Introduction to ICD 10 CM
TLDRThis instructional video offers a comprehensive introduction to the ICD-10-CM coding system, used for diagnosis coding in the United States. The presenter explains the process of condensing official CMS guidelines into a more manageable format for practical use. The video covers the importance of the October 1st start date, the cooperating organizations behind ICD-10, and the transition from ICD-9 to ICD-10, emphasizing the system's relevance for both reimbursement and healthcare statistics. Key concepts such as coding conventions, the use of the alphabetic and tabular indexes, and specific coding guidelines are discussed in detail. The video aims to equip coders with the knowledge to navigate the ICD-10-CM coding system effectively, ensuring accurate and HIPAA-compliant patient information documentation.
Takeaways
- ๐ ICD-10-CM guidelines start October 1st and end September 30th, differing from CPT and HIPAA which run from January 1st to December 31st.
- ๐ ICD-10 is based on the World Health Organization's standards and is used globally, though each country may adapt it for their specific healthcare needs.
- ๐ The document emphasizes the importance of using both the Alphabetic Index and Tabular List when assigning ICD-10-CM codes for accuracy and completeness.
- ๐ The Alphabetic Index is used to look up terms and find corresponding codes, while the Tabular List provides the full code selection and includes necessary notations.
- ๐ ICD-10-CM codes can range from 3 to 7 characters, with a period after the third character if there are more than three characters.
- ๐ฅ Documentation from healthcare providers is crucial for accurate coding, especially when determining if a condition is related or unrelated to another coded condition.
- ๐ The script highlights the difference between 'other specified' (specific condition with no code) and 'not otherwise specified' (insufficient information for a more specific code).
- ๐ The use of 'and', 'or', 'with', and 'in' in code titles and instructional notes has specific meanings that guide how codes should be combined or related.
- ๐ซ Certain conditions should not be coded together due to exclusion notes, and in cases of uncertainty, clarification from the provider is necessary.
- ๐งฌ Etiology and manifestation codes are paired to indicate the cause and effect relationship of certain conditions, with the underlying cause coded first followed by the manifestation.
Q & A
What is the purpose of condensing the official ICD-10-CM guidelines into a smaller document?
-The purpose is to reduce the original document from about 112-120 pages to approximately 57 pages, making the guidelines more accessible and manageable for users without losing any essential information.
When does the annual ICD-10-CM guideline period start and end?
-The ICD-10-CM guideline period starts on October 1st and ends on September 30th of the following year.
Who are the four cooperating parties responsible for the ICD-10-CM?
-The four cooperating parties are the American Hospital Association (AHA), American Health Information Management Association (AHIMA), Centers for Medicare and Medicaid Services (CMS), and the National Center for Health Statistics (NCHS).
What is the significance of the Clinical Modification (CM) in ICD-10-CM for the United States?
-The Clinical Modification (CM) adapts the ICD-10 for diagnosis coding specifically tailored to the healthcare system in the United States, differentiating it from versions used in other countries like ICD-10-AU for Australia and ICD-10-GE for Germany.
How is the use of ICD-10 codes different in countries with socialized medicine compared to the United States?
-In countries with socialized medicine, ICD-10 is primarily used for cataloging diseases rather than for reimbursement purposes, which is the main use in the United States.
What does 'conventions' refer to in the context of ICD-10-CM coding?
-Conventions refer to a series of terms and symbols used in the ICD-10-CM codebook that help users understand the formatting and interpretation of the codes.
Why is it important for a code to have a period after the third character if it has more than three characters?
-The period after the third character is crucial for differentiating ICD-10-CM diagnosis codes from procedure codes and ensuring the code is accurately formatted, especially when it extends beyond three characters.
What is the role of 'placeholders' in ICD-10-CM codes, and how are they represented?
-Placeholders, represented by the letter 'X', are used in certain ICD-10-CM codes to allow for future expansion of the code set and to maintain the required code length for valid coding.
