Clinical Documentation Clinical Documentation Improvement – Telling Improvement – Telling The Patient Story Thru The Patient Story Thru

ICD-10ICD-10

Presented by: Karen Kvarfordt, RHIA, CCS-P, CCDS President, DiagnosisPlus, Inc.

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It will change the way in which we It will change the way in which we document patient care in our document patient care in our

medical records both in the hospital medical records both in the hospital and and

in our practices.in our practices.

Patient’s story will be Patient’s story will be betterbetter told told through through betterbetter documentation! documentation!

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ICD-10 Changes ICD-10 Changes Everything!Everything!

WHO (World Health Organization) owns & WHO (World Health Organization) owns & publishes ‘ICD’ (International Classification of publishes ‘ICD’ (International Classification of Diseases).Diseases).

WHO endorsed ICD-10 in 1990; members WHO endorsed ICD-10 in 1990; members began using ICD-10 or modifications in 1994.began using ICD-10 or modifications in 1994.

United StatesUnited States is the only industrialized country is the only industrialized country notnot using ICD-10 for our coding & reporting of using ICD-10 for our coding & reporting of diseases, illnesses, and injuries. Why?diseases, illnesses, and injuries. Why?

What makes us so different?What makes us so different?

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ICD-10ICD-10

United Kingdom (1995)United Kingdom (1995) Denmark, Finland, Iceland, Norway, Sweden (1994 – Denmark, Finland, Iceland, Norway, Sweden (1994 –

1997)1997) France (1997)France (1997) Australia (1998) Australia (1998) Belgium (1999)Belgium (1999) Germany (2000)Germany (2000) Canada (2001) Canada (2001) United States (2015)United States (2015)

((ReimbursementReimbursement + + Case MixCase Mix))

Countries Using ICD-10 Countries Using ICD-10

For Case MixFor Case Mix

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Currently the U.S. health care industry uses ICD-9-CM Currently the U.S. health care industry uses ICD-9-CM codes for identifying and reporting diagnoses and codes for identifying and reporting diagnoses and procedures.procedures.

ICD-10 will replace the existing ICD-9 code sets ICD-10 will replace the existing ICD-9 code sets (diagnosis & procedure) effective (diagnosis & procedure) effective October 1, 2015October 1, 2015..

ICD-10-CMICD-10-CM = Diagnosis codes = Diagnosis codes ICD-10-PCSICD-10-PCS = = InpatientInpatient hospital procedure codes only hospital procedure codes only No impact on CPT and/or HCPCS codes!No impact on CPT and/or HCPCS codes!

CPT and HCPCS codes will continue to be used for CPT and HCPCS codes will continue to be used for physician and outpatient services including physician physician and outpatient services including physician

hospital visits (Observation & Inpatient) = E&Mhospital visits (Observation & Inpatient) = E&M

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What is ICD-10?What is ICD-10?

Why Should We Do ICD-Why Should We Do ICD-10?10?

What is the benefit to the provider?What is the benefit to the provider? Dramatic improvement in the assignment of Dramatic improvement in the assignment of

costs to procedures performed.costs to procedures performed. ICD-10 will allow us to develop meaningful estimates ICD-10 will allow us to develop meaningful estimates

about what a disease state or a procedure costs us, about what a disease state or a procedure costs us, while ICD-9 is limited in what it can do in this regard.while ICD-9 is limited in what it can do in this regard.

Identify opportunities to avoid cost & improve Identify opportunities to avoid cost & improve lives.lives. Additional information in an ICD-10 diagnosis code Additional information in an ICD-10 diagnosis code

includes severity and specific comorbidity, but it can includes severity and specific comorbidity, but it can also include information about demographics and also include information about demographics and some of the underlying reasons for the diagnosis.some of the underlying reasons for the diagnosis.

