ICD-10-CM: Coding and Clinical Documentation Changes Maternal

Transcription

ICD-10-CM: Coding and Clinical
Documentation Changes
Maternal & Child Care
Presented by:
Angie Audler, MBA, RHIT, CCS, CPC,
AHIMA Approved ICD-10-CM/PCS Trainer
Copyright c 2015
Confidential and Proprietary Information
Disclaimer
• This PowerPoint presentation is an education tool
to provide basic information for coding. The
information is the sole view of the author and
was put together based on experience, research
and expertise in the coding profession. It is not
intended to be an exhaustive review and should
not be considered a substitution for Coding
Guidelines. The presenter does not accept any
responsibility or liability with regard to errors,
omissions misinterpretations or misuse by the
audience.
Copyright c 2015
Today’s Topics
•
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Brief Overview of ICD-10-CM/PCS
How does ICD-10 Impact you as a Provider
Common ICD-10 Codes
Clinical Documentation Awareness Tips for
ICD-10
Copyright © 2015
Brief Overview of ICD-10-CM/PCS
• ICD-10 is composed of two parts:
– ICD-10-CM (clinical modification)
– ICD-10-PCS (procedural coding system)
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The Difference Between ICD-10-CM/PCS
• ICD-10-CM – Replaces ICD-9-CM Vol. 1 & 2 Codes
– ICD-10-CM will be used to identify diagnosis codes in all health
care settings
• ICD-10-PCS – Replaces ICD-9 Vol. 3 Procedure Codes (facility use
only)
ICD-10PCS will be used by facilities to report procedures in the
hospital inpatient setting
• Physicians and Other Healthcare Professionals will continue to use
CPT and HCPCS (Level II) codes to report office and other
procedures and services
• Hospital Outpatient Departments/OPSurgery and Ambulatory
Surgery Centers will also continue to use CPT and HCPCS (Level II)
codes for reporting outpatient procedures and ancillary services
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ICD-10-PCS
• Under ICD-10, new and cutting-edge technology
that have been problematic to code in ICD-9 will
be assigned based on surgeon’s documentation in
the operative note
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Type of surgery
Body system
Root operation
Body part
Approach
Device
Qualifiers (e.g. biopsy, second site, etc.)
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Compliance Date
• October 1, 2015
– Date of service on or after 10/01/2015 for office and
other outpatient services (including Hospital
Observation)
• ED and Observation services prior to 10/1 with overlap on
or after 10/1 will use ICD9 codes for reporting
– Discharge date on or after 10/01/2015 for hospital
inpatient discharges
– Claims for services prior to 10/1/2015 will continue to
flow through systems utilizing ICD-9-CM diagnosis and
ICD-9-CM Vol. 3 procedure codes (for facilities) for a
period of time
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Overview of ICD-10-CM
• The transition to ICD-10 affects all HIPAA-covered
entities – hospitals, physicians, allied health
professionals, home health, skilled nursing, etc.;
as well as payers, business associates – billing
companies, vendors, clearinghouses
• Non-covered entities (e.g. automobile insurance
and worker’s compensation programs are not
required to transition to ICD-10), although it is
recommended
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ICD-10-CM Changes
• There are three main categories of changes in
ICD-10-CM
- Definition Changes
- Differences in Terminology
- Increased Documentation Specificity
• ICD-10 doesn’t affect coding only; it involves
physician reporting, billing, information
technology, and revenue management
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Comparison
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ICD-10-CM
• Although there are approximately 70,000 codes in
ICD-10, specialists will use only a small subset of
those codes
• You will be surprised at how much of this work you
are already doing
• Over 1/3 of the expansion codes are due to laterality
(physicians are already documenting right, left,
bilateral)
– If bilateral and there is no specific code for bilateral, you
code both right and left sides
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Overview of ICD-10-CM
• ICD-9 codes will no longer be maintained once
ICD-10 is implemented
• A claim cannot contain both ICD-9-CM and
ICD-10-CM (CMS Transmittal 950, effective
10/1/2013)
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Risk Mitigation
• Denials can run high for “not medically
necessary reasons”
• In the beginning there is risk of payers not
fully mapping procedures with new allowed
diagnosis reasons
– Be prepared for short term reduced revenues
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HOT OFF THE PRESS…
Source: Modern Healthcare, 9/4/2015
•
Four State Medicaid Programs will NOT Transition to ICD-10 by 10/1
•
CMS will allow four states - California, Louisiana, Maryland and Montana - to use a
"crosswalk technique" to continue using the older code sets for Medicaid fee-forservice programs because their claims processing systems in these four states are
unable to use the new ICD-10 codes.
•
Under the crosswalk technique, the Medicaid programs will convert claims using
the ICD10 system into ICD-9 codes to calculate payments
•
Some provider groups and healthIT experts say the use of such a technique could
result in payment delays and other issues.
•
It was not stated whether this applies to straight Medicaid and/or the Medicaid
Bayou Plans.
Stay tuned for additional information to be released
•
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Administrative Considerations
• Reimbursement
• Potential effect of delays, initial decrease in coder
productivity
• (Industry estimates 20-30% reduction in coder
productivity due to additional specificity; physician
queries; loss of memorized codes; learning curve.)
