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UW MEDICINE ICD-10 ProgramTHE ICD-10 JOURNEYHANDS ON CODINGWSHIMA04.30.20161

DISCLAIMERThis material is designed to provide informationabout clinical documentation, coding, andcompliance in an educational format. It is asnapshot of some aspects of ICD-10. Carefullyreview all coding rules, guidelines, and codes. Thissession is not meant to be a substitute for carefulreview of all coding rules, guidelines, and codes as wellas medical documentation when coding in ICD 10.2ICD-10

GOALS/OBJECTIVES Background UW Medicine Post Go-Live Audit of all UW Medicine Coders Inpatient: I10 CM, PCS, DRG Outpatient Ambulatory Surgery: I10CM/PCS ProFee/Clinic: I10 CM ICD-10-CM Examples Clinic & ProFee CM/PCS Examples Outpatient CM/PCS Examples Inpatient3ICD-10

UW MEDICINE IN BRIEFAirlift Northwest (serving AK, ID, MT & WA)Harborview Medical Center (413 beds)Northwest Hospital & Medical Center (281 beds)Seattle Cancer Care Alliance (20 beds)*UW Medical Center (450 beds)UW Clinics (10 clinics)UW Physicians (1,800 physicians)UW School of Medicine (1,000 students)Valley Medical Center (303 beds)* An alliance of UW Medicine, Fred Hutchinson Cancer ResearchCenter and Seattle Children’s Hospital4ICD-10

BACKGROUND April 2014 – Dual coding started for all codersacross UW Medicine May 2014 – Internal DRG analysis /Shifts Coder/CDI education Newsletter Webinar twice a month Outside audits pre and post go-live 2 Pre go-live audits Post go-live audit5ICD-10

POST G0-LIVE OUTSIDE AUDIT Outside audit of ICD-10 Coding All coders who assign diagnosis and procedurecodes in ICD-10. November 2015 5 cases per coder (150 coders) Results of the audit late Dec.-Mar. Education team reviewed Feedback provided to individual coders6ICD-10

CODING/CDI GUIDANCE Excision saphenous vein for graft (CABG) Greater vs. lesser Radial artery lines Devices placed at outside facilities (Impella) List of contrast by type (low osmolar) Aflutter7ICD-10

CASE # 1: EMERGENCY ROOMDiagnosisCodesDescriptorO02.1Missed abortion (Early fetal death beforecompletion 20 weeks)14 weeks gestation of pregnancyZ3A.148ICD-10

CASE #2: CLINIC VISITDiagnosisCodesDescriptorS01.112DLaceration w/o FB left eyelid and periocular area,subsequent encounterFall on same level from slipping, tripping andstumbling with subsequent striking against othersharp object, subsequent encounterW01.118D9ICD-10

CASE #2: CODING CLINICCoding Clinic, First Quarter ICD-10 2015Question: The physician checks the wounds andremoves sutures from both the scalp and cheek. Whatcode should be assigned. Should code Z48.02,Encounter or removal of sutures, be assigned since theencounter is for suture removal?Answer: Assign code S01.02XD, Laceration withforeign body of scalp, subsequent encounter, as thefirst-listed diagnosis for the office visit for suture. Codealso the code for the external cause of mortality.10ICD-10

CASE # 3: RADIOLOGYDiagnosis CodesDescriptorO36.5920Maternal care for other known or suspected poorfetal growth, second trimester (6th character 2 isfor second trimester, 7th character 0 for notapplicable or unspecified fetus)Oligohydramnios, second trimester (7th character0 for not applicable or unspecified fetus)22 weeks gestation of pregnancyO41.02X0Z3A2211ICD-10

CASE # 4: AMBULATORY SURGERYDiagnosisCodesDescriptorS32.810DMultiple fractures of pelvis with disruption ofpelvic ring, subsequent encounter for fracturewith routine healingW13.2XXDFall from, out of or through roof, subsequentencounterProcedureCodes0QP304ZRemoval of internal fixation device left pelvicbone, open approach12ICD-10

CASE # 5: DIAGNOSIS CODESDiagnosisCodesZ47.33DescriptorJ44.9Aftercare following explantation of knee jointprosthesisCOPD, unspecifiedE11.9Type II diabetes mellitus without complicationK21.9GERDI10Hypertension13ICD-10

