ICD-10-CM
What Do These Items Have In Common?
Killer Bees 1984 Y2k Ice-Free Polar Cap by 2013
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Predictions That Never Came True
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Killer Bees
Expected to reach the U.S. in the 1980s, but delayed 10 years."The Swarm": A huge swarm of deadly African bees spreads terror over American cities by killing thousands of people. Weekly Reader.
By 2013, the number of deaths is minuscule. The Centers for Disease Control doesn’t find enough to make a separate category for killer-bee-related deaths. 2013: 1 death in Central Texas.
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1984
Orwell’s vision of a post-atomic dictatorship in which every individual would be monitored
ceaselessly by means of the telescreen.
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Y2k
Predictions of a Y2K computer bug; it was to crash many computers, and malfunctions would
cause major catastrophes worldwide and society would cease to function.
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Ice-Free Polar Cap in 2013
In 2007, British Broadcasting Corporation reported the Arctic would be ice-free in summer 2013, citing U.S. scientist Wieslaw Maslowski. (Naval Post Graduate School)
Al Gore cited Maslowski's analysis in his acceptance speech at the Nobel Peace Prize ceremony in 2007.
In summer 2013, the Arctic had 533,000 more square miles of ice than the same time in 2012 – a 29% increase.
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ICD-10 Predictions
"The implementation of ICD-10 will be the most significant, costly event that we will
experience" (J.Rumpakis, Review of Optometry 1/15/09)
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ICD-10 Predictions
"To upgrade to ICD-10 will cost a small practice (3 docs) $83,290”
(Nachimson Advisors)
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ICD-10 Predictions
"The cost will be up to 10 times more than the $600 per physician that the U.S Dept. of Health
& Human Services has assumed" (American Academy of Professional Coders)
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ICD-10 Predictions
"The cost of switching to ICD-10 will be about $20"
(Alan Homestead OD)
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What Is ICD-10-CM
International Classification of Diseases, Tenth Revision, Clinical Modification
General information:www.cdc.gov/nchs/icd/icd10cm.htm
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Who CreatedWho Created
National Center for Health Statistics (under Centers for Disease Control and Prevention)
developed & maintains ICD-10-CM
Who created & owns CPT?
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Who AffectedWho Affected
Everyone covered by HIPAA, including providers and payers who do not deal with Medicare claims.
Claims submitted electronically to any payer.
HIPAA = Health Insurance Portability and Accountability HIPAA = Health Insurance Portability and Accountability Act Act
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WhyWhyBetter data for:– Measuring quality, safety, and efficacy of care– Designing payment systems & processing claims for payment– Conducting research, epidemiological studies, and clinical trials– Setting health policy– Operational & strategic planning & designing healthcare delivery systems– Monitoring resource utilization– Improving clinical, financial, and administrative performance– Preventing and detecting healthcare fraud and abuse– Tracking public health and risks
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WhyWhyIn 2012, AMA advocated to halt of implementation of ICD-10.
AMA CEO James Madara: the move will "create significant burdens on the practice of medicine with no direct benefit to individual patient care."
What was the AOA position?What was the AOA position?
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WhenWhen
In 2009, Dept of Health and Human Services published regulation requiring replacement of ICD-9-CM with ICD-10-CM.
Implementation Date: Oct 1, 2014
What does “Implementation Date” mean?
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WhenWhen
IMPORTANTClaims with Date Of Service before Oct 1, 2014 must use ICD-9.
Claims with Date Of Service Oct 1, 2014 (or later) must use ICD-10. Claims for services provided before October 1, 2014 must use ICD-9 even if they are submitted after the compliance date.
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WhenWhen
"After the compliance date, ICD-9 codes will not be accepted and any transactions with ICD-9 codes will be rejected." American Medical Association
False.
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ICD-9 vs. ICD-10ICD-9 vs. ICD-10
ICD-10 code can contain more than one diagnosis – called combination codes.
Example:E11.311 Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema
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ICD-9 vs. ICD-10ICD-9 vs. ICD-10
Combined diagnosis/symptom codes.
More specificity (longer code) to identify etiology, anatomic site, severity.
Laterality.
3 - 7 characters (ICD-9 = 3 to 5 characters).