• Decrease in physician/provider productivity due to
additional specificity needed in charting; additional
specificity needed for orders; additional specificity for
authorizations; answering queries; increased selection
on charge tickets and/or order sets
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ICD-10-CM Structure
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Noteworthy Changes that Fall into
Other Specialty Areas
Clinical Area
ICD-9-CM Codes
ICD-10-CM Codes
Fractures
787
17099
Pregnancy
1104
2155
Diabetes
69
239
Hypertension
33
14
ESRD
11
5
Brain Injury
292
574
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Reporting Differences, Trending and
Analytic Modifications
• Converting from ICD9 to ICD10 more than triples the
number of available codes
• Looking at historical data becomes problematic
unless you can identify and capture needed
information from the two coding systems
• Simple forward mapping will not be sufficient for
most providers to make a successful transition
Copyright © 2015 MEDKODER LLC
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ICD-10-CM
• You will need to map your most frequently
used ICD-9-CM codes to ICD-10-CM
• Due to the number of code choices with some
diagnoses, there may be some challenges with
charge ticket/superbill options and EHR
template “drop-downs”
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General Equivalency Maps (GEMS)
• CMS’ GEMS (General Equivalency Maps)
demonstrate the complexity involved in
moving between the two coding systems
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ICD9/ICD10 Relationships
1:1, Cluster, Combination, Complex
• Individual ICD-9 codes that map to several ICD-10 code
alternatives;
• Individual ICD-9 codes that map to a set of two of more ICD10 codes;
• Two or more ICD-9 codes that map to individual ICD-10 codes;
• ICD-9 codes with no representation in ICD-10;
• ICD-9 codes with an exact match in ICD-10; and
• Individual ICD-9 codes that map to codes with similar but not
identical meanings in ICD-10
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CMS General Equivalent Mappings
Source: http://firstillinoishfma.org/wp-content/uploads/McGladrey-ICD-10-April-2013.pdf
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Considerations
• Font (System and Penmanship)
– Watch I (alpha) vs. 1 (numeric)
– Watch O (alpha) vs. 0 (numeric)
– Watch Z (alpha) vs. 2 (numeric)
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Documentation Awareness
• Physicians are becoming more
aware of the value of clinical
data and the relationships
between their professional
profiles and the diagnosis
(ICD-9/ICD-10) and procedure
codes (CPT) assigned
• If the clinical documentation
and the codes do not
accurately and specifically
represent the work you do, it
could poorly reflect through
reporting and impact your
future reimbursement
Copyright c 2015 Medkoder, LLC
ICD-10 Will Have a Direct Impact on
Physicians Through…..
• Physician quality profiles (PQRS, VBPM, P4P)
– mortality and morbidity reporting
– Not every insurer is profiling physicians yet, but
there are several other entities that do (e.g.
Health Grades – licensing backgrounds and
disciplinary information)
– Payers that profile use their own home-grown
grading systems that use claims data to determine
both “quality” and “efficiency”
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Provider Profiling
• Not all care or every specialty can be measured
• Most programs focus on specific types of physicians
and services
• Most common specialties profiled:
Cardiology
Pediatrics
Pulmonary
Allergy
OB/GYN
Rheumatology
Endocrinology
Nephrology
Infectious Disease
Family medicine
Neurology
Internal Medicine
Orthopedics
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Provider Profiling
• Most common diagnoses monitored:
– All of the major heart, lung and organ diseases
– The most prevalent viruses and inflammation
– Screening for cancers and depression
– Immunization compliance rates
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Provider Profiling
• Provider Efficiency
- Payers compare a physician’s data to their
local market benchmarks for cost of
resources used in delivering healthcare
- ICD-10 codes will capture the management
of chronically ill patients
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Manage Your Profile
• Payers will provide you with feedback on your
scores in the quality and efficiency areas
profiled
• Reports include details on the patients used
for scoring
• Validate or refute the findings, as these scores
may have an impact on your bottom line in
2017 with governmental and third party
payers
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Do You Code Your Own Services?
• If you do not code your services, then training
will be limited to ICD-10 concepts of the
specialty and documentation changes
• If you do your own coding, then you will need
full training on the code set and coding
guidelines
– Be sure to read the Chapter Specific Guidelines
located in front of the ICD-10CM coding manual
Copyright © 2015
Unspecified Code Assignment
• Surveys indicate that as much as 50% of
current physician documentation cannot be
coded to appropriate level of specificity with
ICD-10 resulting in unspecified code use
• Many unspecified codes in ICD-10-CM include
the note: *Codes with a greater degree of
specificity should be considered first
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Unspecified Codes
• Sometimes the use of unspecified codes makes
sense
– Early in the course of evaluation
– Secondary diagnoses not directly being treated by that provider
but impacts that encounter
– Generalist vs specialist
• Area of expertise – the diagnosis may not be in the providers scope of
expertise and will need to get the opinion of a specialist
• Payers are discouraging the use of unspecified
codes
– When providers review their severity and risk scores it may
impact their reimbursement because it won’t have the specificity
in their codes that are needed to justify higher levels and better
reimbursement
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Underdosing (Of Medication Regimen)
(Z91.12-, Z91.13-)
• New concept term in ICD-10 (patient is taking less of
a medication than prescribed)
• Today’s terminology – Non-compliance of
medication
When documenting Underdosing of medication regimen include:
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•
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Intentional
Unintentional
Non-compliance
Reason – financial hardship; age related debility
• The medical condition is sequenced first, with the underdosing listed as a
secondary diagnosis
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Underdosing or Failure in Dosage During
Medical or Surgical Care
(Y63.6, Y63.8 - Y63.9)
• Adverse event
• Y63- describes the circumstance causing an
injury, not the nature of the injury
• It should not be used as a principal diagnosis
(always list as secondary)
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Initial vs. Subsequent Encounters
• One of the biggest misconceptions inherent to
ICD-10 is the term “subsequent” encounter
• It does not mean “second” time seeing patient
• The designation subsequent is meant to
describe the patient has received active
treatment (initial) and the physician is now
providing routine care (subsequent)
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Physician vs. Facility Requirements
• Although physicians will continue to use CPT
codes to report their procedures and services,
you will need to remain cognizant of the
documentation specificity that hospitals will
need to report procedures/services with ICD10-PCS for inpatients
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General Documentation Tips
Incorporating these aspects into your documentation will result
in an accurate picture in the patient’s severity of illness and risk
of mortality
• Use adjectives (acute, chronic, acute-on-chronic, mild,
moderate, severe, persistent)
• Indicate cause and effect (due to or secondary to)
• Be specific about the aspects of the disease (use current
terminology)
• Specify the anatomical site
• Use exact dates
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Clear Clinical Documentation
Avoid using “history of” when documenting a current,
chronic condition; in coding “history of” means the
patient no longer has the condition
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Ordering Diagnostic/Therapeutic
Services
• Governmental and third party payers require the
performing provider (hospital ancillary
departments, outpatient freestanding centers,
independent labs, etc.) to provide ICD9/10 codes
for outpatient diagnostic and/or therapeutic
testing/services that they perform and submit for
payment on behalf of your patients
• These providers rely on you, the ordering
physician, to submit the appropriate diagnosis
code at the time of ordering to establish medical
necessity for the test ordered
Copyright © 2015
CMS FAQ 7579 – Refills
(Louisiana Medicaid)
• If a payer/pharmacy requires a diagnosis code for a
prescription and the prescriber reports an ICD-9 diagnosis
code because it is prescribed prior to the October 1, 2015
ICD-10 implementation date, what diagnosis code must be
reported if that same prescription is filled and processed
after the October 1, 2015 ICD-10 implementation date?
