may 2011 preparing for icd-10 for hospitals copyright 2011 medtronic
TRANSCRIPT
May 2011
Preparing for ICD-10for Hospitals
Copyright 2011 Medtronic
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Notices
Copyright 2011 Medtronic
These coding suggestions and coverage guidelines do not replace seeking coding advice from the payer and/or your coding staff. The ultimate responsibility for correct coding lies with the provider of services. Please contact your local payer for interpretation of the appropriate codes to use for specific procedures. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other third party payers as to the correct form of billing or the amount that will be paid to providers of service.
See NCD 20.8 for Medicare covered indications for pacemakers and NCD 20.4 for Medicare covered indications for defibrillators.
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CEUs for Coders
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AAPCThis program has the prior approval of the American Academy of Professional Coders (AAPC) for 2 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor. AAPC Index# MTI0329110337A.
AHIMAThis program has been approved for 2 continuing education units for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).
A survey will be sent out to all registered participants a few days after the session. The CEU certificates will be included in the survey as attachments for those who listened to the entire session.
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Background
ICD-10-PCS Procedure Codes
ICD-10-CM Diagnosis Codes
Appendix
Topics
DRGs under ICD-10
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Preparing for ICD-10An Introduction to ICD-10 for Cardiovascular
Background
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Components of ICD-10
ICD-10 has two main components:
ICD-10-CM is for diagnosis codes and includes a tabular list, an index, and tables for drugs and neoplasms.
ICD-10-PCS is for procedure codes and includes code tables and an index.
There are other materials that are also officially part of the classification system, including:
GEMs Body Part Key Device Key
Official Guidelines for Coding and Reporting ICD-10-PCS Reference Manual
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This Is Going to Happen
ICD-10 was adopted as the national standard under HIPAA and its use is mandatory
The effective date for implementation is October 1, 2013
Provider
Setting Diagnoses Procedures
Hospitals Inpatient ICD-10-CM ICD-10-PCS
Hospitals Outpatient ICD-10-CM CPT®
ASCs Outpatient ICD-10-CM CPT®
Physicians Facility/Office ICD-10-CM CPT®
Which components of ICD-10 must be used depends on the type of provider:
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(Federal Register, January 16, 2009, pp.3328-3362)
ICD-10 Freeze
Starting October 1, 2011, all codes in ICD-10 will be frozen for 3 years.
The ICD-10 Coordination and Maintenance Committee announced the freeze to allow a period of stability for programming, publishing, and training for implementation of ICD-10.
Limited updates may take place on October 1, 2012 and October 1, 2013 for new technologies and new diseases
The deadline for submitting change requests prior to the freeze has already passed
The C&M Committee will continue to meet during the freeze
Regular annual updates will resume on October 1, 2014
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GEMS
The General Equivalence Mappings are a very useful tool for translating between ICD-9-CM and ICD-10.
The “forward” GEM converts current ICD-9-CM codes to their equivalent ICD-10 codes
The “backward” GEM converts ICD-10 codes back to ICD-9-CM codes
While very handy, GEMS are not a substitute for learning ICD-10. They’re intended for use in converting large databases, not for coding individual cases.
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Limits of GEMS
Particularly for procedure codes, many ICD-9-CM codes convert to far more than one ICD-10 code.
Example: 37.95, implantation of ICD lead(s)
In making the transition to ICD-10, the best way to use the GEMs is either as a starting place or for confirmation.
ICD-9-CM ICD-10-PCS
3795 02H63ME
3795 02H73ME
3795 02HK3ME
3795 02HL3ME
3795 02HN0ME
3795 02HN4ME
Some codes convert to a “cluster” rather than one-for-one
There are other limits in GEMs conversion of ICD-9-CM codes to ICD-10:
Some codes don’t convert directly to ICD-10 at all
Some conversions are theoretically possible but unlikely
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ICD-10-CM Diagnosis Codes
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Format of ICD-10-CM Diagnosis Codes
The format of ICD-10-CM has several new features:
Codes can be from 3 to 7 characters long
The first digit is always a letter (only “U” is not used)
The second and third digits are always numbers
The fourth to seventh digits can be letters or numbers
A decimal is placed after the third digit
Examples
I11.0 Hypertensive heart disease with heart failure
T82.120A Displacement of cardiac electrode, initial encounter
R55 Syncope
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Greater Specificity
ICD-10-CM has far more diagnosis codes than ICD-9-CM.
