THE ICD-10 JOURNEY HANDS ON CODING WSHIMA 04.30.2016 1 - - PowerPoint PPT Presentation

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THE ICD-10 JOURNEY HANDS ON CODING WSHIMA 04.30.2016 1 - - PowerPoint PPT Presentation

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UW MEDICINE | ICD-10 Program THE ICD-10 JOURNEY HANDS ON CODING WSHIMA 04.30.2016 1 DISCLAIMER This material is designed to provide information about clinical documentation, coding, and compliance in an educational format. It is a

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THE ICD-10 JOURNEY HANDS ON CODING

WSHIMA 04.30.2016

UW MEDICINE | ICD-10 Program

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DISCLAIMER

This material is designed to provide information about clinical documentation, coding, and compliance in an educational format. It is a snapshot of some aspects of ICD-10. Carefully review all coding rules, guidelines, and codes. This session is not meant to be a substitute for careful review of all coding rules, guidelines, and codes as well as medical documentation when coding in ICD 10.

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ICD-10 Program

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GOALS/OBJECTIVES

  • Background UW Medicine
  • Post Go-Live Audit of all UW Medicine Coders

− Inpatient: I10 CM, PCS, DRG − Outpatient Ambulatory Surgery: I10 CM/PCS − ProFee/Clinic: I10 CM

  • ICD-10-CM Examples Clinic & ProFee
  • CM/PCS Examples Outpatient
  • CM/PCS Examples Inpatient

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ICD-10 Program

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UW MEDICINE IN BRIEF

Airlift Northwest (serving AK, ID, MT & WA) Harborview Medical Center (413 beds) Northwest Hospital & Medical Center (281 beds) Seattle Cancer Care Alliance (20 beds)* UW Medical Center (450 beds) UW Clinics (10 clinics) UW Physicians (1,800+ physicians) UW School of Medicine (1,000+ students) Valley Medical Center (303 beds)

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ICD-10 Program

* An alliance of UW Medicine, Fred Hutchinson Cancer Research Center and Seattle Children’s Hospital

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BACKGROUND

  • April 2014 – Dual coding started for all coders

across UW Medicine

  • May 2014 – Internal DRG analysis /Shifts
  • Coder/CDI education
  • Newsletter
  • Webinar twice a month
  • Outside audits pre and post go-live
  • 2 Pre go-live audits
  • Post go-live audit

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ICD-10 Program

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POST G0-LIVE OUTSIDE AUDIT

  • Outside audit of ICD-10 Coding
  • All coders who assign diagnosis and procedure

codes in ICD-10.

  • November 2015
  • 5 cases per coder (150 coders)
  • Results of the audit late Dec.-Mar.
  • Education team reviewed
  • Feedback provided to individual coders

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ICD-10 Program

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CODING/CDI GUIDANCE

  • Excision saphenous vein for graft (CABG)
  • Greater vs. lesser
  • Radial artery lines
  • Devices placed at outside facilities (Impella)
  • List of contrast by type (low osmolar)
  • Aflutter

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ICD-10 Program

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CASE # 1: EMERGENCY ROOM

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ICD-10 Program

Diagnosis Codes Descriptor O02.1 Missed abortion (Early fetal death before completion 20 weeks) Z3A.14 14 weeks gestation of pregnancy

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CASE #2: CLINIC VISIT

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ICD-10 Program

Diagnosis Codes Descriptor S01.112D Laceration w/o FB left eyelid and periocular area, subsequent encounter W01.118D Fall on same level from slipping, tripping and stumbling with subsequent striking against other sharp object, subsequent encounter

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CASE #2: CODING CLINIC

Coding Clinic, First Quarter ICD-10 2015 Question: The physician checks the wounds and removes sutures from both the scalp and cheek. What code should be assigned. Should code Z48.02, Encounter or removal of sutures, be assigned since the encounter is for suture removal? Answer: Assign code S01.02XD, Laceration with foreign body of scalp, subsequent encounter, as the first-listed diagnosis for the office visit for suture. Code also the code for the external cause of mortality.