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Additional Benefits…Additional Benefits…

Share higher-quality data with other Share higher-quality data with other health care providers.health care providers. ICD-10 increases the amount of “specific” ICD-10 increases the amount of “specific”

information in every diagnosis code and information in every diagnosis code and makes this more valuable to other makes this more valuable to other providers.providers. For example, ICD-9 has a code for laceration of For example, ICD-9 has a code for laceration of

an artery.an artery. ICD-10 lets you know if that artery was in ICD-10 lets you know if that artery was in

someone’s finger or in their heart.someone’s finger or in their heart.7

Reimbursements will better align Reimbursements will better align with activity & cost. with activity & cost. Payers will reimburse severe & Payers will reimburse severe &

complex cases better and simple complex cases better and simple cases at lower rates.cases at lower rates.How? By the diagnosis codes!How? By the diagnosis codes!

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Here’s an ExampleHere’s an Example

Imagine you had a patient who was Imagine you had a patient who was noncompliant with their medical therapy.noncompliant with their medical therapy. In ICD-9, the only code we have In ICD-9, the only code we have

available is V15.81 (personal history of available is V15.81 (personal history of noncompliance with medical treatment).noncompliance with medical treatment).Is the patient noncompliant because of Is the patient noncompliant because of their own personal reason? Or their own personal reason? Or something else?something else?

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How Will it Look in ICD-How Will it Look in ICD-10?10?

Z9111 (Patient’s noncompliance with dietary regimen)Z9111 (Patient’s noncompliance with dietary regimen) Z91120 (Patient's intentional underdosing of medication Z91120 (Patient's intentional underdosing of medication

regimen due to financial hardship)regimen due to financial hardship) Z91128 (Patient’s intentional underdosing of medication Z91128 (Patient’s intentional underdosing of medication

regimen for other reason)regimen for other reason) Z91130 (Patient’s unintentional underdosing of medicationZ91130 (Patient’s unintentional underdosing of medication

regimen due to age-related debility)regimen due to age-related debility) Z91138 (Patient’s unintentional underdosing of medicationZ91138 (Patient’s unintentional underdosing of medication

regimen for other reason)regimen for other reason)

Shows whether or not the patient’s noncompliance was Shows whether or not the patient’s noncompliance was intentional, but also identifies if the patient needs some intentional, but also identifies if the patient needs some

form of assistance from social services, etc.form of assistance from social services, etc.10

Diagnosis CodingDiagnosis Coding

(ICD-10-CM)(ICD-10-CM)

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Allows for greater “Allows for greater “specificity & detailspecificity & detail” which is ” which is currently lacking in ICD-9-CM.currently lacking in ICD-9-CM.

Moving from Moving from 14,00014,000 ► ►69,00069,000 diagnosis codes! diagnosis codes!25,000 (36%) of all ICD-10-CM diagnosis 25,000 (36%) of all ICD-10-CM diagnosis

codes will now distinguish ‘right’ vs. ‘left’.codes will now distinguish ‘right’ vs. ‘left’.Must be documented in the medical record Must be documented in the medical record

for code capture.for code capture. Expanded # of characters of the ICD-10-CM Expanded # of characters of the ICD-10-CM

diagnosis codes will provide greater specificity to diagnosis codes will provide greater specificity to identify: identify: etiology, anatomical site, & severityetiology, anatomical site, & severity

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ICD-10-CMICD-10-CM

Why Are There So Why Are There So Many New Codes?Many New Codes?

Main difference between ICD-9-CM and Main difference between ICD-9-CM and ICD-10-CM codes, outside of structural ICD-10-CM codes, outside of structural changes, is the changes, is the “SPECIFICITY” “SPECIFICITY” of the code.of the code.

ICD-10-CM diagnosis codes will range ICD-10-CM diagnosis codes will range anywhere from 3 to 7 characters which will anywhere from 3 to 7 characters which will allow us to capture this greater detail. allow us to capture this greater detail.

But it must be documented in the record!But it must be documented in the record!

