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Finding the right ICD-10 Code for Family Medicine 1 Presented by Evan M. Gwilliam, DC MBA BS CPC CCPC NCICS CCCPC CPC-I MCS-P CPMA Chief Product Officer
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Finding the right ICD-10 Code for Family Medicine
Presented by Evan M. Gwilliam, DC MBA BS CPC CCPC NCICS CCCPC CPC-I MCS-P CPMA
Chief Product Officer
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Dr. Evan Gwilliam• Education
• Bachelor’s of Science, Accounting - Brigham Young University• Master’s of Business Administration - Broadview University• Doctor of Chiropractic, Valedictorian - Palmer College of
Chiropractic
• Certifications• Certified Professional Coder (CPC) - AAPC• Nationally Certified Insurance Coding Specialist (NCICS) - NCCT• Certified Chiropractic Professional Coder (CCPC) - AAPC• ChiroCode Certified Chiropractic Professional Coder (CCCPC) -
ChiroCode• Certified Professional Coder – Instructor (CPC-I) - AAPC• Medical Compliance Specialist – Physician (MCS-P) - MCS• Certified Professional Medical Auditor (CPMA) – AAPC, NAMAS• Certified ICD-10 Trainer - AAPC
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ICD-914,567 codes
ICD-1069,832codes
Why can’t we keep using ICD-9?
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Why ICD-10?
ICD-9 ICD-10
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ICD-10 examples
In ICD-9: E844.8 Sucked into jet without accident to aircraft;
ground crew
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ICD-10 examples
In ICD-10: V97.3Person on ground injured in air transport
accident;
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ICD-10 examples
In ICD-10: V97.33 Person on ground injured in air transport
accident; sucked into jet engine
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ICD-10 examples
In ICD-10: V97.33&Person on ground injured in air transport
accident; sucked into jet engine, male;
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ICD-10 examples
In ICD-10: V97.33&µPerson on ground injured in air transport
accident; sucked into jet engine, male; under 5’5” in height;
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ICD-10 examples
In ICD-10: V97.33&µ# Person on ground injured in air transport
accident; sucked into jet engine, male; under 5’5” in height; slightly bald;
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ICD-10 examples
In ICD-10: V97.33&µ#$ Person on ground injured in air transport
accident; sucked into jet engine, male; under 5’5” in height; slightly bald; wearing a jump suit;
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ICD-10 examples
In ICD-10: V97.33&µ#$€ Person on ground injured in air transport
accident; sucked into jet engine, male; under 5’5” in height; slightly bald; wearing a jump suit; during a full moon
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ICD-10-CM code for chronic gout due to renal impairment, left shoulder, without
tophus.
Note: there are 11 gout codes in ICD-9 and 365 in ICD-10
ICD-10 examples
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Tabular list layout
Chapter
21 of themfrom A to Z
Block
Ranges of categories
Categories
3 characters
Subcategories
4th or 5th characters
Codes
6th or 7th characters
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Tabular List
Chapter: 8, Diseases of the ear and mastoid process (H6Ø-H95) (always white font in a black box)
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Tabular list layout
Chapter
21 of themfrom A to Z(body system or condition)
Block
Ranges of categories(related conditions)
Categories
3 characters(more specific condition)
Subcategories
4th or 5th characters(etiology, location, etc.)
Codes
6th or 7th characters(laterality, encounter, etc.)
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Tabular List
Block: Diseases of Middle Ear and Mastoid (H65-H75)
(Always bold CAPS, lined above and below)
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Tabular list layout
Chapter
21 of themfrom A to Z(body system or condition)
Block
Ranges of categories(related conditions)
Categories
3 characters(more specific condition)
Subcategories
4th or 5th characters(etiology, location, etc.)
Codes
6th or 7th characters(laterality, encounter, etc.)
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Tabular List
Category: H65.- Nonsuppurative Otitis Media
(Always all CAPS, with a line above. A hyphen indicates an incomplete code)
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Tabular list layout
Chapter
21 of themfrom A to Z(body system or condition)
Block
Ranges of categories(related conditions)
Categories
3 characters(more specific condition)
Subcategories
4th or 5th characters(etiology, location, etc.)
Codes
6th or 7th characters(laterality, encounter, etc.)
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Tabular List
Subcategory: H65.0-Acute serous otitis media Acute & subacute secretory otitis
(Codes with a hyphen are incomplete)
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Tabular list layout
Chapter
21 of themfrom A to Z(body system or condition)
Block
Ranges of categories(related conditions)
Categories
3 characters(more specific condition)
Subcategories
4th or 5th characters(etiology, location, etc.)
Codes
6th or 7th characters(laterality, encounter, etc.)
Note: Codes may be complete with fewer than 6 characters. Some codes only have 3.
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Tabular List
Highest specificity code: H65.06 Recurrent acute serous otitis media, bilateral
(Complete codes are bolded.)Note: Approximately 40% of the new codes are due to laterality.
Proposed Chapter 22
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Three methods:1. Specialty specific common codes list (but don’t stop there!)2. GEMs code map (don’t stop here either!)3. Alphabetic index (still not safe!)
Always confirm the code using the Tabular List
Finding the ICD-10 code
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1. Common Codes
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2. GEMs
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2. GEMs
General Equivalence Mappings (GEMs)
o Created by the National Center for Health Statistics, part of the CDC
o Forward maps from ICD-9 to ICD-10
o Backward maps from ICD-10 to ICD-9
o Approximations only
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3. Alphabetic index
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ExamplePatient is an 18-month old fussy, white female with a three-day history of otalgia, runny nose and fever of 100. There is no exposure to tobacco smoke. Otoscopic examination reveals acute serous otitis media of the right ear. Assessment: Acute serous otitis media, right ear. On September 30, 2015, the diagnosis is 381.01 Acute serous otitis media.
On October 1, 2015, it is:
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1. Common Codes
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2. GEMs
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3. Alphabetic
index
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Tabular List
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ExamplePatient is an 18-month old fussy, white female with a three-day history of otalgia, runny nose and fever of 100. There is no exposure to tobacco smoke. Otoscopic examination reveals acute serous otitis media of the right ear. Assessment: Acute serous otitis media, right ear. On September 30, 2015, the diagnosis is 381.01 Acute serous otitis media
On October 1, 2015, it is: H65.01 Acute serous otitis media, right ear
NOTE:• Common codes lists are just an expert guess• GEMs often leads to unspecified codes• Alphabetic Index often gives incomplete or multiple options
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Three methods:1. Specialty specific common code list (but don’t stop there!)2. GEMs code map (don’t stop here either!)3. Alphabetic index (still not safe!)
Always confirm the code using the tabular list..then be sure to check instructional notes and guidelines
Finding the ICD-10 code
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The next step for converting to ICD-10
1. Go to the Tabular Listo Look at the following:
1. Notes2. Includes and alternative wording3. Excludes14. Excludes25. Code Also, Code First, Use Additional6. Seventh character extensions
2. Repeat at the level of the code, then the subcategory, category, block, and chapter
3. Reverse map for confirmation if necessary
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ExampleThis 30-year old white male sustained a right knee injury while playing basketball on Saturday. He was seen in our urgent care clinic and sent for MRI of the right knee to rule out meniscal tear. MRI revealed right bucket-handle medial meniscal tear and tear of the anterior cruciate ligament (ACL). Patient will be scheduled for surgery on Tuesday. Initial care visit.
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