codes are to e used only on maternal
record, not on newborn
![Page 32: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/32.jpg)
Alphabetic Index ICD-9
Diseases Illness Injury Other reasons for
encounters Table of Drugs and
Chemicals External Causes of Injury
and Poisoning
ICD-10 Diseases Illness Injury Other reasons for
encounters
![Page 33: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/33.jpg)
Neoplasm Table ICD-9
In alpha index Malignant
Primary Secondary Ca in situ
Benign Uncertain Behavior Unspecified
ICD-10 Separate section Malignant Primary Malignant Secondary Malignant Ca in situ Benign Uncertain Unspecified Behavior
![Page 34: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/34.jpg)
Table of Drugs andChemicals ICD-9
Under Alphabetic Index Poisoning Accident Therapeutic Use Suicide Attempt Assault Undetermined
ICD-10 Accidental
(unintentional) Intentional Self-Harm Assault Undetermined Adverse Effect Underdosing
![Page 35: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/35.jpg)
Index of External Causes ICD-9
Under Alphabetic Index Cause of injury Adverse effects
ICD-10 Alphabetic by main
term indicating the event
![Page 36: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/36.jpg)
Tabular List of Diseasesand Injuries ICD-9
17 chapters Based on diseases
2 Supplementary Classification
ICD-10 21 chapters
Based on body system or nature of injury and disease
![Page 37: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/37.jpg)
Chapter ComparisonChapter ICD-9 CM ICD-10 CM
1 Infectious and Parasitic Diseases
Certain Infectious and Parasitic Diseases
2 Neoplasms Malignant Neoplasms
3Endocrine, Nutritional and Metabolic Diseases, and Immunity Disorders
Disease of the Blood and Blood-Forming Organs and certain Disorders involving Immune Mechanism
4 Disease of the Blood and Blood-Forming Organs
Endocrine, Nutritional and Metabolic Diseases
![Page 38: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/38.jpg)
Chapter ComparisonChapter ICD-9 CM ICD-10 CM
5 Mental DisordersMental and Behavioral Disorders
6 Diseases of the Nervous System and Sense Organs
Diseases of the Nervous System
7 Diseases of the Circulatory System
Diseases of the Eye and Adnexa
8 Diseases of the Respiratory System
Diseases of the Ear and Mastoid Process
![Page 39: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/39.jpg)
Chapter ComparisonChapter ICD-9 CM ICD-10 CM
9 Diseases of Digestive System
Diseases of the Circulatory System
10 Diseases of the Genitourinary System
Diseases of the Respiratory
11Complications of Pregnancy, Childbirth, and the Puerperium
Diseases of the Digestive System
12 Diseases of the Skin and Subcutaneous Tissue
Diseases of the Skin and Subcutaneous Tissue
![Page 40: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/40.jpg)
Chapter ComparisonChapter ICD-9 CM ICD-10 CM
13Diseases of the Musculoskeletal System and Connective Tissue
Diseases of the Musculoskeletal System and Connective Tissue
14 Congenital Anomalies Diseases of the Genitourinary System
15Certain Conditions Originating in the Perinatal Period
Pregnancy, Childbirth and the Puerperium
![Page 41: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/41.jpg)
Chapter ComparisonChapter ICD-9 CM ICD-10 CM
16 Symptoms, Signs and Ill-Defined Conditions
Certain Conditions Originating in the Newborn (Perinatal) Period
17 Injury and PoisoningCongenital Malformations, Deformations and Chromosomal Abnormalities
18 N/A
Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified
![Page 42: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/42.jpg)
Chapter ComparisonChapter ICD-9 CM ICD-10 CM
19 N/AInjury, Poisoning and Certain Other Consequences of External Causes
20 N/A External Causes of Morbidity
21 N/AFactors Influencing Health Status and Contact with Health Services
![Page 43: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/43.jpg)
Chapter ComparisonChapter ICD-9 CM ICD-10 CM
Supplementary Classification
Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
N/A
Supplementary Classification
Classification of External Cause of Injury and Poisoning (E Codes)
N/A
![Page 44: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/44.jpg)
ICD-10-CM Code Examples F03 Unspecified dementia L60.0 Ingrowing nail J09.12 Influenza due to identified novel
H1N1 influenza virus with other respiratory manifestations
M71.061 Abscess of bursa, right knee T21.31xa Burn of third degree of chest
wall
![Page 45: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/45.jpg)
ICD-10-CM Terminologyand New Feature Laterality
Right = character 1 Left = character 2 Bilateral = character 3 Unspecified = character 0 or 9
![Page 46: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/46.jpg)
ICD-10-CM Terminologyand New Feature
Laterality Examples M54.31 – Sciatica, right side
![Page 47: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/47.jpg)
ICD-10-CM Terminologyand New Feature Combination codes
