icd 10: what to expect george a. hill, md director, nashville fertility center nashville, tn 37203

ICD 10: What to Expect

George A. Hill, MDDirector, Nashville Fertility Center

Nashville, TN 37203

LEARNING OBJECTIVES

At the conclusion of this presentation, participants should be able to:– Understand ICD-10 background and history, description, and

future – Comprehend the key distinctions between ICD-9-CM and ICD-

10-CM – Understand what physicians need to do now to prepare– Understand the actions that practices need to take to

implement the change to ICD -10-CM on a timely basis

DISCLOSURE

● Committee Member: United Healthcare Women’s Health Scientific Advisory Board

● Grant Recipient: EMD Serono Inc

Disclaimer

● ICD-10 codes included in this presentation are not valid prior to the implementation date of October 1, 2014

● ICD-10 codes included in this presentation may be revised prior to implementation

● ICD-9 codes should continue to be used until transition date of October 1, 2014

Why the Change?

● ICD-9-CM is 30 years old, out of date and running out of space!

● ICD-10 is the international standard and has been for a number of years

● ICD is important to Health Information Technology (HIT) and the change is needed to fully implement HIT

ICD-10 and HIT

Importance of a better coding classification system:– Integral to HIT Strategy - especially the Electronic

Health Record (EHR)

– Improved clinical specificity = improved patient safety

– Improves understanding of disease / costs and allows providers and others to improve on their delivery

– International Disease Surveillance

ICD-10: Current Status

● Some current opposition to implementation

● Per CMS, no delay or schedule change is pending (except!) (postponed from 10/1/2013 to 10/1/2014)

● Physicians need to be prepared for the change in order to prevent a revenue flow interruption on 10/1/2014

Understanding ICD

● ICD is part of the World Health Organization’s (WHO) system of classification

● ICD-CM (clinical modification) used to track morbidity

● ICD used to report mortality

● In the United States, we (ASRM/ACOG Coding Committees) work through the National Center for Health Statistics to implement changes/updates

History of ICD-10

● ICD-10 adopted by WHO in 1990

● First modification in 1998

● U.S. only industrialized nation that has not yet implemented ICD-10 or a modification in some format

● U.S. first began exploring idea in 1994

● Draft versions available 2002, 2007, 2009, 2010, 2011

● Implementation Date: October 1, 2014!

Key Differences: ICD-9-CM to ICD-10-CM

● ICD-10-CM consists of 21 chapters compared to 17 in ICD-9-CM

● Chapters divided into “blocks” of codes with additional subcategories

● V and E code supplemental classifications incorporated into main classifications

● Conditions of sense organs separated from nervous system


● Certain diseases reclassified to reflect current medical knowledge

● ICD-10 classifies injuries by specific site then by type vs. ICD-9 classification by type

● Postoperative complications moved to procedure specific system chapters (complications of GU surgery in GU chapter)


● ICD-10-CM codes are alphanumeric and up to 7 characters ICD-9-CM are 3-5 characters in length (mostly numeric)

● ICD-10-CM includes full code titles vs. references to common 4th -5th digits

● Addition of 6th characters for some● Addition of code extensions (7th digit)● Addition of dummy placeholder “X”

New Features in ICD-10-CM

● Combination codes for conditions and common symptoms/manifestations

● Combination codes for poisoning and external causes

● Added laterality for some codes (right vs. left)

Key Changes for Reproductive Endocrinology/Infertility

Inclusion of trimesters in obstetric codesSeparate codes to indicate gestational week

Elimination of episodes of care for obstetric codes

Changes in time frames:Abortion vs. Fetal death ( 20 weeks)Early vs. Late pregnancy (20 weeks)

Extensions to denote specific fetusNew GU codes and notes including category title

changes

Structure and Format of ICD-10-CM

● First character is always alphabetic letter– Chapter 14 Diseases of the GU system (N00-N99)– Chapter 15 Pregnancy, Childbirth and Puerperium (O00-O9A)

