ICD10CM will be valid for dates of service on or after October 1 2015 O utpatient dates of service of October 1 2015 and beyond I npatient hospital service claims is effective for dates of discharge after September 30 2015 ID: 1037796
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1. OrthopaedicICD-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. Pain of JointCategory M25.5Excludes1Excludes2Contracture of muscle without contracture of joint (M62.4-)Contracture of tendon (sheath) without contracture of joint (M62.4-)Dupuytren’s contracture (M72.0)acquired deformities of limbs (M20-M21)
13. Pain, ShoulderICD-9 CodeICD-10 CodeDescription719.41M25.511Pain, right shoulder719.41M25.512Pain, left shoulder719.41M25.519Pain, unspecified shoulderPain, ElbowICD-9 CodeICD-10 CodeDescription719.42M25.521Pain, right elbow719.42M25.522Pain, left elbow719.42M25.529Pain, unspecified elbowPain, WristICD-9 CodeICD-10 CodeDescription719.43M25.531Pain, right wrist719.43M25.532Pain, left wrist719.43M25.539Pain, unspecified wristPain, HipICD-9 CodeICD-10 CodeDescription719.45M25.551Pain, right hip719.45M25.552Pain, left hip719.45M25.559Pain, unspecified hipPain, KneeICD-9 CodeICD-10 CodeDescription719.46M25.561Pain, right knee719.46M25.562Pain, left knee719.46M25.569Pain, unspecified knee
14. Pain, Ankle and Foot ICD-9 CodeICD-10 CodeDescription719.47M25.571Pain, right ankle and foot 719.47M25.572Pain, left ankle and foot 719.47M25.579Pain, unspecified ankle and footPain, Unspecified Joint719.40719.48719.49M25.50Pain, unspecified jointDocumentation TipsSiteLateralityRightLeft UnspecifiedUse an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition.
15. Documentation TipsBone versus jointFor certain conditions, the bone may be affected at the upper or lower end, (e.g., avascular necrosis of bone, M87, Osteoporosis, M80, M81). Though the portion of the bone affected may be at the joint, the site designation will be the bone, not the joint.
16. Osteoarthritis of kneeICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2715.96M17.9Osteoarthritis of knee, unspecifiedN/Aosteoarthritis of spine (M47.-)There are more specific code choice selections below:M17.0Bilateral primary osteoarthritis of kneeM17.10Unilateral primary osteoarthritis, unspecified kneeM17.11Unilateral primary osteoarthritis, right kneeM17.12Unilateral primary osteoarthritis, left kneeM17.2Bilateral post-traumatic osteoarthritis of kneeM17.30Unilateral post-traumatic osteoarthritis, unspecified kneeM17.31Unilateral post-traumatic osteoarthritis, right kneeM17.32Unilateral post-traumatic osteoarthritis, left kneeM17.4Other bilateral secondary osteoarthritis of kneeM17.5Other unilateral secondary osteoarthritis of knee
17. IdentifySite LateralityTypePrimaryPost-traumaticOther secondaryUnspecifiedDocumentation Tips
18. Osteoarthritis of hipICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2715.95M16.9 Osteoarthritis of hip, unspecifiedbilateral involvement of single joint (M16-M19)osteoarthritis of spine (M47.-)There are more specific code choice selections below:M16.0Bilateral primary osteoarthritis of hipM16.10Unilateral primary osteoarthritis, unspecified hipM16.11Unilateral primary osteoarthritis, right hipM16.12Unilateral primary osteoarthritis, left hipM16.2Bilateral osteoarthritis resulting from hip dysplasiaM16.30Unilateral osteoarthritis resulting from hip dysplasia, unspecified hipM16.31Unilateral osteoarthritis resulting from hip dysplasia, right hipM16.32Unilateral osteoarthritis resulting from hip dysplasia, left hipM16.4Bilateral post-traumatic osteoarthritis of hipM16.50Unilateral post-traumatic osteoarthritis, unspecified hipM16.51Unilateral post-traumatic osteoarthritis, right hipM16.52Unilateral post-traumatic osteoarthritis, left hipM16.6Other bilateral secondary osteoarthritis of hipM16.7Other unilateral secondary osteoarthritis of hip
19. Identify:LateralityBone versus jointFor certain conditions, the bone may be affected at the upper or lower end, (e.g., avascular necrosis of bone, M87, Osteoporosis, M80, M81). Though the portion of the bone affected may be at the joint, the site designation will be the bone, not the joint.Documentation Tips
20. Cardiac murmur, unspecifiedICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2726.13M75.110Incomplete rotator cuff tear or rupture of unspecified shoulder, not specified as traumaticTear of rotator cuff, traumatic (S46.01-)Shoulder-hand syndrome (M89.0-)There are more specific code choice selections below:M75.111Incomplete rotator cuff tear or rupture of right shoulder, not specified as traumaticM75.112Incomplete rotator cuff tear or rupture of left shoulder, not specified as traumatic
21. Note: Use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal conditionIdentify:LateralityDocumentation Tips