Diagnosis with associated sign or symptom Diagnosis with associated complication Diagnosis with cause
![Page 48: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/48.jpg)
ICD-10-CM Terminologyand New Feature Combination code example
Conditions with symptoms and manifestations K27.2 – Acute peptic ulcer, site unspecified, with both
hemorrhage and perforation
![Page 49: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/49.jpg)
ICD-10-CM Terminologyand New Feature Combination code example
Poisoning and external cause T51.0x2 – Toxic effect of ethanol, intentional, self-
harm
![Page 50: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/50.jpg)
ICD-10-CM New Features Obstetric codes identify trimester
1 = 1st trimester < 14 weeks, 0 days 2 = 2nd trimester 14 weeks, 0 days to < 28
weeks, 0 days 3 = 3rd trimester 28 weeks, 0 days to delivery 0 or 9 = unspecified
![Page 51: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/51.jpg)
Obstetric Codes Ex: O26.02
Excessive weight gain in pregnancy, second trimester
![Page 52: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/52.jpg)
ICD-10-CM Excluded Indications Codes that should not be reported
together
Separately identifiable conditions Excluded condition not part of reported
condition Can have both condition at same time
![Page 53: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/53.jpg)
Example 1 E11 – Type 2 diabetes
(Excludes1: Gestational diabetes (O24.4-); type 1 diabetes (E10.-)
![Page 54: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/54.jpg)
Example 2 I10 – Essential (primary) Hypertension
Includes: High blood pressure hypertension (arterial) (benigh) (essential) (malignant) (primary) (systemic).
(Excludes 2: Essential (primary) hypertension involving vessels of brain (I60-I69); Essential (Primary) hypertension involving vessels of eye (H35.0)
![Page 55: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/55.jpg)
ICD-10-CM Includes Clinical Concepts
Underdosing Blood type Blood alcohol level Encounter type Indication of healing
![Page 56: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/56.jpg)
ICD-10-CMExpanded Codes Significant expansion of codes
Diabetes Substance abuse Postoperative complications
Distinction made between intraoperative complication and postprocedural disorders
![Page 57: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/57.jpg)
Diabetes Increase from 40 to 122 codes Example
E08.321 – Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema
![Page 58: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/58.jpg)
ICD -10 Terminology Granularity
Level of hierarchy Increased description information
![Page 59: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/59.jpg)
ICD -10 Terminology Morbidity
Rate of disease in population Mortality
Rate of death in population
![Page 60: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/60.jpg)
ICD -10 Terminology Principal or First-listed Diagnosis
Primary reason for encounter
Inpatient setting First code on medical record Principal diagnosis
Other health care settings First-listed code
![Page 61: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/61.jpg)
ICD -10 Terminology Rubric
Group of similar conditions Three character category or four character
subcategory
![Page 62: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/62.jpg)
Steps To Code Correctly Identify diagnosis or reason for encounter Locate in Alphabetic Index Verify in Tabular List Read and interpret notes
![Page 63: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/63.jpg)
Steps To Code Correctly Choose tentative code Find highest level of specificity Consult prompts Assign a code
![Page 64: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/64.jpg)
ICD 10 PCS
![Page 65: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/65.jpg)
ICD-10 Part 2 ICD-10-PCS for inpatient procedure
coding All U.S. Inpatient hospital settings only 7 alpha-numeric digits 72,589 ICD-10-PCS
Increased from 3,824 ICD-9-CM procedure codes
![Page 66: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/66.jpg)
Facility Claims Compliance A Must No delays or grace period ICD-9-CM for dates of discharge < October
1, 2014 ICD-10 for dates of discharge ≥ October 1,
2014 ICD-10-PCS for dates of discharge ≥
October 1, 2014
![Page 67: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/67.jpg)
Structure Differences Codes are longer Greater clinical detail and specificity Updated terminology and classifications
![Page 68: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/68.jpg)
ICD-10-PCS Structure 7 digits Each digit is either alpha or numeric
Alpha digits are not case sensitive Letters O and I are not used to avoid confusion
with numbers 0 and 1 Each character has a
value/meaning/option
![Page 69: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/69.jpg)
ICD-10-PCSCode Examples 0FB03ZX – Excision of liver, percutaneous
approach, diagnostic; and 0DQ10ZZ – Repair upper esophagus, open
approach.
