745.4 Goes with Q21.0 to Explain VSD

Even one-to-one matches can surprise you -- check the index for clearness.

When the conversion of ICD-9 to ICD-10 takes place in 2013, one lesson you'll need to keep in mind is that inclusion lists may vary between the two code sets. That implies that ICD- 9 and ICD-10 codes that seem to be twins might not apply to the same list of diagnoses.

Case in point: ICD-9 2011 code 745.4 (Ventricular septal defect) as well as ICD-10 2011 code Q21.0 (Ventricular septal defect) have the same code definition. Both reference ventricular septal defect (VSD), which includes no less than one hole in the wall separating the ventricles of the heart. In the process of conversion of ICD-9 to ICD-10, you will find that regardless of the similarity in the code definitions, the inclusion lists for these codes are not the same.

ICD-9 coding rules: Code 745.4 has an inclusion note informing you that the code is suitable for Eisenmenger's defect or complex, Gerbode defect, interventricular septal defect, left ventricular-right atrial communication, or Roger's Disease.

ICD-10 changes: The inclusion list under Q21.0 shows only Roger's disease.As you will find differences in which diagnoses come under similar ICD-9 and ICD-10 codes, the fundamental principle of checking both the index and the tabular list will be essential for proper ICD-10 coding.

For instance, if you search for Eisenmenger's defect (which falls under 745.4), you'll find that ICD-10 codes this particular defect to Q21.8 (Other congenital malformations of cardiac septa). And in another instance of what's different, Eisenmenger's complex (which also falls under 745.4) is as an alternative coded to I27.89 (Other specified pulmonary heart diseases) under ICD-10.

Article Source :- http://www.supercoder.com/coding-newsletters/my-cardiology-coding-alert/icd-10-7454-matches-to-q210-to-describe-vsd-107520-article

Documentation: In case the patient has one of the named defects (for instance, those listed in the ICD-9 inclusion list), documentation of that definite name will let you check the index to be assured that you have the most suitable ICD-10 code.

You'll also require documentation to take account of whether the VSD is congenital (existing at or before birth), because of myocardial infarction, or or else acquired (a reaction to environmental influences). In the conversion of ICD-9 to ICD-10, you will experience that ICD-10 directs you away from Q21.0 in case the patient has an acquired septal defect (I51.0, Cardiac septal defect, acquired) or a VSD as a current complication of an acute myocardial infarction (I23.2, Ventricular septal defect as current complication following acute myocardial infarction).

Bonus tip: ICD-9 also has an exclusion list in 745.4, so you know not to use the code for common atrioventricular canal type (coded to 745.69, Other endocardial cushion defects) or single ventricle (coded to 745.3, Common ventricle) defects. In the conversion of ICD-9 to ICD-10, you will see that ICD-10 does not have an excludes list for Q21.0, but those diagnoses still are coded in another place: Q21.2 (Atrioventricular septal defect) is applicable to the common atrioventricular canal and Q20.4 (Double inlet ventricle) is applicable to the single or common ventricle diagnosis.

Start Small When Preparing for ICD-10 Conversion

Familiarize yourself with the top 30 diagnoses which you think your practice sees and you'll get an edge towards compliance.

If you've studied the ICD-10 book, you know that it would be virtually impossible to remember all of the codes that it has. But preparing for ICD-10 won't need you to even learn the codes by heart.

Switching from ICD-9 to ICD-10 will not require practitioners to or memorize new code sets--in fact, most practitioners perhaps don't know many ICD-9 codes by heart, so they won't be expected to memorize ICD-10 codes either.

What do physicians need to do for the conversion? To prepare for ICD 9 to ICD-10 conversion, doctors will need to look at the codes they use most regularly in their offices and make novel job aids or superbills for those procedures.


Strategy: Use your list of the top diagnoses that your practice sees to find the corresponding ICD-10 codes, and you've got your cheat sheet. Then, make sure that your coders are well-trained, that your claims are necessarily form 5010 compliant, and also that your claim submission system supplier is ready for ICD-10. Besides, in case you have an electronic medical record or you are planning to get one, ensure that it can handle ICD-10. If you're planning to bring in an EMR, you want to convert to ICD-10 first, not bring one in under ICD-9 and then convert.