System # Diagnosis Codes
ICD-9-CM 14,025
ICD-10-CM 68,069
Greater specificity for injuries, including site, type, and encounter
Laterality (left, right, bilateral)
Specificity for device complications, including encounter
The majority of new codes involve:
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Heart Block
The heart block codes in ICD-10-CM are quite similar to those in ICD-9-CM.
I44 Atrioventricular and left bundle-branch block
I44.0 Atrioventricular block, first degree
I44.1 Atrioventricular block, second degreeAtrioventricular block, type I and IIMobitz block, type I and IISecond degree block, type I and IIWenckebach's block
I44.2 Atrioventricular block, completeComplete heart block NOSThird degree block
………………………………………
Complete heart block retains a distinct code, which remains a CC
ICD-10-CM doesn’t make a distinction between Mobitz and other second degree blocks
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I45 Other conduction disorders
I45.2 Bifascicular block
I45.3 Trifascicular block
I45.6 Pre-excitation syndromeLown-Ganong-Levine syndromeWolff-Parkinson-White syndrome
………………………………………
I45.8 Other specified conduction disorders
I45.81 Long QT syndrome
I45.89 Other specified conduction disordersAtrioventricular dissociationInterference dissociationNonparoxysmal AV nodal tachycardia
Other Conduction Disorders
Other codes for pacemaker and defibrillator indications related to conduction are located in I45.
Codes for bifascicular and trifascicular blocks were actually
simplified; the codes reflect pacemaker indications and also remain CCs
Long QT syndrome retains a distinct code, as needed to reflect the defibrillator indication
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Paroxysmal Tachycardia
Note: As in ICD-9-CM, tachycardia not otherwise specified is assigned to a symptom code.
I47 Paroxysmal tachycardia
I47.0 Re-entry ventricular arrhythmia
I47.1 Supraventricular tachycardiaAtrial paroxysmal tachycardiaAtrioventricular paroxysmal tachycardiaJunctional paroxysmal tachycardiaNodal paroxysmal tachycardia
I47.2 Ventricular tachycardia
I47.9 Paroxysmal tachycardia unspecified
Re-entry ventricular arrhythmia has its own code
Note that I47.0 and I47.1 are not assigned
VT is an indication for defibrillators and remains a CC
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for AVNRT (atrioventricular nodal reentrant tachycardia)
Atrial Fibrillation and Flutter
Like ICD-9-CM, the current version of ICD-10-CM has just two codes for atrial fibrillation and flutter.
I48 Atrial fibrillation and flutter
I48.0 Atrial fibrillation
I48.1 Atrial flutter
However, it is likely that this will be expanded on October 1, 2011 to capture more detail.
WHO is updating the international version of ICD-10 for these codes and the US must maintain compatibility. A proposal was recently presented before the C&M Committee to create specific codes within I48 for atrial fibrillation documented as:
Persistent Permanent
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http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htmMarch 9-10, 2011 proposals, pages 48-50
Paroxysmal First episode
Other Cardiac Arrhythmias
I49 Ventricular fibrillation and flutter
I49.0 Ventricular fibrillation and flutter
I49.01 Ventricular fibrillationI49.02 Ventricular flutter
I49.1 Atrial premature beats
I49.2 Junctional premature depolarization
I49.3 Ventricular premature depolarization
……………………………………
I49.5 Sick sinus syndromeTachycardia-bradycardia syndrome
I49.8 Other specified cardiac arrhythmias
I49.9 Cardiac arrhythmia unspecified
According to the index, AVNRT is assigned to I49.8
SSS retains a distinct code, as needed to reflect the pacemaker indication
VF is a defibrillator indication and
remains an MCC
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The depolarization codes are new
Heart Failure
ICD-10-CM has no code for “congestive heart failure” per se; it is included in I50.9 for unspecified heart failure
ICD-10-CM codes for heart failure are essentially the same as the ICD-9-CM codes. This is actually by intent.
When any form of pulmonary edema (acute, chronic, unspecified) is present with heart failure, L50.1 for left ventricular failure is assigned
“Congestive” is a non-essential term for heart failure
In addition to being a CC or MCC, heart failure is a major indication for defibrillators and bi-ventricular devices.