CASE #5: CODING CLINICCoding Clinic, First Quarter ICD-10 2015 Pages:16-17Question: A patient develops an infection after a primaryhip prosthesis and the prosthesis is removed. How do youcode the admit when the patient returns for removal ofspacer and revision of hip replacement with new hipprosthesis.Answer: Assign code Z47.32 Aftercare followingexplantation of hip joint prosthesis as the PDx for thesecond admission. Code Z47.32 is used to report patientencounters for joint prosthesis insertion following a priorexplantation of the prosthesis, where it was necessary tostage the procedure14ICD-10

CASE #6:Diagnosis CodesDescriptorT84.52XAInfection and inflammatory reaction due to internal left hipprosthesis, initial encounterM86.68Other chronic osteomyelitis, other siteZ85.830Personal history of malignant neoplasm of boneProcedure CodesDescriptor0SPB0JZRemoval of synthetic substitute from left hip joint, openapproach0SHB08ZInsertion of Spacer into left hip joint, open approach15ICD-10

CASE # 7: EMERGENCY ROOMDiagnosisCodesDescriptorS066X9ATraumatic subarachnoid hemorrhage with loss ofconsciousness unspecified duration, initialencounterS065X9ATraumatic subdural hemorrhage with loss ofconsciousness unspecified duration, initialencounterW10.9XXAFall (on)(from) unspecified stairs and steps, initialepisode of care16ICD-10

CASE # 8: CLINIC VISITDiagnosisCodesDescriptorT54.2X1DToxic effects of corrosive acids & acid-likesubstances, accidental (unintentional),subsequent encounterT26.91XDCorrosion of right eye and adnexa, subsequentencounter17ICD-10

CASE # 9: INPATIENT CARDIAC CATH DXDiagnosisCodesDescriptorI21.09STEMI involving other coronary artery of anterior wallI25.10Atherosclerotic heart disease of native coronaryartery w/o anginaI25.84Coronary atherosclerosis due to calcified coronarylesionN18.6End stage renal disease (ESRD)E11.21Type II diabetes mellitus with diabetic nephropathyZ79.4Long term (current) use of insulinZ76.82Awaiting organ transplant statusZ99.2Dependence on renal dialysis18ICD-10

CASE #9: INPATIENT CARDIAC CATH PXProcedureCodesDescriptor027134ZDilation coronary artery 2 sites with drug elutingintraluminal device (stent), percutaneous approach4A023N7Measurement Cardiac sampling/pressure, left heart,percutaneous approach (Left heart catheterization)02C03ZZExtirpation matter from coronary artery, one site ,percutaneousB2111ZZFluoroscopy of multiple coronary arteries using lowosmolar contrastB2151ZZFluoroscopy left heart using low osmolar contrast19ICD-10

CASE # 10: INPATIENT CABGDiagnosis CodesDescriptorI25.119Atherosclerotic heart disease of native coronary artery withunspecified angina pectorisE78.5Hyperlipidemia, re CodesDescriptor02100Z9Bypass coronary artery, one site from left internal mammary, openapproach021009WBypass coronary artery, one site from aorta with autologous venoustissue, open approach06BP0ZZExcision of right greater saphenous vein, open approach5A1221ZPerformance Cardiac Output, continuous20ICD-10

CASE #11: AMBULATORY SURGERYDiagnosis Codes DescriptorN20.0Calculus of kidneyProcedureCodesDescriptor0TF3XZZFragmentation right kidney pelvis, external approach0TJB8ZZInspection of bladder, via natural or artificial openingBT1DZZZFluoroscopy of right kidney, ureter and bladder21ICD-10

CASE #12: AMB. SURG. MENORRHAGIADiagnosis Codes DescriptorN92.0Excessive/frequent menstruation with regular cycle(Menorrhagia)Z01.419Encounter for gynecological examination w/o abnormalfindingsB37.3ProcedureCodesCandidiasis of vulva and vagina (yeast vaginitis)Descriptor8E0UXY7Examination of female reproductive system0UH97HZInsertion Contraceptive device into uterus, via natural orartificial opening (mirena)22ICD-10

CASE #13: WHIPPLEDiagnosis CodesDescriptorC25.0Malignant neoplasm head of pancreasProcedure CodesDescriptor0FBG0ZZExcision pancreas, open approach0DB90ZZExcision duodenum, open approach0FT40ZZResection gallbladder0DBAZ0ZZExcision jejunum0FB90ZZExcision CBD0DB60ZZExcision stomach07BB0ZZExcision mesenteric lymphatic06B50ZZExcision superior mesenteric vein23ICD-10

