ICD-10-CM BootCamp: Diseases of the Nervous System

VantagePoint HealthCare Advisors

12 Jan 201623:38

EducationalLearning

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TLDRThis webinar transcript focuses on ICD-10-CM Chapter 6, which pertains to diseases of the nervous system. It outlines the official ICD-10 guidelines, coding practices, and clinical scenarios for conditions like epilepsy and migraines. The presentation highlights changes from ICD-9, such as the separation of eye and ear diseases into individual chapters and the updated terminology for epilepsy. It emphasizes the importance of laterality in hemiplegia coding and the correct use of G89 codes for pain not elsewhere classified. The transcript also includes a quiz to test understanding of the material.

Takeaways

📚 Chapter six of ICD-10-CM focuses on diseases of the nervous system, with codes starting with the letter 'G', unlike ICD-9 where they started with number '3'.
🔄 There have been significant changes from ICD-9 to ICD-10, including the separation of diseases of the eyes and ears into their own chapters and the reclassification of certain conditions from the circulatory system to the nervous system chapter.
📈 ICD-10 introduced updated terminology for epilepsy, allowing for greater specificity in coding, including terms like localization-related, idiopathic epilepsy, generalized VO, partial seizures, and intractable epilepsy.
🧭 Laterality is a new concept introduced in ICD-10 for conditions like hemiplegia, where the side of the body affected and whether it's the dominant or non-dominant side must be specified in coding.
🔢 When coding for hemiplegia without specified dominance, the default is non-dominant for the left side and dominant for the right side, unless the patient is ambidextrous, in which case the default is dominant.
🌟 The concept of laterality is crucial for coding accuracy in ICD-10, as it affects the specificity of the code and the understanding of the patient's condition.
💡 ICD-10 codes for pain (category G89) can be used in conjunction with codes from other chapters to specify the nature of the pain (acute, chronic, post-procedure, or neoplasm-related).
🚫 A G89 code should not replace the underlying diagnosis unless the reason for the encounter is pain control, not management of the underlying condition.
📌 The default code for post-op pain is the acute form unless documentation specifies it as chronic or is associated with a specific post-op complication.
📈 There is no specific timeline for when pain becomes chronic; this determination is up to the provider's judgment and should be reflected in their documentation.
🔍 The webinar emphasizes the importance of verifying claims and checking for denials based on the ICD-10 conversion after the October 1st, 2015 compliance date in the United States.

Q & A

What is the focus of Chapter 6 in ICD-10-CM?
-Chapter 6 of ICD-10-CM is focused on diseases of the nervous system.
How has the classification of diseases changed from ICD-9 to ICD-10?
-In ICD-10, diseases of the eyes and ears that were included in this chapter in ICD-9 have been separated into their own individual chapters. Additionally, conditions that were part of the circulatory system chapter in ICD-9 have been moved to the nervous system chapter in ICD-10.
What is the new terminology for epilepsy in ICD-10?
-The new terminology for epilepsy in ICD-10 includes localization-related, idiopathic epilepsy generalized VO, partial epilepsy, and special epileptic syndromes.
How is laterality applied in ICD-10 coding for hemiplegia?
-Laterality in ICD-10 coding for hemiplegia includes specifying the side of the body affected and whether it is the patient's dominant or non-dominant side. If the affected side is documented but not the dominance, the default is non-dominant for the left side and dominant for the right side.
What is the correct ICD-10 code for a patient with left-sided hemiplegia when the dominant side is not specified?
-The correct ICD-10 code is G80.1.94, which indicates hemiplegia, unspecified affecting left non-dominant side.
How should pain not elsewhere classified be coded in ICD-10?
-Pain not elsewhere classified should be coded using the G89 category codes, which may be used with codes from other chapters to further define the pain as acute, chronic, or neoplasm-related. A G89 code is used only if the documentation specifically states the pain is acute, chronic, post-procedure, or neoplasm-related.
What is the appropriate sequence for coding a patient's visit for pain control?
-The rule of thumb is that the reason for the visit is the first listed code. If the visit is for pain control, a G89 code would be listed first, followed by the code for the underlying condition or site-specific pain.
How is chronic pain coded in ICD-10?
-Chronic pain is coded using the subcategory G89.2. There is no specific timeline for when pain becomes chronic; it is up to the provider to decide and should be reflected in their documentation.
What is the ICD-10 code for a patient diagnosed with late-onset Alzheimer's disease with dementia and wandering?
-The ICD-10 code for a patient with late-onset Alzheimer's disease with dementia and wandering is G30.1 Alzheimer's disease with late onset, F02.81 dementia with behavioral disturbance, and Z9T.18 wandering in diseases classified elsewhere.
How can one find the correct ICD-10 code for a condition?
-To find the correct ICD-10 code for a condition, one should use the alphabetic index to locate the main term, then find the specific term or condition indented below it. The code can then be confirmed in the tabular list.
What should be done after the transition to ICD-10 on October 1st, 2015?
-After the transition to ICD-10, it is important to verify that claims are being received and to check for denials based on the ICD-10 conversion.

