ICD-10 Is Your Practice Ready?
ICD-10 Is Your Practice Ready? Helping you with the transition Contents Introduction A changing landscape Budgets and payments 3 The position of CMS 3 Top five risks of ICD-10 conversion 3 How much cash should you have available during the first few months following the implementation of the ICD-10 coding system? 4 Have you set a goal to clear out all ICD-9 billings before starting to bill ICD-10 effective October 1, 2015? 4 Is your practice ready? 4 Checklist The time to start is yesterday 5 Have you developed an ICD-10 implementation plan? 5 Organize an implementation effort 6 Make sure you understand testing is essential - you must be aggressive! 6 Establish a communication plan 6 Have you created an ICD-10 budget? 7 Have you contacted your top three payers? 7 Payer questions Checklist Have you conducted an ICD-10 impact analysis? Impact analysis Training Vendors 8 8 Worksheet 9 Who should be trained? 10 Have you conducted ICD-10 training sessions with your staff? 10 Three training approaches to consider 10 Do your physicians understand the impact of ICD-10? 11 Potential impacted areas 12 Have your physicians participated in training? 12 Have you developed a plan to train your coding staff? 13 Do you plan to start coding after training, but before October 1, 2015 to minimize impact and maintain office efficiency? 13 Will you conduct any pre-October 1 coding audits? 14 Are you using a Superbill? 14 Are your vendors ICD-10 ready? Checklist 15 Additional vendor questions to consider Checklist 16 Know your vendors’ plans 17 AAPC diagram ICD-10 will change everything. Will you be ready? 18 AAPC Top 50 codes ICD-9 to ICD-10 crosswalk (multispecialty) 19 Resources Third-party sources of guidance are shown in [square brackets]. 2 Besse Medical ICD-10 Guide – July 2015 25 Introduction The long delayed and controversial implementation of ICD-10-CM scheduled for October 1, 2015 is just around the corner. The information in this document is compiled from various sources to provide your practice with a comprehensive checklist. Coding backlogs and increased denials resulting from the ICD-10 transition will impact reimbursement, and the need for your organization to develop a contingency plan which focuses on cash flow decreases are more important than ever. A changing landscape The position of CMS As of July 2015, CMS and other major payers have announced that on October 1, 2015 they will only accept ICD-10 coding. The guidelines stress the importance of compliant coding, including use of specific codes, even if general ones exist. This has contributed to the broader concern that lack of specificity, or even unintentional mistakes, could result in claim rejections, denials, and interruptions in cash flow. Top five risks of ICD-10 conversion [athenahealth] 1 Lack of preparation by your billing, practice management and EMR vendor 2 Lack of preparation by your payers 3 Insufficient training for your staff 4 Reduced physician and staff productivity 5 Financial risk associated with high transition costs. CMS has addressed these concerns in a guidance document which states: ✓✓ For one year, CMS contractors will not deny claims solely on the basis of lack of specificity, as long as the code is generally correct (from the right family). ✓✓ For 2015, CMS will not impose a penalty under any of its quality reporting programs on the basis of lack of specificity, as long as the code is generally correct (from the right family). ✓✓ When contractors cannot process a claim due to internal administrative problems, an advance partial payment may be applied for. Financial risk will be associated with high transition costs. The two biggest intangible costs will come after implementation from lost productivity and denied or delayed claims due to coding mistakes. Avery Hurt for Physicians Practice Besse Medical ICD-10 Guide – July 2015 3 How much cash should you have available during the first few months following the implementation of the ICD-10 coding system? Industry experts suggest practices should have three to six months of operating cash set aside, or available in the form of a line of credit. Have you set a goal to clear out all ICD-9 billings before starting to bill ICD-10 effective October 1, 2015? Compare your days to pay prior to October 1, and then post October 1 to verify if you are experiencing any delays receiving payments. Is your practice ready? To get a sense of where your practice currently stands, see how many of the following questions you can answer. Encounter documentation ££ What is your EHR vendor’s readiness plan? ££ Can you name all the vendors with which you exchange diagnosis information? ££ Will your providers’ documentation workflows be specific enough for ICD-10? ££ Do you have a training plan for MAs, physicians, and billing staff? Quality measurement ££ Do you know when you’ll need to generate the necessary reporting updates? ££ How will your utilization review or population management reports change? Revenue cycle impact ££ How many certified medical billers do you have? Do they need to re-certify? ££ Do you know which ICD-9 codes are commonly used on your claims? ££ How are they changing in ICD-10? ££ What rules might payers implement, and what are some errors you might see? http://cdn.roadto10.org/wp-uploads/2015/06/ICD10_Quick_Start_Guide.pdf CMS ICD-10 FAQs: http://www.ahima.org/topics/icd10/faqs CMS ICD-10: Are you ready? http://dc.cn.ubm-us.com/i/530145-pulse-icd-10-ebook-2016/2 4 Besse Medical ICD-10 Guide – July 2015 The time to start is yesterday Determine where change needs to happen and what it will cost • Aligning your vendors is key to success • Do not be conservative when allocating a budget • Physicians must be trained as well - ICD-10-CM is very different • Examine your payer policies; some are already translated! • Use 5010 experience to transition into ICD-10 • Take advantage of resources that are available at no charge • Create a list of the top 75 diagnoses codes for your practice and make sure your staff is most