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ICD-9-CMICD-9-CM

◦ 3 - 53 - 5 digits or characters digits or characters ◦ 1st character is 1st character is numeric numeric

oror alphaalpha (E or V codes) (E or V codes) ◦ 22ndnd – 5 – 5thth characters are characters are

numericnumeric◦ Decimal placed after the Decimal placed after the

first 3 charactersfirst 3 characters◦ 1717 Chapters and “V” & Chapters and “V” &

“E” codes are “E” codes are ‘‘supplementalsupplemental’’

◦ 14,00014,000 diagnosis codes diagnosis codes

ICD-10-CMICD-10-CM

◦ 3 - 73 - 7 digits or characters digits or characters◦ 11stst character is character is alphaalpha (all (all

letters used except “U”)letters used except “U”)◦ 22ndnd – 7 – 7thth characters can characters can

be be alpha and/or numericalpha and/or numeric◦ Decimal placed after the Decimal placed after the

first 3 characters (the first 3 characters (the same!)same!)

◦ 2121 Chapters and “V” & Chapters and “V” & “E” codes are ‘“E” codes are ‘notnot’’ supplementalsupplemental

◦ 69,000+69,000+ diagnosis diagnosis codescodes

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ICD-9-CM vs. ICD-10-ICD-9-CM vs. ICD-10-CMCM

ICD-9-CM (Irregular Astigmatism) (367.22)ICD-9-CM (Irregular Astigmatism) (367.22) Only 1 code in ICD-9-CMOnly 1 code in ICD-9-CM

ICD-10-CM (Irregular Astigmatism)ICD-10-CM (Irregular Astigmatism) Will have four choices:Will have four choices:

H52.211 (irregular astigmatism, right eye)H52.211 (irregular astigmatism, right eye) H52.212 (irregular astigmatism, left eye)H52.212 (irregular astigmatism, left eye) H52.213 (irregular astigmatism, bilateral)H52.213 (irregular astigmatism, bilateral) H52.219 (irregular astigmatism, unspecified eye)H52.219 (irregular astigmatism, unspecified eye)

Physicians are likely documenting “laterality” now, but Physicians are likely documenting “laterality” now, but coders aren’t looking for it.coders aren’t looking for it. One easy place to look for documentation improvement!One easy place to look for documentation improvement!

Level of Detail ExampleLevel of Detail Example

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LATERALITY LATERALITY For bilateral sites, the final character of the codes in For bilateral sites, the final character of the codes in ICD-10-CM indicate laterality.ICD-10-CM indicate laterality.

Right side is always character Right side is always character 11 ( (RTRT)) Left side is always character Left side is always character 22 ( (LTLT)) Bilateral code is always character Bilateral code is always character 33 ( (RTRT & & LTLT) )

But be careful! Not all codes will have a ‘bilateral’ But be careful! Not all codes will have a ‘bilateral’ distinction, i.e., carpal tunnel, etc.distinction, i.e., carpal tunnel, etc.““Unspecified” side code is also provided should the Unspecified” side code is also provided should the side not be documented in the medical record.side not be documented in the medical record.

Did we just lose our specificity?Did we just lose our specificity?

Biggest Change in ICD-Biggest Change in ICD-10-CM10-CM

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Joint painJoint pain Joint effusionJoint effusion InjuriesInjuries FracturesFractures DislocationsDislocations ArthritisArthritis Cerebral infarctionCerebral infarction Extremity atherosclerosisExtremity atherosclerosis Pressure ulcersPressure ulcers Cancers, neoplasms (breast, lung, bones, etc.)Cancers, neoplasms (breast, lung, bones, etc.)

Diagnoses That Will Diagnoses That Will Require Laterality Require Laterality

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InjuriesInjuries

Seventh (7Seventh (7thth) character identifies the ) character identifies the patient encounter type, with “patient encounter type, with “AA” for the ” for the initialinitial encounter, “ encounter, “DD” for the ” for the subsequentsubsequent encounter and “encounter and “SS” for ” for sequela sequela encounter.encounter. Initial = Patient is receiving ‘active’ treatment Initial = Patient is receiving ‘active’ treatment

First time being seen for the injury, i.e., ER visit, First time being seen for the injury, i.e., ER visit, surgery, evaluation by new physiciansurgery, evaluation by new physician

