This course was current at the time it was written. Every reasonable effort has been made to assure the accuracy of the information within these pages.  Proper coding may require analysis of statutes, regulations or carrier policies and as a result, the proper code result may vary from one payer to another.  This program is not intended to be legal advice and your attendance should not be construed as a legal opinion of the presenter.   Judy B Breuker, CPC, CCS-P, CHC, CHBME, ACS, PCS, CPC-E/M, CHAP, CHCA Overview of ICD-10-CM  Why is there a need for change?  What are the differences between ICD-9-CM and ICD-10-CM?  Where can you find current and accurate information?          World Health Organization The ICD-10 is the international standard to report and monitor diseases. United Kingdom – 1995 France – 1997 *Australia -1998 *Germany (2000) *Canada (2001) ** Countries have gained approval from WHO to create their own ICD-10 New diagnosis coding system that is being developed (it is still evolving) as a replacement for ICD-9-CM Volumes 1&2  There is another system called ICD10-PCS (Procedure Coding System) which will be a replacement for Volume 3 of ICD-9-CM. This is not a replacement for CPT.    January 16, 2009 the final rule was published in the Federal Register http://edocket.access.gpo.gov/2009/pdf/E9743.pdf The compliance date for this regulation is October 1, 2013  The compliance date refers to all claims received for encounters and discharges occurring on or after 10/01/13  Do you remember the transition to 4010 and the challenges of claims transmissions and clearinghouse issues??????  New Transaction Sets - 5010  ◦ Accommodates ICD-10-CM (7 characters) ◦ Requires new format for electronic transactions  ICD-9-CM ◦ Lacks sufficient specificity and detail ◦ Obsolete and no longer reflect current knowledge of disease processes  ICD-10-CM ◦ Would have better documented the West Nile Virus and SARS outbreak for earlier detection and tracking.  Level I Compliance: Dec. 31, 2010 ◦ “a covered entity can demonstrably create and receive compliant transactions, resulting from the compliance of all design/build activities and internal testing.”  Level II Compliance: Dec. 31, 2011 ◦ “a covered entity has completed end-to-end testing with each of its trading partners, and is able to operate in production mode with the new versions of the standards."  ICD-9-CM  ICD-10-CM ◦ Approximately 68,000 codes   Greater coding accuracy and specificity  Reduced coding errors  Alignment of the US with coding systems worldwide  Space to accommodate future expansion.  ◦ Approximately 14,000 codes ICD-9-CM Combination codes for diagnosis and symptoms Full code titles ICD-10-CM    3-5 characters First digit is numeric or alpha (E & V) Digits 2-5 are numeric  3-7 characters  First digit is alpha  Digit 2 is numeric; and   ICD-9-CM Digit 3-7 are alpha or numeric Laterality (Rt vs. Lt) ICD-10-CM The ICD-10-CM utilizes dummy place holders, always the letter x.  A dummy “x” is used as a 5th character place holder at certain 6 character codes to allow for future expansion.   Example next slide  The 6th character for the codes at categories T36-T50 always indicates the intent:  ◦ unintentional (accidental) ◦ intentional self-harm ◦ assault ◦ undetermined ◦ or an adverse effect ◦ or underdosing (continued) 9 locations codes 707.00 – 707.09  Show broad location, but not depth 125 codes Shows more specific location as well as stage I-IV (depth)     ICD-9-CM ICD-10-CM   1 code 996.1 ICD-9-CM   156 codes Example ◦ T82.310 ◦ Breakdown (mechanical) of aortic (bifurcation) graft (replacement) ICD-10-CM The 5th character x will permit the future expansion of these codes without disturbing the 6th character structure. L89.134  Pressure ulcer of right lower back, stage IV   S52.131a  Displaced fracture of neck of right humerus, initial encounter for closed fracture.  ICD-10-CM describes ◦ Right versus Left ◦ Initial encounter, subsequent encounter ◦ Routine healing, delayed healing, nonunion, or malunion         Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/ICD10/01_Overview .asp#TopOfPage National Center for Health Statistics http://www.cdc.gov/nchs/about/otheract/icd 9/abticd10.htm American Health Information Management Association http://www.ahima.org/icd10/ American Academy of Professional Coders http://www.aapc.com/ICD-10/index.aspx The new coding system will mean new national and local coverage decisions  Education is essential  ◦ Physician and clinical staff must have more specific documentation ◦ Coders/Billers ◦ Payers Training Lost productivity during implementation and training  System upgrades/changes   ◦ Ask your vendors now about HIPAA 5010 and ICD-10-CM  Superbill Sample www.cms.hhs.gov/ICD10/Downloads/ICD-10-CM GEMS www.cms.hhs.gov.gov/ICD10/Downloads  Forward Mapping  Backward Mapping  Rarely will the codes match ◦ ICD-9-CM Code to ICD-10-CM Code ◦ ICD-10-CM to ICD-9-CM ◦ Example: Obstetrics diagnosis ◦ In ICD-9-CM – Episode of care ◦ In ICD-10-CM – Patient’s stage of pregnancy http://libary.ahima.org/xpedio/group/public/documents/ahima http://library.ahima.org/xpedio/groups/public Judy B Breuker [email protected]