icd-10-cm_pcs preparing for icd-10 implementation课件

PreparingforICD 10 CM PCS Whatdoesacoderneedtodonow Presentedby JenniferMcManis RHIT ICD 10 CM PCS ComplianceTimelineTrainingTimelineContinuingEducationRequirementsMythBustersCodeStructureCodingFundamentalsCaseStudiesResources ImplementationDate ICD 10 CM PCSComplianceDeadlineOctober1 2013ClaimsforservicesprovidedonorafterthisdatemustuseICD 10codesCPTcodeswillcontinuetobeusedforoutpatientservices ComplianceTimeline January1 2010InternaltestingofVersion5010forelectronicclaimsDecember31 2010InternaltestingmustbecompleteJanuary1 2011ExternalTestingofVersion5010claimsCMSbeginsacceptingVersion5010Version4010continuetobeacceptedJanuary1 2012AllclaimsmustuseVersion5010Version4010nolongeraccepted OutpatientCoderTraining OutpatientCoderTrainingApproximately16hours2011 2012ReviewcodeStructure CodingConventions LearnthefundamentalsAnalyze practiceapplyingtheICD 10 CMguidelinesReviewandrefreshknowledgeofA Pconcepts OutpatientCodingTraining 2012 2013BecomeanexpertinapplyingICD 10 CMcodestooutpatientcasesinthesixtoninemonthsprecedingOctober1 2013 PracticeusingICD 10 CMcodeseachweekleadinginto golive onOctober1 2013 NetworkwithpeerstoseekanswerstocasesandconfirmapplicationofICD 10 CMcodes TakeadvantageofcomponentMHIMAtrainingopportunities InpatientCoderTraining Approximately50hours2011 12ReviewcodestructureandcodingconventionsforICD 10 CMandICD 10 PCS LearnthefundamentalsoftheICD 10 CMandICD 10 PCSsystems AnalyzeandpracticeapplyingtheICD 10 CMandICD 10 PCSCodingGuidelines ContinuetostudyICD 10 PCSdefinitions memorizethedefinitionsofapproachesandrootoperations Continuetoreviewandrefreshknowledgeofanatomyandphysiologyconcepts InpatientCoderTraining 2012 13BecomeanexpertinapplyingICD 10 CMandICD 10 PCScodestoinpatientcasesinthe6to9monthsprecedingOctober1 2013PracticeusingICD 10 CMandICD 10 PCScodeseachweekleadinginto golive onOctober1 2013NetworkwithpeerstoseekanswerstocasesandconfirmapplicationofICD 10 CM PCScodesTakeadvantageofMHIMAtrainingopportunities ContinuingEducationUnit CEU Requirements RequiredtoparticipateinapredeterminednumberofmandatorybaselineeducationalexperiencesspecifictoICD 10 CM PCS CanBeginEarningCEU sJanuary1 2011thruDecember31 20132009or2010ICD 10 CMAcademy CEURequirements TotalnumberofICD 10 cm PCSCEUrequired byAHIMACredentialCHPS 1CEUCHDA RHIT RHIA 6CEUsCCS P 12CEUsCCS CCA 18CEUsIfyouholdmorethanonecredential onlyreportthehighestnumberofCEUs CEURequirements CEUrequirementswillbeincludedwithinthetotalnumberofCEUsrequiredforagivenCEUCycle Forexample ifyouholdanRHIAcredential youwillobtain6CEUsthatareinrelationtoICD 10 CM PCSalongwiththeadditional24CEUstocompleteyourrecertificationcycle ReportingoftheCEUswillbemadeavailablebyFallof2011 Myths October1 2013isconsideredaflexibledateImplementationplanningshouldbeundertakenwithanassumptionthatDPHHSwillgrantanextensionWorker scomp autoinsurancecompaniesmaychoosenottoimplementICD 10 CM PCSStateMedicaidProgramswillnotberequiredtoupdatetheirsystemsinordertoutilizeICD 10 CM PCSTheincreasednumberofcodeswillmakethenewcodingsystemimpossibletouseDevelopedwithoutanyclinicalinputTherewillnohardcopyofICD 10 CM PCSAllcodingwillbedoneelectronically Myths Developedanumberofyearsago soitisoutofdateUnnecessarilydetailedmedicalrecorddocumentationwillberequiredImplementationcanwaituntilafterelectronichealthrecordsandotherhealthcareinitiativeshavebeenestablishedICD 10 CMbasedsuperbillswillbetoolongortoocomplexTheGEMsareintendedtofacilitatetheprocessofcodingmedicalrecordsEachpayerwillberequiredtodeveloptheirownmappings