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ICD-10
“I’m Back”
October 1, 2015
“in 10 min. or less”
Louis McIntyre, MD
and
William Beach, MD
Conflict of Interest Statement
•
Fellowship Grants
•
•
•
•
•
Share Holder
Tuckahoe Surgery Center & St. Mary’s ASC
•
Comp Recovery
AANA Board of Directors
AAOS Coding, Coverage and Reimbursement
Committee
•
•
•
Smith Nephew
Arthrex
Synthes
Mitek
ICD 10 – Just the Facts
 Determine
how and
how much $ will it
effect you?
 Establish why we
need it?
 Describe when we
need to use it?
 Understand the logic
and it becomes
obvious! (maybe not
easy)
12/4/2014
12/4/2014
ICD 9 –> 10 Why




ICD 9 is out of
numbers!
The 5 digit ICD 9, all
numeric system can no
longer accommodate
new diagnoses!
The desire for more
detail, a more granular
system has lead to the
creation of ICD 10.
CM = Clinical
Modification
When Do Surgeons Need
ICD?

ICD “Legitimizes/Substantiates” “Every” CPT
Codes
 S83.211 (Traumatic bucket handle tear of the right
medial meniscus) or similar code,
substantiates/ALLOWS PAYMENT for 29881
 Need an ICD code to support E&M 99203, 99213-4

NO/Incorrect ICD with CPT = NO
REIMBURSEMENT!
Contrasting ICD 9 & 10
ICD9-CM

Dxs: Vols 1&2
 Procs: Vol 3
ICD10-CM
~14,000
~ 4,000

Dx Codes
 3-5 digits max
 Only numeric
 No placeholder

Specificity
 No laterality
 Injuries grouped by type of injury
 Only open vs closed
fracture

Dxs: ICD10-CM
~68,000
 Procs: ICD10-PCS ~87,000


Dx Codes
 3-7 digits max
 Alphanumeric
 “x” serves as placeholder at 5th
(and 6th) positions
Specificity
 Laterality
 Injuries grouped by anatomical site
 Gustilo open fracture type
Expanded combination codes
ICD 10 = 7 Characters
•
•
7 digits for higher specificity
Alphanumeric Codes
•
•
•
•
•
•
Character 1 is always Alpha
Character 2 is always Numeric
Character 3-7 can be either Alpha or
Numeric
All letters are used except “U”
7th digit for orthopedics = letter
Decimal after the 1st three characters
S83.211A = bucket handle tear R med. men
Logic of ICD 10
(Orthopedics)
A new and better ICD system would
ask/answer:
 Chronic/degenerative (M chapter13 ) vs.
acute/traumatic (S chapter 19)
 Right vs. left (6th digit) (usually 1 or 2)
 Natural history of a condition (7th digit)

Logic of ICD 10
First Character = Chapter M or S
 The next 4 digits – have to learn

 Diagnosis codes to describe a specific
condition. For example a traumatic rotator
cuff tear is S46.01.

The 6th digit describes laterality
 S46.011 is a traumatic right rotator cuff
strain and S46.012 is a traumatic left rotator
cuff strain
 S46.02 = laceration (S46.021 = R)
Logic of ICD 10 - 7th Digit =
Natural History: Non- Fracture
A = initial visit/evaluation of a condition
 D = subsequent (follow-up) visit for the
same condition
 S = sequelae of that condition


S46.021A= R RCT (acute)(initial eval)
ICD 10 Reality of
Orthopedics

Be comfortable with 2 Chapters – M and S
 The “degenerative” conditions of orthopedics are
found in the M Chapter
○ Those conditions have the first character M
○ Derangement of posterior horn of medial
meniscus due to old tear or injury, right knee =
M23.221
 The “traumatic” or “acute” conditions are found in
the S Chapter
○ Those conditions have the first character S
○ Peripheral tear of medial meniscus, current injury,
right knee = S83.221
How to Find an ICD-10 Code?
Helpful Resources


AAOS Code-X Has
pick lists and key
word searches for
ICD-10
GET CODE-X from
the AAOS!!!! Will
allow knee>meniscus->bucket>R/L->7th digit
 7th = initial(A),
subsequent(D) and
sequelae(S)
ICD 10 Example
18 year old football player
injures his right knee. He is
seen in your office, for the first
time with an MRI that shows
bucket handle tear medial
meniscus
Using the AMA Code Book
 Go
to
Alphabetical
List
 Refers you to
CHAPTER - S
 Provides 5 digits
Code Book




Go to
corresponding
TABULAR List
CHAPTER - S
Get the
specifics/laterality
S83.211
Final Code - Add
Character



A = Initial Encounter
D = Subsequent
Encounter
S = Sequelae
S83.211A = bucket
handle tear R med. Men
S83.212A = bucket
handle tear L med. Men
th
7
How to Find an ICD-10 Code?
Helpful Resources
ICD-10
Complete
Official
Code Set
from the
AMA
Fracture ICD 10 = Logical
Confusion
You must know the Gustillo Classification
 All S codes = Traumatic/Acute
 First character = S
 Next 4 are diagnosis specific