● Second character is always a number● Characters 3-7 alpha or numeric

– O9A.311: Physical abuse complicating pregnancy, first trimester


● Alphabetic Index: Alphabetic Listing of Terms and Codes– Index to Diseases and Injury– Index to External Causes of Injury– Neoplasm Table – Table of Drugs and Chemicals

● Tabular List: Chronological list divided into chapters based on body system or condition


● Code Format: XXX.XXX XoXXX= CategoryoXXX= Etiology, anatomic site, severityoX= Extension

● Placeholder Character X– Used with certain codes for potential future expansion– When placeholder exists, must use X in that location for valid

code


● Labor and delivery complicated by cord around neck, without compression: O69.81X2– O69:Labor and delivery complicated by umbilical cord

complications– 81:Cord around neck, without compression– X: Placeholder– 2: Fetus 2

General Coding Guidelines

● Locate code in Alphabetic Index and confirm in Tabular list

● Report the highest number of characters available

● Signs and symptoms are acceptable if diagnosis has not been confirmed by provider (Chapter 18 contains many but not all)

General Coding Guidelines

● Combination codes should be reported when code fully describes condition– Combination code is single code that describes:

o Two diagnoses oDiagnosis with an associated secondary process

(manifestation) o Diagnosis with an associated complication

2012 ICD-10-CM Codes Applicable to RE/I

● C00-D99 Neoplasms● E00-E89 Endocrine, nutritional and metabolic diseases● N00-N99 Diseases of the genitourinary system● O00-09A Pregnancy, childbirth, and the puerperium● Q00-Q99 Congenital Malformation, deformations, and

chromosomal abnormalities● R00-R99 Symptoms, signs and abnormal clinical and

laboratory findings, not elsewhere classified

N00-N99 Diseases of the Genitourinary Sytem

● N70-N77 Inflammatory diseases of female pelvic organs● N80-N98 Noninflammatory disorders of female genital

tract● N99-N99 Intraoperative and postprocedural

complications and disorders of genitourinary system, not elsewhere classified

N80-N98 Noninflammatory disorders of female genital tract

● N80 Endometriosis● N83 Noninflammatory disorders of ovary, fallopian

tube, and broad ligament● N84 Polyp of female genital tract● N92 Excessive, frequent, and irregular menstruation● N96 Recurrent Pregnancy Loss● N97 Female Infertility● N98 Complications associated with artificial

fertilization

Some Diagnoses will be Straight Crosswalks

N80 Endometriosis

ICD-9-CM Description ICD-10-CM

617.0 Endometriosis of uterus N80.0

617.1 Endometriosis of ovary N80.1

617.3 Endometriosis of pelvic peritoneum N80.3

617.5 Endometriosis of intestine N80.5

N97 Female Infertility


628.0 Female Infertility associated with anovulation N97.0

628.2 Female Infertility of tubal origin N97.1

628.3 Female Infertility of uterine origin N97.2

628.8 Female Infertility of other origin N97.8

628.9 Female Infertility, unspecified N97.9

N97 Female Infertility—What are Excludes?

● Type 1 Excludes– Female infertility associated with:

o Hypopituitarism (E23.0_)o Stein Leventhal Syndrome (E28.2_)

● Type 2 Excludes– Incompetence of cervix uteri (N88.3_)

Type 1 Excludes

● A type 1 excludes note is a pure excludes. It means “not coded here”

● A type 1 excludes note indicates that the code excluded should never be used at the same time as (N97)

● Used when 2 conditions cannot occur together

Type 2 Excludes

● A type 2 excludes note represents “not included here”● A type 2 excludes note indicates that the condition excluded is

not part of the condition it is excluded from but a patient may have both conditions at the same time

● When a type 2 excluded note appears under a code it is acceptable to use both the code (N97) and the excluded code together

N97 Female Infertility

● Type 1 Excludes– Female infertility associated with:

o Hypopituitarism (E23.0_)o Stein Leventhal Syndrome (E28.2_)