Subsequent = Follow-up careSubsequent = Follow-up care Sequela = Complication of a previous injurySequela = Complication of a previous injury

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I10 Essential (primary) hypertensionI10 Essential (primary) hypertension S01.02S01.02xxAA Laceration with foreign body of scalp, Laceration with foreign body of scalp,

initialinitial encounterencounter S01.02S01.02xxDD Laceration with foreign body of scalp, Laceration with foreign body of scalp,

subsequent encountersubsequent encounter S02.2S02.2xxxxAA Fracture of nasal bones, Fracture of nasal bones, initial initial

encounterencounter for for closed fracture closed fracture H65.0H65.011 Acute serous otitis media, Acute serous otitis media, rightright ear ear H65.0H65.022 Acute serous otitis media, Acute serous otitis media, leftleft ear ear H65.0H65.033 Acute serous otitis media, Acute serous otitis media, bilateralbilateral

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Examples of ICD-10-CM Examples of ICD-10-CM Emergency RoomEmergency Room

Procedure CodingProcedure Coding

(ICD-10-PCS)(ICD-10-PCS)

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ICD-10-PCS CharactersICD-10-PCS Characters (Medical and Surgical (Medical and Surgical

Section)Section)

RootRoot

SectionSection OperationOperation ApproachApproach QualifierQualifier

BodyBody BodyBody DeviceDevice

System System PartPart

11 22 33 44 55 66 77

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Dissect ICD-10-PCS Dissect ICD-10-PCS CodeCode

Endoscopic Esophageal Excision via Natural or Artificial Endoscopic Esophageal Excision via Natural or Artificial OpeningOpening

ICD-9-CM: 45.16 Esophagogastroduodenoscopy (EGD) with Closed BiopsyICD-9-CM: 45.16 Esophagogastroduodenoscopy (EGD) with Closed Biopsy

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00 DD BB 55 88 ZZ XXSection

(Medical/Surgical)

Body System(Gastro-

intestinal)

Root Operation(Excision)

Body Part(Esophagus

)

Approach(Via natural or

artificial opening

endoscopic)

Device(No Device)

Qualifier(Diagnostic

)

What’s New In ICD-What’s New In ICD-10?10?

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Under ICD-10-CM diagnosis codes will be Under ICD-10-CM diagnosis codes will be based on the based on the stagestage of pregnancy of pregnancy

First trimesterFirst trimester Second trimesterSecond trimester Third trimesterThird trimester

Trimesters are counted from the first day Trimesters are counted from the first day of the last menstrual period, and defined of the last menstrual period, and defined as:as:

First trimester: Fewer than 14 weeksFirst trimester: Fewer than 14 weeks Second trimester: Fourteen weeksSecond trimester: Fourteen weeks Third trimester: Twenty-eight weeksThird trimester: Twenty-eight weeks

Obstetrics Obstetrics

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ICD-10-CM contains a separate category for ICD-10-CM contains a separate category for nicotine dependence with subcategories to nicotine dependence with subcategories to identify the identify the specific tobacco product specific tobacco product and and nicotine-induced disorder(s). For example:nicotine-induced disorder(s). For example: CigarettesCigarettes Chewing tobaccoChewing tobacco Cigar, etc.Cigar, etc.

ICD-9 has only ICD-9 has only oneone diagnosis code (305.1) for diagnosis code (305.1) for tobacco use disorder or tobacco dependence.tobacco use disorder or tobacco dependence.

Nicotine Nicotine DependenceDependence

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New diagnosis code in the ICD-10 world!New diagnosis code in the ICD-10 world! Identifies situations in which a patient Identifies situations in which a patient

has has taken less taken less of a medication than of a medication than prescribed by the physician and prescribed by the physician and captures those reason(s).captures those reason(s).