• When conducting a standard transaction, medical data code
sets (ICD-9 and ICD-10) that are valid at the time that the
service is provided (prescription fill date) must be used (45
CFR 162.1000).For example: A prescription, reporting an ICD9 diagnosis code, is dated 09/20/2015. The prescription is
filled and processed by the pharmacy on 10/02/2015.
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CMS FAQ 7579 - Refills
• The Date of Service reported by the pharmacy
on the claim is 10/02/2015 (even though the
prescription was written 09/20/2015).
• The claim, when submitted on 10/02/2015, is
required to report an ICD-10 diagnosis code. A
prescription, reporting an ICD-9 diagnosis
code, is dated 08/01/2015.
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CMS FAQ 7579 - Refills
• The Date of Service reported by the pharmacy
on the claim is 10/02/2015 (even though the
prescription was written 09/20/2015).
• The claim, when submitted on 10/02/2015, is
required to report an ICD-10 diagnosis code. A
prescription, reporting an ICD-9 diagnosis
code, is dated 08/01/2015.
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ICD-10 Specialty Specific Diagnoses
• The diagnoses reviewed today are not allinclusive, but serve as a guide to improving
clinical documentation, correct coding with
ICD-10 and capturing severity, acuity, and risk
of mortality for the patients you serve
Copyright c 2015
• The diagnoses reviewed today are not allinclusive, but serve as a guide to improving
clinical documentation, correct coding with
ICD-10 and capturing severity, acuity, and risk
of mortality for the patients you serve
Copyright c 2015
• The diagnoses reviewed today are not all-inclusive, but
serve as a guide to improving clinical documentation,
correct coding with ICD-10 and capturing severity,
acuity, and risk of mortality for the patients you serve
• The diagnoses listed are top ICD-9 diagnosis codes
obtained from the Network that providers are using
today. The mappings are a result of current
code/documentation. In order to capture the greatest
level of specificity, compare your current
documentation with code options in the coding manual
to determine opportunities for documentation
improvement.
Copyright c 2015
Obstetrical Enhancements
• Some of the obstetrical coding enhancements
include:
– 1. Elimination of episodes of care for obstetric
codes
– 2. Changes in time frames:
a. Abortion vs. Fetal death (20 weeks)
b. Early vs. Late pregnancy (20 weeks)
Copyright c 2015
Obstetrical Enhancements
– 3. Code extensions to denote the specific fetus in multiple
gestation pregnancies
– 4. One other notable enhancement is that ICD-10-CM
allows the trimester of pregnancy to be designated. Here is
an example of the difference:
ICD-9-CM
ICD-10-CM
649.53 Spotting complicating pregnancy,
antepartum
O26.851 Spotting complicating pregnancy,
first trimester
second trimester
third trimester
unspecified trimester
Gestational Week Codes
• Gestational week codes would be reported in
addition to codes for complications of
pregnancy
• Example:
Z3A.00
Weeks of gestation of pregnancy not specified
Z3A.01
Less than 8 weeks gestation of pregnancy
Z3A.08
8 weeks gestation of pregnancy
Z3A.09
Screening Codes
• Documentation for screenings must include any
abnormal finding which would be listed
secondary to the screening codes
• Screening codes in ICD-10 can be broken down by
the condition, procedure, or anatomic location
depending on the type of screening
– Example
• Prenatal screening of mother Z36
• Congenital anomaly screening Z13.89
• Chromosomal abnormalities (nonprocreative) Z13.79
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Encounter Codes
–
•
High risk pregnancy (coded as
Pregnancy, complicated by high risk)
O09.3-
Due to (History Of)
• Ectopic pregnancy O09.1• Elderly mother
– Multigravida O09.52– Primigravida O09.51• Grand multiparity )09.4• In utero procedure during previous
pregnancy )09.82• In vitro fertilization O09.81• Infertility O09.0• Insufficient prenatal care O09.3• Molar pregnancy O09.1• Multiple previous pregnancies O09.4• Poor reproductive or obstetric history
O09.29• Pre-term labor O09.21• Previous prenatal death O09.29• Social problems O09.7• Specified NEC O09.89• Very young mother
– Multigravida O09.62– Primigravida O09.63-
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Encounter Codes
• ICD-10-CM may index entries that crossreferences back to same code
– Care (of) (for) (following)
• Lactating mother Z39.1
– Examination (for) (following) (general) (of) (routine)
• Lactating mother Z39.1
– Lactation, lactating (breast) (puerperal, postpartum)
• Mother (care and/or examination) Z39.1
– Supervision (of)
• Lactation Z39.1
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Guidelines - OB
•
ICD-9-CM Codes from Chapter 11 and
sequencing priority
– Obstetric cases require codes from
chapter 11, codes in the range 630679, Complications of Pregnancy,
Childbirth, and the Puerperium
– Chapter 11 codes have sequencing
priority over codes from other
chapters
– Additional codes from other chapters
may be used in conjunction with
chapter 11 codes to further specify
conditions
– Should the provider document that
the pregnancy is incidental to the
encounter, then code V22.2 should
be used in place of any chapter 11
codes
– It is the provider’s responsibility to
state that the condition being treated
is not affecting the pregnancy
•
ICD-10-CM Codes from Chapter 15
and sequencing priority
– Obstetric cases require codes from
chapter 15, codes in the range O00O9A, Pregnancy, Childbirth, and the
Puerperium
– Chapter 15 codes have sequencing
priority over codes from other
chapters
– Additional codes from other
chapters may be used in conjunction
with chapter 15 codes to further
specify conditions
– Should the provider document that
the pregnancy is incidental to the
encounter, then code Z33.1, Pregnant
state, incidental, should be used in
place of any chapter 15 codes
– It is the provider’s responsibility to
state that the condition being treated
is not affecting the pregnancy.