![Page 70: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/70.jpg)
ICD-10-PCS Structure First character specifies the section or
type of procedure 0 = Medical and surgical 1 = Obstetrics 2 = Placement 3 = Administration 4 = Measurement and monitoring
![Page 71: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/71.jpg)
ICD-10-PCS Structure First character continued
5 = Extracorporeal Assistance and Performance
6 = Extracorporeal Therapies 7 = Osteopathic 8 = Other Procedures 9 = Chiropractic
![Page 72: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/72.jpg)
ICD-10-PCS Structure First character continued
B = Imaging C = Nuclear Medicine D = Radiation Oncology F = Physical Rehabilitation and Diagnostic
Audiology G = Mental Health H = Substance Abuse Treatment
![Page 73: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/73.jpg)
Medical and SurgicalFirst Character = “0”
Character Meaning
1 Section
2 Body System
3 Root Operation
4 Body Part
5 Approach
6 Device
7 Qualifier
![Page 74: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/74.jpg)
ChiropracticFirst Character = “9”
Character Meaning
1 Section
2 Anatomical Region
3 Root Operation
4 Body Region
5 Approach
6 Method
7 Qualifier
![Page 75: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/75.jpg)
Radiation OncologyFirst Character = “D”
Character Meaning
1 Section
2 Body System
3 Root Type
4 Body Part
5 Modality Qualifier
6 Isotope
7 Qualifier
![Page 76: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/76.jpg)
Mental HealthFirst Character = “G”
Character Meaning
1 Section
2 Body System
3 Root Type
4 Type Qualifier
5 Qualifier
6 Qualifier
7 Qualifier
![Page 77: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/77.jpg)
ICD-10-PCS Structure Second through seventh characters
Same meanings within a section Different meanings per section Third character = general type of procedure
performed See chart in workbook
![Page 78: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/78.jpg)
Parts of ICD-10-PCS Index
Alphabetic lookup Tables
Different organization than ICD-9 List of codes
Listing of unique procedure codes
![Page 79: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/79.jpg)
ICD-10-PCS Table Example0 Medical and Surgical 2 Heart and Great Vessels 7 Dilation: Expanding an orifice or the lumen of a tubular body part
Body Part Approach Device Qualifier
0 = Coronary Artery, One site
1 = Coronary Arteries, Two Sites
2 = Coronary Arteries, Three Sites
3 = Coronary Arteries, Four or More Sites
0 = Open
3 = Percutaneous
4 = Percutaneous Endoscopic
4 = Drug=eluting Intraluminal Device
D = Intraluminal Device
T = Radioactive Intraluminal Device
Z = No Device
6 = Bifurcation
Z = No Qualifier
![Page 80: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/80.jpg)
List of Codes - Example Code descriptions for dilation of one
coronary artery (0270) 027004Z Dilation of Coronary Artery, One Site with
Drug-eluting Intraluminal Device, Open Approach 02700DZ Dilation of Coronary Artery, One Site with
Intraluminal Device, Open Approach 02700TZ Dilation of Coronary Artery, One Site with
Radioactive Intraluminal Device,
![Page 81: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/81.jpg)
ICD-10-PCS Character Meanings http://www.cms.gov/ICD10/Downloads/
pcs_final_report2010.pdf
![Page 82: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/82.jpg)
General Equivalence Mappings (GEMs)
![Page 83: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/83.jpg)
Proper Coding GEMs are not a substitute Select codes base on
Patient’s encounter Medical record documentation
![Page 84: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/84.jpg)
GEMs As A Tool Forward mapping
ICD-9 to ICD-10-CM and PCS Backward mapping
ICD-10-CM or PCS to ICD-9 Convert databases such as
Track quality, record morbidity/mortality, calculate reimbursement
![Page 85: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/85.jpg)
GEMs All ICD-10- CM codes
ICD-10-CM to ICD-9-CM GEM All ICD-9-CM diagnosis codes
ICD-9-CM to ICD-10-CM GEM All ICD-10-PCS codes
ICD-10-PCS to ICD-9-CM GEM All ICD-9-CM procedure codes
ICD-9-CM to ICD-10-PCS GEM
![Page 86: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/86.jpg)
Three Steps To Use GEMs Extract
Select all rows containing code Analyze
Note and understand flags on code Refine
Select rows that meet applied mapping requirements
![Page 87: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/87.jpg)