Outlines

00:00

📚 Introduction to ICD-10-CM Chapter 6

This paragraph introduces Chapter 6 of ICD-10-CM, which focuses on diseases of the nervous system. It outlines the structure of the presentation, which includes official ICD-10 guidelines, clinical scenarios for coding practice, and a quiz. The chapter's codes start with the letter 'G', differing from ICD-9 where they started with '3'. Notable changes from ICD-9 include the separation of diseases of the eyes and ears into individual chapters and the reclassification of certain conditions from the circulatory system to the nervous system chapter. The paragraph also discusses updates in terminology for epilepsy and introduces the concept of laterality in coding for hemiplegia.

05:00

📌 Coding Guidelines for Pain Not Elsewhere Classified

This paragraph delves into the coding guidelines for category G 89, which covers pain not elsewhere classified. It explains the use of G89 codes in conjunction with other chapters to specify the nature of pain (acute, chronic, or related to neoplasm). The paragraph clarifies that G89 codes are not substitutes for underlying diagnoses unless the visit is specifically for pain management. It also provides examples of how to sequence codes for pain related to a specific site or condition, such as post-op pain or neoplasm-related pain, and emphasizes the importance of documentation in determining the appropriate codes.

10:01

🧠 Coding Scenarios: Epilepsy and Pain Management

The paragraph presents coding scenarios involving epilepsy and pain management. It provides detailed steps for coding juvenile myoclonic epilepsy and intractable seizures, as well as acute pain due to trauma from a car accident. The paragraph emphasizes the importance of using the correct ICD-10 codes based on the documentation and the clinical context, such as differentiating between left-sided hemiplegia as non-dominant or dominant and coding for neoplasm-related pain when the reason for the visit is pain management.

15:01

🏥 Clinical Cases: Meningitis, Pneumonia, and Diabetes

This paragraph covers the coding of clinical cases, including pneumococcal meningitis, pneumonia, transient ischemic attack (TIA) with migraine, and type-2 diabetes with neuropathy. It explains how to identify and apply the correct ICD-10 codes based on the confirmed diagnoses and the reason for the encounter. The paragraph also highlights the importance of not coding symptoms unless they are the cause of the visit and provides a step-by-step guide for locating and confirming the codes in the ICD-10 manual.

20:07

🧠 Alzheimer's Disease and Wandering Behavior

The final paragraph discusses the coding of Alzheimer's disease with late onset and behavioral disturbance, specifically wandering. It provides a step-by-step explanation of how to find and confirm the ICD-10 codes for these conditions, including the use of manifestation codes. The paragraph also includes a quiz to test the understanding of the coding concepts discussed in the presentation, with questions on default coding for hemiplegia, pain management for trauma, and the definition of chronic pain.

Mindmap

Keywords

💡ICD-10-CM

ICD-10-CM stands for the International Classification of Diseases, 10th Revision, Clinical Modification. It is a coding system used in the United States for medical billing and reporting purposes. The video script discusses the specific guidelines and coding practices for Chapter 6 of ICD-10-CM, which pertains to diseases of the nervous system. The script provides detailed instructions on how to apply these codes in various clinical scenarios, emphasizing the importance of accurate documentation and coding for medical claims processing.

💡Coding

Coding in the context of the video refers to the process of assigning specific numerical or alphanumeric codes to diagnoses, procedures, and other healthcare services according to the ICD-10-CM coding system. This process is crucial for healthcare providers to accurately report medical information, facilitate communication among healthcare professionals, and ensure proper billing and reimbursement.

💡Nervous System Diseases

Nervous System Diseases encompass a wide range of conditions affecting the brain, spinal cord, and nerves. In the context of the video, Chapter 6 of ICD-10-CM is dedicated to these diseases, and the script discusses the coding guidelines for various conditions such as epilepsy, migraines, and hemiplegia. Understanding these diseases and their coding is essential for healthcare professionals to correctly document and report medical information.

💡Epilepsy

Epilepsy is a neurological disorder characterized by recurrent seizures. In the video, it is discussed how the terminology for epilepsy has been updated in ICD-10-CM, with specific terms like localization-related, idiopathic epilepsy, generalized VO, and special epileptic syndromes. Accurate coding of epilepsy is important for tracking the prevalence and management of this condition in the healthcare system.

