DIAGNOSIS CODING ESSENTIALS FOR LONG-TERM CARE:, Summaries of History

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DIAGNOSIS CODING

ESSENTIALS FOR

LONG-TERM CARE:

THE BASICS

Preferred Clinical Services for

Leading Age Florida

August 26-27, 2015

WHAT IS ICD-10-CM?

• International Classification of Diseases, 10th^ Revision, Clinical Modification
• Official Coding Guidelines approved by AHA, AHIMA, CMS & NCHS
• Code sets are addressed under Administrative Simplifications section of HIPAA (1996)
• First approved in 1990
• US is the final industrialized nation to adopt
• Beginning October 1st, ALL claims must use these codes

WHAT’S NEW?

• 68,000 vs. 16,000 codes
• Codes changed from 3-5 characters to 3-7 characters
  • All codes are alphanumeric: All codes have a “base” of three characters: The letter for that chapter/body system and two numbers
• All letters of the alphabet except U are used
• Greater precision
• Reflective of current technologies
• Addition of laterality
• Time frame changes

WHAT CHANGES?

• No more coding from memory
• Alphabetic and numeric indexes MUST be

referenced for code assignments

• Hypertension table is gone
• Must have better clinical documentation
• Coder must understand terminology and

anatomy/physiology

• Admission for therapy no longer exists

Payers may have their own

interpretations

GEMS

• “General Equivalence Mappings”
• A framework that maps from 9 to 10 and 10 to 9
• Used mainly to convert databases
• Do NOT rely on the GEMs for correct code selection
• May be downloaded from

http://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10- CM-and-GEMs.html

BOOK LAYOUT

• Official Coding Guidelines
• Alphabetic Index: Two Parts
  • Index of Disease and Injury
    • Table of Neoplasms
    • Table of Drugs and Chemicals
    • Main Terms will be in bold Antritis J32. Maxilla J32. Acute J01. Recurrent J01.
  • Index of External Causes of Injury (not for LTC use)
• Pay attention to instructional notes. They always supersede any other guidance.

BOOK LAYOUT,

ALPHABETIC INDEX

Manifestation codes are included in the alphabetic index by including a second code, shown in brackets [ ] directly after the underlying or etiology code which should always be reported first.

Chorioretinitis – see also inflammation chorioretinal Egyptian B76.9 [D63.8] Histoplasmic B39.9 [H32]

BOOK LAYOUT

Tabular Index:

Chapters are subdivided into subchapters (blocks) that contain three character categories and form the foundation of the code.

Chapter 8 Diseases of the Ear and Mastoid Process (H60 – H95) This chapter contains the following blocks: H60 – H62 Disease of external ear H65 – H75 Disease of middle ear and mastoid H80 – H83 Disease of inner ear H90 – H94 Other disorders of ear

TABULAR INDEX

Tabular List Notes

Notes are located at the beginning of chapters or any subdivisions that follow and apply to all the categories within it.

Always read the beginning of each chapter and directly above and below each entry

SEVENTH CHARACTERS

AND

PLACEHOLDER X

The 7 th^ character is used for injuries, external causes

and obstetrics. ONLY injuries apply to LTC.

When required, the 7 th^ character will always be in

the 7 th^ position.

If a code that requires a 7 th^ character has less than

six characters, placeholder X must be used.

S00.03xD Contusion of scalp, subsequent episode of

care

CODING CONVENTIONS

• (NEC) – “not elsewhere classified”: We have a better code than the book
• (NOS) – “not otherwise specified”: The book has a better code than we do. F03.90 Unspecified Dementia without behavioral disturbance – Dementia NOS
• Codes must be used to the highest number of characters available or to the highest level of specificity.

CODING CONVENTIONS

Code First/Use Additional Code:

G30 Alzheimer’s disease Use additional code to identify: dementia with behavioral disturbance (F02.81) dementia without behavioral disturbance (F02.80) G30.0 Alzheimer’s with early onset G30.1 Alzheimer’s with late onset

F02 Dementia in other diseases classified elsewhere Code first the underlying physiological condition, such as Alzheimer’s (G30.-) F02.80 Dementia in other diseases classified elsewhere, without behavioral disturbance F02.81 Dementia in other diseases classified elsewhere, with behavioral disturbance

CODING CONVENTIONS

Cross Reference Notes: Used in the Alphabetic Index to advise the coding professional to look elsewhere before assigning a code. There are three terms used: see, see also, see condition.

• Hemorrhage , cranial – see Hemorrhage, intracranial
• Labyrinthitis (circumscribed) (destructive) (diffuse) (inner ear) (latent) (purulent) (suppurative) - see also subcategory H83.
• Lumbar – see condition