Must be documented in the record!Must be documented in the record!Financial Financial Non-compliance*Non-compliance*

UnderdosingUnderdosing

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Burn codes identify: Burn codes identify: Thermal burns, except for sunburns, Thermal burns, except for sunburns,

that come from a heat sourcethat come from a heat source Burns resulting from electricity and/or Burns resulting from electricity and/or

radiationradiation Addition of the term “Addition of the term “corrosioncorrosion” is new in ” is new in

ICD-10-CM:ICD-10-CM: Corrosions are burns Corrosions are burns due to due to chemicalschemicals

Burns and Burns and CorrosionsCorrosions

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Physician Physician DocumentationDocumentation

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1.1. Laterality (left vs. right) Laterality (left vs. right) 2.2. Stage of Care (initial or follow-up) Stage of Care (initial or follow-up) 3.3. Specific Diagnosis (acute vs. chronic)Specific Diagnosis (acute vs. chronic)4.4. Specific Anatomy (specific bone in the hand)Specific Anatomy (specific bone in the hand)5.5. Associated and/or Related ConditionsAssociated and/or Related Conditions6.6. Cause of Injury (hit by baseball, fall)Cause of Injury (hit by baseball, fall)7.7. Documentation of Additional Symptoms or Documentation of Additional Symptoms or

ConditionsConditions8.8. Dominant vs. Non-Dominant Side Dominant vs. Non-Dominant Side 9.9. Tobacco Exposure or UseTobacco Exposure or Use10.10. Gustilo-Anderson ScaleGustilo-Anderson Scale

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Top 10 Top 10 Documentation Documentation

‘Pearls’‘Pearls’

Documentation Tips Documentation Tips

For Specific Diagnoses For Specific Diagnoses

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GERD GERD DocumentationDocumentation

ICD-10-CM will include 2 codes but does not include the ICD-10-CM will include 2 codes but does not include the abbreviation “GERD” abbreviation “GERD” K21.0 (Gastro-esophageal reflux disease with K21.0 (Gastro-esophageal reflux disease with

esophagitis) esophagitis) K21.9 (Gastro-esophageal reflux disease without K21.9 (Gastro-esophageal reflux disease without

esophagitis)esophagitis) Barrett’s now broken down:Barrett’s now broken down:

With or without ulcerWith or without ulcer With or without dysplasiaWith or without dysplasia Staging of dysplasiaStaging of dysplasia

Low gradeLow grade High gradeHigh grade 31

Digestive Ulcer Digestive Ulcer Documentation needs to include the specific location:Documentation needs to include the specific location:

GastricGastric DuodenalDuodenal PepticPeptic GastrojejunalGastrojejunal

Further specificity needs to identify:Further specificity needs to identify: Acute or chronicAcute or chronic With hemorrhageWith hemorrhage With perforationWith perforation With hemorrhage and perforationWith hemorrhage and perforation Without mention of hemorrhage or perforationWithout mention of hemorrhage or perforation

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Document the Severity (3 levels):Document the Severity (3 levels):

1.1. MildMild (more than two times per week) (more than two times per week)

2.2. Moderate Moderate ((daily and may restrict physical daily and may restrict physical activity)activity)

3.3. SevereSevere (throughout the day with frequent severe (throughout the day with frequent severe attacks limiting the ability to breathe)attacks limiting the ability to breathe)

Clarify whether acute, chronic, intrinsic or extrinsicClarify whether acute, chronic, intrinsic or extrinsic Specify exercise-induced or other formsSpecify exercise-induced or other forms Specify when chronic state asthmatic bronchitis exists Specify when chronic state asthmatic bronchitis exists

and when acute exacerbation occursand when acute exacerbation occurs Document tobacco exposure or history ofDocument tobacco exposure or history of

Asthma Asthma DocumentationDocumentation

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Congestive Heart Congestive Heart FailureFailure

Documentation in ICD-10-CM needs Documentation in ICD-10-CM needs to identify whether the CHF is acute to identify whether the CHF is acute or chronic and the specific ‘type’ of or chronic and the specific ‘type’ of heart failure:heart failure: Combined systolic & diastolic Combined systolic & diastolic DiastolicDiastolic SystolicSystolic Left ventricularLeft ventricular

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BronchitisBronchitis

Need to include specificity such as:Need to include specificity such as: Acute or subacuteAcute or subacute

Further specify with bronchiectasis, COPD, Further specify with bronchiectasis, COPD, etc.etc.

