Pulmonology ICD-10 CM Training - PowerPoint Presentation

1. PulmonologyICD-10 CM Training

2. ICD-10-CM will be valid for dates of service on or after October 1, 2015Outpatient dates of service of October 1, 2015 and beyond. Inpatient hospital service claims, is effective for dates of discharge after September 30, 2015ICD-10-CM Compliance Dates

3. Covered EntitiesEveryone covered by the Health Insurance Portability Accountability Act (HIPPA)Non-Covered EntitiesWorker’s CompensationAuto InsuranceNon covered HIPAA entities are exempt but are encouraged to adapt the new code setCovered and Non-Covered Entities

4. 21 ChaptersAlpha-numeric codes; not case-sensitiveCodes begin with Alpha letter, A-Z, excluding UCommon errorsI verses 1O verses 0“X” Placeholder3 to 7 characters Decimal following 3rd characterICD-10 Code Structure

5. Placeholder “X”Used for future expansion of a codeFills in empty characters when a 6th and/or 7th character applyThe placeholder may be used in different scenarios but should never serve as the final character.Example: W19.XXXA Unspecified fall, Initial EncounterICD-10 Code Structure

6. 7th CharacterProvides specified information regarding the clinical visitIs required for certain categories and must be reported in the seventh positionMay be alpha or numericHas different meanings depending on the coding categoryICD-10 Code Structure

7. LateralitySome ICD-10-CM codes indicate laterality, specifying whether the condition occurs on the left, right or is bilateral. If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side. If the side is not identified in the medical record, assign the code for the unspecified side. OGCR section 1.B.13ICD-10 Code Structure

8. “Other” CodesCodes titled “other” or “other specified” are for use when the information in the medical record provides detail for which a specific code does not exist.“Unspecified” CodesCodes titled “unspecified” are for use when the information in the medical record is insufficient to assign a more specific code.OGCR section 1.A.9.a.bICD-10 Code Structure

9. Excludes NotesExcludes1A type 1 Excludes note is a pure excludes noteIt means “NOT CODED HERE”The code excluded should never be used at the same timeWhen two conditions cannot occur togetherExcludes2Represents “Not included here”The condition excluded is not part of the condition represented by the codeIt is acceptable to use both the code and the excluded code together, when appropriateOGCR section 1.A.12.a.bICD-10 Structure

10. “Code First” and “Use Additional Code”ICD-10 has a coding convention that requires the underlying condition be sequenced first followed by the manifestation.These instructional notes indicate the proper sequencing order of the codes.OGCR section 1.A.13The “-” indicates there are additional reporting optionsICD-10 Code Structure

11. Most Common Diagnosis Codes

12. Chronic Obstructive Pulmonary Disease (COPD)ICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2496J44.9Chronic obstructive pulmonary disease, unspecifiedApplicable to: Chronic obstructive airway disease NOS Chronic obstructive lung disease NOSBronchiectasis (J47.-)Chronic bronchitis NOS (J43)Chronic simple and mucopurulent bronchitis (J14.-)Chronic tracheitis (J42)Chronic tracheobronchitis (J42)Emphyysema without chronic bronchitis (J43.-)Lung diseases due to external agents (J60-J70)N/AThere are more specific code choice selections below:491.22493.21J44.0Chronic obstructive pulmonary disease with acute lower respiratory infection491.21493.22J44.1Chronic obstructive pulmonary disease with (acute) exacerbation

13. Code also type of asthma, if applicable (J45)Use additional code to identify:Exposure to environmental tobacco smoke (Z77.22)History of tobacco use (Z87.891)Occupational exposure to environmental tobacco smoke (Z57.31)Tobacco dependence (F17.-)Tobacco use (Z72.0)COPD Documentation Tips

14. Shortness of breathICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2786.05R06.02Shortness of breathabnormalities originating in the perinatal period (P29.1-)specified arrhythmias (I47-I49)acute respiratory distress syndrome (J80)respiratory arrest (R09.2)respiratory arrest of newborn (P28.81)respiratory distress syndrome of newborn (P22.-)respiratory failure (J96.-)respiratory failure of newborn (P28.5)tachypnea NOS (R06.82)transient tachypnea of newborn (P22.1)abnormal findings on antenatal screening of mother (O28.-)certain conditions originating in the perinatal period (P04-P96)signs and symptoms classified in the body system chaptersPage 935signs and symptoms of breast (N63, N64.5)There are more specific code choice selections below: 786.09R06.00Dyspnea, unspecified786.02R06.01Orthopnea786.09R06.09Other forms of dyspnea

