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DisclaimerThis presentation is intended for educational use. Any duplication is prohibited without written consent of Medtronic’s Economics and Health Policy department. This information does 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 their 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.
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ICD-10-PCS Procedure Codes
ICD-10-CM Diagnosis Codes
Implementation Background
Implementation Issues
Appendix : Key Resources
Topics
Diagnosis Code Crosswalks
Questions
Attachment : Diagnosis Code Crosswalks
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Effective Date
ICD-10 goes into effect October 1, 2015.
ICD-10-CM for diagnosis codes and ICD-10-PCS for procedure codes go into effect together on the same date.
ICD-10 is effective by date of discharge, not by date of admission.
Use of ICD-10 in the United States was formally proposed in August 2008 and finalized in January 2009.
Implementation of ICD-10 was initially scheduled for October 2013 and has been postponed twice since then.
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Who Uses What
Provider Setting Diagnoses Procedures
Physicians Facility/Office ICD-10-CM CPT
Hospitals Outpatient ICD-10-CM CPT
ASCs Outpatient ICD-10-CM CPT
Hospitals Inpatient ICD-10-CM ICD-10-PCS
Physicians, hospitals and all other providers must use ICD-10 diagnosis codes.
Hospitals must also use ICD-10-PCS procedure codes for inpatient cases.
Implementation of ICD-10 does not affect use of CPT®.
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Need an ICD-10-CM Codebook?
Physician offices can download a copy of the entire ICD-10-CM codebook from the CDC website:
This version is official, complete, current, and free.
Offices will need at least the Tabular and the Index.
The Tabular is the running list of diagnosis codes with their descriptions and instructions for use.
http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2105
ICD-10-CM diagnosis codes are administered by the Centers for Disease Control.
The codes are updated once a year on October 1.
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Codes are organized by chapter, mostly by body system. The chapters are virtually identical to those in ICD-9-CM.
Codes are alpha-numeric and can be 3 to 7 digits long.
Talpha
8number
2alpha or number
2 0 A
Category Details Extension
1T82.120ADisplacement of cardiac electrode, initial encounter
R 5 5 R55Syncope
I 5 0
2I50.23Acute on chronic systolic heart failure
3
Decimal
Diagnosis Code Structure
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Volume of Diagnosis Codes
ICD-9-CM14,567 codesICD-10-CM
69,823 codes
ICD-10-CM has far more diagnosis codes than ICD-9-CM and provides a greater level of specificity. Most physicians will use a small
subset of the total codes.
Many of the additional codes are due to laterality. Physicians do not use external cause codes.
There are still ‘unspecified’ codes.
Specialty societies have been very active in requesting new diagnosis codes with additional clinical detail.
Much of the additional specificity captured by ICD-10-CM diagnosis codes is already documented by physicians.
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Greater Specificity … Or Less
Some conditions that use the same code in ICD-9-CM are differentiated in ICD-10-CM and have separate codes.Example: Non-ischemic cardiomyopathy
ICD-9-CM ICD-10-CM
425.4
Otherprimarycardio-myopathies
I42.0 Dilated cardiomyopathy (congestive)I42.5 Other restrictive cardiomyopathy (constrictive cardiomyopathy)I42.8 Other cardiomyopathiesI42.9 Cardiomyopathy, unspecified
Example: Bifascicular blocks
ICD-9-CM ICD-10-CM 426.51 Right bundle branch block and left posterior fascicular block
I45.2 Bifascicular block426.52 Right bundle branch block and left anterior fascicular block 426.53 Bilateral bundle branch block, other
For some conditions though, it’s the opposite.
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ICD-10 Guidelines
Guidelines for use of ICD-10-CM are offered by multiple sources, but two sources are mandatory:
The ICD-10 Official Guidelines for Coding and Reporting
Physicians only need to use the diagnosis guidelines (there’s a separate set of official guidelines for procedures)
Instructions within the ICD-10 codebook itself
Use of these guidelines is mandated under HIPAA.
The guidelines can be found at:
Physicians will be most interested in Section IV: Diagnostic Coding
http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2105
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General Equivalence MappingsCDC posts General Equivalence Mappings (GEMs) on its website. These are a useful tool for going back-and-forth between ICD-9-CM codes and ICD-10 codes.
The first GEM goes forward from ICD-9 to ICD-10.
Both GEMs are updated once a year.
The second GEM goes backward from ICD-10 to ICD-9.
