In anticipation of the switch from ICD-9 to ICD-10 on October 1, 180 NMMS members and their staff gathered in Albuquerque and in Santa Fe on June 3rd to hear a detailed overview of the ICD-10 system and the physician’s role in preparing for the change from the Centers for Medicare and Medicaid (CMS). Some “take homes” from the lecture are included below.
As part of her overview and emphasis on “What is not documented cannot be coded,” Dr. Ramya Sundaraman gave functional suggestions for documentation, including:
1. Always include anatomical site, severity, and laterality in your documentation.
2. As only small percentage of the codes will be used by most providers – create a ‘cheat sheet” for your staff of the most commonly used in your practice.
3. Develop encounter forms. These are available from your specialty society, EMR vendor, on-line search engines, or develop your own for your practice.
4. Weekly case reviews. Select 10 codes used in the past week. Using the GEMS site on the Road to 10 website (www.roadto10.org), translate ICD-9 to ICD-10 category code. Then try to finish the code based on documentation. Make list of what documentation (e.g. laterality, complications, trimester, type of diabetes) is missing to enable you to code as ICD-10. In this way, you may practice using documentation specifics required in “10” before October.
5. Documentation Checklist.
Type of condition
Onset
Etiology/cause
Anatomical location
Laterality
Severity
Environmental Factors
Time Parameters
Comorbidities
Complications
Manifestations
Healing level
Findings and symptoms
External causes
Type of encounter
Anatomy of an ICD-10 structure.
There are 6 to 7 characters.
The first three are the CATEGORY.
The second three are the ETIOLOGY, ANATOMICAL SITE, SEVERITY.
The last is an extension and usually reserved for trauma and pregnancy.
The first character is always Alpha. The second character is always Numeric. The other characters are either Alpha or Numeric.
Code Volume by Clinical Area. Most code volumes increase from ICD-9 to ICD-10. For example, fractures increases from 747 to 17,099, poisoning from 244 to 4662, and diabetes from 69 to 239. Some code volumes decrease with “10” – hypertensive disease decreases from 33 to 14, mood disorders 78 to 71, and chronic respiratory failure from 7 to 4.
Critical Online Resource – https://www.roadto10.org/ There is no way to give credit to level of resources available at the site – it must be explored. For example, it includes:
1. The ICD-10 code book which will be updated yearly and is free.
2. Customizable ACTION PLAN for your office.
3. TEMPLATES for communication with EMR vendors and other external resources.
4. SPECIALTY SPECIFIC WEBCASTS for family and internal medicine, pediatrics. Obstetrics/gynecology, cardiology, orthopedics, and others.
5. QUICK REFERENCES page.
More Information If you’d like a copy of the PowerPoint from the training, please email info@nmms.org. NMMS is on the wait list for another presentation by CMS and is also arranging for some specialty specific trainings in the later in the summer. More information will be forthcoming via newsletter, website, and email blasts as details are confirmed.