The main differences are:
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Heart Failure Code Structure
I50 Heart failure
I50.1 Left ventricular failure
I50.2 Systolic (congestive) heart failure
I50.20 Unspecified systolic (congestive) heart failure I50.21 Acute systolic (congestive) heart failureI50.22 Chronic systolic (congestive) heart failureI50.23 Acute on chronic systolic (congestive) heart failure
I50.3 Diastolic (congestive) heart failure
I50.30 Unspecified diastolic (congestive) heart failure I50.31 Acute diastolic (congestive) heart failureI50.32 Chronic diastolic (congestive) heart failureI50.33 Acute on chronic diastolic (congestive) heart failure
I50.4 Combined systolic (congestive) and diastolic (congestive) heart failure
I50.40 Unspecified combined (congestive) heart failure I50.41 Acute combined (congestive) heart failureI50.42 Chronic combined (congestive) heart failureI50.43 Acute on chronic combined (congestive) heart failure
I50.9 Heart failure, unspecified
CCs and MCCs remain the same
Because it is coded to I50.1, pulmonary edema is a CC rather than an MCC
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Heart Failure Due to Hypertension
ICD-10-CM maintains the current coding practices for heart failure due to hypertension.
I11 Hypertensive heart disease
I11.0 Hypertensive heart disease with heart failureHypertensive heart failure
Use additional code to identify type of heart failure (I50.-)
I11.9 Hypertensive heart disease without heart failure
ICD-10-CM does not differentiate between benign, malignant, and unspecified
hypertensive disease
ICD-10-CM has similar codes for hypertensive heart and chronic kidney disease.
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An additional code is used from I50 to show the type of heart failure
Chest Pain
Chest pain codes are both reorganized and expanded.
ICD-10-CM more clearly differentiates anterior
chest wall pain from types of respiratory- related pain
R07 Pain in throat and chest
R07.0 Pain in throat
R07.1 Chest pain on breathingPainful respiration
R07.2 Precordial pain
R07.8 Other chest pain
R07.81 Pleurodynia
R07.82 Intercostal pain
R07.89 Other chest painAnterior chest wall pain
R07.9 Chest pain unspecified
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According to the index, code R07.89 also classifies chest
pressure, tightness, and discomfort
Coronary Artery Disease
There are over 35 codes for CAD, reflecting different types of vessels as well as combination codes for CAD with angina.
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Category I25.1 is for CAD of native coronary vessels
Category I25.7 is CAD of other coronary vessels with anginaSubcategory Vessel Type
I25.70 Coronary artery bypass graft(s), unspecified type
I25.71 Coronary artery bypass graft(s), autologous vein
I25.72 Coronary artery bypass graft(s), autologous artery
I25.73 Coronary artery bypass graft(s), nonautologous biological
I25.75 Coronary artery, native, transplanted heart
I25.76 Coronary artery bypass graft(s), transplanted heart
I25.79 Coronary artery bypass graft(s), other type
Category I25.8 is CAD of other coronary vessels without angina
CAD of Native Coronary Arteries
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Subcategory I25.11 shows the basic structure for the combination codes for CAD with angina.
I25.1 Atherosclerotic heart disease of native coronary arteryCoronary artery disease
I25.10 ASHD of native coronary artery without angina pectoris
I25.11 ASHD of native coronary artery with angina pectoris
I25.110 ASHD of native coronary artery with unstable angina pectoris
I25.111 ASHD of native coronary artery with angina pectoris with documented spasm
I25.112 ASHD of native coronary artery with other forms of angina pectoris
I25.119 ASHD of native coronary artery with unspecified angina pectoris
ICD-10-CM assumes a causal relationship between angina and atherosclerosis.
Acute Myocardial Infarction
The ICD-10-CM AMI codes have several key differences from the AMI codes in ICD-9-CM.
ICD-10-CM differentiates primarily between anterior wall and inferior wall, then by the coronary artery involved
ICD-10-CM does not differentiate by episode of care
Rather than 8 weeks, acute MI is defined as a duration of 4 weeks (28 days) or less from onset
ICD-10-CM has distinct categories for the initial MI and for subsequent re-infarction
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Subsequent Infarction
I22 Subsequent STEMI and NSTEMI myocardial infarction
I22.0 Subsequent STEMI of anterior wall
I22.1 Subsequent STEMI of inferior wall
I22.2 Subsequent NSTEMI
I22.8 Subsequent STEMI of other sites
I22.9 Subsequent STEMI of unspecified site
Codes in I22 are used for a repeat infarction within 4 weeks (28 days) of a previous AMI, regardless of site.
