ࡱ>  &bjbjww 4@)))))====YL= $`J)))̈NNN))NNN& }J=Td}0N)`NN : AGENDA FOR ICD-10 CODING SEMINAR SHARPENING CODING SKILLS AND DOCUMENTATION TIPS Presenter: Lois Kastner, M.A. CPC-H, Inpatient coder Department Veteran Affairs Member of ICD-10 coding committee Department Veteran Affairs. AHIMA Approved ICD-10 C/PCS Trainer Coding Exercises (see ATTACHMENT A) Coding exercises were sent via email to chapter membership prior to the date of the seminar Logic: to give people time to work on exercises at home (total 2010 will be discussed with PowerPoint, remaining for people to work on and bring questions to seminar). to be able to start seminar and move on with coding discussion and rationale for assigned codes and not to take up valuable time in seminar waiting for people to complete coding. Coding Answers (see ATTACHMENT B) Answer sheets will be given to chapter membership in the seminar It is anticipated that this part of presentation will take maximum three hourspossibly a bit less for each section (respiratory,circulatory, endocrine). Presenter will keep an eye on the time element. Majority of my chapter are outpatient coders. I tried to choose senarios that people would come across In their day to day job situation. For the brave souls in the group, there is one ICD-10 procedure code scenario (Needle biopsy of liver). Last hour will be discussing what coder needs to look for in provider documentation in order to better assign proper code in ICD-10. Example: laterality documentation, etiology, types, stages, association words such as due to, complication ofkey words that will assist in finding proper I-10 code (see page 4 of this Agenda). Plan also to have question and answer period for the additional coding exercises and questions that are not addressed in the PowerPoint. Agenda for presentation: RESPIRATORY CODING Coding exercises in this area chosen to illustrate different types of respiratory situations Exercises on 1st screen Answer for 1st exercise next screen, definition of code Info on diseasetwo forms of COPD (chronic bronchitis & emphysema) Causes of COPD (smoking and exacerbation of) Rationale for codes used Additional codes needed and rationale. ICD-10 guidelines for COPD, exacerbation and infection definitions reference to instructional notes exclude notes with regard to COPD/bronchitis area in Tabular reinforcement of meaning of Excludes 1 & 2 notes Respiratory #2 exercise Answer on next screen Agenda, p2 ICD-10 Seminar, Lois Kastner, M.A., CPC-H, presenter Exercise was chosen to show contrast to #1 exercise by only having one code Rationale for one code, acute bronchitis info How classified Attention to combo codes Only one code needed Signs/symptoms not reported if part of disease Reminder to read all Exclusion notes Respiratory exercise #3 with code options Answer on next screen Exercise was chosen to illustrate need to understand status of persistency New concept to coders for I-10 versus what was required in I-9 Rationale, with I-10 coding references guideline from I-10 manual Explanation of what to look for in I-10 Emphasis on provider documentation requirements Emphasis on coder requirement to understand classification of type of episode What coder needs to know for asthma conditions: Status of persistency mild, moderate, mod persistent or severe persistent Characteristics of disease associated with type of persistency Coder reminded to read notes thoroughly Query if needed Respiratory I-10 Clinical documentation tips Info on where to look for code based on documentation Tips regarding COPD, emphysema, bronchitis I-10 requires smoking code (active or history) in addition to respiratory code Separate codes for respiratory failure with hypercapnea or with hypoxia New requirement for coding, didnt have in I-9 Adult respiratory distress syndrome: adult deleted, acute added instead I-10 feels that adult or pediatric patient can have this condition New concept for I-10, didnt have this in I-9 Reference to P22.0 if infant respiratory distress syndrome ENDOCRINE CODING Exercises chosen for diabetes coding with variable manifestation coding options Scenario # 1 and code options Answer on next screen, with rationale for answer, ICD-10 guidelines