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General Rules for OB Cases
• ICD-9-CM Chapter 11
codes used only on the
maternal record
• ICD-10-CM Chapter 15
codes used only on the
maternal record
– Chapter 11 codes are to
be used only on the
maternal record, never
on the record of the
newborn
– Chapter 15 codes are to
be used only on the
maternal record, never
on the record of the
newborn
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General Rules for OB Case
• ICD-9-CM Fifth Digits
– Categories 640-649, 651-676 have
required fifth-digits, which indicate
whether the encounter is
antepartum, postpartum and
whether a delivery has also
occurred or puerperal
• ICD-10-CM Final character for
trimester
– The majority of codes in Chapter
15 have a final character indicating
the trimester of pregnancy
– The timeframes for the trimesters
are indicated at the beginning of
the chapter
– If trimester is not a component of a
code it is because the condition
always occurs in a specific
trimester, or the concept of
trimester of pregnancy is not
applicable
– Certain codes have characters for
only certain trimesters because the
condition does not occur in all
trimesters, but it may occur in
more than just one
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Timeframes for Trimesters
• Trimesters are counted from the first day of
the last menstrual period
• They are defined in ICD-10-CM as follows:
– 1st trimester - less than 14 weeks 0 days
– 2nd trimester - 14 weeks 0 days to less than 28
weeks 0 days
– 3rd trimester - 28 weeks 0 days until delivery
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• ICD-9-CM Fifth-digits,
appropriate for each code
– The fifth-digits, which are
appropriate for each code number,
are listed in brackets under each
code
– The fifth-digits on each code
should all be consistent with each
other That is, should a delivery
occur all of the fifth-digits should
indicate the delivery
• ICD-10-CM
• Assignment of the final character
for trimester should be based on
the provider’s documentation of
the trimester (or number of
weeks) for the current
admission/encounter.
• This applies to the assignment of
trimester for pre-existing
conditions as well as those that
develop during or are due to the
pregnancy
• The provider’s documentation of
the number of weeks may be
used to assign the appropriate
code identifying the trimester
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• ICD-9-CM
– This rule is not
applicable
• ICD-10-CM
• Whenever delivery
occurs during the
current admission, and
there is an “in
childbirth” option for
the obstetric
complication being
coded, the “in
childbirth” code should
be assigned
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•
•
ICD-9-CM
This rule is not applicable
•
•
ICD-10-CM
Selection of trimester for inpatient
admissions that encompass more
than one trimesters
– In instances when a patient is admitted
to a hospital for complications of
pregnancy during one trimester and
remains in the hospital into a
subsequent trimester, the trimester
character for the antepartum
complication code should be assigned
on the basis of the trimester when the
complication developed, not the
trimester of the discharge
– If the condition developed prior to the
current admission/encounter or
represents a pre-existing condition, the
trimester character for the trimester at
the time of the admission/encounter
should be assigned
58
• ICD-9-CM
• This rule is not applicable
• ICD-10-CM
• Unspecified trimester
– Each category that includes
codes for trimester has a
code for “unspecified
trimester”
– The “unspecified
trimester” code should
rarely be used, such as
when the documentation
in the record is insufficient
to determine the trimester
and it is not possible to
obtain clarification
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• ICD-9-CM
• This rule is not applicable
• ICD-10-CM
• 7th character for Fetus
Identification
– Where applicable, a 7th character
is to be assigned for certain
categories (O31, O32, O33.3 O33.6, O35, O36, O40, O41, O60.1,
O60.2, O64, and O69) to identify
the fetus for which the
complication code applies
• Assign 7th character “0”:
– For single gestations
– When the documentation in the
record is insufficient to determine
the fetus affected and it is not
possible to obtain clarification
– When it is not possible to clinically
determine which fetus is affected
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General Rules for OB
• Many codes from chapter 15 (O00-O99A) require the
use of an additional code from category Z3A (Weeks of
gestation), to identify the specific week of the
pregnancy.
• These codes are for use, only on the maternal record,
to indicate the weeks of gestation of the pregnancy.
– Code first complications of pregnancy, childbirth and the
puerperium (O00-O9A).
•
•
•
•
•
Z3A.00
Z3A.01
Z3A.08
Z3A.09
Z3A.10
Weeks of gestation of pregnancy not specified
Less than 8 weeks gestation of pregnancy
61
• Gestational diabetes needs specification of
diet controlled or insulin controlled
• If both diet and insulin controlled, the ICD-10CM code for insulin controlled will be
assigned
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Screening Documentation Awareness
Document
• Screening
• History of cancer (personal or family) (for cancer screening)
Screening
ICD-9-CM
ICD-10-CM
V76.2 Special screening examination for
malignant neoplasm of cervix
Z12.4 Encounter for screening malignant
neoplasm of cervix
V74.5 Screening examination for venereal
disease
Z11.3 Screening examination for venereal
disease
V72.84 Preoperative examination,
unspecified
Z01.812 Encounter for preprocedural
laboratory examination
Z01.818 Encounter for other preprocedural
examination
V77.91 Screening for lipoid disorders
Z13.220 Encounter for screening for lipoid
disorders
V73.81 Special screening for HPV
Z11.51 Encounter for screening for HPV
Supervision
ICD-9-CM
ICD-10-CM
V22.0 Supervision, normal first pregnancy
V22.1 Supervision, other normal pregnancy
Z34.00 Encounter for supervision of