The GEMs can be found at: http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2105
Although GEMs are useful, CDC and CMS strongly recommend using the ICD-10-CM codebook directly, as studies have consistently indicated that this is most accurate.
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Crosswalk: Heart Failure
ICD-9-CM ICD-10-CM 402.01 Hypertensive heart disease, malignant, with heart failure
I11.0 Hypertensive heart disease with heart failure402.11 Hypertensive heart disease, benign, with heart failure
402.91 Hypertensive heart disease, unspecified, with heart failure
404.01Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified
I13.0
Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
404.11Hypertensive heart and chronic kidney disease, benign, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified
404.91Hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified
404.03Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end stage renal disease
I13.2
Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
404.13Hypertensive heart and chronic kidney disease, benign, with heart failure and chronic kidney disease stage V or end stage renal disease
404.93Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end stage renal disease
Hypertensive Heart Disease with Heart Failure
There’s no distinction between malignant and benign hypertension. The specific type of heart failure is coded separately.
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Crosswalk: Heart FailureICD-9-CM ICD-10-CM
428.0 Congestive heart failure, unspecified I50.9 Heart failure, unspecified 428.1 Left heart failure I50.1 Left ventricular failure 428.20 Systolic heart failure, unspecified I50.20 Unspecified systolic (congestive) heart failure428.21 Acute systolic heart failure I50.21 Acute systolic (congestive) heart failure428.22 Chronic systolic heart failure I50.22 Chronic systolic (congestive) heart failure428.23 Acute on chronic systolic heart failure I50.23 Acute on chronic systolic (congestive) heart failure428.30 Unspecified diastolic heart failure I50.30 Unspecified diastolic (congestive) heart failure428.31 Acute diastolic heart failure I50.31 Acute diastolic (congestive) heart failure428.32 Chronic diastolic heart failure I50.32 Chronic diastolic (congestive) heart failure428.33 Acute on chronic diastolic heart failure I50.33 Acute on chronic diastolic (congestive) heart failure
428.40 Unspecified combined systolic and diastolic heart failure I50.40 Unspecified combined systolic (congestive) and diastolic
(congestive) heart failure
428.41 Acute combined systolic and diastolic heart failure I50.41 Acute combined systolic (congestive) and diastolic
(congestive) heart failure
428.42 Chronic combined systolic and diastolic heart failure I50.42 Chronic combined systolic (congestive) and diastolic
(congestive) heart failure
428.43 Acute on chronic combined systolic and diastolic heart failure I50.43 Acute on chronic combined systolic (congestive) and
diastolic (congestive) heart failure428.9 Unspecified heart failure I50.9 Heart failure, unspecified
Documentation must still specify if the heart failure is acute or chronic, systolic or diastolic.
“Congestive” heart failure does not have its own code.
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Crosswalk: Conduction Disorders
ICD-9-CM ICD-10-CM 426.0 AV block, complete I44.2 Atrioventricular block, complete426.10 AV block, unspecified I44.30 Unspecified atrioventricular block426.11 AV block, first degree I44.0 Atrioventricular block, first degree426.12 AV block, Mobitz II I44.1 Atrioventricular block, second degree426.13 AV block, other second degree
Atrioventricular Block
Bundle Branch BlocksICD-9-CM ICD-10-CM
426.2 Left bundle branch hemiblockI44.4 Left anterior fascicular block I44.5 Left posterior fascicular block
I44.60 Unspecified fascicular block
426.3 Other left bundle branch block I44.69 Other fascicular block I44.7 Left bundle branch block, unspecified
426.4 Right bundle branch block I45.0 Right fascicular block
I45.10 Unspecified right bundle branch block I45.19 Other right bundle branch block
426.50 Bundle branch block, unspecified I45.4 Nonspecific intraventricular block (BBB NOS)426.51 RBBB and left posterior fascicular block
I45.2 Bifascicular block426.52 RBBB and left anterior fascicular block 426.53 Bilateral bundle branch block, other426.54 Trifascicular block I45.3 Trifascicular block
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Crosswalk: Conduction Disorders
ICD-9-CM ICD-10-CM 426.7 Anomalous atrioventricular excitation (WPW) I45.6 Pre-excitation syndrome (WPW) (LGL)426.81 Lown-Ganong-Levine syndrome (LGL)426.82 Long QT syndrome I45.81 Long QT syndrome 426.89 Other specified conduction disorders I45.89 Other specified conduction disorders 426.9 Conduction disorder, unspecified I45.9 Conduction disorder, unspecified
Other BlocksICD-9-CM ICD-10-CM
426.6 Other heart block I45.5 Other specified heart block
Other Conduction Disorders
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Crosswalk: Arrhythmias Tachycardia
ICD-9-CM ICD-10-CM
427.0 Paroxysmal supraventricular tachycardia I47.1 Supraventricular tachycardia (includes AVNRT)I49.2 Junctional premature depolarization
427.1 Paroxysmal ventricular tachycardia I47.0 Re-entry ventricular arrhythmia I47.2 Ventricular tachycardia
427.2 Paroxysmal tachycardia, unspecified I47.9 Paroxysmal tachycardia, unspecified 785.0 Tachycardia, unspecified R00.0 Tachycardia, unspecified
“Paroxysmal” does not need to be documented SVT and VT.
