WHAT IS NEW IN ICD 10 CM 2017 REBECCA H WARTMAN OD NORTH CAROLINA OPTOMETRIC SOCIETY NOVEMBER 2016 DISCLAIMERS FOR PRESENTATION 1.All information was current at time it was prepared 2.Drawn from national policies, with links included in the presentation for your use 3.Prepared as a tool to assist doctors and staff and is not intended to grant rights or impose obligations 4.Prepared and presented carefully to ensure the information is accurate, current and relevant 5.No conflicts of interest exist for presenters- financial or otherwise. However, Rebecca is a paid consultant for Eye Care Center OD PA and writes articles
DISCLAIMERS FOR PRESENTATION 6. Of course the ultimate responsibility for the correct submission of claims and compliance with provider contracts lies with the provider of services 7. AOA, AOA-TPC, NCOS, its presenters, agents, and staff make no representation, warranty, or guarantee that this presentation and/or its contents are error-free and will bear no responsibility or liability for the results or consequences of the information contained herein 8. The content of the COPE Accredited CE activity was prepared with assistance from Kara Webb (AOA Staff), Harvey Richman OD, and Doug Morrow OD AOA THIRD PARTY CENTER CODING EXPERTS Rebecca Wartman OD Douglas Morrow OD Harvey Richman OD
WHAT WE WILL COVER Overview of ICD 10 CM Review of important definitions Updates for 2017 Diabetes Codes ARMD Codes Glaucoma Codes Suggested approaches for review of 2017 changes New Resources of 2017 DO NOT FALL ASLEEP Too important CMS leniency ended October 2016 Coding MUST be exact
OVERVIEW OF ICD 10 CM 1st ICD 10 CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification /Procedure Coding System) 2nd 3rd ICD 10 CM for diagnosis coding ICD 10 PCS for inpatient procedure coding (Hospitals only) ICD 10 CM replaces ICD 9 CM Does not change use of CPT in any way US VERSION OF ICD-10-CM NOT WORLD HEALTH VERSION ICD-10-CM owned by World Health Organization BUT ICD-10-CM code set for use in the United States is maintained by the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC) Thus some different rules will apply for US vs World Health Organization versions of code set www.cdc.gov/nchs/icd/icd10cm.htm
ICD-10-CM STRUCTURE ICD 10 CM =68,000 + 3 7 characters Character 1= alpha (except U) Character 2 = numbers Characters 3 7=alpha or # Decimal after 3 characters Alpha characters not case sensitive ICD 10:Dummy placeholder x used when need 7 th character ICD-10-CM TERMINOLOGY AND CONVENTIONS TABULAR LIST Tabular list chapters body system/condition Divided into categories, subcategories and codes Can ONLY report codes Categories 3 characters If has no further subdivision is equivalent to code Subcategories 4 or 5 characters Each level of subdivision after a category is a subcategory If no further subdivision is equivalent to a code Codes 3, 4, 5, 6 or 7 characters Final level of subdivision If 7th character is required invalid without 7th character If placeholder needed X used for code to be valid code
ICD-10-CM TERMINOLOGY AND CONVENTIONS TABULAR LIST Category Subcategory NOT a code These are final codes Subcategory that is Code ICD-10-CM TERMINOLOGY AND CONVENTIONS 7TH CHARACTERS Certain ICD 10 CM categories need 7th character When 7th character is required used for all codes within category or as noted in Tabular List instructions The 7th character must be 7th character in data field If code requires 7th character but is not 6 characters long THEN must use placeholder X to fill in empty characters
ICD-10-CM TERMINOLOGY AND CONVENTIONS EXCLUDES NOTES Excludes1 Pure excludes note- meaning NOT CODED HERE! Excluded code should never be used at same time as code above Excludes1 note Used when two conditions cannot occur together (Example: congenital versus acquired form of same condition Excludes2 Means Not included here Excluded condition is not part of condition represented by code, BUT patient may have both conditions at the same time Excludes2 code acceptable to use when both the code and excluded code occur together ICD-10-CM TERMINOLOGY AND CONVENTIONS EXAMPLES Excludes 1 note Excludes 2 note