familiar with these. Have you developed an ICD-10 implementation plan? Divide plan into sections: • Planning - organize implementation effort and establish a communication plan • Vendors - contact system vendors • Budgeting - estimate budget • Training - develop training plan, analyze business processes and policy change development • Testing - deployment of code • Payers - communicate and assess their readiness • Go-live / Monitoring - implementation compliance CMS ICD-10: Get Ready Now! http://www.cms.gov/Medicare/Coding/ICD10/Downloads/CMSICD10FullInfographic.pdf Besse Medical ICD-10 Guide – July 2015 5 Organize an implementation effort Look at all areas that will impact your practice and identify each area that will be affected. ✓✓ List of codes ✓✓ Practice management system ✓✓ Electronic medical record (if applicable) ✓✓ Superbills ✓✓ Clinical areas and pharmacy Schedule regular meetings to share information with physicians and discuss progress and barriers to implementation. AMA ICD-10 Implementation Project Plan Template: https://download.ama-assn.org/resources/doc/washington/icd-10-project-plan-template.xls Make sure you understand testing is essential - you must be aggressive! 30% 30% of heathcare payers plan to test with most of their healthcare providers 60% 60% plan to test with a sample of their providers 10% 10% plan to test clearinghouses only IDC-10 Readiness Survey Results (1174 participants). Posted February 2015 by Workgroup Electronics Data Interchange (WEDI) Establish a communication plan Write and distribute a plan covering how and when things will happen, such as: ✓✓ Training ✓✓ Testing ✓✓ Systems testing ✓✓ Go-live date ✓✓ Chart audits ✓✓ Monitoring ✓✓ Dual coding ✓✓ Shut down of ICD-9-CM 6 Besse Medical ICD-10 Guide – July 2015 Budgets and payments Have you created an ICD-10 budget? Budget considerations should include: Cost breakdown example: New hardware cost New software cost and licensing Training Parallel coding Physician query Productivity loss Temporary workers Jeopardy to cash flow Printing and document change Transcription Lending/charge cards Overtime Education Process analysis Superbill changes IT costs Increased doc. Cash flow disrupt. $ 2,500 $ 7,000 $ 3,000 $ 7,500 $44,000 $20,000 TOTAL $84,000 ICD-10 Cost Calculator: http://www.aafp.org/practice-management/payment/coding.html Have you contacted your top three payers? Lack of preparation by your payers is going to happen. It’s happened with other big industry transitions such as NPI and ANSI-5010, and it’s bound to happen with ICD-10. New Payer contracts (perhaps some even before the ICD-10 deadline) will need to be renegotiated using ICD-10, and practices need to fully understand ICD-10 to determine if contracts are favorable. Besse Medical ICD-10 Guide – July 2015 7 Payer question checklist ££ Are your top payers ready for ICD-10? ££ Other than CMS, can you do any testing? What date can you begin testing? ££ What specifically are they testing? ££ Will testing provide you with what you need to know about compliance? ££ How disruptive is testing? ££ What type of rejections/denials might you expect? ££ Do your payers see any increase in days to receiving payment? ££ Will it cost you money in software, staffing or claim delays? ££ Have you confirmed how your systems/payers will handle billing pre October 1 ICD-9 claims and post October 1 ICD-10 claims at the same time? Medicare Testing includes two types: Acknowledgement Testing and End-to-end Testing. Some of these opportunities are limited in your MAC jurisdiction. Query your vendors and ask if they participated, and if so, what were the results? CMS Payer Assessment http://cdn.roadto10.org/wp-uploads/2013/12/Payer-Assessment.doc To access the CMS MCD, visit: http://www.cms.gov/medicare-coverage-database/indexes/national-and-local-indexes.aspx Have you conducted an ICD-10 impact analysis? • Develop a reasonable timeline that can be accomplished in your practice. • Map out a project plan using a MS Excel spreadsheet with benchmarks and status of completion. Develop a plan for Systems, Processes, Departments, and Training. • Managers and/or coders should get physician approval for the project plan and its impact on the practice. Make sure you show and tell them the level of work it will take. 8 Besse Medical ICD-10 Guide – July 2015 Impact analysis worksheet Use this worksheet to track the various systems and processes that use ICD-9 today. The assumption is that all current systems that use ICD-9 will need to be upgraded to ICD-10. Review your current systems, and consider converting manual processes to electronic processes. Work process People Systems Claims submission Billing system Posting payments Clinical documentation, eg, patient reports, EMR Patient registration system Checking patient’s eligibility Verifying referral/ prior authorization Writing referrals Writing orders Encounter forms Coding tool, eg, superbills, programs, books, resource materials Quality reporting Public health reporting Disease registry/ disease management Health insurance contracting Laboratory systems Other Other http://www.cms.org/uploads/Impact-Analysis-Worksheet.pdf Besse Medical ICD-10 Guide – July 2015 9 Training Who should be trained? Physicians, coders, billing staff, administration, nurses, MAs, pharmacists. • Determine the required number of hours per role, dependent on tasks and coding interface. Coders must pass proficiency test. • Establish a training schedule or ‘train the trainer’ and choose a trusted coding employee to communicate necessary information to clinicians. • Your coding point person should flag any claims that have not been paid as the filing deadline draws near, in case the payer never received it or rejects it with no time to resubmit. Insufficient training for your staff presents a HIGH risk. Learning all new information will be a significant challenge for providers and their staff, and if not handled efficiently and effectively, ICD-10 could become very costly for your practice. ICD-10 is far more complex than ICD-9, breaking