GEMhavebeendevelopedforCMSuseonlyMedicallyunnecessarydiagnostictestswillneedtobeperformedinordertoassignanICD 10 CMcodeCPTwillbereplacedbyICD 10 CM PCS ICD10 CMCodeStructure ICD10 CMContainsmorethan68 000codesComparethistoICD 9 CMwhichcontains13 000codesConsistsof3 7charactersFirstdigitisalphaAllLettersareusedexceptU4th 5th 6th 7thDigitscanbenumericDecimalplacedafterthe1stthreecharacters ICD 10 CMCodeStructure ICD 10 CMCodeStructureXXX XXXX1st3Characters Category4th5th6thCharacters Etiology AnatomicSite Severity7thCharacter Extension VisitEncounter Sequelae ExternalCauses ICD 9 CMCodeStructureXXX XX1st3Characters Category4th5thCharacters Etiology AnatomicSite Manifestation ICD 10 CM StructureIndex TabularListTwoPartsoftheIndexDisease InjuryTableofDrugs ChemicalsNeoplasmTableExternalCausesCodingGuidelinesSomechangesfromICD 9Fractures DefaultDisplaced2CategoriesforAcuteMIAcuteMIis4weeksinsteadof8weeksOsteoporosiswithcurrentpathologicalfractureVcodesarenowZCodes ICD 10 CM NewFeaturesCombinationcodesforconditions commonsymptomsCombinationcodesforpoisonings externalcausesAddedlateralityAddedextensionsforepisodeofcareExpandedcodesInclusionoftrimesterinobstetriccodesandeliminationoffifthdigitsforepisodeofcareExternalcausecodesnolongerasupplementaryclassification ICD 10 CM DiabetesMellitusCodesNoLongerClassifiedasuncontrolled controlledIncludesdiabetes thecomplicationInjuriesGroupedbyAnatomicalsiteratherthantypeofinjuryCodeExtensiontoidentify 7thCharacter A InitialencounterD SubsequentencounterS Sequelae ICD 10 CM CodeExamplesI10 HypertensionHypertensionTableRemovedCombinationcodesCertainConditionsandAssociatedSymptomsK57 21 DiverticulitisoflargeintestinewithperforationandabscesswithbleedingI25 110 ArterioscleroticHeartDiseaseofnativecoronaryarterywithunstableanginapectorisK571 51 ToxicLiverdiseasewithchronicactivehepatitiswithascitesE10 610 Type1diabetesmellituswithdiabeticneuropathicarthropathy ICD 10 CM CombinationcodesforpoisoningsandtheirexternalcauseT42 3x2S Poisoningbybarbituates intentionalself harm sequelaLateralityC50 212 Malignantneoplasmofupper innerquadrantofleftfemalebreastL89 213 Pressureulcerofrighthip stageIII ICD 10 CM CodesforclinicalconceptsthatdonotexistinICD 9 CMT45 526D Underdosingofantithromboticdrugs subsequentencounterZ67 40 TypeOBlood RHpositiveCodesforpostoperativecomplications intraoperative andpost proceduraldisordersD78 01 IntraoperativehemorrhageandhematomaofspleencomplicatingaprocedureonthespleenD78 21 Post proceduralhemorrhageandhematomaofspleenfollowingaprocedureonthespleenObstetriccodesidentifytrimesterinsteadofepisodeofcare026 02 Excessiveweightgaininpregnancy secondtrimester ICD 10 CMCodingGuidelines Chapter1 CertainInfectiousandParasiticDiseases A00 B99 d Sepsis SevereSepsis andSepticShockCaseStudy Patientwastakentotheemergencydepartmentandadmittedtothehospitalafterbeingfoundsemi consciouswithmarkedlyabnormalvitalsigns afeverofover39degreesC aheartrateof110 andarespiratoryrateof22 min FinaldiagnosesincludedsepsisandsepticshockwithacuterespiratoryfailureAnswer A41 9Sepsis generalized R65 21Shock septic duetoseveresepsis J96 0Failure respiration respiratory acute ICD 10 CMCodingGuidelines Chapter4 Endocrine Nutritional andMetabolicDiseases E00 E89 a Diabetesmellitus6 SecondaryDiabetesMellitusCaseStudyThis34 year oldpatientisbeingseenforongoingmanagementofsteroid induceddiabetesmellituswhichwasduetotheprolongeduseofcorticosteroids whichhavebeendiscontinued Thepatient sdiabetesismanagedwithinsulinwhichhehasbeentakingforthelasttwoyearsAnswer T38 0 x5SRefertoDrugandChemicalTable Corticosteroid adverseeffectE09 9Diabetes diabetic mellitus