Codes in I22 are never used alone; they are always used with a code from I21
The I22 code is sequenced first if the repeat AMI leads to a second admission, or after the I21 code if it occurs during the same admission as the initial AMI
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Cardiomyopathy
Cardiomyopathy, an indication for defibrillators, has expanded codes for greater specificity.
Ischemic cardiomyopathy has
its own code, distinct from other forms of chronic ischemic
heart disease
I25.5 Ischemic cardiomyopathy
I42 Cardiomyopathy
I42.0 Dilated cardiomyopathyCongestive cardiomyopathy
I42.1 Obstructive hypertrophic cardiomyopathy
I42.2 Other hypertrophic cardiomyopathyNon-obstructive ……………………………………
I42.5 Other restrictive cardiomyopathy……………………………………
I42.8 Other cardiomyopathies
I42.9 Cardiomyopathy unspecified
Congestive, restrictive and non-obstructive hypertrophic
cardiomyopathy have their own codes,
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Non-Rheumatic Valve Disorders
In ICD-10-CM, each valve has its own code category.
I35 Non-rheumatic aortic valve disorders
I35.0 Non-rheumatic aortic (valve) stenosis
I35.1 Non-rheumatic aortic (valve) insufficiencyNon-rheumatic aortic (valve) incompetenceNon-rheumatic aortic (valve) regurgitation
I35.2 Non-rheumatic aortic (valve) stenosis with insufficiency
I35.8 Other non-rheumatic aortic valve disorders
I35.9 Non-rheumatic aortic valve disorder unspecified
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Within each category, there are distinct codes for each specific
type of valve disorder
Category Valve
I34 Mitral
I35 Aortic
I36 Tricuspid
I37 Pulmonary
Historical Conditions
As with ICD-9-CM, historical conditions which are indications for defibrillators are distinctly identified in ICD-10-CM.
I25.2 Old myocardial infarction
This has its own code in chronic ischemic heart disease
Z86.74 Personal history of sudden cardiac arrestPersonal history of sudden cardiac death successfully resuscitated
Old Myocardial Infarction
History of SCD
Family and personal history are separately identified
Z82.41 Family history of sudden cardiac death
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Attention to Cardiac Device
Like ICD-9-CM, ICD-10-CM has specific codes for use when the encounter focuses on attention to a device rather than the underlying condition, as in:
Routine device replacement, eg. end-of-battery life
Z45.0 Encounter for adjustment and management of cardiac device
Z45.01 Encounter for adjustment/management of cardiac pacemaker
Z45.010 Encounter for checking and testing pacemaker pulse generatorEncounter for replacing cardiac pacemaker pulse generator [battery]
Z45.018 Encounter for adj/mgt of other part of cardiac pacemaker
Z45.02 Encounter for adj/mgt of automatic implantable cardiac defibrillator
Z45.09 Encounter for adj/mgt of other cardiac device
Encounter for device interrogation or programming
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Device Complications
ICD-10-CM continues to classify device complications as mechanical, infection, and other (non-mechanical).
Definitions are the same as ICD-9-CM for mechanical (eg. breakdown) and other non-mechanical (eg. pain)
Mechanical complication codes are defined as electrode vs generator, rather than by the type of device
The nature of the mechanical complication is more specific, eg. breakdown, displacement or other complication
The nature of the non-mechanical complication is also more specific, eg. embolism, hemorrhage
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Device Complication Code Structure
T82.1 Mechanical complication of cardiac electronic device
T82.11 Breakdown (mechanical) of cardiac electronic device
T82.110 Breakdown of cardiac electrodeT82.111 Breakdown of cardiac pulse generatorT82.118 Breakdown of other cardiac electronic device
T82.12 Displacement of cardiac electronic device
T82.120 Displacement of cardiac electrodeT82.121 Displacement of cardiac pulse generatorT82.128 Displacement of other cardiac electronic device
…………………………………………………
T82.7 Infection/inflammatory reaction to other cardiac devices
………………………………………………….