diagnosis codes down to a much finer level of granularity. Ensure you are staffed for the change. Have you conducted ICD-10 training sessions with your staff? ££ Who will be responsible for training staff? ££ Have you determined who will code for ICD-10 and any extra training required? ££ Have you identified a physician champion expert for the practice who will assist with initial and future training needs? This expert should be trained on all aspects of ICD-10 including the general equivalence mappings (GEMs), what GEMs are, and understanding why GEMs are not a substitute for appropriate coding, but should be used only as a mapping tool between ICD-9 and ICD-10. ££ Have you reviewed your workflow? (Note: temporary coders may impact your workflow) 10 Besse Medical ICD-10 Guide – July 2015 Three training approaches to consider [Angie Comfort for Physicians Practice] 1 Awareness training Office managers, schedulers, and non-clinical personnel are examples of roles that may need only basic ICD-10 training. Engage these employees with small doses of what they need to know throughout the next few months. 2 Intense training Quality Managers, Compliance Officers, Physicians, PAs, NPs, Registered Nurses, Medical Assistants, Imaging or Lab Managers fall into the intense training category. Reassure physicians the conversion is not a bureaucratic change that will only fall in the hands of the administrator... Schedule regular meetings to share information with physicians and discuss progress and barriers of implementation. Do not joke about this or tell them it will be delayed. These employees need training for ICD-10 awareness, but would additionally need to have targeted training based on the practices’ top 20 billed diagnosis codes. Main points to be communicated are the Roberta Buell, OnPoint Oncology differences between ICD-9 and ICD-10, code structure, and conventions review. Some of the areas will need to be reviewed again at different intervals to retain the information and changes between the two code sets. 3 Extensive training This training includes any practice employee whose role includes assigning ICD-9 codes for ordering tests, reimbursement, or quality initiatives. One valuable exercise would be to have the expert trainer review the current clinician documentation and identify gaps that need to be remedied for ICD-10 readiness. Do your physicians understand the impact of ICD-10? The transition to ICD-10 will be disruptive, and may well impact cash flow in your practice. • Make sure lines of credit are in place. Perform a blitz and get rid of as much A/R as you can by September 30. Diagnostic codes are used everywhere - used by every person, every process, every system. Superbills, Payments/EOBs/ERAs, Referrals, Contracts, EMRs/Order Entry, Payer Policies. Besse Medical ICD-10 Guide – July 2015 11 Potential impacted areas Clinical Area Patient coverage Disability requests Superbills ABNs Managers Policies and procedures Vendor/payer contracts Budgets Training plan Physicians Documentation Code specialty Problem lists Lab Documentation Reporting Billing Policies and procedures Training Coding Code set Clinical knowledge Concurrent use Front Desk Referrals/history codes Systems Nurses Forms Documentation Prior Authorization Have your physicians participated in training? Will the physician be assigning codes in ICD-10? ✓✓ Demonstrate the differences in coding using internal or external resources. ✓✓ If the physician is selecting the ICD-10 code, either on a superbill or within an EHR, a detailed course/training covering guidelines and conversions may be in order. ✓✓ If the physician is coding, then train specifically on their patient population disease site. ✓✓ Train physician on the use of key terms per disease site when dictating or completing assessment. ✓✓ When training, make sure you have a post test (use coding examples from your charts). ✓✓ Consider training on specific medical terminology for updated coding. If the physician has coding staff that assign the diagnosis codes based on the documentation, the focus of training should be on the nuances of documentation for ICD-10. Road To 10: Physician Champion Tips http://www.roadto10.org/physician-champion-tips/ 12 Besse Medical ICD-10 Guide – July 2015 Perhaps the best way to help physicians improve their coding accuracy is to spend 10 minutes at physician meetings having them read a blinded note and coding it together with a certified coder. Shelly Schwartz Have you developed a plan to train your coding staff? AHIMA estimates that approximately 16 hours of hands-on coding training in ICD-10 will be needed for an individual to learn the new code set. Coders must understand how to: ✓✓ Use all resources available to ensure continued accuracy of coded data ✓✓ Identify the differences between ICD-9 and ICD-10 coding guidelines ✓✓ Ensure accurate and compliant ICD-10 coding on claims. The CMS website provides a list of the mappings of ICD-9 to ICD-10 codes called the General Equivalence Mappings (GEMs). View it here: http://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-CM-and-GEMs.html This tool is helpful as a first step for practices to compare the commonly used ICD-9 codes to the related ICD-10 codes. However, the user must keep in mind GEMs are not a crosswalk. The full list of ICD-10 codes, including coding guidelines and conventions, must be reviewed to determine the appropriate code assignment. Do you plan to start coding after training, but before October 1, 2015 to minimize impact and maintain office efficiency? ££ When you start practicing coding after training consider: Week 1 - Coding one patient per MD per day Week 2 - Coding two patients per MD per day ££ Where will you be able to store the ICD-10 codes before October 1? The list of ICD-10 codes can be overwhelming; therefore, you should ensure your staff is familiar with your top 50-75 codes. Do not attempt to only use a crosswalk — you may need to code with greater specificity. Initial training exercise: Have coders and billing staff use existing