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ICD-10 Program

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CASE # 3: RADIOLOGY

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ICD-10 Program Diagnosis Codes Descriptor

O36.5920 Maternal care for other known or suspected poor fetal growth, second trimester (6th character 2 is for second trimester, 7th character 0 for not applicable or unspecified fetus) O41.02X0 Oligohydramnios, second trimester (7th character 0 for not applicable or unspecified fetus) Z3A22 22 weeks gestation of pregnancy

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CASE # 4: AMBULATORY SURGERY

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ICD-10 Program

Diagnosis Codes Descriptor S32.810D Multiple fractures of pelvis with disruption of pelvic ring, subsequent encounter for fracture with routine healing W13.2XXD Fall from, out of or through roof, subsequent encounter Procedure Codes 0QP304Z Removal of internal fixation device left pelvic bone, open approach

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CASE # 5: DIAGNOSIS CODES

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ICD-10 Program

Diagnosis Codes Descriptor Z47.33 Aftercare following explantation of knee joint prosthesis J44.9 COPD, unspecified E11.9 Type II diabetes mellitus without complication K21.9 GERD I10 Hypertension

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CASE #5: CODING CLINIC

Coding Clinic, First Quarter ICD-10 2015 Pages:16-17 Question: A patient develops an infection after a primary hip prosthesis and the prosthesis is removed. How do you code the admit when the patient returns for removal of spacer and revision of hip replacement with new hip prosthesis. Answer: Assign code Z47.32 Aftercare following explantation of hip joint prosthesis as the PDx for the second admission. Code Z47.32 is used to report patient encounters for joint prosthesis insertion following a prior explantation of the prosthesis, where it was necessary to stage the procedure

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ICD-10 Program

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CASE #6:

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ICD-10 Program Diagnosis Codes Descriptor

T84.52XA Infection and inflammatory reaction due to internal left hip prosthesis, initial encounter M86.68 Other chronic osteomyelitis, other site Z85.830 Personal history of malignant neoplasm of bone

Procedure Codes Descriptor

0SPB0JZ Removal of synthetic substitute from left hip joint, open approach 0SHB08Z Insertion of Spacer into left hip joint, open approach

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CASE # 7: EMERGENCY ROOM

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ICD-10 Program

Diagnosis Codes Descriptor S066X9A Traumatic subarachnoid hemorrhage with loss of consciousness unspecified duration, initial encounter S065X9A Traumatic subdural hemorrhage with loss of consciousness unspecified duration, initial encounter W10.9XXA Fall (on)(from) unspecified stairs and steps, initial episode of care

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CASE # 8: CLINIC VISIT

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ICD-10 Program

Diagnosis Codes Descriptor T54.2X1D Toxic effects of corrosive acids & acid-like substances, accidental (unintentional), subsequent encounter T26.91XD Corrosion of right eye and adnexa, subsequent encounter

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CASE # 9: INPATIENT CARDIAC CATH DX

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ICD-10 Program

Diagnosis Codes Descriptor I21.09 STEMI involving other coronary artery of anterior wall I25.10 Atherosclerotic heart disease of native coronary artery w/o angina I25.84 Coronary atherosclerosis due to calcified coronary lesion N18.6 End stage renal disease (ESRD) E11.21 Type II diabetes mellitus with diabetic nephropathy Z79.4 Long term (current) use of insulin Z76.82 Awaiting organ transplant status Z99.2 Dependence on renal dialysis

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CASE #9: INPATIENT CARDIAC CATH PX

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ICD-10 Program

Procedure Codes Descriptor 027134Z Dilation coronary artery 2 sites with drug eluting intraluminal device (stent), percutaneous approach 4A023N7 Measurement Cardiac sampling/pressure, left heart, percutaneous approach (Left heart catheterization) 02C03ZZ Extirpation matter from coronary artery, one site , percutaneous B2111ZZ Fluoroscopy of multiple coronary arteries using low

  • smolar contrast

B2151ZZ Fluoroscopy left heart using low osmolar contrast

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CASE # 10: INPATIENT CABG

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ICD-10 Program Diagnosis Codes Descriptor

I25.119

Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris

E78.5

Hyperlipidemia, unspecified

E87.1

Hyponatremia

I10

Hypertension Procedure Codes Descriptor 02100Z9 Bypass coronary artery, one site from left internal mammary, open approach 021009W Bypass coronary artery, one site from aorta with autologous venous tissue, open approach 06BP0ZZ Excision of right greater saphenous vein, open approach 5A1221Z Performance Cardiac Output, continuous