15. Dyspnea TypeShortness of breathOrthopneaOther formsDocumentation Tips

16. Use of symptom codesCodes that describe symptoms and signs are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider.Use of a symptom code with a definitive diagnosis codeCodes for signs and symptoms may be reported in addition to a related definitive diagnosis when the sign or symptom is not routinely associated with that diagnosis, such as the various signs and symptoms associated with complex syndromes. The definitive diagnosis code should be sequenced before the symptom code.Signs or symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.Combination codes that include symptomsICD-10-CM contains a number of combination codes that identify both the definitive diagnosis and common symptoms of that diagnosis. When using one of these combination codes, an additional code should not be assigned for the symptom.Documentation Tips

17. Sleep apnea (adult) (pediatric)ICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2327.20780.51G47.30Sleep apnea, unspecifiedApplicable to:Sleep apnea NOSApnea NOS (R06.81)Cheyne-Stokes breathing (R06.3)Pickwickian syndrome (E66.2)Sleep apnea of newborn (P28.3)nightmares (F51.5)nonorganic sleep disorders (F51.-)sleep terrors (F51.4)sleepwalking (F51.3)There are more specific code choice selections below: SEE NEXT SLIDE

18. Sleep apneaICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2327.21G47.31Primary central sleep apneaApnea NOS (R06.81)Cheyne-Stokes breathing (R06.3)Pickwickian syndrome (E66.2)Sleep apnea of newborn (P28.3)nightmares (F51.5)nonorganic sleep disorders (F51.-)sleep terrors (F51.4)sleepwalking (F51.3)327.22G47.32High altitude periodic breathing327.23G47.33Obstructive sleep apnea (adult) (pediatric)327.24G47.34Idiopathic sleep related nonobstructive alveolar hypoventilationApplicable To:Sleep related hypoxia327.25G47.35Congenital central alveolar hypoventilation syndrome327.26G47.36Sleep related hypoventilation in conditions classified elsewhere327.27G47.37Central sleep apnea in conditions classified elsewhere327.29G47.39Other sleep apneaCode also any associated underlying condition

19. Other nonspecific abnormal finding of lung fieldICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2793.19R91.8Other nonspecific abnormal finding of lung fieldApplicable To:Lung mass NOS found on diagnostic imaging of lungPulmonary infiltrate NOSShadow, lungabnormal findings on antenatal screening of mother (O28.-)diagnostic abnormal findings classified elsewhere - see Alphabetical IndexN/AThere are more specific code choice selections below: 793.11R91.1Solitary pulmonary noduleApplicable to:Coin lesion lungSolitary pulmonary nodule, subsegmental branch of the bronchial tree

20. Includes:nonspecific abnormal findings on diagnostic imaging by computerized axial tomography [CAT scan]nonspecific abnormal findings on diagnostic imaging by magnetic resonance imaging [MRI][NMR]nonspecific abnormal findings on diagnostic imaging by positron emission tomography [PET scan]nonspecific abnormal findings on diagnostic imaging by thermographynonspecific abnormal findings on diagnostic imaging by ultrasound [echogram]nonspecific abnormal findings on diagnostic imaging by X-ray examinationDocumentation Tips

21. AsthmaICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2493.00, 493.10J45.20Mild intermittent asthma, uncomplicated or NOSbronchitis due to chemicals, gases, fumes and vapors (J68.0)cystic fibrosis (E84.-)493.01, 493.11J45.22Mild intermittent asthma with status asthmaticusN/AN/A493.02, 493.12J45.21Mild intermittent asthma with (acute) exacerbationN/AN/A493.82J45.991Cough variant asthmaN/AN/A493.90J45.909J45.998Unspecified asthma, uncomplicatedOther asthmaN/AN/A493.91J45.902Unspecified asthma with status asthmaticusbronchitis due to chemicals, gases, fumes and vapors (J68.0)cystic fibrosis (E84.-)493.92J45.901Unspecified asthma with (acute) exacerbationbronchitis due to chemicals, gases, fumes and vapors (J68.0)cystic fibrosis (E84.-)