AllergicAllergic AsthmaticAsthmatic ChronicChronic ObstructiveObstructive ViralViral

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ICD-9 features 59 codes for diabetes, ICD-9 features 59 codes for diabetes, while ICD-10 offers more than while ICD-10 offers more than 200200 and and adds a provision of “poorly controlled” to adds a provision of “poorly controlled” to categories of controlled or not controlled.categories of controlled or not controlled.

Diabetes mellitus codes expanded to Diabetes mellitus codes expanded to include the classification of the diabetes include the classification of the diabetes AND the manifestation.AND the manifestation. Needs to be clearly documented in the Needs to be clearly documented in the

record!record!

Diabetes MellitusDiabetes Mellitus

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More on DiabetesMore on Diabetes

Identify Type 1, Type 2, due to other Identify Type 1, Type 2, due to other secondary cause, i.e., gestational, etc.secondary cause, i.e., gestational, etc.

In Type 2 or secondary cause, identify when In Type 2 or secondary cause, identify when using insulin long-termusing insulin long-term

Identify all body systems affected by the Identify all body systems affected by the diabetes (neuropathy and its manifestation, diabetes (neuropathy and its manifestation, retinopathy and proliferative or retinopathy and proliferative or nonproliferative, nephropathy and stage of nonproliferative, nephropathy and stage of CKD, vasculopathy, etc.)CKD, vasculopathy, etc.)

Identify all manifestations (ulcer, coma, Identify all manifestations (ulcer, coma, gangrene, osteomyelitis, etc.)gangrene, osteomyelitis, etc.) 37

Hypertension & CKDHypertension & CKD

When a patient has both a diagnosis of When a patient has both a diagnosis of hypertension and CKD, there is an hypertension and CKD, there is an assumed ‘cause and effect’ relationship assumed ‘cause and effect’ relationship and will be reported as “hypertensive and will be reported as “hypertensive chronic kidney disease, stage I through chronic kidney disease, stage I through stage IV, or unspecified, unspecified stage IV, or unspecified, unspecified benign or malignant”.benign or malignant”.

If not related, provider documentation If not related, provider documentation must be stated as must be stated as not duenot due to hypertension. to hypertension.

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Additional documentation needs to Additional documentation needs to include:include: Stage IStage I Stage II (mild)Stage II (mild) Stage III (moderate)Stage III (moderate) Stage IV (severe)Stage IV (severe) Stage VStage V Requiring chronic dialysisRequiring chronic dialysis End-stage renal diseaseEnd-stage renal disease 39

Chest PainChest Pain

Medical record documentation must Medical record documentation must include the specific location of the include the specific location of the chest pain:chest pain: Anterior wallAnterior wall AtypicalAtypical IntercostalIntercostal MusculoskeletalMusculoskeletal Non-cardiacNon-cardiac PrecordialPrecordial

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Documentation will need to include the following Documentation will need to include the following

to accurately code a fracture in ICD-10-CM:to accurately code a fracture in ICD-10-CM: Displaced or non-displacedDisplaced or non-displaced Open or closedOpen or closed Laterality (left vs. right vs. bilateral)Laterality (left vs. right vs. bilateral) Specific bone and location of the bone Specific bone and location of the bone

Distal, proximal, mid-shaft, etc.Distal, proximal, mid-shaft, etc. EncounterEncounter

Initial, subsequent, sequelaInitial, subsequent, sequela

Fracture Fracture DocumentationDocumentation

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Fracture “Subsequent” Fracture “Subsequent” EncounterEncounter

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Gustilo-Anderson classification identifies the ‘Gustilo-Anderson classification identifies the ‘severity of soft severity of soft tissue damagetissue damage’ in ’ in openopen fractures – may be new to coders and fractures – may be new to coders and physicians:physicians: Type IType I: Wound is smaller than 1 cm, clean, and generally : Wound is smaller than 1 cm, clean, and generally

caused by a fracture fragment that pierces the skin (low caused by a fracture fragment that pierces the skin (low energy injury)energy injury)