Atrial Fibrillation and FlutterICD-9-CM ICD-10-CM
427.31 Atrial fibrillation
I48.0 Paroxysmal atrial fibrillationI48.1 Persistent atrial fibrillationI48.2 Chronic atrial fibrillation
I48.91 Unspecified atrial fibrillation
427.32 Atrial flutterI48.3 Typical atrial flutter (type I)I48.4 Atypical atrial flutter (type II)
I48.92 Unspecified atrial flutter
Documentation should specify the type of atrial fibrillation, and the abbreviation “PAF” should be avoided.
Tachycardia that’s unspecified is assigned to symptom code R00.0.
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Crosswalk: Arrhythmias Ventricular Fibrillation and Flutter
ICD-9-CM ICD-10-CM 427.41 Ventricular fibrillation I49.01 Ventricular fibrillation427.42 Ventricular flutter I49.02 Ventricular flutter
Particularly for surgical patients, documentation should specify bradycardia as “sick sinus syndrome” or “tachycardia-bradycardia syndrome”.
BradycardiaICD-9-CM ICD-10-CM
427.81 Sinoatrial node dysfunction (SSS) I49.5 Sick sinus syndrome (tachy-brady syndrome)— R00.1 Bradycardia, unspecified
Bradycardia that is unspecified or documented only as “sinoatrial bradycardia” or “sinus bradycardia” is assigned to symptom code R00.1.
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Crosswalk: Arrhythmias Other Arrhythmias
ICD-9-CM ICD-10-CM 427.60 Premature beats, unspecified I49.40 Unspecified premature depolarization 427.61 Supraventricular premature beats I49.1 Atrial premature depolarization
427.69 Other premature beats I49.3 Ventricular premature depolarizationI49.49 Other premature depolarization
427.89 Other specified cardiac dysrhythmias I49.8 Other specified cardiac arrhythmias427.9 Cardiac dysrhythmia, unspecified I49.9 Cardiac arrhythmia, unspecified 794.31 Abnormal electrocardiogram R94.31 Abnormal electrocardiogram
Cardiac Arrest (Sudden Cardiac Death) ICD-9-CM ICD-10-CM
427.5 Cardiac arrestI46.2 Cardiac arrest due to underlying cardiac conditionI46.8 Cardiac arrest due to other underlying condition I46.9 Cardiac arrest, cause unspecified
If the underlying cause is known, it should be documented and coded separately. The cause code is sequenced before code I46.-.
ICD-9-CM ICD-10-CM
V12.53 Personal history of sudden cardiac arrest (SCD) (successfully resuscitated) Z86.74 Personal history of sudden cardiac arrest (SCD)
(successfully resuscitated)
V17.41 Family history of sudden cardiac death (SCD) Z82.41 Family history of sudden cardiac death
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ICD-9-CM410.0x Acute myocardial infarction, of anterolateral wall 410.1x Acute myocardial infarction, of other anterior wall 410.2x Acute myocardial infarction, of inferolateral wall410.3x Acute myocardial infarction, of inferoposterior wall410.4x Acute myocardial infarction, of other inferior wall 410.5x Acute myocardial infarction, of other lateral wall410.6x Acute myocardial infarction, true posterior wall 410.7x Acute myocardial infarction, subendocardial (NSTEMI)410.8x Acute myocardial infarction, of other specified sites 410.9x Acute myocardial infarction, unspecified site
Crosswalk: Acute Myocardial Infarction
AMI: ICD-9-CM
AMI: ICD-10-CM
Episode of care is not identified per se. AMI is differentiated between initial AMI (I21) and subsequent AMI (I22) The AMI site identifies the specific coronary artery involved.