normal first pregnancy, unspecified
Z34.88 Encounter for supervision of
other normal pregnancy, unspecified
trimester
Z33.1 Pregnant state, incidental
O09.90 Supervision of high risk
pregnancy, unspecified, unspecified
pregnancy, unspecified, first trimester
pregnancy, unspecified, second
trimester
pregnancy, unspecified, third trimester
V22.2 Pregnancy state, incidental
V23.9 Supervision of high-risk pregnancy,
NOS
Copyright c 2015
Gynecological Examination, Routine
ICD-9-CM
ICD-10-CM
V72.31 Gynecological Examination,
routine
Z01.411 Encounter for gynecological
examination (general) (routine) with
abnormal findings
Z01.419 Encounter for gynecological
examination (general) (routine) without
abnormal findings
Routine Postpartum Followup
ICD-9-CM
ICD-10-CM
V24.2 Routine postpartum followup
Z39.2 Encounter for routine postpartum
followup
Routine Medical Exam
ICD-9-CM
ICD-10-CM
V70.0 Routine medical examination
Z00.00 Encounter for general adult
medical examination without abnormal
findings
Z00.01 Encounter for general adult
medical examination with abnormal
findings
Delivery
ICD-9-CM
ICD-10-CM
650 Delivery, normal
654.21 Cesarean previous, delivery with
or without mention of antepartum
condition
669.71 Delivery, cesarean, NOS, delivered
with and without mention of antepartum
condition
O80 Encounter for full-term
uncomplicated delivery
O34.21 Maternal care for scar from
previous cesarean delivery
• Code first any associated obstructed
labor (O65.5)
• Use additional code for specific
condition
Menstrual Disorder
ICD-9-CM
ICD-10-CM
626.0 Absence of Menstruation
626.2 Excessive or Frequent
Menstruation
626.8 Menstrual disorder, NEC
N91.2 Amenorrhea, unspecified
N92.0 Excessive and frequent
menstruation with regular cycle
N92.5 Other specified irregular
menstruation
N93.8 Other specified uterine and vaginal
bleeding
N92.6 Irregular menstruation,
unspecified
N93.9 Abnormal uterine and vaginal
bleeding, unspecified
626.9 Menstrual disorder, NOS
Contraceptive Management, NOS
ICD-9-CM
ICD-10-CM
V25.9 Contraceptive Management, NOS
Z30.9 Encounter for contraceptive
management, unspecified
Postprocedural Status
ICD-9-CM
ICD-10-CM
V45.89 Postprocedural status, NEC
Z98.89 Other specified postprocedural
states
Symptoms Associated w/Female
Genital Organs, NOS
ICD-9-CM
ICD-10-CM
625.9 Symptom associated with female
genital organs, NOS
N94.89 Other specified conditions
associated with female genital organs and
menstrual cycle
Initiate Contraceptive Measure, NEC
ICD-9-CM
ICD-10-CM
V25.02 Initiate contraceptive measure,
NEC
V25.09 Contraceptive management, NEC
Z30.018 Encounter for initial prescription
of other contraceptives
Z30.09 Encounter for other general
counseling and advice on contraception
Leiomyoma Uterus, NOS
ICD-9-CM
ICD-10-CM
218.9 Leiomyoma uterus, NOS
D25.9 Leiomyoma of uterus, unspecified
Postmenopausal Bleeding
ICD-9-CM
ICD-10-CM
627.1 Postmenopausal bleeding
N95.0 Postmenopausal bleeding
Abnormal Findings
ICD-9-CM
ICD-10-CM
796.9 Abnormal findings
795.00 Abnormal finding glandular pap
smear cervix
R68.89 Other general symptoms and
signs
R87.619 Unspecified abnormal
cytological findings in specimens from
cervix uteri
Vaginitis and vulvovaginitis
ICD-9-CM
616.10 Vaginitis and vulvovaginitis,
unspecified (acute or chronic)
ICD-10-CM
N76.0 Acute vaginitis
N76.1 Subacute and chronic vaginitis
N76.2 Acute vulvitis
N76.3 Subacute and chronic vulvitis
N76.81 Mucositis (ulcerative) of vagina
and vulva
N76.89 Other specified inflammation of
vagina and vulva
IUD
ICD-9-CM
ICD-10-CM
V25.11 Encounter for Insertion of IUD
V25.42 IUD Surveillance
Z30.430 Encounter for insertion of
intrauterine contraceptive device
Z30.431 Encounter for routine checking
of intrauterine contraceptive device
Pregnancy Exam/Test Unconfirmed
ICD-9-CM
ICD-10-CM
V72.40 Pregnancy exam/test,
unconfirmed
Z32.00 Encounter for pregnancy test,
result unknown
Signs and symptoms
ICD-9-CM
780.79 Other malaise and fatigue
ICD-10-CM
R53.0 Neoplastic (malignant) related
fatigue
R53.1 Weakness
R53.81 Malaise NOS
R53.82 Chronic fatigue unspecified
R53.83 Fatigue NOS
787.91 Diarrhea
R19.7 Diarrhea NOS
K59.1 Functional diarrhea
627.2 Symptomatic menopausal or
female climacteric states
N95.1 Menopausal and female
climacteric states
Neoplasm Documentation
Neoplasm Documentation Awareness
Documentation should include:
• Behavior
- Malignant (primary, secondary, in-situ)
Document any secondary sites
- Benign
- Unspecified behavior
- Of certain histological behavior
• Laterality (right/left)
• Anatomical site (topography)
• Other condition(s) associated with malignancy – (dehydration, anemia, etc.)
• Complication(s) associated with neoplasm
• Include estrogen receptor status (if applicable)
• History of:
- Has the malignancy been excised or eradicated?
- Is there still treatment being provided for the primary and/or secondary site?
- Is there evidence of remaining malignancy at the primary site?
• Document any associated diagnoses/conditions
82
Neoplasms
• Overlapping sites
• Laterality – Left vs. Right
• C50.2 Malignant neoplasm, of upper-inner
quadrant of breast)
– C50.21 Malignant neoplasm of upper-inner quadrant
of breast, female
• C50.211 Malignant neoplasm of upper-inner quadrant of
right female breast
• C50.212 Malignant neoplasm of upper-inner quadrant of left
female breast
• C50.219 Malignant neoplasm of upper-inner quadrant of
unspecified female breast
83
CA of Breast
ICD-9-CM
ICD-10-CM
174.9 Malignant neoplasm of breast
(female, unspecified)
C50.919 Malignant neoplasm of
unspecified site of unspecified
female breast
* Use additional code to identify
estrogen receptor status
(Z17.0, Z17.1)
84
CA of Breast
ICD-9-CM
ICD-10-CM
** There are more specific code choice
selections available in ICD-10-CM. These
include:
unspecified site of right female
breast
unspecified site of left female
breast
unspecified site of right male
breast
unspecified site of left male
breast
unspecified site of unspecified male breast
85
Neoplasm
ICD-9-CM
ICD-10-CM
182.0 Neoplasm, malignant, corpus uteri
180.9 Neoplasm, malignant, cervix uteri,