What distinguishes a 'combination code' in ICD-10-CM?
-A combination code in ICD-10-CM is a single code used to classify two diagnoses, or a diagnosis with an associated secondary process or complication, thereby reducing the need for multiple codes.
How should 'borderline' diagnoses be coded in ICD-10-CM?
-Borderline diagnoses should be coded as confirmed unless the ICD-10-CM provides a specific entry for borderline conditions. This approach applies regardless of the care setting.
Outlines
๐ Introduction to ICD-10-CM
The paragraph discusses the basics of ICD-10-CM, a coding system used for medical diagnoses. It explains the process of obtaining official guidelines from cms.gov, CDC, and NIH websites, and how these guidelines are condensed into a more manageable format. The speaker emphasizes the importance of understanding the guidelines, which are effective from October 1st to September 30th of the following year, and the need to be HIPAA compliant. It also introduces the four cooperating parties responsible for ICD-10 and the World Health Organization's role in its development.
๐ Understanding ICD-10 Coding Structure
This section delves into the structure of ICD-10 codes, highlighting the difference between ICD-10 and ICD-9, and the expansion of codes from three to seven characters. It explains the use of placeholders like 'X' for future expansion, the importance of using the full code including the 7th character where applicable, and the use of tables for drugs, neoplasms, and external causes. The paragraph also discusses the significance of categories, subcategories, and codes, and the difference between 'other specified' and 'not otherwise specified' in coding.
๐ Coding Conventions and Abbreviations
The paragraph focuses on the conventions and abbreviations used in ICD-10 coding, such as the use of ' NEC' and 'NOS' to indicate 'not elsewhere classified' and 'not otherwise specified'. It also explains the use of punctuation in coding, including brackets for synonyms and manifestation codes, parentheses for supplementary words, and colons for incomplete terms. The section emphasizes the importance of understanding these conventions to accurately assign codes and ensure reimbursement.
๐ Etiology and Manifestation Codes
This section discusses the concept of etiology and manifestation codes in ICD-10-CM, explaining how certain conditions have both an underlying cause and multiple body system manifestations. It outlines the coding convention that requires the underlying condition to be sequenced first, followed by the manifestation. The paragraph also introduces the use of 'use additional code' and 'code first' notes, whichๆ็คบ the proper sequencing order of codes.
๐ ICD-10 Data and Coding Examples
The speaker uses the ICD-10 Data website to illustrate how to look up codes and understand the coding conventions. They provide examples of how to find codes for conditions like dementia and how to apply the 'code first' and 'use additional code' notes. The paragraph emphasizes the importance of using both the alphabetic index and the tabular list when assigning codes, and the need to verify the necessity of 7th characters in the tabular list.
๐ Provider Documentation and Coding
This section emphasizes the importance of provider documentation in the coding process. It explains that the assignment of diagnosis codes is based on the provider's diagnostic statement, not on clinical criteria. The paragraph also discusses the use of 'C' and 'also' notes in the alphabetic index, which direct coders to other main terms for correct code location. It highlights the need to reference additional codes when necessary and the importance of following sequencing guidelines.
๐ Signs, Symptoms, and Diagnostic Coding
The paragraph discusses the difference between signs and symptoms and established diagnoses. It explains that codes for symptoms and signs are acceptable when a definitive diagnosis has not been established. The section also addresses the coding of conditions that require testing for confirmation, and the use of 'maybe' or 'probably' diagnoses in the outpatient setting. It stresses the importance of provider documentation in determining whether conditions are connected and the need to query providers for clarification.
๐ Additional Coding Scenarios and Guidelines
This section covers various coding scenarios, including the use of additional codes for conditions like bacterial infections and the coding of sequelae (sequel a) as residual effects of previous conditions. It explains the need for multiple codes in certain conditions and the identification of combination codes. The paragraph also addresses the coding of impending or threatened conditions in the inpatient setting and the unique rules for such scenarios.