22. Unspecified fracture of forearmICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2813.40S52.90xAUnspecified fracture of unspecified forearmTraumatic amputation of forearm (S58.-)Fracture of wrist and hand level (S62.-)There are more specific code choice selections below:S52.91x-Unspecified fracture of right forearmS52.92x-Unspecified fracture of left forearmThe appropriate 7th character is to be added to all codes from category S52A - initial encounter for closed fractureB - initial encounter for open fracture type I or IIinitial encounter for open fracture NOSC - initial encounter for open fracture type IIIA, IIIB, or IIICD - subsequent encounter for closed fracture with routine healingE - subsequent encounter for open fracture type I or II with routine healingF - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healingG - subsequent encounter for closed fracture with delayed healingH - subsequent encounter for open fracture type I or II with delayed healingJ - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healingK - subsequent encounter for closed fracture with nonunionM - subsequent encounter for open fracture type I or II with nonunionN - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunionP - subsequent encounter for closed fracture with malunionQ - subsequent encounter for open fracture type I or II with malunionR - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunionS - sequela
23. A fracture not indicated as open or closed should be coded to closed. A fracture not indicated whether displaced or not displaced should be coded to displaced.The open fracture designations are based on the Gustilo open fracture classificationIdentify:LateralityDocumentation Tips
24. Low back painICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2724.2M54.5Low back painLoin painLumbago NOSpsychogenic dorsalgia (F45.41)low back strain (S39.012)lumbago due to intervertebral disc displacement (M51.2-)lumbago with sciatica (M54.4-)N/A
25. Document site and lateralityUnspecified codes should be used only in rare circumstancesWith or without sciaticaUse an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition.Low Back Pain Documentation Tips
26. Trochanteric bursitisICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2726.5M70.60Trochanteric bursitis, unspecified hipApplicable to:Trochanteric tendinitisbursitis NOS (M71.9-)bursitis of shoulder (M75.5)enthesopathies (M76-M77)pressure ulcer (pressure area) (L89.-)M70.70Other bursitis of hip, unspecified hipM76.10Psoas tendinitis, unspecified hipM76.20Iliac crest spur, unspecified hipThere are more specific code choice selections below:M70.60Trochanteric bursitis, unspecified hipM70.61Trochanteric bursitis, right hipM70.62Trochanteric bursitis, left hip
27. Identify:lateralityDocumentation Tips
28. Carpal tunnel syndrome, unspecified upper limbICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2354.0G56.00Carpal tunnel syndrome, unspecified upper limbcurrent traumatic nerve disorder - see nerve injury by body regionN/AThere are more specific code choice selections below:G56.01Carpal tunnel syndrome, right upper limbG56.02Carpal tunnel syndrome, leftt upper limb
29. Identify:LateralityDocumentation Tips
30. Unspecified intracapsular fracture of femurICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2820.00S72.019AUnspecified intracapsular fracture of femurApplicable to:Subcapital fracture of femurtraumatic amputation of hip and thigh (S78.-)fracture of lower leg and ankle (S82.-)fracture of foot (S92.-)periprosthetic fracture of prosthetic implant of hip (T84.040, T84.041)There are more specific code choice selections below:S72.011-Unspecified intracapsular fracture of right femurS72.012-Unspecified intracapsular fracture of left femurThe appropriate 7th character is to be added to all codes from category S72A - initial encounter for closed fractureB - initial encounter for open fracture type I or IIinitial encounter for open fracture NOSC - initial encounter for open fracture type IIIA, IIIB, or IIICD - subsequent encounter for closed fracture with routine healingE - subsequent encounter for open fracture type I or II with routine healingF - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healingG - subsequent encounter for closed fracture with delayed healingH - subsequent encounter for open fracture type I or II with delayed healingJ - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healingK - subsequent encounter for closed fracture with nonunionM - subsequent encounter for open fracture type I or II with nonunionN - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunionP - subsequent encounter for closed fracture with malunionQ - subsequent encounter for open fracture type I or II with malunionR - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunionS - sequela
31. A fracture not indicated as open or closed should be coded to closedThe open fracture designations are based on the Gustilo open fracture classificationIdentify:LateralityOpen or closedDocumentation Tips