● Type 2 Excludes– Incompetence of cervix uteri (N88.3_)

N96 Recurrent Pregnancy Loss

● Type 1 Excludes– Recurrent pregnancy loss with current pregnancy (O26.2-)

o O26.20 …unspecifiedo O26.21 …first trimestero O26.22 …second trimestero O26.23 …third trimester

Some Codes may be less specific

O00 Ectopic Pregnancy

ICD-9-CM Description ICD-10-CM633.0 Abdominal pregnancy O00.0633.1 Tubal pregnancy O00.1

633.10 without intrauterine pregnancy633.11 with intrauterine pregnancy

633.2 Ovarian pregnancy O00.2633.8 Other ectopic pregnancy O00.8633.9 Ectopic pregnancy, unspecified O00.9

Some codes may have the same specificity

O02 Other abnormal products of conception

● O02.81Inappropriate change in quantitative human chorionic gonadotropin (hCG) in early pregnancy

● Currently in ICD-9-CM: 631.0

Some codes may be more specific

O30 Multiple Gestation

ICD-9-CM Description ICD-10-CM651.0_ Twin pregnancy O30.0V91.02 Twin pregnancy, monochorionic/diamniotic O30.03

…first trimester O30.031V91.03 Twin pregnancy, dichorionic/diamniotic O30.04

…first trimester O30.041651.1_ Triplet pregnancy O30.1

V91.11Triplet pregnancy with 2 or more monochorionic fetuses O30.11 …first trimester O30.111

Some codes will replace multiple codes, some will be

new

N98 Complications associated with artificial fertilization

N98.1 Hyperstimulation of ovaries (620.8, 256.1, E932.4)

N98.3 Complications of attempted introduction of embryo in embryo transfer

What about Fibroids?

Neoplasms (C00-D49)

● (D10-D36) Benign neoplasms, except benign neuroendocrine tumors– D25 Leiomyoma of Uterus

D25 Leiomyoma of Uterus


218.0 Submucous leiomyoma of uterus D25.0

218.1 Intramural leiomyoma of uterus D25.1

218.2 Subserous leiomyoma of uterus D25.2

218.9 Leiomyoma of uterus, unspecified D25.9

Z31 Encounter for Procreative Management

● Z31.41 Encounter for fertility testing (V26.21)

Z32 Encounter for pregnancy test and childbirth and childcare instruction


V72.4 Encounter for pregnancy test Z32.0

V72.40 …result unknown Z32.00

V72.42 …result positive Z32.01

V72.41 …result negative Z32.02

Summary

● Greatly increased number of codes in ICD-10, but RE/I will still only routinely use a small subset of the new code set

● Due to greater specificity, ICD-10 often allows the use of fewer codes than ICD-9 to adequately capture specific patient conditions

● The general coding principles/diagnosis code selection processes that apply to ICD-9-CM will also apply to ICD-10-CM

Summary

● System changes will be necessary to accommodate increased digits and character changes

● May require changes in medical record documentation to support increased specificity

● Education will be necessary for staff and providers

What to Do Now

● Assess the quality of medical record documentation– Consider conducting a documentation assessment audit

● Implement documentation improvement strategies if necessary based on audit results

● Monitor the impact of any documentation improvement strategies

● Reassess and refine

● DO NOT PANIC!!

Planning for the Transition

● Verify with software vendors plans for testing and implementation

● Assign internal implementation team– Include physicians and other providers– Clinical staff (nursing, lab, etc)– Administrative staff– Coding/ Billing staff

Planning for the Transition

● Assess current uses and users of ICD-9 in practice– Assess skills and understanding of ICD

● Determine who needs ICD-10 training

● Evaluate training options

● Evaluate current documentation practices

● Plan for changes to charge capture documents

ACOG: ICD-10-CM Resources

● ICD-10 page on ACOG website

● Monthly Subscription Listserv (contains latest ICD-10 news, updates and links)