T82.8 Other specified complications of cardiac/vascular devices
T82.84 Pain from cardiac and vascular devices
T82.847 Pain from cardiac devices, implants and graftsT82.848 Pain from vascular devices, implants and grafts
…………………………………………………..
All codes require a 7th digit for episode of care
All codes are CCs but only for the initial episode of care
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A initial encounter D subsequent encounterS sequela
ICD-10-CM Coding Guidelines
Codes aren’t complete without uniform guidelines on usage.
As with ICD-9-CM, there is a set of “ICD-10-CM Official Guidelines for Coding and Reporting”
Use of the Official Guidelines is mandatory under HIPAA
The Official Guidelines are still in draft form but will be finalized prior to October 1, 2013
The quarterly journal Coding Clinic® will also continue
Coding Clinic® will begin addressing ICD-10 guidance in advance of the 2013
implementation date
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ICD-10-PCS Procedure Codes
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A New Concept
ICD-10-PCS is completely unlike ICD-9-CM, or any other coding system for that matter.
All terms, particularly root operations, have standard definitions
Within a section, each character represents a standard element
There are very few defaults
Key characteristics are:
Codes are not assigned, they are built character-by-character from tables of values
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Format of ICD-10-PCS Codes
The format of ICD-10-PCS is a complete departure from the past.
All codes are 7 characters long, without exception
All codes are alphanumeric (letters “I” and “O” are not used)
There are no decimal points
Examples
027034Z Dilation of Coronary Artery, One Site, with Drug-Eluting Intraluminal Device, Percutaneous Approach
0JH60P5 Insertion of CRT-D Pulse Generator into Subcutaneous Tissue/Fascia, Chest, Open Approach
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Character Counts!
1 2 3 4 5 6 7
sectionbody system
root operation approach qualifierbody part device
In section “0”, Medical and Surgical procedures, the character meanings are:
Body system, eg. urinary, GI, respiratory, upper arteries
Root operation, eg. bypass, dilation, destruction
Body part, eg. left external iliac artery, duodenum, sacrum
Approach, eg. open, endoscopic via natural opening
Device, eg. infusion device, cardiac lead, tissue expander
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Coding Character by Character
1 Section
Body system
Root operation
Approach
Qualifier
Body part
Device
2
3
4
5
6
7
0
2
7
3
0
4
Z
Medical & Surgical
Heart & Great Vessels
Dilation
Percutaneous
No Qualifier
Coronary Artery, One Site
Drug-Eluting Intraluminal Device
027034Z Dilation of Coronary Artery, One Site, with Drug-Eluting Intraluminal Device, Percutaneous Approach
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Code Table Example: PTCA and Stent
027034Z Dilation of Coronary Artery, One Site, with Drug-Eluting Intraluminal Device, Percutaneous Approach
02703DZ Dilation of Coronary Artery, One Site, with Intraluminal Device, Percutaneous Approach
PTCA with drug-eluting stent
PTCA with non-drug-eluting (bare metal) stent
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Insertion of CRDM Generators
Pacemaker: 0JH60P2
Defibrillator: 0JH60P4
CRT-P (BiV): 0JH60P3
CRT-D (BiV): 0JH60P5
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Insertion of CRDM Leads
Pacemaker leads, RA and RV, transvenous:02H63MA, 02HK3MA
Defibrillator leads, RV, epicardial placement:02HN0ME
CRT-P leads, RA and RV, transvenous:02H63MA, 02HK3MA
CRT-D leads, RA, RV, and LV via the CS, transvenous:02H63ME, 02HK3ME, 02H43ME
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Codes for CRDM Systems
Unlike ICD-9-CM, ICD-10-PCS does not have codes for implantation of an entire device system. Instead, components are coded individually.
Implantation of dual chamber pacemaker with transvenous RA and RV leads
Generator 0JH60P2
RA lead 02H63MA
RV lead 02H6KMA
Implantation of CRT-D with transvenous RA and RV leads, and transvenous LV lead via the coronary sinus
Generator 0JH60P5RA lead 02H63MERV lead 02HK3MELV (CS) lead 02H43ME
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Replacement of Device
Instead, device replacement in ICD-10-PCS takes two codes:
Insertion of the new device, using operation H-Insertion
Removal of the old device, using operation P-Removal
Removal codes contain less detail than Insertion codes.