documentation to code patient encounters prior to the ICD-10 transition. Be sure to monitor every claim prior to submission for code compliance. Greg Vap for Physicians Practice Besse Medical ICD-10 Guide – July 2015 13 Will you conduct any pre-October 1 coding audits? • Who will audit the coding by physician, by coder, etc., and check for accuracy? • Will you be coding your problem list effective October 1 with ICD-10? Start with only the codes that are needed for billing, and then work your way to coding all problems. For coding problems, review the Continuity of Care document that you may receive from other providers. Coding tools: EncoderPro https://optumcoding.com/Product/20510 Supercoder http://www.supercoder.com CodeItRightOnline http://www.codeitrightonline.com Are you using a Superbill? If yes, what method will you be using with ICD-10? (ie, ICD-10 manual, phone app) ✓✓ Create Superbills per disease site and for symptom management. ✓✓ Do NOT convert superbills/charge documents too early as things can change. ✓✓ Assign ICD-10 CM codes directly, not by applying ICD-9 CM to ICD-10 CM map, or use a tool that has REMS and GEMS. http://www.physicianspractice.com/icd-10/superbill-and-forms-revision-icd-10 Billing services assessment Evaluate your billing department: http://cdn.roadto10.org/wp-uploads/2013/12/Billing-Service-Assessment.doc Diagnosis code impact inventory template: http://cdn.roadto10.org/wp-uploads/2013/12/Process-and-System-Inventory-Template.doc 14 Besse Medical ICD-10 Guide – July 2015 The ICD-10 set contains about 68,000 codes with three to seven characters, compared to only 13,000 codes in the ICD-9 set, each three to five characters long. Of course, no single provider will be using all 68,000 new codes but it’s important to recognize that all providers face an increase in the number of relevant codes for use within their practices. While the increased specificity allows for more information to be conveyed in a code — such as reporting what side of the body or limb is being evaluated — many in the healthcare industry have voiced concern that there is no simple translation between ICD-9 and ICD-10 diagnosis code sets. There are some one-to-one correspondences, but often a single ICD-9 code can map to a number of ICD-10 codes, or several ICD-9 codes match with one ICD-10 code — increasing the likelihood of potential miscoding. Are your vendors ICD-10 ready? To assess whether your vendor is prepared, ask these questions: ££ What date will you be ready for ICD-10? ££ When will you be able to show me how ICD-10 will function in my system? ££ Will you be able to fully support ICD-10? ££ Is your software going to run on the same platform and database currently used? ££ Will I need to re-customize my templates and content for ICD-10 compliance? ££ When can I begin testing? ££ Will you support both ICD-9 and ICD-10 codes? ££ Will I be able to search for ICD-9 and ICD-10 codes? ££ Will you help me test ICD-10 compliance with my payers? ££ Are there any upgrade costs or fees associated? ££ What tools, training and support will you provide? ££ Will you be able to run test claims prior to October 1, 2015? ££ How will existing interfaces with other vendors be upgraded? ££ Do you know when most payers will begin accepting ICD-10 codes for pre-authorizations for dates of services that will take place after October 1, 2015? Technology vendor assessment: http://cdn.roadto10.org/wp-uploads/2013/12/Technology-Vendor-Assessment.doc Besse Medical ICD-10 Guide – July 2015 15 Additional vendor questions to consider ££ Have you spoken with your clearinghouse and asked if they are ready to handle your ICD-10 feed? Have they tested, and if so, with whom? ££ What issues do they foresee? Is there anything that you can do to assist on the practice side? ££ Did you or your clearinghouse participate in any of the CMS testing periods (last period was June 1-5)? ££ If your EMR and PM systems support both ICD-9 and ICD-10 codes, where will they be located? This is important because dual compatibility is required since not all insurance claims will be forced to submit ICD-10 coding. An example of this is Workers’ Compensation. ££ Is your coding translated to incentive programs? (eg, PQRS, EHR) ££ Will your practice require new hardware due to updates? (computers, servers, etc.) ££ Do you have a lab interface? ££ Are ICD-10 codes imported or exported and are both systems ready? Determine when they allow for test submissions of ICD-10 claims, which will assist in the identification of problems with both provider and payer systems that may delay reimbursement. http://cdn.roadto10.org/wp-uploads/2013/12/Clearinghouse-Assessment.doc Prepare for costly software upgrades and lost or delayed revenue due to delayed preparation for ICD-10 by some payers — which, as we’ve already established, is highly likely. It is important to recognize that the complexity of the ICD-10 transition will make it virtually impossible for you to go it alone. To make the transition successful, it is essential that your billing, practice management, and EHR vendor help you plan and execute the changes that need to be made to your practice processes and systems. October is not a good time to schedule vacations! 