GEM Resources http://www.cms.gov/
ICD10/12_2010_ICD_10_CM.asp#TopOfPage
http://www.cms.gov/ICD10/13_2010_ICD10PCS.asp#TopOfPage
![Page 88: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/88.jpg)
GEM Details One ICD-9-CM diagnosis code represented
by multiple ICD-10-CMs 82002 represented by
S72031A S72031G S72032A S72032G Other codes from GEMs
![Page 89: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/89.jpg)
GEM Details One ICD-10-CM diagnosis code
represented by multiple ICD-9-CMs E11341 represented by
25050 36206 36207
![Page 90: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/90.jpg)
GEM Details Some ICD-10-CM have no ICD-9-CMs
T500x6A T501x6A T502x6A T503x6A T504x6A Others found in GEMs
![Page 91: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/91.jpg)
GEM Details One ICD-9-CM procedure code captured by
multiple ICD-10-PCSs 8659 captured by
JQ10ZZ JQ13ZZ JQ40ZZ JQ43ZZ Others found in GEMs
![Page 92: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/92.jpg)
GEM Formatting Three columns
ICD-10-CM Source system code is on the left side
ICD-9-CM Target system code is in the middle Flags are on the right
![Page 93: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/93.jpg)
GEM Mapping ExampleICD-10 Source
CodeICD-9 Target
CodeFlags
T1500xA 9300 10111
T1500xA E914 10112
T1500xD 9300 10111
T1500xD E914 10112
T1500xS 9085 10000
![Page 94: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/94.jpg)
GEM Mapping Example
T1500xA Foreign body in cornea, unspecified eye, initial encounter
9300 Corneal foreign bodyE914 Foreign body accidentally entering eye and adnexa
T1500xD Foreign body in cornea, unspecified eye, subsequent encounter
9300 Corneal foreign bodyE914 Foreign body accidentally entering eye and adnexa
T1500xS Foreign body in cornea, unspecified eye, sequela
9085 Late effect of foreign body in orifice
![Page 95: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/95.jpg)
GEM Flags 5 digit code (Ex: 10111) First position
1 = translation is approximate match T1500xA 9300 10111 T1500xA E914 10112
0 = translation is identical match 41411 12542 00000
![Page 96: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/96.jpg)
GEM Flags Second position
1 = no plausible translation No Description Found (NODX) 0 = at least one plausible translation
Examples T500x6A NODX 11000 T500x6A NODX 11000 T500x6S NODX 11000
![Page 97: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/97.jpg)
GEM Flags Third position
1 = code maps to more than one code 0 = code maps to single code
T1500xA 9300 10111
T1500xA E914 10112
T1500xD 9300 10111
T1500xD E914 10112
T1500xS 9085 10000
![Page 98: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/98.jpg)
Reasons For No One-To-One Match ICD-10 New concepts not in ICD-9-CM No matching code exist in GEMs Multiple ICD-9-CM codes exist for a single
ICD-10 code Multiple ICD-10 codes exist for a single
ICD-9-CM code
![Page 99: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/99.jpg)
GEM Updates Posted in January Updated annually Access updated GEMs for diagnoses
http://www.cms.gov/ICD10/12_2010_ICD_10_CM.asp
Access updated GEMs for procedures http://www.cms.gov/
ICD10/13_2010_ICD10PCS.asp
![Page 100: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/100.jpg)
Reimbursement Mappings
![Page 101: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/101.jpg)
Reimbursement Mappings CMS developed One-to-one reimbursement crosswalk
Temporary mechanism Codes submitted ≥ October 1, 2014 ICD-10-CM/PSC to reimbursement equivalent
ICD-9-CM codes Utilized GEMs
![Page 102: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/102.jpg)
Reimbursement Mappings Two crosswalks
ICD-10-CM to ICD-9-CM diagnosis code(s) Ex: K50012 crosswalks to 555.0 and 560.9
ICD-10-PCS to ICD-9-CM procedure code Ex: 037544Z crosswalks to DX 395.0 and Procedure
and Intervention codes 00.40, 00.55 and 00.45
![Page 103: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/103.jpg)
Reimbursement Mapping FormatPosition Length Contents
1 8 I-10 code
9 1 Number of I-9 codes this I-10 code maps to. Values 1 through 5.
10 6 First I-9 code
16 6 Second I-9 code
22 6 Third I-9 code
28 6 Fourth I-9 code
34 6 Fifth I-9 code
![Page 104: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/104.jpg)
Reimbursement Mapping Resource ICD-10-CM-PCS to ICD-9 Reimbursement
Mapping Documentation and User Guide http://www.cms.gov/
ICD10/08a_Payer_Resources.asp#TopOfPage.