Root operation W-Revision is also not used to code replacement of devices. It’s for correcting an existing device, eg. repositioning a lead.
Root operation R-Replacement is not used to code replacement of devices. It’s used for replacing a native body part with a device, eg. valve replacement.
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Removal of CRDM Generators
PacemakerDefibrillatorCRT-P (BiV)CRT-D (BiV)
0JPT0PZ
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Removal of CRDM Leads
02PA3MZ
PacemakerDefibrillatorCRT-P (BiV)CRT-D (BiV)
Any chamber or location
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Replacement of Rhythm Devices
When a device is replaced, eg. end-of-battery life, complication, or upgrade, Insertion and Removal codes are used together.
Replacement of defibrillator generator due to end-of-life
Insertion of new generator 0JH60P4Removal of old generator 0JPT0PZ
Upgrade of pacemaker to CRT-D (replacement of generator, new LV lead via coronary sinus, retention of existing RA and RV leads)
Insertion of new CRT-D generator0JH60P5
Removal of old pacer generator0JPT0PZ
Insertion of LV lead via CS02H43ME
Replacement of broken CRT-D RV lead, transvenous
Insertion of new lead02HK3MERemoval of old lead 02PA3MZ
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Diagnostic EPS
Diagnostic EPS : 4A023FZ
It is essential to use code 4A023FZ to obtain correct DRG assignment for EPS
The ICD-10-PCS Reference Manual uses EPS as an example of root operation K-Map but the example is incomplete
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* See the Appendix for table 02K for mapping and table 025 for EP ablation
Cardiac Catheterization
RHC: 4A023N6 LHC: 4A023N7 R&L HC: 4A023N8
It’s essential to use code 4A023N~ to obtain correct DRG assignment, particularly when the cardiac cath is performed with other CRDM and cardiac procedures
Additional codes are assigned from table B20 or B21 for angiography of the heart and coronary arteries
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* See the Appendix for table B21 as used for arteriography of the heart/coronary arteries
PTCA : What is a Site?
A “site” does not equal a single coronary artery Interventions at distinct sites within the same coronary artery are coded as multiple sites, but multiple stents in the same coronary artery may or may not be different sites
Angioplasty of two distinct sites in the LAD each with a drug-eluting stent, LCx with a drug-eluting stent, and angioplasty of RCA without stent: 027234Z, 02703ZZ
Different interventions require separate codes
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Atherectomy
In ICD-9-CM, angioplasty and atherectomy use the same code but in ICD-10-PCS, they are separate codes
Angioplasty is coded to root operation 7-Dilation but atherectomy is coded to root operation C-Extirpation
No guidelines have been published yet but presumably, if both angioplasty and atherectomy take place within the same vessel, both are coded
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CABG
Device refers to grafts obtained from patients (eg. SVG) or cadavers, or as products; no device is direct anastomosis
The qualifier refers to the origin of the bypass, ie.
source of the new blood flow Separate codes are assigned
for each bypass that uses a different device or qualifier
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Aorta-coronary bypass, one site, with SVG: 021009W
RIMA-coronary artery bypass, one site: 02100Z8
Valve Replacement
This is a true replacement for coding purposes because the new valve physically takes over the place and thefunction of the native valve
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Replacement of aortic valve with porcine valve: 02RF08Z
Replacement of mitral valve with mechanical valve: 02RG0JZ
Greater Specificity
ICD-10-PCS has far more procedure codes than ICD-9-CM.
System # Procedure Codes
ICD-9-CM 3,824
ICD-10-PCS 72,589
The structure of ICD-10-PCS has key consequences in:
The sheer volume of codes can be daunting at first but some constructs are far less likely than others.
ease of expansion for new procedures and technologies
greater depth of clinical documentation and knowledge required to assign codes
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ICD-10-PCS Coding Guidelines
The ICD-10-PCS Reference Manual contains an appendix with draft procedure coding guidelines
Guideline use is mandatory under HIPAA
Coding Clinic® will address procedure code issues as well
The ICD-10-PCS Reference Manual also contains many helpful examples
CMS is developing an ICD-10-PCS Device Key with trade names to help users choose the correct device value
An ICD-10-PCS Body Part Key is available to help users choose the correct value for specific anatomic structures
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DRGs under ICD-10
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MS-DRG Conversion
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CMS’s stated objective in the MS-DRG conversion is:
“for data coded in ICD-10, the ICD-10 MS-DRGs would assign the same MS-DRG had the same case been coded using ICD-9-CM codes”
In other words, CMS is not taking advantage of the ICD-10 transition to make changes to MS-DRG assignments.