ICD-10-CM SEQUENCING ORDER TABULAR NOTES In diseases classified elsewhere codes: Never permitted to be used as first-listed diagnosis code Must be used with underlying condition code Must be listed following the underlying condition Some manifestation codes do not have in diseases classified elsewhere in title use additional code note for the etiology code code first note at the manifestation code Rules for sequencing apply etiology code then manifestation code ICD-10-CM TERMINOLOGY AND CONVENTIONS OTHER NOMENCLATURE Code also note Instructs that two codes may be required to fully describe condition, but this note does not provide sequencing direction Default codes Listed next to a main term in Alphabetic Index The default code represents condition most commonly associated with main term or is the unspecified code for the condition If condition is documented in medical record (for example, appendicitis) without any additional information, such as acute or chronic, the default code should be assigned
WE ARE READY TO CONQUER THIS 2017 ICD 10 CM MOUNTAIN!! CHANGES TO THE DIABETES CODES 2017 All DM patients on DM medication must use 2º code: Z79.4 or Z79.84 Note: does not apply to E10 only
CHANGES TO THE DIABETES CODES 2017 2016 2017 NEW: 7 th character Per Eye CHANGES TO THE DIABETES CODES 2017 2017 Diabetic coding changes are for all the categories No medication code for Type 1 only
CHANGES TO THE DIABETES CODES 2017 2016 2017 Long term Insulin use No change New code for oral DM medications Both used when appropriate In addition to DM diagnosis CHANGES TO THE DIABETES CODES 2017 2016 Several other description were added to E11.35 subcategory. HOWEVER These changes were originally omitted from the initial recorded webinar
CHANGES TO DRY ARMD CODES 2017 2016 Beware: 7 th character Now per eye CHANGES TO DRY ARMD CODES: STAGING DRY ARMD No AMD: >5 small (<63 microns) drusen Mild AMD: Multiple small drusen or some intermediate (63 124 microns) drusen Intermediate AMD: Extensive intermediate drusen, >1 large (>125 microns) drusen, or non central geographic atrophy Advanced AMD: Central geographic atrophy or neovascularization causing vision loss (<20/32) in one eye www.retinalphysician.com
DRY ARMD CODING EXAMPLE : OD AND OS Advanced AMD OD H35.3122 2 = OS 2 = Intermediate Intermediate AMD OD www.goodhopeeyeclinic.org.uk H35.3113 1 = OD avclinic.com 3 = Advanced Both codes necessary to describe patient H35.3113 and H35.3122 CHANGES TO WET ARMD CODES 2017 2016 BEWARE: Similar change for Wet ARMD 7 th character Now per eye
CHANGES TO WET ARMD CODING EXAMPLE H35.3221 2 = OS H35.3213 1 = Active choroidal neo 1 = OD 3 = inactive scar retinagallery.com Both codes necessary to describe patient H35.3213 and H35.3221 webeye.ophth.uiowa.edu CHANGES TO GLAUCOMA CODING 2017 2016 2017 POAG now PER EYE!! Staging remains the same
CHANGES TO GLAUCOMA CODING 2017 Code 1 st No change Removed DM from Excludes1 Added an Excludes2 note for glaucoma in DM CHANGES TO CRVO CODES 2017 2016 2017 NOTE!! 7 th Character Still Per Eye
CRVO CODING EXAMPLE 1 = OD H34.8110 lifeinthefastlane.com 0 = With ME CRVO CODING EXAMPLE Well compensated CRVO H34.8122 2 = OS 2 = Old CRVO emedicine.medscape.com
CHANGES TO BRVO CODING 2016 2017 Similar to CRVO New 7 th Character Still Per Eye BRVO CODING EXAMPLES Left BRVO = H34.832 +7th en.wikipedia.org H34.8320 0 = with ME H34.8322 2 = Stable, old emedicine.medscape.com
CHANGES TO AMBLYOPIA CODES 2017 Brand new subcategory within Amblyopia POSTPROCEDURAL CODE CHANGES 2017 2017 ALL of these codes are per eye for 2016 and 2017 ONLY Subcategories listed here
OTHER CODE CHANGES OF NOTE 2017 2016 2017 Also for: I69.11 I69.21 I69.31 I69.81 I69.91 OTHER CODE CHANGES OF NOTE 2017 2016 2017 2016
OTHER CODE CHANGES OF NOTE 2017 Chapter 20: Wording changes added some Excludes1 and Excludes2 codes Review any of these codes used for changes from 2016 ICD-10-CM RESOURCES American Optometric Association www.aoa.org/coding AOA Coding Today http://aoa.codingtoday.com/ CDC ICD 10 CM Official USA site http://www.cdc.gov/nchs/icd/icd10cm.htm 2017 release of ICD 10 CM has all the downloads CMS ICD 10 CM information https://www.cms.gov/medicare/coding/icd10/index.html X World Health X but Use for general training only http://apps.who.int/classifications/apps/icd/icd10training
EQUIP YOUR OFFICE FOR ICD 10 CHANGES From AOA Marketplace Preorder 2017 AOA Coding Bundle available Sept. 15 Includes: 2017 AOA Codes for Optometry (ICD 10) 2017 ICD 10 CM AOA Express Mapping Card (not sold separately) 2017 AMA CPT Professional Edition Additional ICD 10 resources from AOA: http://www.aoa.org/optometrists/tools and resources/medicalrecords and coding/icd 10 SUCCESS!! HAPPY CODING!!
QUESTIONS??? Submit all ICD 10 CM questions and any coding questions to: https://www.aoa.org/ask the coding experts THANK YOU!!