๐ Outpatient Coding Guidelines
The paragraph outlines the guidelines for outpatient coding, emphasizing the importance of following the conventions and general coding guidelines. It discusses the use of 'encounter' and 'visit' interchangeably and the need to sequence the first-listed diagnosis based on the medical record. The section also covers specific scenarios like outpatient surgery, observation, and diagnostic services, and how to code them according to ICD-10-CM guidelines.
๐ Summary of Coding Conventions and Outpatient Guidelines
The final paragraph summarizes the key points discussed in the video script, including the coding conventions, symbols, and terms used in ICD-10-CM, as well as the general coding guidelines for outpatient services. It reiterates the importance of understanding the guidelines, the need to use both alphabetic index and tabular list for accurate coding, and the significance of provider documentation in the coding process.
Mindmap
Keywords
๐กICD-10-CM
๐กCMS.gov
๐กCooperating Parties
๐กHIPAA Compliance
๐กAlphabetic Index and Tabular List
๐กEtiology and Manifestation Codes
๐กSigns and Symptoms
๐กOutpatient Guidelines
๐กSequencing of Codes
๐กZ Codes
๐กPreoperative Evaluations
Highlights
Introduction to ICD-10-CM coding guidelines, emphasizing the importance of accurate documentation and adherence to guidelines.
Explanation of the difference between ICD-10-CM and CPT/HIPAA codes, including their respective start and end dates for the coding year.
Discussion of the four cooperating parties responsible for ICD-10-CM: American Hospital Association, American Health Information Management Association, Centers for Medicare and Medicaid Services, and National Center of Healthcare Statistics.
The necessity of using both the alphabetic index and tabular list when locating and assigning ICD-10-CM codes for comprehensive and accurate coding.
Clarification on the use of 'conventions' in ICD-10-CM, which refers to a series of terms and symbols used in the code book for understanding the coding system.
Description of the structure of ICD-10-CM, including the alphabetic index and tabular list, and the process of looking up codes for conditions like bronchitis, asthma, and GERD.
Explanation of the importance of the 'X' as a placeholder in certain ICD-10-CM codes, allowing for future expansion and the requirement to use it for valid coding.
Discussion on the use of abbreviations in ICD-10-CM such as ' NEC ' for other specified and ' NOS ' for not otherwise specified, and their implications on coding specificity.
Details on the use of punctuation in ICD-10-CM, including brackets, parentheses, and colons, and their significance in coding.
Explanation of the etiology and manifestation coding convention in ICD-10-CM, where the underlying condition must be sequenced first, followed by the manifestation.
Guidance on the use of 'code also' notes in ICD-10-CM, which require the use of an additional code but do not provide sequencing direction.
Instructions on coding for signs and symptoms versus an established diagnosis, and when it is appropriate to use each in outpatient settings.
Clarification on the assignment of diagnosis codes based on the provider's diagnostic statement, and the importance of not using clinical criteria or 'maybe' diagnoses.
Discussion on the use of combination codes in ICD-10-CM, which classify two aspects of a diagnosis or a diagnosis with an associated secondary process.
Explanation of the sequela (sequelae) codes in ICD-10-CM, which represent residual effects after the acute phase of an illness or injury has terminated.
Guidelines for coding in the outpatient setting, including the use of 'encounter' and 'visit' interchangeably and the importance of starting with the alphabetic index for correct code assignment.
Instructions for coding when a patient presents for outpatient surgery or same-day surgery, emphasizing the need to code the reason for the surgery as the first listed diagnosis.
Clarification on coding for patients admitted for observation in a hospital, where the reason for admission becomes the first listed diagnosis.
Details on the use of Z codes for factors influencing health status and contact with health services, which are used for non-disease or injury related healthcare encounters.
Guidance on coding for chronic diseases treated on an ongoing basis, stating that they can be coded and reported as many times as a patient receives treatment for the conditions.
Transcripts
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