💡Hemiplegia

Hemiplegia is a condition in which one side of the body is paralyzed. In the context of ICD-10-CM coding, it is important to specify the affected side and whether it is the patient's dominant or non-dominant side. This level of detail is crucial for accurate medical record-keeping and understanding the impact of the condition on the patient's functionality.

💡Laterality

Laterality refers to the side of the body on which a condition or symptom occurs. In the context of ICD-10-CM coding, laterality is particularly relevant for conditions like hemiplegia, where specifying the affected side (left or right) and whether it is the dominant or non-dominant side is necessary for accurate coding and medical documentation.

💡Pain

Pain is a subjective physical sensation that can be associated with various medical conditions. In the ICD-10-CM coding system, there are specific codes for pain not elsewhere classified (G89), which can be used to indicate the nature of the pain (acute, chronic, post-procedure, or neoplasm-related). Correctly coding pain is important for pain management and for understanding the prevalence and impact of pain on patient health.

💡Neoplasm-related Pain

Neoplasm-related pain is pain that is caused by cancer or a malignant growth. In ICD-10-CM, there is a specific code (G89.3) for this type of pain, which should be used when the reason for the medical encounter is pain management related to malignancy. This distinction is important for accurately documenting the impact of cancer on a patient's quality of life and for appropriate billing and treatment planning.

💡Migraine

Migraine is a common headache disorder characterized by severe, throbbing pain, often on one side of the head, and can be accompanied by nausea, vomiting, and sensitivity to light and sound. In ICD-10-CM, there are specific codes for different types of migraines, such as G43.1 for migraine with aura. Accurate coding of migraines helps in tracking the prevalence of this condition and in ensuring appropriate treatment and management.

💡Transient Ischemic Attack (TIA)

A Transient Ischemic Attack, also known as a mini-stroke, is a temporary blockage of blood flow to the brain, causing symptoms similar to those of a stroke. In ICD-10-CM, TIA is coded as G45.9, and it is important to document and code these events because they can be a warning sign of a potential future stroke. Coding TIA accurately is crucial for patient follow-up and preventive care.

💡Alzheimer's Disease

Alzheimer's Disease is a progressive neurodegenerative disorder that causes memory loss, cognitive decline, and behavioral changes. In ICD-10-CM, Alzheimer's Disease is coded under G30.1, with additional codes to specify the type and presence of behavioral disturbances. Accurate coding of Alzheimer's Disease is important for epidemiological tracking, research, and appropriate patient care.

💡Chronic Pain

Chronic pain is pain that persists or recurs over a long period, often more than three months. The determination of when pain becomes chronic is based on the provider's judgment rather than a strict time frame. In the context of ICD-10-CM coding, chronic pain is coded using specific codes under category G89, and it is important to document and code chronic pain accurately to ensure appropriate management and care for patients.

Highlights

The presentation covers the official ICD-10 guidelines for Chapter 6, which is about diseases of the nervous system.

Coding practice scenarios and a quiz are provided at the end of the presentation for each coding example.

The chapter codes start with the letter 'G', differing from ICD-9 where they started with number '3'.

Diseases of the eyes and ears have been separated into their own individual chapters in ICD-10, unlike in ICD-9.

Conditions previously in the circulatory system chapter of ICD-9 have been moved to the nervous system chapter in ICD-10.

The terminology for epilepsy has been updated in ICD-10, allowing for greater specificity in coding.

ICD-10 introduces the concept of laterality for conditions like hemiplegia, specifying the affected side of the body.

For hemiplegia, if the affected side is not specified as dominant or non-dominant, defaults are applied based on the side affected.

An example coding scenario involves a patient with left-sided hemiplegia, which defaults to non-dominant side.

The category G 89 focuses on pain not elsewhere classified, with specific guidelines for coding acute, chronic, or neoplasm-related pain.

G89 codes are not used in place of the underlying diagnosis unless the reason for the encounter is pain control.

Post-op pain is coded with G89 only when it is not associated with a specific post-op complication.

Chronic pain does not have a defined timeline and is determined by the provider's judgment.

An example involves coding for a 16-year-old female with intractable juvenile myoclonic epilepsy.

Another example covers coding for a patient with breast cancer and severe acute pain due to liver metastases.

A patient with pneumococcal meningitis and pneumonia is another coding example provided.

A type 2 diabetic patient with neuropathy, transient ischemic attack, and intractable migraine is used as a coding example.

The final example is about coding for a patient with late-onset Alzheimer's disease, dementia, and wandering behavior.

A quiz is included at the end of the presentation to test understanding of the ICD-10 coding principles.

After October 1st, 2015, it is crucial to verify that claims are being received and to check for denials based on the ICD-10 conversion.

Transcripts

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ICD-10-CM Nervous System Coding Guidelines Clinical Scenarios Webinar Medical Training Epilepsy Pain Management Diagnosis Coding Healthcare Industry