sugar duetodrugorchemicalZ79 4Long term current drugtherapy useof insulin ICD 10 CMCodingGuidelines Chapter9DiseasesofCirculatorySystem I00 I99 CaseStudyPatientisseenfortreatmentofunstableangina Thepatienthasahistoryofatheroscleroticheartdiseaseandunderwenta3 vesselcoronarybypassapproximately2yearsago ThepatientrecentlyunderwentacardiaccatheterizationofallthreecoronarybypassgraftswhichshowedthempatentAnswer I25 110Angina attack cardiac chest heart pectoris syndrome vasomotor withatheroscleroticheartdisease seeArteriosclerosis coronary artery nativevesselwithanginapectoris unstableZ95 1Status post aortocoronarybypass ICD 10 CMCodingGuidelines Chapter12 DiseasesofSkinandSubcutaneousTissue L00 L99 a PressureulcerstagecodesCaseStudyThispatienthasagangrenouspressureulceroftherighthipandapressureulcerofthesacrumdocumentedbythephysician ThenursingassessmentindicatesastageIIpressureulcerofthesacrumwithastageIIIdecubitusulceroftherighthip Answer I96Ulcer gangrenous seeGangrene Gangrene gangrenous connectivetissue dropsical dry moist skin ulcer seealsonecrosis Necrosis skinorsubcutaneoustissueNECL89 213Ulcer ulcerated ulcerating ulceration ulcerative pressure pressurearea stageIII healing fullthicknessskinlossinvolvingdamageornecrosisofsubcutaneoustissue L89 152Ulcer ulcerated ulcerating ulceration ulcerative pressure pressurearea stageII healing abrasion blister partialthicknessskinlossinvolvingepidermisand ordermis sacralregion tailbone ICD 10 CMCodingGuidelines Chapter9 DiseasesofCirculatorySystem I00 I99 a Hypertension1 HypertensionwithHeartDisease3 HypertensiveHeartandChronicKidneyDiseaseCaseStudyThispatientishospitalizedwithadiagnosisofcongestiveheartfailureduetohypertensiveheartdisease PatientalsohasStage5chronickidneyfailure ThepatienthasbeenprescribedLasixpreviouslybutadmitsheforgetstotakehismedicationeveryday Thisisduetohisadvancedage ICD 10 CMCodingGuidelines Answer I13 2Disease diseased heart organic hypertensive seeHypertension heart Hypertension hypertensive accelerated benign essential idiopathic malignant systemic heart disease withkidneydisease chronic seeHypertension cardiorenal disease withheartfailure withstage5orendstagerenaldiseaseI50 9Failure heart acute sudden congestive compensated decompensated The useadditionalcode statementundercodeI13 2indicatestheuseofthiscodetoidentifythetypeofheartfailureN18 5Disease diseased kidney functional pelvis chronic stage5 The useadditionalcode statementundercodeI13 2indicatestheuseofthiscodetoidentifythestageofthechronickidneydiseaseT50 1x6ARefertoTableofDrugsandChemicals Lasix underdosingZ91 130Noncompliance medicationregimen underdosing unintentional duetopatient sage relateddebility ICD 10 CMCodingGuidelines Chapter20 Chapter20 ExternalCausesofMorbidity V01 Y99 CaseStudyAn18year olddriverofacarthatcollidedwithapickuptruckontheinterstatehighway Thedriverconfessedtousinghiscellphonetosendatextmessagetohisgirlfriend AssigntheexternalcausecodesonlyAnswer V43 53xAIndextoExternalCauses Accident car seeAccident transport caroccupant Accident transport caroccupant driver collision with pickuptruck traffic Y92 411IndextoExternalCauses Placeofoccurrence highway interstate Y93 c2IndextoExternalCauses Activity involving ofvictimattimeofevent cellular telephone ICD 9 CMCodingGuidelines Chapter21 Factorsinfluencinghealthstatusandcontactwithhealthservices Z00 Z99 CaseStudyThispatienthadalateralwallSTEMIandwasbroughtbyambulancetotheemergencyroom HereceivedtPAandwastransferredtoatertiarycarecenterforcontinuedcare ThepatientwasreceivedwithtPAinfusioncontinuing andimmediatelytakentothecardiaccathlab