HEALHTCARE
ADMINSITRATION
HA3
ICD-10 CM CODING
Reimbursement Methodology
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LEARNING OBJECTIVE
The students will be able to;
◦ Gain The Concept of ICD 10 CM.
◦ Understand the Importance of ICD 10
CM.
◦ Compare ICD-10 CM from ICD-9 CM.
◦ Gain knowledge of the providers
Impact.
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Why ICD-10 CM Coding?
Current ICD-9 Code Set is:
Outdated: 3 decades old
Current code structure limits amount of new
codes that can be created
Has obsolete groupings of disease families
Lacks specificity and detail to support:
◦ Accurate anatomical positions
◦ Differentiation of risk & severity
◦ Key parameters to differentiate disease
manifestations
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CPT and HCPCs Codes
No impact on
◦ Current Procedural Terminology (CPT) Codes.
◦ Healthcare Common Procedure Coding System
(HCPCS) Codes
CPT and HCPCS will continue to be used for
Physician and Ambulatory Services including
Physician Visits to Inpatients
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ICD-10 Implementation
October 1, 2015 – Compliance date for
implementation of ICD-10-CM (diagnoses) and
ICD-10-PCS (procedures)
ICD-10-CM (diagnoses) will be used by all
providers in every health care setting
ICD-10-PCS (procedures) will be used only for
hospital claims for inpatient hospital procedures
◦ ICD-10-PCS will not be used on physician
claims, even those for inpatient visits
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Diagnosis Code Structure
Comparison
ICD-9-CM (Volume 1 & 2) ICD-10-CM
3-5 characters in length 3-7 characters in length
Approximately 14,000 codes Approximately 68,000 codes
First digit may be Alpha (E or V) Digit 1 is alpha (to indicate the
or category);
Numeric; digits 2-5 are numeric Digit 2 is numeric (in the future,
alpha characters may be used if
code expansion is needed);
Digits 3-7 can be alpha or numeric
Limited space for adding new Flexible for adding new codes
codes
Lacks detail Very specific
Lacks laterality Includes laterality (i.e., codes
identifying right vs. left) 6
ICD-10-CM (diagnosis) Code Format
2nd – Always Numeric
Alpha 3rd-7th Alpha or Numeric Additional
(except U) Characters
S 3 2 0 1 0 A
Category Etiology, Anatomic Site,
Severity
Added code extensions (7th Character) for
3-7 Characters obstetrics, injuries and external causes of
injuries
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Procedure Code Structure
Comparison
ICD-9-CM (Volume 3) ICD-10-PCS
3-4 numbers in length 7 alpha-numeric characters in length
Approximately 3,000 codes Approximately 87,000 available codes
Based on outdated technology Reflects current usage of medical
terminology and devices
Limited space for adding new codes Flexible for adding new codes
Lacks detail Very specific
Lacks laterality Has laterality
Generic terms for body parts Detailed descriptions for Body Parts
Lacks descriptions of methodology and Provides detailed descriptions of
approach for procedures methodology and approach for procedures
Lacks precision to adequately define Precisely defines Procedures Detail
procedures Regarding Body Part, Approach, Device
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Used and Qualifier.
ICD-10-PCS Code Format
S 3 2 0 1 0 A
Section Root Approach Qualifier
Operation
Body Body Device
System Part
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Comparison: ICD-9 to ICD-10
ICD-9 Procedure Code
39.50 Angioplasty
39.31 Suture of Artery
47.01 Laparoscopic Appendectomy
ICD-10 Procedure Code
0DN90ZZ Release of Duodenum, Open Approach
0FB03ZX Excision of Liver, Percutaneous
Approach, Ddiagnostic
02PS0CZ Removal, Extraluminal Device from
Pulmonary Vein, Right, Open 10
ICD-10 Provider Impacts
Clinicaldocumentation is the foundation of successful
ICD-10 Implementation
Golden Rule of Documentation
◦ If it isn’t documented by the physician, it didn’t
happen
◦ If it didn’t happen, it can’t be billed
The purpose in documentation is to tell the story of
what was performed and what is diagnosed accurately
and thoroughly reflecting the condition of the patient
◦ what services were rendered and
◦ what is the severity of the illness
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continued
The key word is SPECIFICITY
◦ Granularity
◦ Laterality
Complete and concise documentation allows for
accurate coding which leads to maximized
reimbursement
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ICD-10 Changes Everything!
ICD-10 is a Business Function Change, not
just another code set change.
ICD-10 Implementation will impact everyone:
◦ Registration, Nurses, Managers, Lab,
Clinical Area, Billing, Physicians, and
Coding.
Know your role – How is ICD-10 going to
change what you do?
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ICD-10 Resources
CMS Resources
◦ MS-DRG Conversion Report
http://www.cms.hhs.gov/ICD10/Downloads/MsdrgConversion.pd
f
◦ ICD-10 General Information
http://www.cms.hhs.gov/ICD10
Thefollowing organizations offer providers and others ICD-10
resources
◦ AHIMA (American Health Information Management Association)
http://www.ahima.org/icd10/default.aspx
◦ WEDI (Workgroup for Electronic Data Interchange)
http://www.wedi.org
◦ HIMSS (Health Information and Management Systems Society)
http://www.himss.org/icd10
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QUESTIONS?
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