reference Scenario #2 and code options Answer on next screen with code rationale I-10 requirements and ICD-10 coding guideline reference info Scenario #3 and code options Answer on next screen I-10 requirements and coding guideline reference Agenda, p3 ICD-10 Seminar, Lois Kastner, M.A., CPC-H, Presenter Scenario #4 and code options Answer on next screen Rationale, coding guideline reference and explanations CIRCULATORY, RENAL and ASSOCIATED STUFF CIRCULATORY SCENARIO #1 Exercise chosen for illustration of atherosclerosis and ulcer Answer on next screen Reasons why certain codes used =Explanation of atherosclerosis hierarchy of codes (just like I-9 with code progression as severity progresses) =Reminder that causal relationship is assumed when atherosclerosis and chronic ulcer RENAL-RELATED SCENARIO #2 Exercise chosen to illustrate adverse effect of drug Answer on next screen What the coder needs to know Code sequence as used to do in I-9 Reminder that T codes in I-10, were E codes in I-9 Explanation how to determine Keflex code =determine use of Keflex in scenario (antibiotic) =determine type of antibiotic (sulfa etc) =Keflex is cephalosporincode s to T36.1- CIRCULATORY SCENARIO #3 Exercise chosen to illustrate problem due to chemotherapy Answer on next screen Rationale for codes, I-10 coding guideline reference Code sequencing explanation =Reminder: works same way as it did in I-9 =code 1st the manifestation 2nd the neoplasm, 3rd T code Reminder that sequencing depends on provider documentation Reminder to query if uncertain CIRCULATORY SCENARIO #4 Exercise chosen for what to do when coder needs info type of situation Exercise chosen to see if coders would identify coding problem Answer next screen Rationale: =Dr needs to be queried for additional info-not enough info to code =Numerous dxs under tabular-need more info to code properly =Coder needs to be aware of differences of thalassemia major and minormight assist with narrowing down code assignment =Explanation of major and minor thalassemia =Next screen: signs/symptoms/characteristics of thalassemia types Agenda, p4, ICD-10 Seminar, Lois Kastner, M.A. CPC-H, Presenter For last hour of seminar- Quick overview of documentation importance (synopsis here): No one is asking dr to do the coding What the coder needs is the tools, the documentation that will assist us to do our jobs properly, and hopefully without having to query every last thing if we can do so. ICD-10 is based on precision and detail. It is here to stay. We all have to get used to it and work with itcoders and providers alike. Documention clues done by providers that coders can look for to assist them in assigning correct ICD-10 code. Includes some of these examples : TIMING: frequency, initial subsequent, exact time of onset or occurrence ACUITY: acute, acute on chronic, chronic, exacerbation, decompensation SEVERITY does condition create problems for another part of body? TYPES AND STAGES: Type I, Type II, cancer staging info, groups LATERALITY/LOCATION: left, right, upper, lower, ascending, descending ASSOCIATION WORDS: caused by, due to, secondary to, causing, with MANIFESTATIONS: Miscellaneous adjectives, intractable, displaced, non-displaced, congenital ETIOLOGY: infection, traumatic, pathological fracture, induced by alcohol/drugs/lifestyle ABBREVIATION USE: encourage correct abbreviations Finishing up question and answer session  !"QR^   1 M Y  < L X Y  Ulz|.ƻhw*hEXhEXH*h_(?h_(?hX>*h_(?hEX>*hU]h?KhG4+hEXhXh_(?CJaJhU]hU]CJaJhU]CJaJhU]5>*CJaJhEX5>*CJaJhU]h_(?5>*CJaJhU]hEX5>*CJaJ2"RS  , 2 L M   dgd?K  & FdgdEX dgdEX dgd_(?l.GnBZp  & F dgdzC d^gdw*  & FdgdzC  & Fdgdw*  & FdgdEX  & F dgdzC  & FdgdEX  & F'dgd_(? dgdEX.npzdeO~t~ GHI^c"&NO]|簬h[2h]h_(?h[2>* hX>*h_(?hX>*hhhX>*hh>*h_(?h~">*hU]hzC hG4+hU]h~"hG4+h?KhG4+>* h?K>*h?Kh?K>*hXhw*hEX8p,;TiH d^gdzC  & FdgdzCd^`gdU]  & FdgdU] pd^pgd~" pd^pgdw*  & F dgd[2  & F dgdG4+ dgdG4+%s-UeB O~ dgd~" d^gd~"  & FdgdzC  & FdgdU]  & FdgdzC  & Fdgd~"  & FdgdzC;-Ct  & FdgdzC  & FdgdzC dgdX d^gd~"  & FdgdzC  & Fdgd~"  & FdgdzC dgd~" HIcN-  & F,dgd[2 pd^pgd] d^gdXd^`gd]  & F dgd]  & F+dgd[2 dgdU] dgdX d^gdXQq!57GIKjk* . e f !!!-!.!X!h!!!!! 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