 Code X
 Cheat Sheet

7th character = Letter = History
 Initial encounter, routine healing, delayed
healing, non-union, mal-union or sequelae
ICD 10 7th Digit: Fractures =
Gustilo Classification






A = initial encounter for a closed fracture
B = initial encounter for an open grade I or II
C = initial encounter for and open grade III
(A,B,C)
D = subsequent encounter for a closed fracture
with routine healing
E = subsequent encounter for an open grade I
or II with routine healing
F = subsequent encounter for an open grade III
(A,B,C) with routine healing
ICD 10 7th Digit: Fractures =
Gustilo Classification
G = subsequent encounter for a closed
fracture with delayed healing;
 H = subsequent encounter for an open
grade I or II with delayed healing;
 There is no letter “I.”
 J = subsequent encounter for an open
grade III (A,B,C) with delayed healing

ICD 10 7th Digit: Fractures =
Gustilo Classification
K = subsequent encounter for a closed
fracture non-union;
 There is no letter “L.”
 M = subsequent encounter for an open
grade I or II with a non-union;
 N = subsequent encounter for an open
grade III (A,B,C) with a non-union
 There is no letter “O.”

ICD 10 7th Digit: Fractures =
Gustilo Classification
P = subsequent encounter for a closed
fracture with a mal-union;
 Q = subsequent encounter for an open
grade I or II with a mal-union
 R = subsequent encounter for an open
grade III (A,B,C)
 S = sequelae

Closed Fracture – 7th character
(5 options)
A = initial encounter for a closed
fracture
 D = subsequent encounter for a closed
fracture with routine healing
 G = subsequent encounter for a closed
fracture with delayed healing
 K = subsequent encounter for a closed
fracture non-union;
 P = subsequent encounter for a closed
fracture with a mal-union;

Open Fracture Grade I or II
7th Character (5 options)
B = initial encounter for an open grade I or II
 E = subsequent encounter for an open grade I
or II with routine healing
 H = subsequent encounter for an open grade I
or II with delayed healing
 M = subsequent encounter for an open grade I
or II with a non-union
 Q = subsequent encounter for an open grade I
or II with a mal-union;

Open Fracture Grade III 7th
Character (5 options)
C = initial encounter for and open grade III
(A,B,C)
 F = subsequent encounter for an open grade
III (A,B,C) with routine healing
 J = subsequent encounter for an open grade
III (A,B,C) with delayed healing
 N = subsequent encounter for an open grade
III (A,B,C) with a non-union
 R = subsequent encounter for an open grade
III (A,B,C)

Keys – Get Started!
Organize the implementation (10
months)
 Analyze the impact on your practice
 Contact systems vendors - KEY
 Budget for costs – training, IT,
outsourced coding
 Contact trading partners
 Implement system/software upgrades

Create aTime Table
Conduct internal testing
 Update internal processes
 Conduct staff training
 Conduct external testing of transactions
wit ICD-10 codes
 Implement (Up to 22 months!!)
 Monitor (3-6 months!)

Implement Action Items
Run ICD-9 Frequency Report for the top
25 OFFICE codes
 Pull OP notes for the top 10
PROCEDURES and evaluate for ability
to code ICD-10
 By end of first quarter of 2015, goal is to
code in both systems
 Check with vendors for resources and
support

Coordinate with Payors/Vendors
Check with top ten payers for their ICD10 status and medical necessity
guidelines-check websites
 Plan test by April-May (2015)? to see if
system is working well enough to
generate payments

Choices
Consider reserving cash, establishing
Line of Credit for cash flow problems
 Get Educated!
 Get a Plan! NOW!
 Get your vendors onboard!

 Consider Scribes = Front End Coders
Remember ONE Thing!!! 2014
 “We are recommending to our clients that
they get a line of credit now and they
should be prepared to cover overhead for 6
months” – Margi Maley (Karen Zepko)
 We reference many articles just like the
one below to support our recommendation.
 http://www.healthcarefinancenews.com/ne
ws/cash-hand-youll-need-it-icd-10?page=0
Practice Conclusion

BECOME A BUSINESS PERSON!
 WHO IS YOUR BEST PAYOR
○ CREATE PROGRAMS THAT ENCOURAGE THEIR
UTILIZATION OF YOUR SERVICE
 REVIEW EOB’S!!!
 MEET WITH YOUR BUSINESS PEOPLE AND ASK
QUESTIONS
○ PAYMENT
○ CONTRACTS
○ ANCILLARIES
 SCRIBES = FRONT END CODERS,
DOCUMENTATION EXPERTS!!!
References
CDC & HCHS for general information
 http://www.cdc.gov/nchs/icd.htm

ICD-10-CM files, information and 9-CM and 10-CM GEMs
 http://www.cdc.gov/nchs/icd/icd10cm.htm

Official guidelines 2011
 http://www.cdc.gov/nchs/data/icd9/10cmguidelines2011_FINAL.p
df


CMS
 http://www.cms.hhs.gov/ICD10
 http://www.cms.hhs.gov/ICD10/02k_2010_ICD_10_CM.asp#

AHIMA
 http://www.ahima.org/icd10