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

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Questions and Answers

What is the principal diagnosis sequencing change from ICD-9 to ICD-10 for neoplasm-related anemia?

Anemia and malignancy are sequenced together.

Anemia is sequenced as the principal diagnosis.

Malignancy is sequenced as the principal diagnosis. (correct)

Anemia and malignancy can both be principal diagnoses.

How has the classification of unilateral weakness with stroke changed from ICD-9 to ICD-10?

It is assumed to be hemiparesis/hemiplegia. (correct)

Unilateral weakness can no longer be coded.

It is coded as a separate diagnosis.

Unilateral weakness must be confirmed through a query.

What default classification applies to unspecified coronary artery disease (CAD) in ICD-10?

It defaults to a native artery. (correct)

It defaults to a grafted artery.

It defaults to a bypassed artery.

It defaults to a non-specified vascular issue.

Which root operation in ICD-10-PCS is exclusive to amputations?

Detachment Signup and view all the answers

What is the purpose of the root operation 'destruction' in ICD-10-PCS?

To eradicate or destroy a body part. Signup and view all the answers

Which of the following root operations involves pulling out a portion or the entirety of a body part?

Extraction Signup and view all the answers

How many root operations are classified under ICD-10-PCS?

31 root operations Signup and view all the answers

Which of the following root operations would NOT involve the complete removal of a body part?

Destruction Signup and view all the answers

Which root operation involves the addition of a device that reinforces a body part?

Supplement Signup and view all the answers

What is the primary purpose of properly sequencing ICD-10-CM codes in an inpatient setting?

To select the principal diagnosis accurately Signup and view all the answers

During which process might a coder encounter terms referring to 'upper' or 'lower' body parts?

Procedure coding Signup and view all the answers

Which of the following root operations involves exchanging a device?

Change Signup and view all the answers

How can resequencing codes affect hospital reimbursement?

It can change the DRG selection positively or negatively. Signup and view all the answers

What documentation is critical for selecting a principal diagnosis when two equally meet the criteria?

Supportive healthcare documentation Signup and view all the answers

What defines a device in the context of ICD-10-PCS coding?

An appliance or material remaining in or on the body after the procedure Signup and view all the answers

Which root operation is utilized for removal of a device?

Removal Signup and view all the answers

When can a coder resequence ICD-10-CM codes for optimal reimbursement?

When both diagnoses have been treated therapeutically Signup and view all the answers

Which of the following is not a root operation involving a device?

Separation Signup and view all the answers

What should be avoided in the coding process to maintain ethical standards?

Changing codes to inappropriately increase payment Signup and view all the answers

What is the primary factor to consider when determining the principal diagnosis?

The diagnosis treated at the highest level of specificity Signup and view all the answers

Which of the following statements is true regarding upper and lower body parts in ICD-10-PCS coding?

The diaphragm is the dividing line between upper and lower body parts. Signup and view all the answers

Study Notes

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.

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Description

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.