NOS
233.1 CA in-situ, cervix uteri
endometrium
myometrium
C54.3 Malignant neoplasm of fundus
uteri
C54.9 Malignant neoplasm of corpus
uteri, unspecified
Infertility Female
ICD-9-CM
ICD-10-CM
628.9 Infertility, female NOS
N97.9 Female infertility, unspecified
Infertility - Male
ICD-9-CM
ICD-10-CM
606.0 Azoospermia
606.1 Oligospermia
606.8 Infertility due to extratesticular
causes
606.9 Unspecified male infertility
N46.01 – N46.9
N46.021 Azoospermia due to drug
therapy
N46.022 Azoospermia due to infection
N46.023 Azoospermia due to obstruction
of efferent ducts
N46.024 Azoospermia due to radiation
N46.025 Azoospermia due to systemic
disease
N46.029 Azoospermia extratesticular
causes
* Code also associated cause
Copyright c 2015
Candidiasis
ICD-9-CM
ICD-10-CM
112.1 Candidiasis, vulva/vagina
B37.3 Candidiasis of vulva and vagina
Ovarian Cyst
ICD-9-CM
ICD-10-CM
620.2 Ovarian Cyst, NEC/NOS
Sterilization
ICD-9-CM
ICD-10-CM
V25.2 Sterilization
Poor Fetal Growth - Documentation
ICD-9-CM
ICD-10-CM
Maternal care for known or suspected poor fetal
growth
Poor fetal growth affecting management
• Due to known or suspected
of mother
- Placental insufficiency
- Other poor fetal growth
- Light-for-dates
- Light-for-dates NOS
- Small-for-dates
- Small-for-dates NOS
- Placental insufficiency
• Trimester
Episode of care
- First (less than 14 weeks 0 days)
- Second (14 weeks 0 days to less than 28
- Antepartum
weeks 0 days)
- Delivered
- Third (28 weeks 0 days until delivery)
- Unspecified or not applicable
- Unspecified
• Fetus affected by complication
- Multiple gestation pregnancy
- Fetus 1
- Fetus 2
- Fetus 3
- Fetus 4
- Fetus 5
- Other
- Unspecified or not applicable (i.e.,
single fetus)
92
Poor Fetal Growth – Perinatal Record
Documentation
ICD-9-CM
ICD-10-CM
•
•
•
•
•
•
•
•
Poor fetal growth
Light-for-dates
Small-for-dates
Fetal growth retardation
-Intrauterine growth retardation
• With or without fetal malnutrition
• Birthweight in grams
- Unspecified to >2,500 gms
Light-for-dates
Small-for-dates
Small-and-light-for-dates
Fetal (intrauterine) malnutrition not
light or small for gestational age
• Newborn affected by slow
intrauterine growth, unspecified
• Birthweight in grams
- Unspecified to 2,499 gms
93
Antepartum Hemorrhage
Documentation
ICD-9-CM
ICD-10-CM
No change in the way you document
antepartum hemorrhage in ICD-10-CM
with the exception of documenting
trimester rather than episode of care
94
False Labor Codes
ICD-9-CM
ICD-10-CM
644.03 Threatened preterm labor,
antepartum (without delivery)
O47.00 False labor before 37 weeks of
completed gestation, unspecified
trimester
O47.02 False labor before 37 completed
weeks of gestation, second trimester
O47.03 False labor before 37 completed
weeks of gestation,
third trimester
O47.1 False labor at or after 37 completed
weeks of gestation
O47.9 False labor, unspecified
** An additional code from category Z3A
is needed to specify the weeks of
gestation of the pregnancy.
95
Antepartum Drug Dependence Codes
ICD-9-CM
ICD-10-CM
648.33 Drug dependence, antepartum
O99.320 Drug use complicating
pregnancy, unspecified trimester
pregnancy, first trimester
pregnancy, second trimester
pregnancy, third trimester
** The codes from this subcategory
require an additional code from F11-F16
and F18-F19 to identify manifestations of
the drug use
96
Other Specified Complications of
Pregnancy Codes
ICD-9-CM
ICD-10-CM
646.83 Other specified complications of
pregnancy, antepartum
O26.891 Other specified pregnancy
related conditions, first
trimester
related conditions, second
trimester
related conditions, third
trimester
related conditions,
97
Other Specified Complications of
Pregnancy Codes
ICD-9-CM
ICD-10-CM
There are other code selections available for codes previously
coded to 646.83:
O26.10 Low weight gain in pregnancy, unspecified trimester
O26.11 Low weight gain in pregnancy, first trimester
O26.12 Low weight gain in pregnancy, second trimester
O26.13 Low weight gain in pregnancy, third trimester
O26.40 Herpes gestationis, unspecified trimester
O26.41 Herpes gestationis, first trimester
O26.42 Herpes gestationis, second trimester
O26.43 Herpes gestationis, third trimester
O26.811 Pregnancy related exhaustion and fatigue, first
trimester
O26.812 Pregnancy related exhaustion and fatigue, second
trimester
O26.813 Pregnancy related exhaustion and fatigue, third
trimester
O26.819 Pregnancy related exhaustion and fatigue, unspecified
trimester
**An additional code from category Z3A is needed to specify
the weeks of gestation of the pregnancy.
98
Missed Abortion Codes
ICD-9-CM
ICD-10-CM
632 Missed Abortion
O02.1 Missed abortion
** Use additional code from category
O08 to identify any associated
complication
is needed to specify
the weeks of gestation of the pregnancy.
99
Twin Pregnancy Codes
ICD-9-CM
ICD-10-CM
651.03 Twin Pregnancy, antepartum
O30.001 Twin pregnancy, unspecified
number of placenta and
unspecified number of amniotic sacs, first
trimester
number of placenta and unspecified
number of amniotic sacs, second trimester
number of placenta and unspecified
number of amniotic sacs, third trimester
number of placenta and
unspecified number of amniotic sacs,
unspecified
trimester
100
ICD-9-CM
ICD-10-CM
O30.011 Twin pregnancy,
monochorionic/monoamniotic, first
trimester
monochorionic/monoamniotic,
second trimester
monochorionic/monoamniotic, third
trimester
monochorionic/monoamniotic,
O30.031 Twin pregnancy, monochorionic/diamniotic,
first trimester
second trimester
third trimester
101
ICD-9-CM
ICD-10-CM
dichorionic/diamniotic, first trimester
dichorionic/diamniotic, second
trimester
dichorionic/diamniotic, third trimester
dichorionic/diamniotic, unspecified
trimester
102
ICD-9-CM
ICD-10-CM
O30.091 Twin pregnancy, unable to
determine number of placenta and
number of amniotic sacs, first trimester
number of amniotic sacs, second
trimester
number of amniotic sacs, third trimester
number of amniotic sacs, unspecified
trimester
**An additional code from category Z3A is
needed to specify the weeks of gestation
of the pregnancy.