CASE #14: COLECTOMYDiagnosis CodesDescriptorC18.6Malignant neoplasm descending colonK42.09Umbilical hernia without obstruction or gangreneProcedure CodesDescriptor0DTM4ZZResection descending colon, percutaneous endoscopicapproach0DBN4ZZExcision sigmoid colon, percutaneous endoscopicapproach0DBL4ZZExcision transverse colon, percutaneous endoscopicapproach0WQF4ZZRepair abdominal wall, percutaneous endoscopicapproach24ICD-10

CASE #15: EMBOLIZATIONDiagnosis CodesDescriptorK92.2GI hemorrhage, unspecifiedI95.9Hypotension, unspecifiedD62Acute posthemorrhagic anemiaR57.8Hemorrhagic shockProcedure CodesDescriptor04L33DZOcclusion gastric artery w intraluminal device,percutaneousB4121ZZFluoroscopy hepatic artery using low osmolar contrast25ICD-10

CASE #16: THROMBOSIS DIALYSISCATHETERDiagnosis CodesDescriptorN18.6ESRDT82.8684AThrombosis dialysis catheterProcedure CodesDescriptor02HV33ZInsertion infusion device with tip in SVCB5181ZAFluoroscopy SVC using low osmolar contrast guidance26ICD-10

CASE #16: CODING CLINICCoding Clinic Fourth Quarter ICD-10 2015Question: What is the correct body part value for adialysis catheter inserted via internal jugular with tip incavoatrial junction.Answer: Assign code 02HV33ZInsertion of infusion device into superior vena cava,percutaneous approach27ICD-10

CASE #17: EMERGENCY ROOMDiagnosis CodesDescriptorT87.89Other complications amputation stumpE11.40Type II Diabetes mellitus with diabetic neuropathy,unspecifiedY83.5Amputation of limb as the cause of abnormal reaction ofthe patient, or of later complication without mention ofmisadventure at the time of the procedureZ89.421Acquired absence of right toe(s)28ICD-10

CASE #18: AMBULATORY SURGERYDiagnosis CodesDescriptorG50.0Trigeminal neuralgiaProcedure CodesDescriptor00NK0ZZRelease trigeminal nerve29ICD-10

CASE #19: MELANOMADiagnosis CodesDescriptorC43.62Malignant melanoma of left upper limb, includingshoulderProcedure CodesDescriptor0JBF0ZZExcision left upper arm subcutaneous tissue and fascia,open approach07B60ZXExcision left axillary lymphatic open approach,diagnostic.30ICD-10

CASE #20: DECOMPRESION LAMINECTOMYDiagnosis CodesDescriptorM48.06Spinal Stenosis, lumbar regionProcedure CodesDescriptor01NB0ZZRelease lumbar nerve, open approach31ICD-10

CASE #20: CODING CLINICCoding Clinic, Second Quarter ICD-10 2015 Question:Question:The patient presents for decompressivelumbar laminectomy. Should this be coded to rootoperation ‘excision’ or ‘release’.Answer: Decompressive laminectomy releases thepressure and frees the spinal nerve root. Assign rootoperation ‘release’.01NB0ZZ Release lumbar nerve, open approach32ICD-10

CASE #21: CORONARY ANGIOGRAMDiagnosis CodesDescriptorI25.110Atherosclerotic heart disease of native coronary arterywith unstable angina pectorisProcedure CodesDescriptor027034ZDilation of coronary artery, one site with Drug-elutingintraluminal device, percutaneous approachB2111ZZFluoroscopy of multiple coronary arteries using lowosmolar contrast33ICD-10

CASE #22: AMBULATORY SURGERYAMPUTATIONDiagnosis CodesDescriptorC44.629Squamous cell carcinoma of skin of left upper limb,including shoulderProcedure CodesDescriptor0X6W0Z3Detachment at Left Little Finger, low, open approach34ICD-10

CASE # 23: AMBULATORY SURGERYDiagnosisCodesDescriptorN81.3Complete uterovaginal prolapseProcedureCodesDescriptor0UT94ZZResection uterus, percutaneous endoscopic approach0UT74ZZResection bilateral fallopian tubes, percutaneousendoscopic approach0JUC0JZSupplement of pelvic region subcutaneous tissue andfascia with synthetic substitute, open approach8E0W4CZRobotic assisted procedure of trunk region,percutaneous endoscopic approach35ICD-10

CASE #24: TAVRDiagnosis CodesDescriptorI35.0Nonrheumatic aortic (valve) stenosisI48.91Unspecified atrial fibrillationE11.9Type II diabetes mellitus, uncomplicatedProcedure CodesDescriptor02RF38HReplacement of aortic valve w zooplastic tissue,transapical, percutaneous approach36ICD-10