22. Asthma Severity ChartINTERMITTENTMILD PERSISTENTMODERATE PERSISTENTSEVERE PERSISTENTSYMPTOMS2 or less daysper weekMore than 2days perweekDailyThroughoutthe dayNIGHTIME AWAKENINGS2 x’s permonth or less3 – 4 x’s permonthMore thanonce perweek but notnightlyNightlyRESCUE INHALER USE2 or less daysper weekMore than 2days perweek, but notdailyDailySeveral timesper dayINTERFERENCE WITH NORMAL ACTIVITYNoneMinorlimitationSomelimitationExtremelylimitedLUNG FUNCTIONFEVI>80% predicted and normal between exacerbationsFEV1>80%predictedFEV1 60 –80%predictedFEV1 lessthan 60%predicted

23. When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site (e.g. tracheobronchitis to bronchitis in J40). Use additional code, where applicable, to identify:exposure to environmental tobacco smoke (Z77.22)exposure to tobacco smoke in the perinatal period (P96.81)history of tobacco use (Z87.891)occupational exposure to environmental tobacco smoke (Z57.31)tobacco dependence (F17.-)tobacco use (Z72.0)Documentation Tips

24. CoughICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2786.2R05CoughCough with hemorrhage (R04.2)Smoker’s Cough (J41.0)N/A

25. Symptom Codes Codes that describe symptoms and signs are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider.Use of a symptom code with a definitive diagnosis codeCodes for signs and symptoms may be reported in addition to a related definitive diagnosis when the sign or symptom is not routinely associated with that diagnosis code.Signs or symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.Cough Documentation Tips

26. Cystic fibrosisICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2277.00 E84.9Cystic fibrosis, unspecifiedIncludes:mucoviscidosisandrogen insensitivity syndrome (E34.5-)congenital adrenal hyperplasia (E25.0)Ehlers-Danlos syndrome (Q79.6)hemolytic anemias attributable to enzyme disorders (D55.-)Marfan's syndrome (Q87.4)5-alpha-reductase deficiency (E29.1)N/AThere are more specific code choice selections below:277.02E84.0Cystic fibrosis with pulmonary manifestationsUse additional code to identify any infectious organism present, such as: Pseudomonas (B96.5)277.01E84.11Meconium ileus in cystic fibrosisExcludes1: meconium ileus not due to cystic fibrosis (P76.0)277.03E84.19Cystic fibrosis with other intestinal manifestationsDistal intestinal obstruction syndrome277.09E84.8Cystic fibrosis with other manifestations

27. Identify:Anatomical siteManifestations (e.g. bronchopneumonia)Documentation Tips

28. Pulmonary fibrosisICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2515J84.10Pulmonary fibrosis, unspecifiedApplicable to:Capillary fibrosis of lungCirrhosis of lung (chronic) NOSFibrosis of lung (atrophic) (chronic) (confluent) (massive) (perialveolar) (peribronchial) NOSInduration of lung (chronic) NOSPostinflammatory pulmonary fibrosisdrug-induced interstitial lung disorders (J70.2-J70.4)interstitial emphysema (J98.2)lung diseases due to external agents (J60-J70)pulmonary fibrosis (chronic) due to inhalation of chemicals, gases, fumes or vapors (J68.4)pulmonary fibrosis (chronic) following radiation (J70.1)N/AThere are more specific code choice selections below:J84.89Other specified interstitial pulmonary diseases

29. When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site (e.g. tracheobronchitis to bronchitis in J40).Use additional code, where applicable, to identify:exposure to environmental tobacco smoke (Z77.22)exposure to tobacco smoke in the perinatal period (P96.81)history of tobacco use (Z87.891)occupational exposure to environmental tobacco smoke (Z57.31)tobacco dependence (F17.-)tobacco use (Z72.0)Documentation Tips

30. SarcoidosisICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2135D86.9Sarcoidosis, unspecifiedautoimmune disease (systemic) NOS (M35.9)functional disorders of polymorphonuclear neutrophils (D71)human immunodeficiency virus [HIV] disease (B20)N/AThere are more specific code choice selections below:135D86.0Sarcoidosis of lung

31. Idiopathic interstitial pneumoniaICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2516.30J84.111Idiopathic interstitial pneumonia, not otherwise specified lymphoid interstitial pneumonia (J84.2)pneumocystis pneumonia (B59)N/AThere are more specific code choice selections below:516.31J84.112Idiopathic pulmonary fibrosis516.32J84.113Idiopathic non-specific interstitial pneumonitis516.33J84.114Acute interstitial pneumonitis516.34J84.115Respiratory bronchiolitis interstitial lung disease516.36J84.116Cryptogenic organizing pneumonia516.37J84.117Desquamative interstitial pneumonia

32. When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it shouldbe classified to the lower anatomic site (e.g. tracheobronchitis to bronchitis in J40).Use additional code, where applicable, to identify:exposure to environmental tobacco smoke (Z77.22)exposure to tobacco smoke in the perinatal period (P96.81)history of tobacco use (Z87.891)occupational exposure to environmental tobacco smoke (Z57.31)tobacco dependence (F17.-)Tobacco use (Z72.0)Documentation Tips

33. BronchiectasisICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2494.0J47.9Bronchiectasis, uncomplicatedApplicable to:Bronchiectasis NOScongenital bronchiectasis (Q33.4)tuberculous bronchiectasis (current disease) (A15.0))N/AThere are more specific code choice selections below:494.1J47.0Bronchiectasis with acute lower respiratory infectionApplicable to: Bronchiectasis with acute bronchitis494.1J47.1Bronchiectasis with (acute) exacerbation

34. When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it shouldbe classified to the lower anatomic site (e.g. tracheobronchitis to bronchitis in J40).Use additional code, where applicable, to identify:exposure to environmental tobacco smoke (Z77.22)exposure to tobacco smoke in the perinatal period (P96.81)history of tobacco use (Z87.891)occupational exposure to environmental tobacco smoke (Z57.31)tobacco dependence (F17.-)Tobacco use (Z72.0)Documentation Tips

35. Multiple sclerosisICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2340G35Multiple sclerosisApplicable To:Disseminated multiple sclerosisGeneralized multiple sclerosisMultiple sclerosis NOSMultiple sclerosis of brain stemMultiple sclerosis of cordN/A

36. Chronic Obstructive Pulmonary Disease (COPD)ICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2496491.20J44.9Chronic obstructive pulmonary disease, unspecifiedApplicable to: Chronic obstructive airway disease NOS Chronic obstructive lung disease NOSBronchiectasis (J47.-)Chronic bronchitis NOS (J43)Chronic simple and mucopurulent bronchitis (J14.-)Chronic tracheitis (J42)Chronic tracheobronchitis (J42)Emphyysema without chronic bronchitis (J43.-)Lung diseases due to external agents (J60-J70)N/AThere are more specific code choice selections below:491.22493.21J44.0Chronic obstructive pulmonary disease with acute lower respiratory infection491.21493.22J44.1Chronic obstructive pulmonary disease with (acute) exacerbation

37. Code also type of asthma, if applicable (J45)Use additional code to identify:Exposure to environmental tobacco smoke (Z77.22)History of tobacco use (Z87.891)Occupational exposure to environmental tobacco smoke (Z57.31)Tobacco dependence (F17.-)Tobacco use (Z72.0)COPD Documentation Tips

38. Other respiratory disordersICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2519.8J98.8Other specified respiratory disordersnewborn apnea (P28.4)newborn sleep apnea (P28.3)apnea NOS (R06.81)sleep apnea (G47.3-)There are more specific code choice selections below:J98.01Acute bronchospasmJ98.09Other diseases of bronchus, not elsewhere classifiedJ98.11AtelectasisJ98.19Other pulmonary collapseJ98.2Interstitial emphysemaJ98.3Compensatory emphysemaJ98.4Other disorders of lungJ98.5Diseases of mediastinum, not elsewhere classifiedJ98.6Disorders of diaphragmJ98.9Respiratory disorder, unspecified