103
Premature Rupture of Membrane Codes
ICD-9-CM
ICD-10-CM
658.23 Delayed delivery after
spontaneous or unspecified rupture of
membranes, antepartum condition or
complication
O42.111 Preterm premature rupture of
membranes, onset of labor more than 24
hours following rupture, first
trimester
hours following rupture, second
trimester
hours following rupture, third trimester
hours following rupture, unspecified
trimester
104
Abnormality in Fetal Heart Rate or
Rhythm Codes
ICD-9-CM
ICD-10-CM
659.73 Abnormality in fetal heart rate or
rhythm, antepartum
O76 Abnormality in fetal heart rate and
rhythm complicating
labor and delivery
105
Certain Conditions Originating in the
Perinatal Period (P00-P96)
• These codes are only reported for the
newborn
• They include conditions that have their origin
in the fetal or perinatal period (before birth
through the first 28 days after birth) even if
morbidity occurs later
106
Diagnosis Codes for Newborns
•
•
•
•
•
•
•
•
•
•
•
•
P00-P04 Newborn affected by maternal factors and by complications of pregnancy,
labor, and delivery;
P05-P08 Disorders related to length of gestation and fetal growth;
P09 Abnormal findings on neonatal screening;
P10-P15 Birth trauma;
P19-P29 Respiratory and cardiovascular disorders specific to the perinatal period;
P35-P39 Infections specific to the perinatal period;
P50-P61 Hemorrhagic and hematological disorders of newborn;
P70-P74 Transitory endocrine and metabolic disorders specific to newborn;
P76-P78 Digestive system disorders of newborn;
P80-P83 Conditions involving the integument and temperature regulation of
newborn;
P84 Other problems with newborn; and,
P90-P96 Other disorders originating in the perinatal period.
107
Newborn Documentation
• When coding a birth episode in a newborn record, a
code from category Z38.- (liveborn infant according to
place and type of delivery) is always assigned as the
principal diagnosis.
• Birth takes precedence over other conditions
• What we need to know
–
–
–
–
How many babies
Where did the baby arrive
How was the baby delivered
Coders can’t make assumptions about each infant in a
multiple birth situation. Documentation has to be specific
on each
108
Newborn Documentation
• Documentation should include all clinically
significant conditions noted on a routine
newborn examination
• A condition is clinically significant if it requires
any of the following
–
–
–
–
–
–
Clinical evaluation
Therapeutic treatment
Diagnostic procedures
Extended length of hospital stay
Increased nursing care and/or monitoring
Has implications for future health care needs
109
Observation for Suspected Condition
• There are many instances where a newborn is
observed for a suspected condition but after study the
condition is ruled out
• P00-P04, has codes for use for newborns suspected of
having an abnormality resulting from exposure from
the mother or the birth process but without signs or
symptoms, and, after examination and observation, is
found not to exist.
– Example:
• P04.41 Newborn (suspected to be) affected by maternal use of
cocaine, or
• P00.0 Newborn (suspected to be) affected by maternal
hypertensive disorders
110
Prematurity & Fetal Growth
Retardation
• Prematurity and Fetal Growth Retardation (P05-P08) describe newborn
gestational age and weight disorders.
• Providers utilize different criteria in determining prematurity. A code for
prematurity should not be assigned unless it is documented.
• Assignment of codes in categories P05, Disorders of newborn related to
slow fetal growth and fetal malnutrition, and P07, Disorders of newborn
related to short gestation and low birth weight, not elsewhere classified,
should be based on the recorded birth weight and estimated gestational
age.
• Codes from category P05 should not be assigned with codes from category
P07. When both birth weight and gestational age are available, two codes
from category P07 should be assigned, with the code for birth weight
sequenced before the code for gestational age.
– Example:
• P05.12 (Newborn small for gestational age, 500-749 grams)
• P07.22 (Extreme immaturity of newborn, 24-26 completed weeks).
111
Other Newborn Conditions
• birth injuries
– e.g. Scalpel wound P15.8
• aspiration conditions
– e.g. Aspiration meconium w/o respiratory symptoms
P24.00
• respiratory conditions
– e.g. Aspiration meconium with pneumonitis P24.31
• infections
– e.g. Newborn affected by maternal infectious disease
P00.2
• endocrine disorders
– e.g. newborn late metabolic acidosis P74.0
112
Feeding Problems
• Feeding problems are described in category
P92, and include vomiting, slow feeding,
underfeeding, fast feeding, and difficulty in
feeding at breast
113
Applying ICD-10-CM Concepts for
External Causes
• Pregnancy codes sequenced first
• External Cause status
– When documenting the history in the clinical statement,
note the External Cause of the injury
• Indicate whether the individual was involved in a work
or non-work activity at the time of the event
• Indicate whether the event occurred during military
activity
114
Urosepsis
• Urosepsis will not be considered synonymous
with sepsis. It has no default code in the
Alphabetic Index.
• Should a Provider use this term he/she must
be queried for clarification
Copyright c 2015
Urinary Tract Infection
ICD-9-CM
ICD-10-CM
599.0 Urinary Tract Infection, unspecified
N39.0 Urinary Tract Infection, site not
specified
*Use additional code to identify
infectious agent (B95-B97)
**There are more specific code choice
selections available in ICD-10-CM These
include:
N30.00 Acute cystitis without hematuria
N30.01 Acute cystitis with hematuria
N30.10 Interstitial cystitis chronic without
hematuria
N30.11 Interstitial cystitis chronic with
hematuria
N30.20 Other chronic cystitis without
hematuria
N30.21 Other chronic cystitis with
hematuria
Urinary Tract Infection
ICD-9-CM
ICD-10-CM
N30.30 Trigonitis without hematuria
N30.31 Trigonitis with hematuria
N30.40 Irradiation cystitis without
hematuria
N30.41 Irradiation cystitis with hematuria
N30.80 Other cystitis without hematuria
N30.81 Other cystitis with hematuria
N30.90 Cystitis, unspecified without
hematuria
N30.91 Cystitis, unspecified with
hematuria
N15.9 Renal tubulo-interstitial disease,
unspecified
N34.1 Nonspecific urethritis
N34.2 Other urethritis
117
Sepsis
Clinical Documentation Awareness
In ICD-10, there will no longer be a designation for “septicemia”; bacteremia (R78.81)
or bacterial sepsis will be preferred. Specify whether bacteremia is due to septic
condition in the body or is transient due to a procedure or unknown cause
Sepsis documentation should include:
• the source of the infection if known
• the patient’s signs and symptoms of sepsis
• the presence of organ failure (renal, respiratory, hepatic, etc.) related to sepsis
• whether positive blood cultures are clinically significant or contaminates
• other factors such as immunocompromise (diabetes, steroid therapy, malnutrition,
immunoglobulin deficiency, chemotherapy)
• the likely relationship to implanted devices
Copyright c 2015
Sepsis
ICD-9-CM
ICD-10-CM
995.91 Sepsis
A41.9 Sepsis, unspecified organism
Copyright c 2015
Diabetes Mellitus
ICD-9-CM Code
ICD-10-CM Code(s)
250.00 – Diabetes mellitus without
mention of complications type II or
unspecified type, not states as controlled
E11.9 – Type 2 diabetes mellitus without
complications
Diabetes Mellitus Documentation Awareness
Capturing the correct code for Diabetes Mellitus requires clear and precise
documentation of the underlying cause. Diabetes mellitus codes in ICD-10 reflect
combination codes. The components of the combination codes are:
• Type of Diabetes
• Body System Affected
• Specified complications/manifestations affecting the body system
120
Type of Diabetes
• Drug or Chemical Induced (E09) – (anticonvulsants; antihypertensive drugs
including diuretics and beta blockers; antipsychotic drugs including lithium
and antidepressants; antiretroviral drugs; chemotherapy drugs; hormone
supplements including anabolic steroids, contraceptives, estrogen, growth
hormones and hormones for prostate cancer)
• Due to an underlying condition (E08)
• Type I diabetes (E10) – controlled/not specified; uncontrolled
• Type 2 diabetes (E11) – controlled/not specified; uncontrolled
• Other specified diabetes (E13) – secondary diabetes mellitus –
controlled/not specified; uncontrolled
For Type 2 diabetes mellitus and secondary diabetes mellitus, any long-term
or current use of insulin is reported as an additional code.