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CASE #11: AMBULATORY SURGERY

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ICD-10 Program

Diagnosis Codes Descriptor N20.0 Calculus of kidney Procedure Codes Descriptor 0TF3XZZ Fragmentation right kidney pelvis, external approach 0TJB8ZZ Inspection of bladder, via natural or artificial opening BT1DZZZ Fluoroscopy of right kidney, ureter and bladder

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CASE #12: AMB. SURG. MENORRHAGIA

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ICD-10 Program

Diagnosis Codes Descriptor N92.0 Excessive/frequent menstruation with regular cycle (Menorrhagia) Z01.419 Encounter for gynecological examination w/o abnormal findings B37.3 Candidiasis of vulva and vagina (yeast vaginitis) Procedure Codes Descriptor 8E0UXY7 Examination of female reproductive system 0UH97HZ Insertion Contraceptive device into uterus, via natural or artificial opening (mirena)

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CASE #13: WHIPPLE

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ICD-10 Program Diagnosis Codes Descriptor

C25.0 Malignant neoplasm head of pancreas

Procedure Codes Descriptor

0FBG0ZZ Excision pancreas, open approach 0DB90ZZ Excision duodenum, open approach 0FT40ZZ Resection gallbladder 0DBAZ0ZZ Excision jejunum 0FB90ZZ Excision CBD 0DB60ZZ Excision stomach 07BB0ZZ Excision mesenteric lymphatic 06B50ZZ Excision superior mesenteric vein

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CASE #14: COLECTOMY

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ICD-10 Program Diagnosis Codes Descriptor

C18.6 Malignant neoplasm descending colon K42.09 Umbilical hernia without obstruction or gangrene

Procedure Codes Descriptor

0DTM4ZZ Resection descending colon, percutaneous endoscopic approach 0DBN4ZZ Excision sigmoid colon, percutaneous endoscopic approach 0DBL4ZZ Excision transverse colon, percutaneous endoscopic approach 0WQF4ZZ Repair abdominal wall, percutaneous endoscopic approach

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CASE #15: EMBOLIZATION

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ICD-10 Program Diagnosis Codes Descriptor

K92.2 GI hemorrhage, unspecified I95.9 Hypotension, unspecified D62 Acute posthemorrhagic anemia R57.8 Hemorrhagic shock

Procedure Codes Descriptor

04L33DZ Occlusion gastric artery w intraluminal device, percutaneous B4121ZZ Fluoroscopy hepatic artery using low osmolar contrast

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CASE #16: THROMBOSIS DIALYSIS CATHETER

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ICD-10 Program Diagnosis Codes Descriptor

N18.6 ESRD T82.8684A Thrombosis dialysis catheter

Procedure Codes Descriptor

02HV33Z Insertion infusion device with tip in SVC B5181ZA Fluoroscopy SVC using low osmolar contrast guidance

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CASE #16: CODING CLINIC

Coding Clinic Fourth Quarter ICD-10 2015

Question: What is the correct body part value for a dialysis catheter inserted via internal jugular with tip in cavoatrial junction. Answer: Assign code 02HV33Z Insertion of infusion device into superior vena cava, percutaneous approach

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ICD-10 Program

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CASE #17: EMERGENCY ROOM

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ICD-10 Program Diagnosis Codes Descriptor

T87.89 Other complications amputation stump E11.40 Type II Diabetes mellitus with diabetic neuropathy, unspecified Y83.5 Amputation of limb as the cause of abnormal reaction of the patient, or of later complication without mention of misadventure at the time of the procedure Z89.421 Acquired absence of right toe(s)

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CASE #18: AMBULATORY SURGERY

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ICD-10 Program Diagnosis Codes Descriptor

G50.0 Trigeminal neuralgia

Procedure Codes Descriptor

00NK0ZZ Release trigeminal nerve

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CASE #19: MELANOMA

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ICD-10 Program Diagnosis Codes Descriptor

C43.62 Malignant melanoma of left upper limb, including shoulder

Procedure Codes Descriptor

0JBF0ZZ Excision left upper arm subcutaneous tissue and fascia,

  • pen approach

07B60ZX Excision left axillary lymphatic open approach, diagnostic.