39. When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it shouldbe classified to the lower anatomic site (e.g. tracheobronchitis to bronchitis in J40).Use additional code, where applicable, to identify:exposure to environmental tobacco smoke (Z77.22)exposure to tobacco smoke in the perinatal period (P96.81)history of tobacco use (Z87.891)occupational exposure to environmental tobacco smoke (Z57.31)tobacco dependence (F17.-)Tobacco use (Z72.0)Documentation Tips

40. Localized swelling, mass and lump, trunkICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2786.6R22.2Localized swelling, mass and lump, trunkabnormal findings on diagnostic imaging (R90-R93)edema (R60.-)enlarged lymph nodes (R59.-)localized adiposity (E65)swelling of joint (M25.4-)intra-abdominal or pelvic mass and lump (R19.0-)intra-abdominal or pelvic swelling (R19.0-)abnormal findings on antenatal screening of mother (O28.-)certain conditions originating in the perinatal period (P04-P96)signs and symptoms classified in the body system chapterssigns and symptoms of breast (N63, N64.5)breast mass and lump (N63)

41. Symptom Codes Codes that describe symptoms and signs are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider.Use of a symptom code with a definitive diagnosis codeCodes for signs and symptoms may be reported in addition to a related definitive diagnosis when the sign or symptom is not routinely associated with that diagnosis code.Signs or symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.Documentation Tips

42. On October 01, 2015 we will monitor claims for date of service rulesOutpatient claims cannot have crossover dates Outpatient claims will be coded according to date of serviceInpatient facility claims will be coded per date of dischargeWe will monitor claims to resolve any unanticipated problems with the submission processMonitor Claims

43. We will monitor for claim denialsWe will monitor editing trends for ICD-10 Coding guidelinesWe will provide feedback to the physicians regarding supporting documentation requirements We will monitor WC or Liability carriers for published rules on use of ICD-9 or ICD-10 code setsClaim Denial and Management

44. Client will need to update TemplatesOrder SetsSuperbillsFavoritesFuture OrdersRemove ICD-9 code add ICD-10 codeClient Responsibilities

45. All Conditions treated or assessed must be documented in the medical record. In addition to the documentation tips reviewed, below are more areas to document that will ensure proper ICD-10-CM code selection.Site specificityDocument notation of qualifiersExacerbationManifestationsRelapseStatusStagesIndicate acute or chronicIndicate underlying or external cause factorsMedicationSmokeAccidentsMechanical failureLateralityBilateralRight LeftDocumentation – Start Now

46. Episode of Care for injuries, poisoning, external causes and other conditionsInitial EncounterUse while the patient is receiving active treatment of the conditionActive treatment includes surgical treatment, an emergency encounter, and evaluation and treatment by a new physicianSubsequent EncounterUsed on encounter after the patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase.Medication adjustments, aftercare, device adjustments, cast changeSequelaUsed for complications or conditions that arise as a direct result of a condition, late effectDocumentation – Start Now

47. Combination codes that captureEtiology and manifestationRelated conditionsDisease, injury or other medical condition and complicationsDisease or other medical conditions and common signs or symptomsAdd ICD-10 Codes to patient Problem ListDocumentation – Start Now

48. UnderdosingUnderdosing refers to taking less of a medication than is prescribed by a provider or a manufacturer’s instruction. For underdosing, assign the code from categories T36-T50 (fifth or sixth character “6”).Codes for underdosing should never be assigned as principal or first-listed codes. If a patient has a relapse or exacerbation of the medical condition for which the drug is prescribed because of the reduction in dose, then the medical condition itself should be coded.Noncompliance (Z91.12-, Z91.13-) or complication of care (Y63.6-Y63.9) codes are to be used with an underdosing code to indicate intent, if known.OGCR Section 1.C.19.e.5.cOfficial Guidelines for Coding and Reporting

49. codingresource@g1hs.comCenters for Disease Control and Prevention (ICD-10-CM)http://www.cdc.gov/nchs/icd/icd10cm.htmQuestions