32. Pain in limbICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2729.5 M79.60-Pain in limb, unspecifiedpsychogenic rheumatism (F45.8)soft tissue pain, psychogenic (F45.41)Pain in joint (M25.5-)There are more specific code choice selections below:729.5 M79.62-Pain in upper arm729.5 M79.63-Pain in forearm729.5 M79.64-Pain in hand and fingers729.5 M79.65-Pain in thigh729.5 M79.66-Pain in leg729.5 M79.67-Pain in foot and toes
33. SiteLateralityUse an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal conditionDocumentation Tips
34. Sprain of unspecified rotator cuff capsuleICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2840.4S43.429ASprain of unspecified rotator cuff capsule, initial encounterrotator cuff syndrome (complete) (incomplete), not specified as traumatic (M75.1-)strain of muscle, fascia and tendon of shoulder and upper arm (S46.-)injury of tendon of rotator cuff (S46.0-)840.4S43.429DSprain of unspecified rotator cuff capsule, subsequent encounter840.4S43.429SSprain of unspecified rotator cuff capsule, sequelaCode also any associated open woundThere are more specific code choice selections below:S43.421-Sprain of right rotator cuff capsuleS43.422-Sprain of left rotator cuff capsuleS43.429-Sprain of unspecified rotator cuff capsule
35. Use secondary code(s) from Chapter 20, External causes of morbidity, to indicate cause of injury. Codes within the T section that include the external cause do not require an additional external cause codeThe chapter uses the S-section for coding different types of injuries related to single body regions and the T-section to cover injuries to unspecified body regions as well as poisoning and certain other consequences of external causes. Identify:LateralityDocumentation Tips
36. Secondary osteoarthritis, shoulderICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2715.21M19.219Secondary osteoarthritis, unspecified shoulderPolyarthritis (M15.1-)arthrosis of spine (M47.-)Hallux rigidus (M20.2)osteoarthritis of spine (M47.-)There are more specific code choice selections below:M19.211Secondary osteoarthritis, right shoulderM19.212Secondary osteoarthritis, left shoulder
37. Identify:LateralityPrimary, Secondary, Post-traumaticDocumentation Tips
38. Displaced intertrochanteric fracture of femurICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2820.21S72.143-Displaced intertrochanteric fracture of unspecified femurtraumatic amputation of hip and thigh (S78.-)fracture of lower leg and ankle (S82.-)fracture of foot (S92.-)periprosthetic fracture of prosthetic implant of hip (T84.040, T84.041)There are more specific code choice selections below:S72.141-Displaced intertrochanteric fracture of right femurS72.142-Displaced intertrochanteric fracture of left femurThe appropriate 7th character is to be added to all codes from category S72A - initial encounter for closed fractureB - initial encounter for open fracture type I or IIinitial encounter for open fracture NOSC - initial encounter for open fracture type IIIA, IIIB, or IIICD - subsequent encounter for closed fracture with routine healingE - subsequent encounter for open fracture type I or II with routine healingF - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healingG - subsequent encounter for closed fracture with delayed healingH - subsequent encounter for open fracture type I or II with delayed healingJ - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healingK - subsequent encounter for closed fracture with nonunionM - subsequent encounter for open fracture type I or II with nonunionN - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunionP - subsequent encounter for closed fracture with malunionQ - subsequent encounter for open fracture type I or II with malunionR - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunionS - sequela
39. A fracture not indicated as open or closed should be coded to closedThe open fracture designations are based on the Gustilo open fracture classificationIdentify:LateralityDocumentation Tips
40. Other specified postprocedural statesICD-9 CodeICD-10 CodeDescriptionExcludes1Excludes2V45.89Z98.89Other specified postprocedural statesApplicable To:Personal history of surgery, not elsewhere classifiedN/AN/ACode also any follow-up examination (Z08-Z09)
41. Note: Z codes represent reasons for encounters. A corresponding procedure code must accompany a Z code if a procedure is performed. Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00-Y89 are recorded as 'diagnoses' or 'problems'. This can arise in two main ways:(a) When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury.(b) When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury. 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. codingresource@g1hs.comCenters for Disease Control and Prevention (ICD-10-CM)http://www.cdc.gov/nchs/icd/icd10cm.htmQuestions