ICD-10-CM handles acute myocardial infarction differently from ICD-9-CM.
5th digit
0 – unspecified episode of care
1 – initial episode of care
2 – subsequent episode of care
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Initial AMI (I21)
Crosswalk: Acute Myocardial Infarction
Documentation should specify the coronary artery or wall involved.
ICD-10-CMI21.01 ST elevation (STEMI) myocardial infarction involving left main coronary arteryI21.02 ST elevation (STEMI) myocardial infarction involving left anterior descending coronary arteryI21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall I21.11 ST elevation (STEMI) myocardial infarction involving right coronary arteryI21.19 ST elevation (STEMI) myocardial infarction involving other coronary arteryI21.21 ST elevation (STEMI) myocardial infarction involving left circumflex coronary arteryI21.29 ST elevation (STEMI) myocardial infarction involving other sitesI21.3 ST elevation (STEMI) myocardial infarction of unspecified site I21.4 Non-ST elevation (NSTEMI) myocardial infarction
Initial AMI codes continue to be assigned to encounters for continued care, including transfer to another hospital or post-acute setting, while the AMI is within 28 days of onset.
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Crosswalk: Acute Myocardial Infarction
ICD-10-CMI22.0 Subsequent ST elevation (STEMI) myocardial infarction of anterior wallI22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wallI22.2 Subsequent non-ST elevation (NSTEMI) myocardial infarctionI22.8 Subsequent ST elevation (STEMI) myocardial infarction of other sitesI22.9 Subsequent ST elevation (STEMI) myocardial infarction of unspecified site
Subsequent AMI (I22)
A subsequent AMI is a new AMI that occurs within 28 days of a previous AMI, regardless of site.
Codes from I22 cannot be assigned alone. They must always be assigned with a code from I21. Sequencing of the codes depends on the circumstances.
Old AMI
ICD-9-CM ICD-10-CM 412 Old myocardial infarction I25.2 Old myocardial infarction
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Crosswalk: Other Heart Disorders
ICD-9-CM ICD-10-CM
414.8 Other specified forms of chronic ischemic heart disease (used for ischemic cardiomyopathy) I25.5 Ischemic cardiomyopathy
425.11 Hypertrophic obstructive cardiomyopathy I42.1 Obstructive hypertrophic cardiomyopathy
425.4 Other primary cardiomyopathies
I42.0 Dilated cardiomyopathy (congestive)
I42.5 Other restrictive cardiomyopathy (constrictive cardiomyopathy)
I42.8 Other cardiomyopathiesI42.9 Cardiomyopathy, unspecified
Cardiomyopathy
ShockICD-9-CM ICD-10-CM
785.50 Shock, unspecified R57.9 Shock, unspecified 785.51 Cardiogenic shock R57.0 Cardiogenic shock
785.59 Shock, other R57.1 Hypovolemic shock R57.8 Other shock
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Crosswalk: SymptomsSyncope
ICD-9-CM ICD-10-CM 780.2 Syncope R55 Syncope
Chest PainICD-9-CM ICD-10-CM
786.50 Chest pain, unspecified R07.9 Chest pain, unspecified 786.51 Precordial pain R07.2 Precordial pain786.59 Chest pain , other R07.89 Other chest pain
Other SymptomsICD-9-CM ICD-10-CM
780.4 Dizziness R42 Dizziness785.1 Palpitations R00.2 Palpitations
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Crosswalk: Cerebrovascular Disorders
ICD-9-CM ICD-10-CM
434.91 Cerebral artery occlusion, unspecified (used for cryptogenic ischemic stroke) I63.9 Cerebral infarction, unspecified
Cryptogenic Stroke
ICD-9-CM ICD-10-CM 435.9 Unspecified transient cerebral ischemia G45.9 Transient cerebral ischemic attack, unspecified
Transient Cerebral Ischemia
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Crosswalk: Device Complications
ICD-9-CM ICD-10-CM
996.01
996.04
Mechanical complication due to cardiac pacemaker
Mechanical complication due to implantable defibrillator
T82.110A Breakdown (mechanical) of cardiac electrode, initial encounterT82.111A Breakdown (mechanical) of cardiac pulse generator, initial encounterT82.118A Breakdown (mechanical) of other cardiac electronic device, initial encounterT82.120A Displacement of cardiac electrode, initial encounterT82.121A Displacement of cardiac pulse generator, initial encounterT82.128A Displacement of other cardiac electronic device, initial encounterT82.190A Other mechanical complication of cardiac electrode, initial encounterT82.191A Other mechanical complication of cardiac pulse generator, initial encounterT82.198A Other mechanical complication of other cardiac electronic device, initial encounter
Mechanical Complication of Pacemaker and Defibrillator
Mechanical complication is defined the same way in ICD-10-CM as it is in ICD-9-CM. Breakage of device Malposition of device Leakage of device
Mechanical obstruction of device Perforation of device Protrusion of device
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Crosswalk: Device Complications Infection of implanted cardiac device
ICD-9-CM ICD-10-CM
996.61Infection due to cardiac device, implant and graft
T82.7xxA Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter
Other complications
“x” is a placeholder. This code is only four digits but extension “A” must always be in the 7th position. So “x” holds the empty 5th and 6th positions.
