ICD 10 conventions and guidelines
TLDRThis webinar transcript covers the second session of Karen B's four-part physician training program focused on ICD-10 coding. Dr. Williams, an expert in medical coding and ICD-10, discusses the importance of understanding conventions and guidelines for accurate coding. He emphasizes the need to follow general coding guidelines, such as coding to the highest level of specificity and listing the main reason for the visit first. Specific examples are provided to illustrate how to apply these rules, including the use of 'and', 'or', and exclusion notes in code descriptions. The session aims to equip healthcare providers with the knowledge to navigate ICD-10 effectively, ensuring proper documentation and claim processing.
Takeaways
- 📘 Understanding ICD-10 conventions and guidelines is crucial for accurate coding and claim processing.
- 🔍 ICD-10 codes should be used to their highest level of specificity, utilizing all available characters for a code.
- 📌 The order of coding is important; the primary reason for the encounter should be listed first.
- 🚫 Unspecified codes should be used sparingly and only when the specific information is not documented or known.
- 🔗 The 'and', 'or', and ' NEC/nos' conventions in ICD-10 have specific meanings that guide how codes are grouped or selected.
- 📈 ICD-10 has specific rules for acute and chronic conditions, and these should be sequenced correctly in the coding.
- 🤔 When a definitive diagnosis is not established, it is acceptable to report symptoms using ICD-10 symptom codes.
- 🌟 Chapter-specific guidelines are available for different medical specialties to aid in more detailed and accurate coding.
- 📝 Documentation improvement is key for ensuring that coders can correctly identify and apply the appropriate ICD-10 codes.
- 📆 Dedicated Q&A sessions are being conducted to address questions related to ICD-10 and its implementation.
- 🔄 The use of the 'X' placeholder and 7-character extensions in ICD-10 codes is important for capturing nuanced information.
Q & A
What is the main focus of the second session of Karen B's physician training program?
-The main focus of the second session is on conventions and guidelines in coding, which is considered the most exciting topic in coding.
Who is the trainer for the second session of the training program?
-The trainer for the second session is Dr. Williams, a certified professional coding instructor, medical compliance specialist, and certified professional medical auditor.
What are the two types of excludes in ICD-10?
-The two types of excludes in ICD-10 are excludes1, which are mutually exclusive codes, and excludes2, which indicates conditions not included in the code and may require additional coding.
What is the significance of the 'and' and 'or' in ICD-10 coding conventions?
-In ICD-10 coding conventions, 'and' means both conditions must be present, while 'or' means any one of the conditions listed may be applicable.
What is the purpose of the 'NEC' and 'NOS' abbreviations in ICD-10 coding?
-NEC stands for 'not elsewhere classified' or 'classifiable' and is used when a specific code does not exist for the medical record details. NOS stands for 'not otherwise specified' and is used when the medical record information is insufficient to assign a more specific code.
How can a physician ensure their documentation is prepared for ICD-10 coding?
-Physicians can ensure their documentation is prepared for ICD-10 coding by including specific details and using the correct conventions and guidelines as taught in the training program.
What is the role of the 'includes' term in ICD-10 coding?
-The 'includes' term in ICD-10 coding further defines and clarifies the content of a code category, indicating what else is included within that category.
Why is it important to understand the ICD-10 coding conventions and guidelines?
-Understanding the ICD-10 coding conventions and guidelines is important because it helps ensure accurate and efficient coding, which can prevent claim denials and ensure proper reimbursement.
How does the use of the 'X' placeholder work in ICD-10 coding?
-The 'X' placeholder in ICD-10 coding is used in positions 4, 5, or 6 when the 7th character needs to stay in a certain position, allowing for more specificity in the code.
What are the three levels of items that CARICOM is working on to help with ICD-10 transition?
-The three levels of items CARICOM is working on include: 1) the ICD-10 Resource Center with documentation readiness assessments and FAQs, 2) the ICD-10 Physician Training Program with code conversion assistance and role-based checklists, and 3) ICD-10 Consultancy Services for personalized guidance and support.
Outlines
📚 Introduction and Overview of Training Program
The session begins with a greeting to all attendees and an overview of Karen B's four-part physician training program. It highlights the availability of a recording for the previous session on the CureMD wiki and the webinar section of the Carey website. The importance of the ICD-10 wiki for answering questions is emphasized, and the upcoming dedicated Q&A sessions are announced. The host, Ken Edwards, introduces Dr. Williams, a certified professional coding instructor and medical compliance specialist, who will lead the training on coding conventions and guidelines.