DRG titles and concepts are unchanged. The conversion is strictly about the codes used, not about the MS-DRG structure itself.
(See the Appendix for the link)
DRG Grouper Version
The final version of the MS-DRG Grouper with ICD-10 codes is subject to the formal rule-making process
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CMS has gone through two iterations of the MS-DRG Grouper using ICD-10 codes:
Although ICD-10 codes will be final in October 2011, the MS-DRG Grouper for ICD-10 is still in draft form.
V26 (FY 2009) was released for public comment in 2009
V28 (FY 2011) was released in February 2011 and comments are currently being taken
V29 (FY 2012) is expected to be released in October 2011
CC/MCC Lists
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In keeping with the objective of assigning the same DRGs, all conditions that are CCs/MCCs in ICD-9-CM are also CCs/MCCs in ICD-10-CM.
In some cases where ICD-10-CM codes reflect combined conditions, an automatic CC or MCC DRG is assigned
In conflicts where an ICD-10-CM code could be either a CC or an MCC, designation was based on frequency data
New codes were factored into the CC Exclusion List
Example: I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris
Example: I22.~, subsequent AMI, is excluded as an MCC when I21.~, initial AMI, is the principal diagnosis
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Qualifier Z for Lead Insertion
Don’t default to qualifier Z!
Pacemaker DRGs are assigned when qualifier Z is used
Be sure to assign qualifier A for all pacemaker and CRT-P leads and qualifier E for all defibrillator and CRT-D leads
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Different DRGs?
Be alert to unexpected DRGs.
Check the ICD-10 codes assigned, with attention to the value for each character and the need for multiple codes
If the ICD-10 DRG assigned to a particular case is different from the ICD-9-CM DRG, either the codes are incorrect or the DRG structure is flawed.
Verify the DRG assignment manually
Medtronic can assist in DRG verification and in notifying CMS about discrepant DRG logic.
Appendix
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Key Websites
The CDC and CMS have a wealth of educational materials and resources available on-line, both for implementation of ICD-10 and the MS-DRG conversion.
http://www.cdc.gov/nchs/icd/icd10cm.htm
ICD-10-CM tabular and index
diagnosis code GEMS
draft ICD-10-CM coding guidelines
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ICD-10-CM Diagnosis Codes
Key Websites
http://www.cms.gov/ICD10/11b_2011_ICD10PCS.asp#TopOfPage
ICD-10-PCS tables and index
procedure code GEMS
ICD-10-PCS Reference Manual
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ICD-10-PCS Procedure Codes
Key Websites
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Hospital payment impact analysis
http://www.cms.gov/ICD10/17_ICD10_MS_DRG_Conversion_Project.asp#TopOfPage
DRGs
MS-DRG Grouper in ICD-10 (manual)
MS-DRG Grouper in ICD-10 (pilot software)
Table 02K: Mapping
Table 02K is used for cardiac mapping, eg. 02K83ZZ
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This does not represent a full electrophysiologic study
For EPS plus cardiac mapping, two codes must be used:
one from table 4A0 for the electrophysiologic study
one from table 02K for mapping
Table 025: Electrophysiologic Ablation
Endovascular EP ablation of arrhythmogenic focus in LA: 02573ZZ
Endovascular EP ablation of atrioventricular node: 02583ZZ
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Table B21: Heart Angiography
Arteriography of native coronary arteries with high osmolar contrast: B2110ZZ
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Left ventriculography with low osmolar contrast: B2150ZZ
When performed with a cardiac catheterization, these codes are assigned separately
Coding Hotlines
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You can contact Medtronic for assistance with coding and reimbursement issues.
Cardiac Rhythm Disease Management(866) 877-4102, option 1
Vascular(877) 347-9662
Structural Heart(866) 616-8400
Question Time
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We hope this was informative. If you have any comments or questions,
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