Physicians should tighten up documentation: As is the case under ICD-9, coders will be unable to bring together ICD-10 codes from a physician's documentation if it isn't detailed and comprehensive, so physicians should take this as an opportunity to enhance their documentation skills. Coders cannot code what's not present in the medical record. Because there are more opportunities for coders to choose from a list, they're going to be coming back to physicians early on to say 'Wait, I need more definition to help me pick A or B.'

Non-Medicare Payers, Too, Are Prepping for ICD-9 to ICD-10 Conversion

CMS has no plans of postponing the implementation of ICD-10 beyond Oct. 1, 2013. However, not all entities are prepared for the ICD-9 to ICD-10 conversion

Starting July 2011, 11 state Medicaid programs are at high risk for not meeting the ICD-10 implementation date, though 21 states are at moderate risk, 15 are at low risk, and four states have not told CMS as to where do stand in the process.

Interestingly, many non-required entities like workers compensation programs and property and casualty insurers are also working towards ICD-9 to ICD-10 conversion. Besides, keep in mind that CMS is very close to determining how to process claims that span the ICD-10 implementation date.

Source URL :- http://www.supercoder.com/coding-newsletters/my-ophthalmology-coding-alert/icd-10-readiness-start-small-when-prepping-for-icd-10-conversion-cms-says-107689-article

Four Phases to Help you Begin Your ICD-10 Preparations Right Way

Start your initial plan of conversion straight away so you can project your practice's timeline.

Medical practices that have got an early start to ICD-10 transition say that it's not an easy task as far as the process's vast nature is concerned. So if your practice has been putting off its preparations, it is time to get onboard the ICD-10 train.

Procrastinators should be careful: ICD-10 will go into effect on October 1, 2013, and CMS will not provide you a grace period post that date. To put it in other words, you will be better placed of you have your ICD-10 systems ready prior to that date so that your claims continue to flow smoothly. Experts warn that if you're not ready, your claims may not flow at all.

Key: The transition will have no effect on CPT code or HCPCS code use. Both of these coding systems will remain to be used as they are now.

4 phases help you begin preparing right away

At a medical practice, every month is a busy month. But then it's very important that you make time for your ICD-10 preparation sooner rather than later. An important takeaway message from today's session is the totally critical importance of not delaying in getting this implementation process started.

You should institute a well-planned implementation process to be ready in year 2013 rather than hastily scrambling your ICD-10(http://www.supercoder.com/icd-10/icd-10-bridge) program together at the last minute.

Here's how you should do it: break your ICD-10 implementation planning program into four phases. Here're the goals for each phase with suggested timelines:

Phase 1: Implementation plan development and impact assessment, suggested to span from the first quarter of year 2009 through the second quarter of this year

Phase 2: Implementation preparation, suggested to take place between the first quarter of this year and the second quarter of 2013

Phase 3: "Go live" preparation, should potentially take place between the 1st and 2nd quarters of 2013

Phase 4: Post-implementation follow-up, suggested to occur between the fourth quarter of 2013 and fourth quarter of 2014.

Normally, your phase one work should be approaching completion or at least be well on its way. For those of you who may not have gotten started yet or who have hardly gotten started, I urge you to move forward with this as soon as possible.

Reason: You will not be able to schedule phases through four until phase one is done, and you need to be able to calculate the resources you will require for those subsequent phases. Till you know the scope of the effect of ICD-10 in your organization, you do not know how much time and resources will be required to finish the preparation activities; as such you do not want to wait too long prior to making that assessment.

Tips to Help You Get Closer to ICD-10 Compliance

 As is likely, when ICD-9 becomes ICD-10, there will not always be a simple crosswalk relationship between old and new codes. Sometimes you will have more options that may need changing the way you document services and a coder reports it. Here are some examples of how ICD-10 will alter your coding options from October 1, 2013.

Rejoice sinusitis codes' one-to-one relationship for ICD-10

At present: When your doctor treats a patient for sinusitis, you should use the proper sinusitis code for sinus membrane lining inflammation. For acute sinusitis, report 461.x. For chronic sinusitis, frequent or persistent infections lasting more than three months – use 473.x.

For both acute and chronic conditions, you will select the fourth digit code based on where the sinusitis occurs. For example, for ethmoidal chronic sinusitis, you should use 473.2, Chronic sinusitis; ethmoidal. Your otolaryngologist will most probably prescribe a decongestant, pain reliever or antibiotics to treat sinusitis.