![Page 105: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/105.jpg)
Reimbursement Mapping Example
00160K6 - Bypass Cerebral Ventricle to Peritoneal Cavity with Nonautologous
Tissue Substitute, Open Approach
![Page 106: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/106.jpg)
03754DZ Dilation of Right Axillary Artery with Intraluminal Device, Percutaneous Endoscopic Approach
Reimbursement Mapping Example
![Page 107: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/107.jpg)
Converting MS-DRGs to ICD-10-CM and ICD-10-PCS CMS Project Convert ICD-9-CM Medicare Severity –
Diagnosis Related Groups (MS-DRGs), version 26.0, to ICD-10-CM and ICD-10-PCS (ICD-10-CM/PCS) codes
Information available at: http://www.cms.gov/
ICD10/17_ICD10_MS_DRG_Conversion_Project.asp#TopOfPage.
![Page 108: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/108.jpg)
Preparation Steps
![Page 109: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/109.jpg)
Other Countries Experiences Problems with implementation
1. Clinical documentation2. IT: space, time and money3. Productivity
![Page 110: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/110.jpg)
ICD-10Are You Ready To S.W.A.P. S = Schedule Training W = Work With Staff A = Adjust Work Processes P = Prepare Now
![Page 111: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/111.jpg)
Basic Steps to Prepare forVersion 5010/ICD 10
Identify system and work processes that use ICD-9 Where are ICD-9 codes used
Identify potential changes
![Page 112: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/112.jpg)
Basic Steps to Prepare forVersion 5010/ICD 10 Assess staff training needs
Find training opportunities Train the trainer
Train on Codes Anatomy, physiology, pathophysiology,
pharmacology Medical terminology
![Page 113: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/113.jpg)
Test YourKnowledge of Anatomy Ulna Proximal phalanges Vomer Basal Ganglia Thymus Tibial nerve
ICD-10
6
4
3
2
5
1
![Page 114: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/114.jpg)
Basic Steps to Prepare forVersion 5010/ICD 10 Contact practice management system
vendor Readiness for 5010 Needed upgrades to hardware/software Costs Implementation dates Training and customer support
![Page 115: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/115.jpg)
Basic Steps to Prepare forVersion 5010/ICD 10 Contact clearinghouses, billing services
About 5010 and ICD-10 compliance Timeframe for transitions
Contact payers ICD-10 affects on contracts, payment
schedules, or reimbursement Timeframe for transitions
![Page 116: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/116.jpg)
Basic Steps to Prepare forVersion 5010/ICD 10 Budget time and costs
ICD-10 implementation System changes Resource materials Training Money in case of implementation problems
![Page 117: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/117.jpg)
Basic Steps to Prepare forVersion 5010/ICD 10 Conduct testing
Payers and clearinghouses Allow time for approval
![Page 118: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/118.jpg)
New Draft1500 Claim Form
![Page 119: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/119.jpg)
New Draft1500 Claim Form
Room for 12ICD-10 CM Codes
![Page 120: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/120.jpg)
New CMS Guidelines Beginning July 1, 2012 Medicare contractors shall not accept new
direct submitter using HIPAA Version 4010A1
All new direct submitters will be required to enroll using HIPAA Version 5010 transactions
![Page 121: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/121.jpg)
Resources American Medical Association www.ama-assn.org/go/5010
Fact Sheets 5010 Checklist Project Plan Template – Helping Practices
Prepare for the New HIPAA Standards 7 Steps
![Page 122: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/122.jpg)
Resources The Centers for Medicare & Medicaid
Services (CMS) Web site www.cms.gov/ICD10
CMS sponsored calls http://www.cms.gov/
ICD10/02c_CMS_Sponsored_Calls.asp#TopOfPage
![Page 123: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/123.jpg)
Resources American Academy of Professional Coders
(AAPC) Countdown to implementation Training Monthly articles Code translator
![Page 124: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/124.jpg)
Resources GEMs and User’s Guides
http://www.cms.gov/ICD1013_2010_ICD10PCS.asp
Workgroup for Electronic Data Interchange (WEDI) http://www.wedi.org
![Page 125: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/125.jpg)
Resources Health Information and Management
Systems Society (HIMSS) http://www.himss.org/icd10
American Health Information Management Association (AHIMA) http://www.ahima.org/ICD10/
![Page 126: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/126.jpg)
Questions?
Complete Evaluations
![Page 127: ICD-10 Are You Ready to S.W.A.P](https://reader035.vdocuments.site/reader035/viewer/2022081501/56814881550346895db58eee/html5/thumbnails/127.jpg)