📖 Understanding ICD-10 Conventions and Guidelines
Dr. Williams starts by comparing ICD-10 to learning a foreign language, emphasizing the importance of understanding grammar rules. He outlines the structure of the ICD-10 code set, including conventions, general coding guidelines, and specialty-specific coding guidelines. The session covers the basics of ICD-10, including the significance of abbreviations like NEC (Not Elsewhere Classified) and NOS (Not Otherwise Specified), and the importance of following the correct sequence when coding multiple conditions.
🔍 ICD-10 Coding: Specifics and Examples
Dr. Williams delves into the specifics of ICD-10 coding, using examples to illustrate how to apply conventions and guidelines. He explains the use of 'includes' terms, the meaning of 'and/or' in coding descriptions, and the importance of understanding the sequence of etiology and manifestation codes. The session also covers the use of 'excludes1' and 'excludes2' in the tabular list, which help determine the appropriate codes for a patient's condition.
📝 Applying Guidelines to Select the Right ICD-10 Codes
This segment focuses on the practical application of ICD-10 guidelines in selecting the correct codes. Dr. Williams demonstrates how to work backwards from a chosen code to ensure its accuracy, considering various instructional notes and exclusions. He emphasizes the importance of coding to the highest level of specificity and listing the primary reason for the encounter first. The session also touches on the use of 'with' and 'without' in coding and the need to document conditions that coexist with the main diagnosis.
📋 General Coding Guidelines and Their Implications
Dr. Williams reviews key general coding guidelines from the ICD-10 manual, such as coding to the highest level of specificity, listing the main diagnosis first, and reporting signs and symptoms when a definitive diagnosis is not established. He clarifies the guidelines for coding acute and chronic conditions, combination codes, and the use of the X placeholder and 7-character extensions. The session concludes with a reminder of the importance of avoiding unspecified codes and the need for detailed and accurate documentation.
🤝 Closing Remarks and Future Training Sessions
Ken Edwards concludes the session by thanking Dr. Williams and providing attendees with information on future training sessions. He encourages participants to review the ICD-10 Resource Center and upcoming Q&A sessions, emphasizing the availability of support for various specialties. The session ends with a reminder of the importance of preparing for ICD-10 and the resources provided to ensure a smooth transition.
Mindmap
Keywords
💡ICD-10
💡Coding Conventions
💡General Coding Guidelines
💡Chapter-Specific Guidelines
💡Tabular List Instructions
💡Documentation Improvement
💡Q&A Sessions
💡Certified ICD-10 Trainer
💡Webinar
💡Physician Training Program
Highlights
Introduction to the second session of Karen B's four-part physician training program.
Availability of last week's session recording on the CureMD wiki and the webinar section of the Carey website.
Access to the ICD-10 section of the Cure wiki for answers to questions.
Dedicated Q&A sessions starting next Thursday at two different times to accommodate all attendees.
Exploration of the GoToWebinar toolbar for sharing questions during the session.
Introduction of Dr. Williams, a certified professional coding instructor and medical compliance specialist.
Emphasis on the importance of understanding conventions and guidelines in coding, which is often overlooked.
Overview of the ICD-10 workshop structure, including fundamentals, navigation, conventions, guidelines, code selection, and documentation improvement.
Explanation of the significance of conventions like NEC (Not Elsewhere Classified) and NOS (Not Otherwise Specified) in ICD-10 coding.
Discussion on the use of 'includes' and 'and/or' in ICD-10 coding and how they affect the selection and application of codes.
Clarification on the use of 'excludes1' and 'excludes2' in ICD-10, indicating mutually exclusive conditions and additional codes to consider.
Importance of coding to the highest level of specificity as per ICD-10 guidelines.
Instructions on listing the primary reason for the visit or service first in the claim and the implications of certain conditions like diabetes or pregnancy on patient care.
Explanation of how to work backwards from a code using the ICD-10 guidelines to ensure accuracy and validity.
Discussion on the use of 'with' and 'without' in coding and the default assumption when not specified.
Guidelines on not coding diagnoses documented as probable, suspected, questionable, or as a working diagnosis indicating uncertainty.
Clarification on coding acute and chronic conditions simultaneously and the correct sequence for listing them.
Information on combination codes in ICD-10 that encompass both a diagnosis and its associated manifestation or complication.
Explanation of the use of the X placeholder and 7-character extensions in ICD-10 coding for specific situations.
Instructions on handling unspecified codes and the importance of avoiding their unnecessary use while finding the most accurate code possible.
Overview of the three levels of ICD-10 resources provided by Kareo, including the resource center, physician training program, and consultancy services.
Details on the upcoming Q&A sessions and the availability of the training videos and answers on the Kareo wiki and website.
Transcripts
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