The document discusses upcoming changes to ICD and HIPAA coding standards. It notes that ICD-9 will be replaced with ICD-10 on October 1, 2013 and HIPAA transaction standards will transition from version 4010/4010A1 to 5010/D0 by January 1, 2012. ICD-10 and 5010/D0 will provide greater specificity and support additional functionality compared to previous standards. Covered entities need to prepare for testing and compliance with the new standards on the specified deadlines.
38. Example: ICD-9-CM vs. ICD-10-CM Diagnosis: Chest Pain ICD-9-CM ICD-10-CM 786.50 Chest pain: NOS R07.9 Chest pain: NOS
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63. A 54-year-old male is admitted into the hospital with a principal diagnosis of surgical site infection secondary to a recent right side below the knee amputation . Patient is a type I diabetic with diabetic peripheral vascular disease and congestive heart failure . The patient sought treatment when the wound began to exude purulent drainage. On the second day of his hospitalization he had developed nausea, uncontrolled diabetes, and ketoacidosis . Moist saline dressings were applied twice daily to the wound. Wound culture tested positive for Staphylococcus aureus and was resistant to flucloxacillin . Ciprofloxacin effectively treated the infection. Diabetic ketoacidosis managed well and blood glucose was brought under control. Patient was discharged to a rehabilitation facility for continued wound management. Example: ICD-9-CM vs. ICD-10-CM Inpatient – Acute Care **From V Codes to Z Codes: Transitioning to ICD-10 by Karen M. Kostick, RHIIT, CCS,
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68. Medical and Surgical Section Body Systems (Character 2) **From V Codes to Z Codes: Transitioning to ICD-10 by Karen M. Kostick, RHIIT, CCS, Central Nervous Peripheral Nervous Heart and Great Vessels Upper Arteries Lower Arteries Upper Veins Lower Veins Lymphatic and Hemic Eye Ear, Nose, Sinus Respiratory Mouth and Throat Gastrointestinal Hepatobiliary and Pancreas Endocrine Skin and Breast Subcutaneous Tissue and Fascia Muscles Tendons Bursae and Ligaments Head and Facial Bones Upper Bones Lower Bones Upper Joints Lower Joints Urinary Female Reproductive Male Reproductive Anatomical Regions, General Anatomical Regions, Upper Extremities Anatomical Regions, Lower Extremities
69. Medical and Surgical Section Root Operations (Character 3) Alteration Bypass Change Control Creation Destruction Detachment Dilation Division Excision Extirpation Extraction Fragmentation Fusion Insertion Inspection Map Occlusion Release Removal Repair Replacement Reposition Resection Restriction Revision Transfer
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74. Example: ICD-10-PCS Percutaneous placement of pacemaker lead into the left atrium A M 3 7 H 2 0 7 Qualifier 6 Device 5 Approach 4 Body Part 3 Root Operation 2 Body System 1 Section
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76. Example: ICD-9-CM vs. ICD-10-PCS Repair of fracture, radius w/internal fixation device 1 Section 2 Body System 3 Root Operation 4 Body Part 5 Approach 6 Device 7 Qualifier ICD-9-CM ICD-10-PCS 79.32 0PQJ04Z 0 P Q J 0 4 Z
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78. Example: ICD-9-CM vs. ICD-10-PCS *Percutaneous Transluminal Coronary Angioplasty with Stent 1 Section 2 Body System 3 Root Operation 4 Body Part 5 Approach 6 Device 7 Qualifier 0 2 7 0 3 D Z ICD-9-CM ICD-10-PCS 00.66 36.06 02703DZ
92. General Equivalence Mapping Example of ICD-10-CM mapping CMS Downloads General Equivalence Mappings and User’s Guides May 2009 10000 9085 T1500xS 10112 E914 T1500xD 10111 9300 T1500xD 10112 E914 T1500xA 10111 9300 T1500xA Flags ICD-9-CM Target Code ICD-10-CM Source Code
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98. What must be considered? IT Readiness Physician/Clinician Adoption Vendor Readiness Coder / Staff Training Payer Readiness Quality, Compliance and Audit Readiness Reporting Readiness Strategic Planning Financial Impact Senior Leadership Support
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101. Who needs to be involved? Any one else who touches ICD-9 today, HIM, Reporting, etc… Administrative Staff, Nursing Staff Quality, Compliance, Audit Registration and Scheduling Staff, Pre-cert Staff Finance and Billing All Ancillary System Administrators, Vendors, Payers Coding, Finance, and Billing Information Services and Technology Physicians and Clinical Staff Senior Leadership
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104. Prepare Readiness Chart Payer Analysis Contract Negotiation Granularity to our advantage Payer Integration Internal Readiness Strategic Support Gap Analysis Vendor Readiness Gap Analysis Competing Projects Staffing Needs Assessment Tools Assessment Awareness Timeline Budget Lahey Readiness Vendor Integration IT Readiness Education Strategic Planning
118. All information was current at the time this presentation was written. All information was obtained from the sources sited on this document. Use of pictures, examples, etc…are for educational purposes only. All reasonable effort has been taken to ensure accuracy of information and to site sources. Author and agents do not guarantee accuracy and assume no responsibility or liability for content. Any references should be followed from applicable laws, regulations, and guidelines or rulings from appropriate sources. "CPT copyright 2010 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association." Applicable FARS/DFARS Restrictions Apply to Government Use Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not par of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The U.S. Copyright Law, under Chapter One, Section 107, exempts certain limited use of copyrighted works, referred to a "fair use" and such uses are permissible without a license. A good faith attempt at “fair use” has been made and believed to be sufficient for any use of this material. U. S. Copyright Law, Chapter One, Section 107, Fair Use (PDF) Disclaimer
119. Cynthia A. Trapp CHFP, CMPE, CPCO, CPC, CPC-I, CCS-P, CHC, PCA [email_address] Contact Information
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