McKesson Corporation · NYSE:MCK
McKesson — Technical Presentation (March 2013)
47 slides from McKesson's technical presentation, Mar 14, 2013
Slide 1: ICD-10-CM Coding for Internal Medicine including Primary Care, Pediatrics and OB/GYN
ICD-10-CM Coding for Internal Medicine including Primary Care, Pediatrics and OB/GYN Presented by: Cindy Cain, MED3OOO Bess Ann Bredemeyer, McKesson http://www.mckessonhealthcareconsulting.com/ICD-10.htm
Slide 2: McKesson At-a-Glance
McKesson At-a-Glance America’s oldest and largest healthcare services company Founded in 1833 Ranked 14th on Fortune’s list Headquartered in San Francisco More than 37,000 employees Two segments: Distribution Solutions and Technology Solutions Together with our customers and partners, we a
Slide 3: McKesson Revenue Management Solutions (RMS) Services & Products
McKesson Revenue Management Solutions (RMS) Services & Products ACO Services Physician Practice Technology Services and Management Services Consulting Services IPA Operations and Management Solutions TPA Operations and Management Physician Group Operations Physician Managed Care Contracting Electron
Slide 4: ICD-9-CM and ICD-10: Key differences
ICD-9-CM and ICD-10: Key differences ICD-9-CM Volume 1 & 2 ICD-10-CM 13,000 Diagnosis Codes 68,000 Diagnosis Codes 3- to 5-digit Codes 3- to 7-digit Codes Code Format: Code Format: Numeric Codes for all Chapters Digit 1 is alphabetic Alphanumeric for Supplementary Digits 2-7 are numeric Chapters (V-
Slide 5: Agenda
Agenda • Index • Common Terminology • Documentation Guidelines • Chronic Problems • Case Examples • Wellness Examples • Using signs and symptoms • Questions
Slide 6: The Index
The Index • In ICD-9-CM, the index is the very first place to go when you are trying to find information about a specific condition, disease, sign or symptom, or any other clue that would help us find a particular code. • In ICD-10-CM you use the very same process except: • ICD-10-CM has a first cha
Slide 7: Using the Index
Using the Index • The same rules apply in ICD-10 as were followed in ICD-9 Example: B02.9 Zoster without complications • First, go to the word Zoster in the index and it references to see Herpes zoster • Then go to Herpes Zoster (see also condition) B02.9 o Complicated NEC B02.8 • Herpes Zoster with
Slide 8: Documentation Guidelines
Documentation Guidelines • ICD-10-CM Changes • Greater Clinical detail o Updated to conditions and diseases seen today • Laterality: left and right o Specific codes related to site of condition, disease or injury • BMI and Pressure Ulcers o BMI should be referenced as a secondary diagnoses o Pressur
Slide 9: Signs and Symptoms
Signs and Symptoms • When to use Signs and Symptoms? • Conditions that are an integral part of a disease process should not be identified separately • Conditions that are NOT a part of a disease may be listed separately in addition to a definitive diagnoses from another condition, disease or problem
Slide 10: Structural Differences in ICD-10-CM
Structural Differences in ICD-10-CM • Sense organs (eyes and ears) have been separated from the nervous system and have their own chapters in ICD-10-CM. • ICD-9-CM’s V and E codes are incorporated into the main classification in ICD- 10-CM. • Injuries are grouped first by specific site (head, arm, e
Slide 11: Structural Differences
Structural Differences • ICD-10-CM utilizes a placeholder character ‘X’ • ‘X’ is used as a placeholder at certain codes to allow for future expansion o Example of this is at the poisoning, adverse effect and underdosing codes, categories T36 – T50 • Where a placeholder exists, the X must be used in
Slide 12: Structural Differences
Structural Differences X X X X X X X Category Etiology (cause), Always Always Always anatomic site, severity Capital Numeric Numeric Letter Extension Alpha or numeric Alpha or numeric; Example: J40 Additional characters that Bronchitis, not specified as provide more acute or chronic detailed informa
Slide 13: ICD-10-CM: What is different from ICD-9?