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ExamplesExamples
Most eye codes start with “H”
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ExamplesExamples
367.9 Unspecified disorder of refraction & accomodation comparable to
H52.7 Unspecified disorder of refraction
(no laterality)
(myopia, hyperopia, astigmatism: all have laterality)
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ExamplesExamples
365.00 Preglaucoma, unspecified comparable to
H40.001 Preglaucoma, unspecified, right eyeH40.002 Preglaucoma, unspecified, left eyeH40.003 Preglaucoma, unspecified, bilateralH40.009 Preglaucoma, unspecified, unspecified eye
(1 = right, 2 = left, 3 = bilateral)(9 is not "unspecified" as general rule)
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ExamplesExamples
366.10 Senile cataract comparable to
H25.9 Unspecified age-related cataract
(no laterality)
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ExamplesExamples
366.16 Nuclear sclerosis comparable to
H25.10 Age-related nuclear cataract, unspecified eyeH25.11 Age-related nuclear cataract, right eyeH25.12 Age-related nuclear cataract, left eyeH25.13 Age-related nuclear cataract, bilateral
(1 = right, 2 = left, 3 = bilateral)(0 is not "unspecified" as general rule)
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ExamplesExamples
362.51 Nonexudative senile macular degeneration, dry comparable to
H35.31 Nonexudative age-related macular degeneration
(no laterality)
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ExamplesExamples
Symptoms
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ExamplesExamples
379.91 Pain in or around eye
comparable to
H57.10 Ocular pain, unspecified eyeH57.11 Ocular pain, right eyeH57.12 Ocular pain, left eyeH57.13 Ocular pain, bilateral
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ExamplesExamples
784.0 Headache comparable to
R51 Headache
(no laterality)
(R = Symptoms, Signs, Abnormal Findings)
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ExamplesExamples
250.00 Diabetes mellitus without mention of complication, type 2 or unspecified type, not stated as uncontrolled
comparable to
E13.9 Other specified diabetes mellitus without complications
(E = Endocrine, nutritional, metabolic disease)
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ExamplesExamples
250.50 Diabetes with opthalmic manifestations, type 2 or unspecified type, not stated as uncontrolled
comparable to
E13.8 Other diabetes mellitus with unspecified complications
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ExamplesExamples
362.01 Background diabetic retinopathy
comparable to
E13.39 Other specified diabetes mellitus with other diabetic ophthalmic complication
(many many choices)(was in eye section, now in diabetes section)
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ExamplesExamples
918.1 Abrasion, cornea
comparable to
S05.00XA Injury of conjunctiva and corneal abrasion without foreign body, unspecified eye, initial encounteror
S05.00XD Injury of conjunctiva and corneal abrasion without foreign body, unspecified eye, subsequent encounter
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ExamplesExamples
S = S = Injury, poisoning and certain other consequences of external causes
””55thth” character:” character:
0 = unspecified eye0 = unspecified eye
1 = right eye1 = right eye
2 = left eye2 = left eye
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ExamplesExamples
““66thth”” character: character:
X – space saverX – space saver
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ExamplesExamples
““77thth”” character is to be added to S05 codes character is to be added to S05 codes
A - initial encounterA - initial encounter
D - subsequent encounterD - subsequent encounter
S – sequelaS – sequela
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ExamplesExamples
930.0 Foreign body, cornea
comparable to
T15.00XA Foreign body in cornea, unspecified eye, initial encounteror
T15.00XD Foreign body in cornea, unspecified eye, subsequent encounter
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ExamplesExamples
T = T = Injury, poisoning & certain other consequences of external causes
””55thth” character:” character:
0 = unspecified eye0 = unspecified eye
1 = right eye1 = right eye
2 = left eye2 = left eye
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ExamplesExamples
““66thth”” character: character:
X = space saverX = space saver
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ExamplesExamples
““77thth”” character is to be added to T15 codes character is to be added to T15 codes
A - initial encounterA - initial encounter
D - subsequent encounterD - subsequent encounter
S – sequelaS – sequela
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ExamplesExamples
V58.69 Long term use of other medications
comparable to
Z79.899 Other long term drug therapy (Z = Factors influencing health status and contact with health services
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How To Find a CodeHow To Find a Code
Crosswalking with:
General Equivalency Mappings (GEMs)
Maps ICD-9 to ICD-10 & vice versa.
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How To Find a CodeHow To Find a Code
GEMs “attempt to find corresponding codes between the two code sets”.
GEMs do not provide an exact crosswalk between codes.
An exact one-to-one match of ICD-9 and ICD-10 codes cannot be made.
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How To Find a CodeHow To Find a Code
GEM:www.cdc.gov/nchs/icd/icd10cm.htm File w/ 2 columns
Other sources: www.aapc.com/icd-10/codes Enter ICD-9 or ICD-10 code, it finds comparable code www.icd10data.com Alphabetical and numeric converter.
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How To Find a CodeHow To Find a Code
Or
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How To Find a CodeHow To Find a Code
Stat ICD-10 app
Free
$20 Alphabetical search
Save frequently used codes
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How To Find a CodeHow To Find a Code
Create document w/commonly used ICD-9s
Cross reference ICD-9’s w/GEMs or AAPC website.
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Where To Get ICD-10-CMWhere To Get ICD-10-CM
www.cdc.gov/nchs/icd/icd10cm.htm
DownloadDownload
ICD-10-CM PDF FormatICD-10-CM PDF Format
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