Good tidings: These sinusitis choices have a one-to-one match with soon-to-come ICD-10 codes. For acute sinusitis diagnoses, you will look at the J01.-0 codes. For example, 461.0 (Acute maxillary sinusitis) translates to J01.00 (Acute maxillary sinusitis, unspecified). Remember how the definitions are generally identical. Just as in ICD-9, the fourth digit changes to specify location.

For chronic sinusitis diagnoses, you will have to take a look at J32.- codes. For example, in the mentioned instance, 473.2 maps direction to J32.2 (Chronic ethmoidal sinusitis). What's more, this is a direct one-to-one ratio with identical definitions. Just like ICD-9, the fourth digit changes to specify location.

Physician documentation: Presently, the doctor should pinpoint the location of the sinusitis. This will not change in year 2013.

Tips: You will scrap the 461.x and 473.x options and turn to J01.-0 and J32.- in your ICD-10 manual. Apart from the change in code number and the addition of a letter, you should treat these claims the same as before.

Osteoarthritis will need heightened documentation in 2013

Imagine your diagnoses osteoarthrosis (715.xx-716. xx) in a new patient. These codes specify location, primary or secondary.

ICD-10 difference: After October 1, 2013, you should look to:

M15 (Polyosteoarthritis)

M16 (Osteoarthritis of hip)

M17 (Osteoarthritis of knee)

M18 (Osteoarthritis of first carpometacarpal joint)

M19 (Other and unspecified osteoarthritis).

These codes are broken down into location, primary and secondary such as your ICD-9 codes; however they also sometimes specify unilateral, bilateral and post-traumatic indications:

Physician documentation: In order to submit the most detailed diagnosis, the doctor will need to maintain osteoarthrosis documentation; however expand it to unilateral, bilateral, and/or post-traumatic specification. Some important terms are '"osteoarthritis," "arthritis," "arthrosis," "DJD," "arthropathy," "post traumatic arthritis," and "traumatic arthritis."

Tips: Note how codes M19.01--M19.93 entail unspecified locations. ICD-10 no longer group unspecified locations together with the specific locations for each type. You'll find them at the end of the code grouping (M19.90--"M19.93) for each specific type, however in an unspecified location.

What's more, traumatic osteoarthritis is now more properly indexed and described as post-traumatic osteoarthritis, the true condition.  Source URL :- http://www.supercoder.com/coding-newsletters/my-part-b-coding-alert/icd-10-3-tips-will-get-you-closer-to-icd-10-compliance-article

Focus On Drug Dependence versus Abuse to Assign Diagnosis

ICD-9 does not provide a specific code for a urine drug test. The same is the case with ICD-10 too. The proper diagnosis code for billing a lab drug test depends on the signs, symptoms, patient condition, or other reason for the test, say for instance screening.

Example: The physician orders a drug screen for a patient diagnosed with Cannabis dependence who uses the drug intermittently. Code the ordering diagnosis as 304.32 (Cannabis dependence, episodic use) with ICD-9.

Cross walking from ICD-9 to ICD-10: Even though ICD-10 provides more detail than ICD-9, leading to more code choices for ICD-10, the opposite is correct in this instance. The subsequent three ICD-9 codes crosswalk to a single ICD-10 code (F12.20, Cannabis dependence, uncomplicated):

304.30 -- Cannabis dependence, unspecified use

304.31 -- Cannabis dependence, continuous use

304.32 -- Cannabis dependence, episodic use.

Report different codes for abuse or use

Both ICD-9 as well as ICD-10 differentiates between drug dependence versus drug abuse. For example, 304.3x identifies Cannabis dependence while 305.2x (Non-dependent Cannabis abuse) identifies Cannabis abuse.

Likewise, ICD-10 provides F12.20 for Cannabis dependence, and F12.10 (Cannabis abuse, uncomplicated) for Cannabis abuse.

Article Source :- http://www.supercoder.com/coding-newsletters/my-icd-10-coding-alert/reader-question-focus-on-drug-dependence-vs-abuse-to-assign-diagnosis-108833-article

What's more, ICD-10 provides separate codes for drug use when the doctor does not specify whether the use constitutes dependence or abuse. For example, you would code Cannabis use as F12.90 (Cannabis use, unspecified, uncomplicated).