ICD-10-CM: What is different from ICD-9? ICD-10-CM Code for: Unspecified part of right clavicle, initial encounter for closed fracture S 4 2 0 0 1 A ICD-9-CM Code for: Fractured clavicle, unspecified, closed 8 1 0 0 0 What additional details does the ICD-10-CM code provide? • Laterality – Right clav
Slide 14: Common Terminology
Common Terminology Endocrine and Metabolic Disease Term Description The term ‘diabetes mellitus’ refers to a group of diseases that Diabetes Mellitus affect how your body uses blood glucose, commonly called blood sugar A product of living cells that circulates in body fluids (as blood) or sap and pr
Slide 15: Common Terminology
Common Terminology Mental and Behavioral Disorders Term Description Abuse is defined as any action that intentionally harms or injures Abuse another person Dependence A compulsive or chronic need; an addiction A psychological disorder in which severe physical symptoms like Conversion disorders blind
Slide 16: Common Terminology
Common Terminology Respiratory System Term Description A breathing (respiratory) condition in which there is an infection of Pneumonia the lung Inflammation of the pharyngeal mucous membrane and Pharyngitis submucous lymphoid tissues A type of chronic obstructive pulmonary disease (COPD) involving E
Slide 17: Common Terminology
Common Terminology Musculoskeletal System Term Description Inflammation of the fluid-filled sac (bursa) that lies between a Bursitis tendon and skin, or between a tendon and bone A term used to describe various diseases (‘-pathy’) of the back Dorsopathies and or spine (‘dorso-’) A clinical term used
Slide 18: Precision, Accuracy and Detail
Precision, Accuracy and Detail PRECISION and ACCURACY of ICD-10-CM over ICD-9-CM ICD-9-CM Description ICD-10-CM Description Coronary artery Atherosclerotic heart disease of native coronary artery with I25.110 414.01 disease, native unstable angina pectoris 411.1 vessels AND Atherosclerotic heart dis
Slide 19: Comparisons
Comparisons Tobacco Abuse Diabetes Mellitus Fracture of Radius ICD-9-CM: 1 Codes ICD-9-CM: 10 Code ICD-9-CM: 33 Codes ICD-10-CM: 5 Codes ICD-10-CM: 318 Codes ICD-10-CM: 1818 Codes
Slide 20: Fainting
Fainting • 46 year old female presents to physician's office for evaluation after fainting this morning at her home. After the study, the physician determines that there is no physiological reason for her fainting • Process: Index, Syncope • Diagnosis code: R55 Syncope and collapse
Slide 21: Headache
Headache • 46 year old female presents to the clinic for evaluation of her headaches. She states that she gets these ‘headaches’ frequently and really cannot pinpoint any specific event that brings them on. The physician examines the patient and determines that she has chronic intractable tension-ty
Slide 22: Depression
Depression • Forget about the catch all: 311 • At a minimum you need to identify if it is a single episode or recurrent. – F32.? or F33.? • Then there are choices: – is your depression mild, moderate, or severe? 4th digit of 0 or 1 or 2 • Or with psychotic features F32.3 or F33.3 • Or is the depress
Slide 23: Malignant Neoplasm
Malignant Neoplasm • 66 year old female, with a history of severe stomach problems over the past two years, presents to day after studies were conducted to determine the reason for her pain. She has seen another physician who indicated that she had cancer and she wanted a second opinion. Physician i
Slide 24: Cholesteatoma
Cholesteatoma • 40 year old man presents to the clinic for a problem with his left ear. He states that he was trying to clean his ears but it felt like he has something growing on his left ear and it was painful. The physician examines the patient and after the exam indicates that the patient has a
Slide 25: Congenital Malformation
Congenital Malformation • 5 year old little boy presents to the ENT clinic for evaluation of a deformity of his left nostril. He has had this since birth and has seen several physicians for consultation to determine what it is. He is examined by the specialist and the medical record indicates the pa
Slide 26: Glaucoma
Glaucoma • 58 year old female presents to the ophthalmology clinic for evaluation of her vision. Her primary care provider referred her after she complained of having visual problems over the last couple of months. After careful evaluation the ophthalmologist indicates that the patient has open-angl
Slide 27: Otitis Externa
Otitis Externa • 34 year old male hairdresser presents today after trying a new dye product on his hair and after several hours his ears became red and inflamed and are becoming progressively more painful. He has no history of any previous allergies and is otherwise healthy. After examination by the
Slide 28: Bruxism
Bruxism • 27 year male college student is sent to the neurologist for evaluation of his sleep disorder. The patient was sent by his dentist as he noted the ridges of his teeth had shown some wear that indicated the need for a bite guard. The physician examines the patient and agrees with the dentist
Slide 29: Swimmer's Ear
Swimmer’s Ear • 25 year old female presents to the clinic after having pain in her right ear. She is part of the Dolphin swim team and has been practicing hard for the upcoming championships. The physician examines the patient and determines that the patient has swimmers ear • Process: Index, swimme
Slide 30: Hypertension
Hypertension • 56 year old male presents in F/U for his Hypertension. He has been checking his B/P at the local supermarket but thinks that he is not getting correct readings. His B/P log shows his pressures to be running between 160/90 – 130/60. His B/P is taken in the office and is 184/102 and aft
Slide 31: Strep Throat
Strep Throat • 33 year old woman presents to the physician's office with a complaint of severe sore throat. He was leaving the house to go to work this morning and he went to kiss his wife. She told him he had ‘strep breath’. His son was just diagnosed with strep throat two days ago. Physician exami
Slide 32: Diabetes
Diabetes • 25 year old female is seen at the diabetic clinic for evaluation of her Type I diabetes. She is doing well, watches her diet, and exercises four days a week. She always carries snacks with her and is very aware of when her blood sugar level is low. She will return to the clinic in six mon
Slide 33: Diabetes with CKD
Diabetes with CKD • 66 year old man who presents to his physician's office for follow- up visit for his diabetes and CKD. He has been taking his blood sugars more consistently than in the past and states that he is really trying. He also states that it is really hard being married to such a good bak
Slide 34: ESRD
ESRD • 65 year old man, with a history of kidney disease over the past couple of years, has now progressed to end-stage renal disease and will be admitted in the next day or two for a procedure to insert a Hickman catheter for renal dialysis • Process: Index, disease, end-stage renal (ESRD) • Diagno
Slide 35: Medicare Female with Osteoporosis and Pathological Humerus Fracture
Medicare Female with Osteoporosis and Pathological Humerus Fracture • ICD-9-CM: 733.01 & 733.11 • ICD-10-CM: M80.0221A or D or G or K or P or S M80.0222A or D or G or K or P or S o Which side, right or left? Right=M80.021? Left=M80.22? o What type of encounter? Initial, Subsequent or Sequela?