16 Besse Medical ICD-10 Guide – July 2015 Know your vendors’ plans [athenahealth] Your billing, practice management, and EHR vendors should be working hard right now, with you and your payers, to adapt your processes and systems for the changeover to ICD-10. Your vendor should have the software, knowledge and services to make the transition as smooth as possible. Software • Continuously updated as the industry moves toward the ICD-10 cutover • Flexibility to support a variety of vendor requirements and timelines Knowledge • Leverage learning from ANSI 5010 conversion for the smoothest possible ICD-10 conversion • Conduct extensive and ongoing payer readiness surveys • Reaffirm the relationships with payers that enable proactive creation of updated coding rules Service • Conduct individual payer and vendor testing, when available • Establish cross-functional teams monitoring and responding in real-time to changes in the performance of clients, vendors, and payers • Streamline triage workflow to provide quick prioritization and problem resolution Your billing, practice management and EHR vendor should provide: • Support for diagnosis code selection • Dual billing workflows to support coding staff • Testing with payers and vendors on ICD-10, as available • Movement of payers and vendors to ICD-10 • Management of highly specified implementations (eg, payers, labs, interfaces, reports) • Updates to all relevant rules (eg, billing, coding, utilization) • Ongoing communications on the progress of the conversion • Tips and reporting tools to minimize productivity loss during transition (eg, guidance on metrics to track, workflows to review, timelines, etc.) • Training and consideration of a period of reduced productivity as your practice adapts to the new codes. Besse Medical ICD-10 Guide – July 2015 17 Nurse Policies and Procedures: All payer reimbursement policies may be revised. Billing ICD-10 Will Change Everything Will You Be Ready? Physicians Documentation: The need for speciﬁcity dramatically increases by requiring laterality, stages of healing, weeks in pregnancy, episodes of care, and much more. Code Training: Codes increase from 17,000 to 140,000. Physicians must be trained. Forms: Every order must be revised or recreated. Documentation: Must use increased speciﬁcity Prior Authorizations: Policies may change, requiring training and updates. Lab Documentation: Must use increased speciﬁcity Reporting: Health plans will have new requirements for the ordering and reporting of services. Clinical Area Patient Coverage: Health plan policies, payment limitations, and new ABN forms are likely. Superbills: Revisions required and paper superbills maybe impossible. Systems: Updates to systems are likely required and may impact patient encounters HIPAA: Privacy policies must be revised and patients will need to sign the new forms. Front Desk ABNs: Health plans will revise all policies linked to LCDs or NCDs, etc., ABN forms must be reformatted and patients will require education. Training: Billing department must be trained on new policies and procedures and the ICD-10-CM code set. Besse Medical ICD-10 Guide – July 2015 Managers New Policies and Procedures: Any policy or procedure associated with a diagnosis code, disease management, tracking, or PQRI must be revised. Vendor and Payer Contracts: All contracts must be evaluated and updated. Budgets: Changes to software, training, new contracts, new Paperwork will have to be paid for. Training Plan: Everyone in the practice will need training on the changes. Coding Code Set: Codes will increase from 17,000 to 140,000. As a result, code books and styles will completely change. Clinical Knowledge: More detailed knowledge of anatomy and medical terminology will be required with increased speciﬁcity and more codes. Concurrent Use: Coders may need to use ICD-9-CM and ICD-10-CM concurrently for a period of time until all claims are resolved. AAPC can help every aspect of your practice’s transition to ICD-10. Whether you just want the basics or need complete implementation training, AAPC has a solution to ﬁt your needs. 18 Fast Forward Top 50 Codes ICD-9-CM Code ICD-10-CM Code(s) 2015 Multispecialty ICD-9-CM Code ICD-10-CM Code(s) 789.00 Abdominal pain, unspecified site 311 Depressive disorder, not elsewhere classified ICD-10-CM Codes R10.9 Unspecified abdominal pain *There are more specific code choice selections available in ICD-10-CM. These include: R10.0 Acute abdomen R10.10 Upper abdominal pain, unspecified R10.11 Right upper quadrant pain R10.12 Left upper quadrant pain R10.13 Epigastric pain R10.2 Pelvic and perineal pain R10.30 Lower abdominal pain, unspecified R10.31 Right lower quadrant pain R10.32 Left lower quadrant pain R10.33 Periumbilical pain R10.84 Generalized abdominal pain ICD-10-CM Codes F32.9 Major depressive disorder, single episode, unspecified *There are more specific code choice selections available in ICD-10-CM. These include: F32.0 Major depressive disorder, single episode, mild F32.1 Major depressive disorder, single episode, moderate F32.2 Major depressive disorder, single episode, severe without psychotic features F32.3 Major depressive disorder, single episode, severe with psychotic features F32.4 Major depressive disorder, single episode, in partial remission F32.5 Major depressive disorder, single episode, in full remission F32.8 Other depressive episodes 466.0 Acute bronchitis 461.9 Acute sinusitis, unspecified ICD-10-CM Codes ICD-10-CM Codes J01.90 Acute sinusitis, unspecified **Use additional code (B95-B97) to identify infectious agent * There are more specific code choice selections available in ICD-10-CM. These include: J01.00 Acute maxillary sinusitis, unspecified J01.10 Acute frontal sinusitis, unspecified J01.20 Acute ethmoidal sinusitis, unspecified J01.30 Acute sphenoidal sinusitis, unspecified J01.40 Acute pansinusitis, unspecified J01.80 Other acute sinusitis J20.9 Acute bronchitis, unspecified * There are more specific code choice selections available in ICD-10-CM. These include: J20.0 Acute bronchitis due to Mycoplasma pneumoniae J20.1 Acute bronchitis due to Hemophilus influenzae J20.2 Acute bronchitis due to streptococcus J20.3 Acute bronchitis due to coxsackievirus J20.4 Acute bronchitis due to parainfluenza virus J20.5 Acute bronchitis due to respiratory syncytial virus J20.6 Acute bronchitis due to rhinovirus J20.7 Acute bronchitis due to echovirus J20.8 Acute bronchitis due to other specified organisms 784.0 Headache R51 Headache 724.5 Backache, unspecified 250.00 Diabetes mellitus without mention of complications type II or unspecified type, not stated as uncontrolled E11.9 Type 2 diabetes mellitus without complications ICD-10-CM Codes 599.0 Urinary tract infection, site not specified ICD-10-CM Codes N39.0 Urinary tract infection, site not specified ** Use additional code (B95-B97)to