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CASE #20: DECOMPRESION LAMINECTOMY

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ICD-10 Program Diagnosis Codes Descriptor

M48.06 Spinal Stenosis, lumbar region

Procedure Codes Descriptor

01NB0ZZ Release lumbar nerve, open approach

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CASE #20: CODING CLINIC

Coding Clinic, Second Quarter ICD-10 2015 Question: Question:The patient presents for decompressive lumbar laminectomy. Should this be coded to root

  • peration ‘excision’ or ‘release’.

Answer: Decompressive laminectomy releases the pressure and frees the spinal nerve root. Assign root

  • peration ‘release’.

01NB0ZZ Release lumbar nerve, open approach

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ICD-10 Program

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CASE #21: CORONARY ANGIOGRAM

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ICD-10 Program Diagnosis Codes Descriptor

I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris

Procedure Codes Descriptor

027034Z Dilation of coronary artery, one site with Drug-eluting intraluminal device, percutaneous approach B2111ZZ Fluoroscopy of multiple coronary arteries using low

  • smolar contrast
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CASE #22: AMBULATORY SURGERY AMPUTATION

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ICD-10 Program Diagnosis Codes Descriptor

C44.629 Squamous cell carcinoma of skin of left upper limb, including shoulder

Procedure Codes Descriptor

0X6W0Z3 Detachment at Left Little Finger, low, open approach

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CASE # 23: AMBULATORY SURGERY

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ICD-10 Program

Diagnosis Codes Descriptor N81.3 Complete uterovaginal prolapse Procedure Codes Descriptor 0UT94ZZ Resection uterus, percutaneous endoscopic approach 0UT74ZZ Resection bilateral fallopian tubes, percutaneous endoscopic approach 0JUC0JZ Supplement of pelvic region subcutaneous tissue and fascia with synthetic substitute, open approach 8E0W4CZ Robotic assisted procedure of trunk region, percutaneous endoscopic approach

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CASE #24: TAVR

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ICD-10 Program Diagnosis Codes Descriptor

I35.0 Nonrheumatic aortic (valve) stenosis I48.91 Unspecified atrial fibrillation E11.9 Type II diabetes mellitus, uncomplicated

Procedure Codes Descriptor

02RF38H Replacement of aortic valve w zooplastic tissue, transapical, percutaneous approach

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CASE # 25: INPATIENT SURGERY DX

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ICD-10 Program Diagnosis CodesZ85.038 Descriptor

C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct C77.5 Secondary & unspecified malignant neoplasm of intrapelvic lymph nodes C79.89 Secondary malignant neoplasm of other specified sites Z85.038 Personal history of other malignant neoplasm of large intestine Z85.850 Personal history of malignant neoplasm of thyroid

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CASE #25: INPATIENT SURGERY PX

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ICD-10 Program Procedure Codes Descriptor

0FB04ZZ Excision of liver, percutaneous endoscopic approach 07BC0ZZ Excision of pelvis lymphatic, open approach 0WBF0ZZ Excision of abdominal wall, open approach 0WUF0JZ Supplement abdominal wall w synthetic substitute, open approach 8E0W4CZ Robotic assisted procedure of trunk region, percutaneous endoscopic approach

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NEW CODES FOR FY2017

  • New diagnosis codes for FY2017

http://www.cdc.gov/nchs/icd/icd9cm_maintenance. htm

  • New procedure codes for FY2017

https://www.cms.gov/Medicare/Coding/ICD9ProviderD iagnosticCodes/ICD-9-CM-C-and-M-Meeting- Materials.html

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ICD-10 Program

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ICD-10 Program

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CONTACT INFORMATION

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ICD-10 Program

Carol Garsi, M.Ed., RHIT, CCS ICD-10-CM/PCS approved Trainer Coding Manager Coding Education and Auditing Division UW Medicine garsic@u.washington.edu 206-744-9065

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CONTACT INFORMATION

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ICD-10 Program

Kassie Koledin, M.S., RHIA, CCS ICD-10-CM/PCS approved Trainer Coding Compliance Analyst Coding Education and Auditing Division UW Medicine kassik@u.washington.edu 206-744-9405