ICD-9 to ICD-10 Coding and PCS Operations / Revenue Cycle Part 4

ICD-9 to ICD-10 Coding Changes

• Neoplasm-related anemia: ICD-10 sequences malignancy as the principal diagnosis; impacts reimbursement positively or negatively depending on the malignancy type.
• Hemiplegia/hemiparesis: ICD-10 assumes unilateral weakness with a stroke is hemiparesis/hemiplegia, unlike ICD-9 which required confirmation through a query.
• Coronary artery disease (CAD): ICD-10 defaults to native arteries for unspecified CAD in patients with a history of bypass grafting, differing from ICD-9's approach.

ICD-10-PCS Root Operations (Removing Body Parts)

• Excision: Cuts out a portion of a body part.
• Resection: Cuts out the entire body part.
• Detachment: Cuts out extremities only (related to amputations).
• Destruction: Destroys a body part without removal.
• Extraction: Pulls out a body part with force.
• There are 31 root operations in 9 procedure groups. Other groups involve solids/fluids/gases, cutting/separation, insertion/re-insertion, changing tubular structures, device use, examinations, repairs or other objectives.

ICD-10-PCS Root Operations Involving Devices

• Insertion: Adds a nonbiological device (e.g., Foley catheter).
• Replacement: Adds a device replacing a body part (e.g., IOL implant).
• Supplement: Adds a device to reinforce a body part (e.g., mesh for hernia repair).
• Change: Exchanges a device (e.g., tracheostomy tube).
• Removal: Removes a device (e.g., endotracheal tube).
• Revision: Modifies a malfunctioning device (e.g., pacemaker lead adjustment).

Upper and Lower Body Parts in ICD-10-PCS

• For ICD-10-PCS, "upper" and "lower" body part references (e.g., upper/lower arteries) are determined by the diaphragm. This impacts the appropriate body system used in the procedural code's second character.

Sequencing ICD-10-CM Codes (Inpatients)

• Sequencing diagnostic codes is vital for accurate DRG (Diagnosis-Related Group) assignment.
• The principal diagnosis is the most crucial code; it must be highly specific. Secondary diagnoses, categorized as complications, comorbidities, or major complications, are sequenced afterward.
• DRG selection is influenced by the relationship between the principal and secondary diagnoses.
• Thorough review of all healthcare documentation is necessary.
• Procedure codes can impact DRG assignments.

Resequencing ICD-10 Codes

• Ethical Considerations: AHIMA's ethical standards prohibit code changes to inappropriately increase payment. Only use ICD-10 rules for resequencing.
• Financial Impact: Resequencing can positively or negatively impact reimbursement by changing the DRG.
• Documentation Requirement: Resequencing needs supporting documentation; upcoding risks fraud accusations.

Resequencing ICD-10-CM Codes for Optimal Reimbursement

• Resequencing is appropriate when two or more diagnoses equally meet the criteria for principal diagnosis (refer to Section IIC of ICD-10-CM Official Guidelines for Coding and Reporting).
• Both diagnoses must be the cause of admission and to have been treated therapeutically or worked up with diagnostics.
• Select the diagnosis linked to the higher-weighted DRG as the principal diagnosis in such instances. An example is a patient's admission due to an exacerbation of COPD and acute-on-chronic diastolic heart failure, where both conditions were treated equally.

Test your knowledge on the key changes from ICD-9 to ICD-10, particularly focusing on neoplasm-related anemia, hemiplegia, and coronary artery disease. Additionally, explore the various root operations in ICD-10-PCS, including excision, resection, and detachment. This quiz covers essential coding concepts for healthcare professionals.