You may report more than one diabetes code for patients with multiple
complications or when multiple body systems are affected as a result of the
diabetes.
Secondary diabetes is defined as a diabetic condition with an underlying
cause other than genetics or environmental conditions (includes due to
drugs, chemicals, medical conditions, surgical procedures or trauma)
121
Diabetes
Body System Affected
• Circulatory complications
• Hyperosmolarity
• Kidney complications
• Ketoacidosis
• Other coma
• Neurological complications
• Ophthalmic complications
• Other specified complications/manifestations
• Unspecified complications/manifestations
• Without complications/manifestations
122
Specified complications/manifestations affecting the body system
•
•
•
•
•
•
•
•
•
•
Circulatory complications – peripheral
Hyperosmolarity
Hypoglycemia (with or without coma)
Kidney complications – diabetic nephropathy; chronic kidney disease; other
Ketoacidosis – with or without coma
Neurological complications – amyotrophy; autonomic polyneuropathy;
mononeuropathy, polyneuropathy; other; unspecified
Ophthalmic complications – diabetic retinopathy (mild, moderate or severe
nonproliferative with or without macular edema); diabetic cataract; other
Other specified complications/manifestations – skin complications (dermatitis,
foot ulcer; other skin ulcer; other skin complications; oral complications
(periodontal disease; other)
Unspecified complications/manifestations
Without complications/manifestations
123
Gestational Diabetes
ICD-9-CM
ICD-10-CM
V12.21 Personal history of gestational
diabetes
Z86.32 Personal history of gestational
diabetes
Copyright c 2015
Gestational Diabetes
ICD-9-CM
ICD-10-CM
648.81 Anormal glucose tolerance of
mother, delivered, with or without
mention of antepartum condition
648.83 Abnormal glucose tolerance of
mother, antepartum condition or
complication
O24.419 Gestational diabetes mellitus in
Pregnancy, unspecified control
O24.429 Gestational diabetes mellitus in
childbirth, unspecified control
O99.810 Abnormal glucose complicating
pregnancy
O99.814 Abnormal glucose complicating
childbirth
Copyright c 2015
Omphalitis in the Newborn Secondary
to Tetanus Bacillus
ICD-9-CM
ICD-10-CM
771.4 Omphalitis of the newborn
(excludes Tetanus omphalitis)
A33 Tetanus bacillus of the newborn
771.3 Tetanus neonatorum (omphalitis)
Copyright c 2015
ICD-10-PCS
• There is great complexity in coding ICD-10-PCS
code
– Terminology differences
– Increased knowledge of Anatomy and Physiology
– Greater specificity in the operative note
ICD-10-PCS Code Structure
Character
1
Character
2
Character
3
Character
4
Character
5
Character
6
Character
7
Section
Body
System
Root
Operation
Body Part
Approach
Device
Qualifier
Obstetrical Lacerations
• Documentation must include the location of
the obstetrical laceration in the delivery note
in order for the coder to properly assign the
code (e.g. perineal, urethral, etc.)
Copyright c 2015
Obstetrical Perineal Laceration
• Perineal repair after either an episiotomy or spontaneous
obstetric laceration is one of the more common procedures
performed following a vaginal delivery
• Perineal lacerations are classified according to their depth
or degree of the laceration, with each higher degree
involving a deeper laceration
• There are four different degrees of perineal lacerations
with the ICD-10-PCS code(s) assigned for each of these
different degrees being dependent upon the body part(s)
involved in the laceration
• The root operation to repair all degrees of perineal
lacerations is Repair.
Copyright c 2015
• A first degree perineal laceration involves the
skin and subcutaneous tissue of the perineum
– 0WQN0ZZ
• A second degree perineal laceration involves
the muscles of the perineal body in addition
to the skin and subcutaneous tissue of the
perineum – also coded 0WQN0ZZ
Copyright c 2015
• A third degree perineal laceration involves the
anal sphincter in addition to the muscles of
the perineal body and skin and subcutaneous
tissue of the perineum – two ICD-10-PCS
codes are assigned – 0WQN0ZZ and 0DQR0ZZ
(the second code representing the repair of
the anal sphincter)
Copyright c 2015
• A fourth degree perineal laceration involves
the rectal mucosa in addition to the anal
sphincter, muscles of the perineal body and
the skin and subcutaneous tissue of the
perineum – three ICD-10-PCS codes are
assigned – 0WQN0ZZ, 0DQR0ZZ, and 0DQP0ZZ
(The third code representing repair of the
rectal mucosa)
Copyright c 2015
Training & Education Resources
• Medkoder, LLC
- http://www.medkoder.com
- [email protected]
• AAPC
- http://www.aapc.com
• AHIMA
- http://www.ahima.org
• CMS
– http://www.cms.gov/Medicare/Coding/ICD10/Index.html
– http://www.roadto10.org
Copyright © 2015
134
Questions
Copyright © 2015
135
Thank You!
MEDKODER
200 Greenleaves Blvd. Suite 7
Mandeville, LA 70448
985-778-0962 phone | 800-421-9418 fax
[email protected]
[email protected]
http://medkoder.com
136

ICD-10-CM: Coding and Clinical Documentation Changes Maternal

Transcription

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