Slide 36: Preventive Diagnosis
Preventive Diagnosis • 2 year old baby girl come in for her 24 month check-up. She is doing well, and MOC has no complaints. She is eating well, and she continues growing in the 75% range. She will have her normal immunizations and return as needed until her next scheduled preventive service • Proce
Slide 37: Preventive Diagnosis
Preventive Diagnosis • 10 year old boy wants to participate in sports at school but requires a physical and approval of participation. The physician does a physical as outlined on the forms that are necessary for participation and signs off with approval. The medical record indicates an examination
Slide 38: Preventive Diagnosis
Preventive Diagnosis • 35 year old presents to the primary care provider for preoperative physical for upcoming lung surgery. The physician indicates that the patient is doing well and has no complications or comorbidities that would limit him from having the procedure. The medical record indicates
Slide 39: Documentation Problems
Documentation Problems • Specificity in a diagnoses code • Identification of conditions that contribute to the complexity of a disease • Identification of the severity of a contributing co-morbidity • Stages of diseases: CKD, Dementia, Asthma • Type of Diabetes and severity • Review complete histori
Slide 40: Preparing for ICD-10: Impact to Providers
Preparing for ICD-10: Impact to Providers Family Practice Superbill - Codes from ICD-9 to ICD-10 Super-bill Diagnosis Section Number of ICD -9 Codes Number of ICD-10 Codes Infectious & Parasitic Diseases 6 25 Neoplasms 2 2 Endocrine, Nutritional & Metabolic Disorders 6 6 Metabolic/Other 5 7 Blood Di
Slide 41: Preparing for ICD-10: Impact to Providers
Preparing for ICD-10: Impact to Providers Sample Infectious & Parasitic Disease ICD-9 vs ICD-10 from Family Practice Super-bill ICD-9 Codes Code Description ICD-10 Translation Code Description ICD-10 (6 codes) ICD-9 (25 codes) 054.9 Herpes simplex, any site B00.9 Herpesviral infection, unspecified A
Slide 42: Preparing for ICD-10: Impact to Providers
Preparing for ICD-10: Impact to Providers Family Practice Super-bill – Codes from ICD-9 to ICD-10 One page to 8+ pages Superbill Number of ICD -9 – Number of ICD-10-CM Diagnosis Section (continued) CM Codes Codes Pregnancy, Child Birth 5 16 Skin, Subcutaneous Tissue 14 58 Musculoskeletal & Connectiv
Slide 43: Educational Tips for Coders
Educational Tips for Coders • Evaluate your current encounter form for common diagnoses used most frequently in your practice • Find resources that are specific to your specialty • Check with your specialty societies for specific resources relating to ICD-10-CM • Learn about cross-walks from ICD-9-C
Slide 44: Education for Providers
Education for Providers • Continue to work closely with providers regarding the changes from ICD-9-CM to ICD-10-CM • Continue to monitor documentation in the medical records for medical necessity • Evaluate the use of your EHR for documentation specific changes that will need to made from ICD-9- CM
Slide 45: Resources
Resources • Watch for additional educational trainings throughout the year! • Remember that everyone is involved with the transition process and working together will result in the best possible outcome not only for the physician’s but for everyone in the practice! • Ask questions
Slide 46: Questions?
MED Now Part of McKesson Questions? MCKESSON
Slide 47: Upcoming Specialty Specific ICD-10 Webinars
Upcoming Specialty Specific ICD-10 Webinars • Register for upcoming webinars at • www.MED3000.com/webinars • May 14: Emergency Medicine, Orthopedic • July 9: Anesthesiology, Pain Management, Orthopedics, General Surgery, Neurology, Neurosurgery, Critical Care, Cardiology • September 10: Radiology, P