ICD Training Plan– 2013

o Increased number of Coding Workshops (14)oAll Workshops presented using only ICD-10 codeso ICD-10 to ICD-9 / ICD-9 to ICD-10 Crosswalks included

for each Workshop moduleo Each Workshop attendee will receive a draft copy of the

current ICD-10 code set o Separate (1/2 day) ICD-10 only training modules

Focused exercises using the new code set Staff may attend alone


● Separate (1 page) ICD-10 and CPT Encounter Forms and Quick Reference Sheets in 2013

● Coding Publications– Essential Guide, Frequently Asked Questions, (all coding

publications with ICD info) will be updated to include ICD-10 content

What will ASRM do?

● Coding courses at the Annual Clinical Meeting● Information in the Coding Corner of the Website● Communicate with the ASRM Coding Committee any ideas

you have that would be beneficial in helping our members implement ICD-10-CM

ICD-10-CM Resources

● CMS– http://www.cms.gov/ICD10

● NCHS (CDC)– http://www.cdc.gov/nchs/icd/icd10.htm

● AHIMA– http://www.ahima.org/icd10/

● AAPC– http://www.aapc.com/icd-10/

ICD-10-CM Resources

● The best web site I have found to help with looking up ICD-10-CM codes:

ICD10Data.com

ICD Future

ICD -11 is on the horizon internationally:Tweaked version of ICD-10, not a huge change from 10 to 11

● ICD-11 initial version made available for public review - May 2011

● WHO plans to present ICD-11 to the World Health Assembly in 2015

Other Important Codes in ICD-10● W61.11XA: Bitten by macaw, initial

encounter● W61.11XD: Bitten by macaw, subsequent

encounter● W61.11XS: Bitten by macaw, sequela● W61.12XA: Struck by macaw, initial

encounter● W61.12XD: Struck by macaw, subsequent

encounter● W61.12XS: Struck by macaw, sequela● W61.19XA: Other contact with macaw, initial

encounter● W61.19XD: Other contact with macaw,

subsequent encounter● W61.19XS: Other contact with macaw,

sequela

Important Codes in ICD-10● V90.27XA: Drowning and submersion due to falling or

jumping from burning water-skis, initial encounter● V90.27XD: Drowning and submersion due to falling or

jumping from burning water-skis, subsequent encounter● V90.27XS: Drowning and submersion due to falling or jumping

from burning water-skis, sequela● V90.37XA: Drowning and submersion due to falling or

jumping from crushed water-skis, initial encounter● V90.37XD: Drowning and submersion due to falling or

jumping from crushed water-skis, subsequent encounter● V90.37XS: Drowning and submersion due to falling or jumping

from crushed water-skis, sequela● V90.87XA: Drowning and submersion due to other accident to

water-skis, initial encounter● V90.87XD: Drowning and submersion due to other accident to

water-skis, subsequent encounter● V90.87XS: Drowning and submersion due to other accident to

water-skis, sequela● V91.07XA: Burn due to water-skis on fire, initial encounter● V91.07XD: Burn due to water-skis on fire, subsequent

encounter

● V92.07XA: Drowning and submersion due to fall off water-skis, initial encounter

● V92.07XD: Drowning and submersion due to fall off water-skis, subsequent encounter

● V92.07XS: Drowning and submersion due to fall off water-skis, sequela

● V92.27XA: Drowning and submersion due to being washed overboard from water-skis, initial encounter

● V92.27XD: Drowning and submersion due to being washed overboard from water-skis, subsequent encounter

● V92.27XS: Drowning and submersion due to being washed overboard from water-skis, sequela

● V93.87XA: Other injury due to other accident on board water-skis, initial encounter

● V93.87XD: Other injury due to other accident on board water-skis

September 2014 rolls around, You haven’t prepared!

● TIME TO PANIC!!

QUESTIONS?

icd 10: what to expect george a. hill, md director, nashville fertility center nashville, tn 37203

Documents