identify infectious agent ** 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 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 M54.9 Dorsalgia, unspecified *There are more specific code choice selections available in ICD-10-CM. These include: M54.89 Other dorsalgia M54.6 Pain in thoracic spine M54.5 Low back pain M53.3 Sacrococcygeal disorders, not elsewhere classified V72.31 Routine gynecological exam ICD-10-CM Codes Z01.411 Encounter for gynecological examination (general) (routine) with abnormal findings * Use additional code to identify abnormal findings Z01.419 Encounter for gynecological examination (general) (routine) without abnormal findings Instructional note under codes should be as follows: **Use additional code: for screening for human papillomavirus, if applicable (Z11.51) for screening vaginal pap smear, if applicable (Z12.72) to identify acquired absence of uterus, if applicable (Z90.71-) 616.10 Vaginitis and vulvovaginitis, unspecified ICD-10-CM Codes N76.0 Acute vaginitis **Use additional code (B95-B97), to identify infectious agent There are other codes from this subcategory to describe vaginitis: N76.1 Subacute and chronic vaginitis N76.2 Acute vulvitis N76.3 Subacute and chronic vulvitis N76.89 Other specified inflammation of vagina and vulva 719.41 Pain in joint, shoulder region ICD-10-CM Codes M25.511 Pain in right shoulder M25.512 Pain in left shoulder M25.519 Pain in unspecified shoulder Copyright © 2015 AAPC all rights reserved — 2480 S. 3850 W. Suite B. Salt Lake City, Utah, 84120 — 800-626-2633 — www.aapc.com/icd-10/ Page 1 Fast Forward Top 50 Codes ICD-9-CM Code ICD-10-CM Code(s) 2015 Multispecialty ICD-9-CM Code ICD-10-CM Code(s) V10.83 Personal history of other malignant neoplasm of skin 782.3 Edema ICD-10-CM Codes Z85.828 Personal history of other malignant neoplasm of skin *There are more specific code choice selections available in ICD-10-CM. These include: Z85.820 Personal history of malignant melanoma of skin Z85.821 Personal history of Merkel cell carcinoma ICD-10-CM Codes R60.0 Localized edema R60.1 Generalized edema R60.9 Edema, unspecified 786.2 Cough V70.0 Routine general medical examination at a health care facility ICD-10-CM Codes Z00.00 Encounter for general adult medical examination without abnormal findings Z00.01 Encounter for general adult medical examination with abnormal findings ** Use additional code to identify abnormal findings 729.5 Pain in limb ICD-10-CM Codes M79.609 Pain in unspecified limb ** There are more specific code choice selections available in ICD-10-CM. These include: M79.601 Pain in right arm M79.602 Pain in left arm M79.603 Pain in arm, unspecified M79.604 Pain in right leg M79.605 Pain in left leg M79.606 Pain in leg, unspecified M79.631 Pain in right upper arm M79.622 Pain in left upper arm M79.629 Pain in unspecified upper arm M79.631 Pain in right forearm M79.632 Pain in left forearm M79.639 Pain in unspecified forearm M79.651 Pain in right thigh M79.652 Pain in left thigh M79.659 Pain in unspecified thigh M79.661 Pain in right lower leg M79.662 Pain in left lower leg M79.669 Pain in unspecified lower leg 724.1 Pain in thoracic spine M54.6 Pain in thoracic spine 723.0 Spinal stenosis of cervical region M48.02 Spinal stenosis, cervical region 724.3 Sciatica ICD-10-CM Codes M54.30 Sciatica, unspecified site M54.31 Sciatica, right side M54.32 Sciatica, left side M54.40 Lumbago with sciatica, unspecified site M54.41 Lumbago with sciatica, right side M54.42 Lumbago with sciatica, left side 706.2 Sebaceous cyst 707.9 Chronic ulcer of unspecified site ICD-10-CM Codes L98.499 Non-pressure chronic ulcer of skin of other sites with unspecified severity *There are more specific code choice selections available in ICD-10-CM. These include: L98.411 Non-pressure chronic ulcer of buttock limited to breakdown of skin L98.412 Non-pressure chronic ulcer of buttock with fat layer exposed L98.413 Non-pressure chronic ulcer of buttock with necrosis of muscle L98.414 Non-pressure chronic ulcer of buttock with necrosis of bone L98.419 Non-pressure chronic ulcer of buttock with unspecified severity L98.421 Non-pressure chronic ulcer of back limited to breakdown of skin L98.422 Non-pressure chronic ulcer of back with fat layer exposed L98.423 Non-pressure chronic ulcer of back with necrosis of muscle L98.424 Non-pressure chronic ulcer of back with necrosis of bone L98.429 Non-pressure chronic ulcer of back with unspecified severity L98.491 Non-pressure chronic ulcer of skin of other sites limited to breakdown of skin L98.492 Non-pressure chronic ulcer of skin of other sites with fat layer exposed L98.493 Non-pressure chronic ulcer of skin of other sites with necrosis of muscle L98.494 Non-pressure chronic ulcer of skin of other sites with necrosis of bone L72.3 Sebaceous cyst 272.4 Hyperlipidemia, other and unspecified ICD-10-CM Codes E78.4 Other hyperlipidemia E78.5 Hyperlipidemia, unspecified **There are more specific code choice selections available in ICD-10-CM. These include: E78.0 Pure hypercholesterolemia E78.1 Pure hyperglyceridemia E78.2 Mixed hyperlipidemia E78.3 Hyperchylomicronemia E78.6 Lipoprotein deficiency R05 Cough 786.59 Chest pain, other 722.52 Degeneration of lumbar or lumbosacral intervertebral disc ICD-10-CM Codes R07.89 Other chest pain NOS R07.82 Intercostal pain ICD-10-CM Codes M51.36 Other intervertebral disc degeneration, lumbar region M51.37 Other intervertebral disc degeneration, lumbosacral region Copyright © 2015 AAPC all rights reserved — 2480 S. 3850 W. Suite B. Salt Lake City, Utah, 84120 — 800-626-2633 — www.aapc.com/icd-10/ Page 2 Fast Forward Top 50 Codes ICD-9-CM Code ICD-10-CM Code(s) 592.0 Calculus of kidney ICD-10-CM Codes N20.0 Calculus of kidney N20.9 Urinary calculus; unspecified N20.2 Calculus of kidney and ureter 585.9 Chronic kidney disease, unspecified ICD-10-CM Codes N18.9 Chronic kidney disease, unspecified ** Code first any associated: Diabetic chronic kidney disease (E08.22, E09.22, E10.22, E11.22, E13.22) Hypertensive chronic kidney disease (I12-, I13-) Use