Type IIType II: Wound is longer than 1 cm, not contaminated, and : Wound is longer than 1 cm, not contaminated, and w/o major soft tissue damage or defect (low energy injury)w/o major soft tissue damage or defect (low energy injury)

Type IIIType III: Wound is longer than 1 cm, with significant soft : Wound is longer than 1 cm, with significant soft tissue disruption. The mechanism often involves high-tissue disruption. The mechanism often involves high-energy trauma, resulting in a severely unstable fracture energy trauma, resulting in a severely unstable fracture with varying degrees of fragmentation.with varying degrees of fragmentation.

What is Gustilo-Anderson What is Gustilo-Anderson Scale?Scale?

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HerniasHernias

Specify location (inguinal, femoral, Specify location (inguinal, femoral, umbilical, ventral, diaphragmatic; all other umbilical, ventral, diaphragmatic; all other abdominal hernias default to “other”, etc.)abdominal hernias default to “other”, etc.)

Specify unilateral (which side) or bilateralSpecify unilateral (which side) or bilateral Specify with obstruction when presentSpecify with obstruction when present Specify with gangrene when presentSpecify with gangrene when present Specify when recurrent hernia (defaults to Specify when recurrent hernia (defaults to

primary)primary)

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Malignancy ExampleMalignancy Example

Malignant Neoplasm Lung/BronchusMalignant Neoplasm Lung/Bronchus 63 choices available in ICD-10-CM63 choices available in ICD-10-CM Documentation must include:Documentation must include:

Specific site/locationSpecific site/location:: Hilus, lingula, main bronchus, lower lobe, middle Hilus, lingula, main bronchus, lower lobe, middle

lobe, upper lobe, etc.lobe, upper lobe, etc. LateralityLaterality Tobacco exposure or useTobacco exposure or use (secondary (secondary

diagnosis)diagnosis) Example: C34.2 (Malignant neoplasm of middle Example: C34.2 (Malignant neoplasm of middle

lobe, bronchus or lung)lobe, bronchus or lung) 45

ICD-10-CM diagnosis codes will impact every ICD-10-CM diagnosis codes will impact every physician practice large or small! physician practice large or small!

Look at all areas that will impact your practice and Look at all areas that will impact your practice and identify each one that will be affected:identify each one that will be affected:

Practice Management SystemPractice Management SystemElectronic Medical Record (EMR)Electronic Medical Record (EMR)Paper recordPaper recordSuperbill/encounter form – Does it have Superbill/encounter form – Does it have

diagnosis codes on it?diagnosis codes on it?Lab requisitionsLab requisitions

Physician PracticesPhysician Practices

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Although the coding book is “huge”, Although the coding book is “huge”, many physician practices use only a many physician practices use only a small set or # of diagnosis codes. small set or # of diagnosis codes.

Start developing crosswalks between Start developing crosswalks between

ICD-9-CM & ICD-10-CM codes you use ICD-9-CM & ICD-10-CM codes you use

most frequently in the office. most frequently in the office. Revise your superbill/encounter form if it Revise your superbill/encounter form if it

currently contains ICD-9-CM codes.currently contains ICD-9-CM codes.

Task Is Not As HugeTask Is Not As Huge As It Appears! As It Appears!

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That’s ICD-10!That’s ICD-10!

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Contact Info:Contact Info:

Karen Kvarfordt, RHIA, CCS-P, CCDSKaren Kvarfordt, RHIA, CCS-P, CCDS

AHIMA Certified ICD-10 TrainerAHIMA Certified ICD-10 Trainer

President, DiagnosisPlus, Inc. President, DiagnosisPlus, Inc.

PO Box 486PO Box 486

Pocatello, ID 83204Pocatello, ID 83204

(208) 221-5486(208) 221-5486diagnosisplus1@live.com

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