Answer I21 29Infarct infarction myocardium myocardial acute withstateddurationof4weeksorless STelevation STEMI lateral apical lateral basal lateral high Z92 82Status post seealsoPresence of administrationoftPA rtPA inadifferentfacilitywithinthelast24hourspriortoadmissiontocurrentfacility ICD 10 PCS ICD 10 PCSInpatientProceduresContainsOver72 000codes7Character alphanumericcodestructureEachcharactercontainsupto34possiblevaluesTheletterOisnotusedNoDecimals ICD 10 PCS StructureIndexCodesfoundbasedontypeofprocedure NodiagnosticinformationinthedescriptionOneyouknowthetables youcangodirectlytothetablestheindexdoesnotneedtobeusedfirstFirstThreevaluesintheindexdirectyoutothetableTablesEachpageinthesectioniscomposedofrowsthatspecifyvalidcombinationsofcodevaluesRootOperationsApproach ICD 10 PCS ICD 10StructureXXXXXXX1st Section MedicalImaging 2nd BodySystem3rd RootOperation Resection Transfusion 4th BodyPart5th Approach6th Device7th Qualifier ICD 10 PCS CodeExamples0HTT0ZZ RightTotalMastectomy0X6C0ZZ Amputationatleftelbowlevel0FT44ZZ LapChole0HBT0ZX RightBreastBiopsy0 MedicalSurgicalH Skin BreastB ExcisionT bodyPart0 ApproachZ DeviceX Qualifier ICD 10 PCS RootOperations30RootOperationsIdentifiestheobjectiveoftheprocedureInordertodeterminetheappropriaterootoperation thefulldefinitionoftherootoperationascontainedinthePCSTablesmustbeapplied Componentsofaprocedurespecifiedintherootoperationdefinitionandexplanationarenotcodedseparately Proceduralstepsnecessarytoreachtheoperativesiteandclosetheoperativesitearealsonotcodedseparately Example ResectionofajointaspartofajointreplacementprocedureisincludedintherootoperationdefinitionofReplacementandisnotcodedseparately Laparotomyperformedtoreachthesiteofanopenliverbiopsyisnotcodedseparately ICD 10 PCS RootOperations Excisionvs ResectionPCScontainsspecificbodypartsforanatomicalsubdivisionsofabodypart suchaslobesofthelungsorliverandregionsoftheintestine Resectionofthespecificbodypartiscodedwheneverallofthebodypartiscutoutoroff ratherthancodingExcisionofalessspecificbodypart Example LeftupperlunglobectomyiscodedtoResectionofUpperLungLobe LeftratherthanExcisionofLung Left ICD 10 PCS RootOperations BiopsyfollowedbymoredefinitivetreatmentIfadiagnosticExcision Extraction orDrainageprocedure biopsy isfollowedbyamoredefinitiveprocedure suchasDestruction ExcisionorResectionatthesameproceduresite boththebiopsyandthemoredefinitivetreatmentarecoded Example Biopsyofbreastfollowedbypartialmastectomyatthesameproceduresite boththebiopsyandthepartialmastectomyprocedurearecoded Controlvs moredefinitiverootoperationsTherootoperationControlisdefinedas Stopping orattemptingtostop postproceduralbleeding Ifanattempttostoppostproceduralbleedingisinitiallyunsuccessful andtostopthebleedingrequiresperforminganyofthedefinitiverootoperationsBypass Detachment Excision Extraction Reposition Replacement orResection thenthatrootoperationiscodedinsteadofControl Example ResectionofspleentostoppostproceduralbleedingiscodedtoResectioninsteadofControl ICD 10 PCS RootOperations ReleaseproceduresIntherootoperationRelease thebodypartvaluecodedisthebodypartbeingfreedandnotthetissuebeingmanipulatedorcuttofreethebodypart Example Lysisofintestinaladhesionsiscodedtothespecificintestinebodypartvalue Releasevs DivisionIfthesoleobjectiveoftheprocedureisfreeingabodypartwithoutcuttingthebodypart therootoperationisRelease Ifthesoleobjectiveoftheprocedureisseparatingortransectingabodypart therootoperationisDivision Examples FreeinganerverootfromsurroundingscartissuetorelievepainiscodedtotherootoperationRelease Severinganerveroottorelievepainiscodedtot