additional code to identify kidney transplant status, if applicable (Z94.0) ** There are more specific code choice selections available in ICD-10-CM. These include: N18.1 Chronic kidney disease, stage 1 N18.2 Chronic kidney disease, stage 2 (mild) N18.3 Chronic kidney disease, stage 3 (moderate) N18.4 Chronic kidney disease, stage 4 (severe) N18.5 Chronic kidney disease, stage 5 N18.6 End stage renal disease ** Use additional code to identify dialysis status (Z99.2) 443.9 Peripheral vascular disease, unspecified ICD-10-CM Codes I73.9 Peripheral vascular disease, unspecified ** There are more specific code choice selections available. These include: I73.00 Raynaud’s syndrome without gangrene I73.01 Raynaud’s syndrome with gangrene I73.1 Thromboangiitis obliterans (Buerger’s disease) I73.81 Erythromelalgia I73.89 Other specified peripheral vascular diseases 780.97 Altered mental status ICD-10-CM Codes R41.82 Altered mental status, unspecified ** There are more specific code choice selections available in ICD-10-CM. These include: R41.0 Disorientation, unspecified R41.81 Age-related cognitive decline R41.840 Attention and concentration deficit R41.89 Other symptoms and signs involving cognitive functions and awareness 327.23 Obstructive sleep apnea (adult)(pediatric) ICD-10-CM Codes G47.33 Obstructive sleep apnea (adult)(pediatric) ** Code also any associated underlying condition 385.30 Cholesteatoma, unspecified ICD-10-CM Codes H71.90 Unspecified cholesteatoma, unspecified ear H71.91 Unspecified cholesteatoma, right ear H71.92 Unspecified cholesteatoma, left ear H71.93 Unspecified cholesteatoma, bilateral ** There are more specific code choice selections available in ICD-10-CM. These include: H71.00 Cholesteatoma of attic, unspecified ear H71.01 Cholesteatoma of attic, right ear 2015 Multispecialty ICD-9-CM Code ICD-10-CM Code(s) ICD-10-CM Codes (cont.) H71.02 Cholesteatoma of attic, left ear H71.03 Cholesteatoma of attic, bilateral H71.10 Cholesteatoma of tympanum, unspecified ear H71.11 Cholesteatoma of tympanum, right ear H71.12 Cholesteatoma of tympanum, left ear H71.13 Cholesteatoma of tympanum, bilateral H71.20 Cholesteatoma of mastoid, unspecified ear H71.21 Cholesteatoma of mastoid, right ear H71.22 Cholesteatoma of mastoid, left ear H71.23 Cholesteatoma of mastoid, bilateral H60.40 Cholesteatoma of external ear, unspecified ear H60.41 Cholesteatoma of right external ear H60.42 Cholesteatoma of left external ear H60.43 Cholesteatoma of external ear, bilateral 715.00 Osteoarthrosis, generalized, site unspecified ICD-10-CM Codes M15.0 Primary generalized (osteo)arthritis M15.4 Erosive (osteo)arthritis M15.8 Other polyosteoarthritis M15.9 Polyosteoarthritis, unspecified 729.1 Myalgia and myositis, unspecified ICD-10-CM Codes M79.1 Myalgia M79.7 Fibromyalgia M60.9 Myositis, unspecified **There are more specific code choice selections available in ICD-10-CM. These include: M60.811 Other myositis, right shoulder M60.822 Other myositis, left shoulder M60.819 Other myositis, unspecified shoulder M60.821 Other myositis, right upper arm M60.822 Other myositis, left upper arm M60.829 Other myositis, unspecified upper arm M60.831 Other myositis, right forearm M60.832 Other myositis, left forearm M60.839 Other myositis, unspecified forearm M60.841 Other myositis, right hand M60.842 Other myositis, left hand M60.849 Other myositis, unspecified hand M60.851 Other myositis, right thigh M60.852 Other myositis, left thigh M60.859 Other myositis, unspecified thigh M60.861 Other myositis, right lower leg M60.862 Other myositis, left lower leg M60.869 Other myositis, unspecified lower leg M60.871 Other myositis, right ankle and foot M60.872 Other myositis, left ankle and foot M60.879 Other myositis, unspecified ankle and foot Copyright © 2015 AAPC all rights reserved — 2480 S. 3850 W. Suite B. Salt Lake City, Utah, 84120 — 800-626-2633 — www.aapc.com/icd-10/ Page 3 Fast Forward Top 50 Codes ICD-9-CM Code ICD-10-CM Code(s) 2015 Multispecialty ICD-9-CM Code ICD-10-CM Code(s) R06.02 Shortness of breath 726.5 Enthesopathy of hip region 786.05 Shortness of breath ICD-10-CM Codes M70.60 Trochanteric bursitis, unspecified hip M70.61 Trochanteric bursitis, right hip M70.62 Trochanteric bursitis, left hip M70.70 Other bursitis, unspecified hip M70.71 Other bursitis, right hip M70.72 Other bursitis, left hip ** Use additional external cause code to identify activity causing disorder (Y93-) M76.10 Psoas tendinitis, unspecified hip M76.11 Psoas tendinitis, right hip M76.12 Psoas tendinitis, left hip M76.20 Iliac crest spur, unspecified hip M76.21 Iliac crest spur, right hip M76.22 Iliac crest spur, left hip 493.90 Asthma, unspecified ICD-10-CM Codes J45.909 Unspecified asthma, uncomplicated **Use additional code 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) ** There are more specific code choice selections available in ICD-10-CM. These include: J45.20 Mild intermittent asthma, uncomplicated J45.21 Mild intermittent asthma with (acute) exacerbation J45.22 Mild intermittent asthma with status asthmaticus J45.30 Mild persistent asthma, uncomplicated J45.31 Mild persistent asthma with (acute) exacerbation J45.32 Mild persistent asthma with status asthmaticus J45.40 Moderate persistent asthma, uncomplicated J45.41 Moderate persistent asthma with (acute) exacerbation J45.42 Moderate persistent asthma with status asthmaticus J45.50 Severe persistent asthma, uncomplicated J45.51 Severe persistent asthma with (acute) exacerbation J45.52 Severe persistent asthma with status asthmaticus J45.901 Unspecified asthma with (acute) exacerbation J45.902 Unspecified asthma with status asthmaticus J45.990 Exercise induced bronchospasm J45.991 Cough variant asthma J45.998 Other asthma V72.31 Routine gynecological exam ICD-10-CM Codes Z01.411 Encounter for gynecological examination (general) (routine) with abnormal findings * Use additional code to identify abnormal findings Z01.419 Encounter for gynecological examination (general) (routine) without abnormal findings Instructional note under codes should be as