A diagnosis of “failed” device must be further specified.
ICD-9-CM ICD-10-CM
996.72
Other complicationdue to other cardiac device, implant and graft
T82.817A Embolism of cardiac prosthetic devices, implants and grafts, initial encounterT82.827A Fibrosis of cardiac prosthetic devices, implants and grafts, initial encounterT82.837A Hemorrhage of cardiac prosthetic devices, implants, grafts, initial encounterT82.847A Pain from cardiac prosthetic devices, implants and grafts, initial encounterT82.857A Stenosis of cardiac prosthetic devices, implants and grafts, initial encounterT82.867A Thrombosis of cardiac prosthetic devices, implants, grafts, initial encounter
T82.897A Other specified complication of cardiac prosthetic devices, implants and grafts, initial encounter
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Crosswalk: Encounters and Status
Use Z45.- for encounters for device replacement due to expected end-of-life and expected device removal (eg, end of surveillance). These types of encounters are not coded as complications.
ICD-9-CM ICD-10-CM
V53.31 Fitting and adjustment of cardiac pacemakerZ45.010 Encounter for checking and testing of cardiac
pacemaker pulse generator [battery]
Z45.018 Encounter for adjustment and management of other part of cardiac pacemaker
V53.32 Fitting and adjustment of automatic implantable cardiac defibrillator Z45.02 Encounter for adjustment and management of
automatic implantable cardiac defibrillator
V53.39 Fitting and adjustment of other cardiac device Z45.09 Encounter for adjustment and management of othercardiac device
Encounters
ICD-9-CM ICD-10-CM
V45.01 Cardiac pacemaker in situ Z95.0 Presence of cardiac pacemaker
V45.02 Automatic implantable cardiac defibrillator in situ Z95.810 Presence of automatic (implantable) cardiac
defibrillatorV45.09 Other specified cardiac device in situ Z95.818 Presence of other cardiac implants and grafts
Device Status
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ICD-10-PCS Format
ICD-10-PCS procedure codes are administered by CMS.
Codes are alpha-numeric and are always 7 digits long.
Each position in an ICD-10-PCS procedure code represents a distinct element.
1 2 3 4 5 6 7
sectionbody system
root operation approach qualifierbody part device
There are virtually no unspecified or default codes. ICD-10-PCS uses standardized definitions throughout.
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Structure of ICD-10-PCS Codes In ICD-10-PCS, codes are not assigned per se. They are
constructed, character by character. Rather than a Tabular list of codes, ICD-10-PCS displays
tables from which values for each position are selected.
Defibrillator generator: Evera0JH608Z Insertion of defibrillator generator, into chest subcutaneous tissue and fascia, open approach
CRT-D generator: Viva 0JH609Z Insertion of cardiac resynchronization defibrillator pulse generator into chest subcutaneous tissue and fascia, open approach
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ICD-10-PCS Terminology
Pulmonary vein isolation (ie. for atrial fibrillation)02583ZZ Destruction of conduction mechanism, percutaneous approach
“It is the coder’s responsibility to determine what the documentation in the medical record equates to in the PCS definitions. The physician is not expected to use the terms used in PCS code descriptions…”
No need to document Destruction, keep documenting PVI or ablation No need to document Percutaneous Endoscopic, thoracoscopic is fine
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Volume of Procedure Codes ICD-10-PCS has far more procedure codes than ICD-9-CM and provides much greater specificity. Full system CRT-D
ICD-9-CM 1 code ICD-10-PCS 4 codes
ICD-9-CM3,882 codesICD-10-PCS71,962 codes
CRT-D generator with transvenous RA, RV, LV leads
02H63KZ Insertion of defibrillator lead into right atrium, percutaneous approach02HK3KZ Insertion of defibrillator lead into right ventricle, percutaneous approach02H43KZ Insertion of defibrillator lead into coronary vein, percutaneous approach
0JH609Z Insertion of CRT-D generator into chest subcutaneous tissue, open approach
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Documentation PracticesICD-10 raises the bar on specificity in documentation for diagnoses.