follows: **Use additional code: for screening for human papillomavirus, if applicable (Z11.51) for screening vaginal pap smear, if applicable (Z12.72) to identify acquired absence of uterus, if applicable (Z90.71-) 786.50 Chest pain, unspecified ICD-10-CM Codes R07.9 Chest pain, unspecified **There are more specific code choice selections available in ICD-10-CM. These include: R07.89 Other chest pain R07.2 Precordial pain R07.1 Chest pain on breathing R07.81 Pleurodynia 401.1 Essential hypertension, benign 600.01 Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS) lower urinary tract symptoms (LUTS) ICD-10-CM Codes I10 Essential (primary) hypertension Two codes are required in ICD-10-CM: N40.1 Enlarged prostate with lower urinary tract symptoms (LUTS); AND N13.8 Other obstructive and reflux uropathy ** Note under N40.1 states – Use additional code for associated symptoms, when specified: tIncomplete bladder emptying (R39.14) tNocturia (R35.1) tStraining on urination (R39.16) tUrinary frequency (R35.0) tUrinary hesitancy (R39.11) tUrinary incontinence (N39.4-) tUrinary obstruction (N13.8) tUrinary retention (R33.8) tUrinary urgency (R39.15) tWeak urinary stream (R39.12) ** Note under N13.8 states – Code first, if applicable, any causal condition, such as: tEnlarged prostate (N40.1) 474.00 Chronic tonsillitis ICD-10-CM Codes J35.01 Chronic tonsillitis * Use additional code 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) 474.10 Hypertrophy of tonsils with adenoids ICD-10-CM Codes J35.3 Hypertrophy of tonsils with hypertrophy of adenoids * Use additional code 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) Copyright © 2015 AAPC all rights reserved — 2480 S. 3850 W. Suite B. Salt Lake City, Utah, 84120 — 800-626-2633 — www.aapc.com/icd-10/ Page 4 Fast Forward Top 50 Codes ICD-9-CM Code ICD-10-CM Code(s) 2015 Multispecialty ICD-9-CM Code ICD-10-CM Code(s) 787.20 Dysphagia, unspecified 285.9 Anemia, unspecified ICD-10-CM Codes R13.10 Dysphagia, unspecified ** There are more specific code choice selections available in ICD-10-CM. These include: R13.11 Dysphagia, oral phase R13.12 Dysphagia, oropharyngeal phase R13.13 Dysphagia, pharyngeal phase R13.14 Dysphagia, pharyngoesophageal phase R13.19 Other dysphagia ICD-10-CM Codes 780.79 Other malaise and fatigue ICD-10-CM Codes R53.1 Weakness R53.81 Other malaise R53.83 Other fatigue G93.3 Postviral fatigue syndrome R53.0 Neoplastic (malignant) related fatigue * Code first associated neoplasm D64.9 Anemia, unspecified ** There are more specific code choice selections available for use. These include: D64.0 Hereditary sideroblastic anemia D64.1 Secondary sideroblastic anemia due to disease ** Code first underlying disease D64.2 Secondary sideroblastic anemia due to drugs and toxins ** Code first (T36-T65) to identify drug or toxin ** Code first poisoning due to drug or toxin, if applicable (T36– T65 with fifth or sixth character 1–4 or 6) * Use additional code for adverse effect, if applicable, to identify drug (T36–T50 with fifth or sixth character 5) D64.3 Other sideroblastic anemia D64.81 Anemia due to antineoplastic chemotherapy D64.89 Other specified anemias 780.97 Altered mental status ICD-10-CM Codes R41.82 Altered mental status, unspecified ** There are more specific code choice selections available in ICD-10-CM. These include: R41.0 Disorientation, unspecified R41.81 Age-related cognitive decline R41.840 Attention and concentration deficit R41.89 Other symptoms and signs involving cognitive functions and awareness 276.51 Dehydration 786.52 Painful respiration ICD-10-CM Codes R07.1 Chest pain on breathing R07.81 Pleurodynia R07.89 Other chest pain 782.3 Edema ICD-10-CM Codes R60.0 Localized edema R60.1 Generalized edema R60.9 Edema, unspecified 300.00 Anxiety state, unspecified ICD-10-CM Codes F41.1 Generalized anxiety disorder F41.8 Other specified anxiety disorders F41.9 Anxiety disorder, unspecified 530.81 Esophageal reflux ICD-10-CM Codes K21.9 Gastro-esophageal reflux disease without esophagitis K21.0 Gastro-esophageal reflux disease with esophagitis E86.0 Dehydration Copyright © 2015 AAPC all rights reserved — 2480 S. 3850 W. Suite B. Salt Lake City, Utah, 84120 — 800-626-2633 — www.aapc.com/icd-10/ Page 5 Copyright © 2015 AAPC all rights reserved — 2480 S. 3850 W. Suite B. Salt Lake City, Utah, 84120 — 800-626-2633 — www.aapc.com/icd-10/ Resources American Medical Association Quick Start Guide http://www.ama-assn.org/resources/doc/washington/icd-10-readiness-testing.pdf CMS ICD-10 Quick Start Guide http://cdn.roadto10.org/wp-uploads/2015/06/ICD10_Quick_Start_Guide.pdf CMS ICD-10 FAQs http://www.ahima.org/topics/icd10/faqs CMS ICD-10 ‘Are You Ready?’ http://dc.cn.ubm-us.com/i/530145-pulse-icd-10-ebook-2016/2 CMS Payer Assesment Template http://cdn.roadto10.org/wp-uploads/2013/12/Payer-Assessment.doc Diagnosis Code Impact Inventory Template http://cdn.roadto10.org/wp-uploads/2013/12/Process-and-System-Inventory-Template.doc ICD-10-CM Online http://www.cdc.gov/nchs/icd/icd10cm.htm GEMs Mapping Files ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2011/ CMS ICD-10 Information https://www.cms.gov/ICD10/ CMS Road to 10: The Small Physician Practice’s Route to ICD-10 http://www.roadto10.org/ Coding Tools EncoderPro https://optumcoding.com/Product/20510 Supercoder http://www.supercoder.com CodeItRightOnline http://www.codeitrightonline.com Hospitals - 3M Coders http://solutions.3m.com/wps/portal/3M/en_US/Health-Information-Systems/HIS/Products-and-Services/Products-ListA-Z/Coding-and-Reimbursement-System/ Short link: http://tinyurl.com/pdh9z69 Impact Analysis Worksheet http://www.cms.org/uploads/Impact-Analysis-Worksheet.pdf Superbill and Forms Revision for ICD-10 http://www.physicianspractice.com/icd-10/superbill-and-forms-revision-icd-10 Billing Services Assessment http://cdn.roadto10.org/wp-uploads/2013/12/Billing-Service-Assessment.doc Besse Medical ICD-10 Guide – July 2015 25 besse.com Where knowledge, reach and partnership shape healthcare delivery. 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