Culprit lesion or site of acute myocardial infarction Type of cardiomyopathy: ischemic/non-ischemic, congestive, constrictive Acuity and type of heart failure: acute/chronic, systolic/diastolic Type of atrial fibrillation: paroxysmal, persistent, chronic Type of atrial flutter: type I, type II Nature of bradycardia: SSS, tachycardia-bradycardia syndrome Nature of tachycardia: SVT, VT, AVNRT Device complication: true complication or expected end-of-life? Nature of device complication: stenosis, breakdown, premature depletion
Documentation for Diagnosis Specificity
“PAF”
“device failure”
“tachycardia”“CHF”
“bradycardia”
“STEMI” (unspecified)
“decompensated HF”
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Documentation Practices
Take note of coder queries requesting additional information and include those details in similar cases going forward.
http://www.roadto10.org/action-plan/phase-2-train/primer-cardiology/ CMS has a useful primer for cardiology documentation:
Conventional or resynchronization pacemaker or defibrillator Exact anatomic location of subcutaneous devices: chest, back, abdominal wall Specific name and model of devices used
Documentation for Procedure Specificity
ICD-10 also raises the bar on specificity in documentation for procedures.
Other documentation considerations
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Coverage IssuesCMS has converted its NCDs and ICD-10-CM codes are already being displayed on LCDs and on private payers’ medical policies.
Be aware that the specificity of ICD-10-CM may allow payers to now enforce existing coverage rules more stringently.
Identify the practice’s largest payers and check the codes on their on-line medical polices for familiarity as well as omissions.
Alert the payer to possible discrepancies.
Check practice superbills against payer policies for differences.
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Practice Implementation Checklist1. Lay out a plan Identify which ICD-9 codes you use heavily Identify the staff that need to be trained in coding and/or documentation Contact vendors to learn their plans, ICD-10 related costs to the practice, and
resources available to the practice Contact the specialty society for any resources available to the practice Visit the CMS website for useful tools and materials
2. Get trained Buy or download an ICD-10 diagnosis codebook Arrange and implement ICD-10 coding training for staff Arrange and obtain documentation training for physicians and other clinicians Crosswalk common diagnosis codes to ICD-10 and identify new requirements or
differences in essential documentation Sign up for key CMS webinars to increase understanding of the ICD-10 environment
3. Update internal practice tools Convert superbills to ICD-10 Convert other materials to ICD-10, such as authorizations, orders and referrals Identify common code-related causes for current claim denials and identify areas where
ICD-10's specificity in documentation and code assignment can address this Obtain payer medical polices with ICD-10 codes for comparison
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4. Work with vendors and payers Arrange and implement ICD-10 software upgrades Train staff on use of new software, either directly or via the
vendor Identify EHR documentation templates and assess how they
support ICD-10 specificity for claims submission and medical necessity
Engage payers on any discrepancies and omissions in ICD-10 coding for medical policies
Identify if payers anticipate any changes in processing and payment due to ICD-10
Identify availability of testing with major payers
5. Test the process Perform testing on systems within the practice Perform end-to-end testing with vendors and/or payers Identify and correct issues raised during testing Educate staff on the impact of ICD-10 to payer edits, adjudication, and other claims
elements to processes within the practice Repeat!
Practice Implementation Checklist
http://coalitionforicd10.org/2015/01/12/you-can-do-it-guide-to-physician-icd-10-conversion/
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Key Websites CDC and CMS have a wealth of resources and educational materials available on-line for physician practices.
http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2105• ICD-10-CM Tabular and Index
• Diagnosis code GEMS• Official ICD-10-CM guidelines
http://www.roadto10.org/
CDC
CMS• Webcasts
• Templates for assessing vendors, billing services, payers • FAQs on ICD-10
• Specialty references (common codes, documentation primers)• Customizable practice action plans
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Medtronic Contacts Medtronic is available to assist with your ICD-10 questions and issues.
Hotline: 1-866-877-4102
Email us:[email protected]
We’re here to
help make this
transition smoother for you
Visit the CRHF reimbursement website at:www.medtronic.com/crdmreimbursement