Advanced ICD-10 for Physicians Including Worker’s Compensation and Personal Injury

Eugene Fukumoto

• Publisher: Productivity Press
• Year: 2017
• eBook ISBN: 9781315317328
• Topic: Business
• Subtopic: Operations
• Index: Business

ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization. It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury of diseases. The code set allows more than 14,000 different codes and permits the tracking of many new diagnoses.

The U.S. has used ICD-10-CM (Clinical Modification) since October, 2015. This national variant of ICD-10 was provided by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics, and the use of ICD-10-CM codes are now mandated for all inpatient medical reporting requirements.

This book is for physicians, practice managers and all others who need learn ICD-10. It's designed for the clinician to learn how to put their diagnosis into a code and not rely on staff or computer software programs to decide it form them.

ICD-10 is a complex system of coding and Medicare and third party insurers have been lenient giving providers a year to get used to the coding system. As a result, physicians and their staff have become very complacent regarding proper coding. However, Medicare and third party insurers will soon begin to deny claims which are not coded correctly, which in turn will cost physician groups time and money.

This book focuses on Worker's Compensation and Personal Injury, a very large segment of the healthcare industry and is a new area to ICD-10. The diagnosis coding for injuries is much different than for Medicare or group insurance and unless the physicians and their staff learn how to use it properly, they risk losing income for themselves and worse, they risk losing the case for the patient.

Contents

Preface

Acknowledgments

Other Books by Eugene Fukumoto

Disclaimer

1 Chapter One

Introduction to ICD-10, Including Worker’s Compensation and Personal Injury

Icd-10

Reasons to Avoid Relying on GEM Software

2 Chapter Two

Structural Overview of the ICD-10-CM Book

Code Structure Basics

Using ICD-10 Overview

3 Chapter Three

Components of ICD-10 and Their Usage

External Causes

Combination Codes

Specialty Crosswalk Enclosed

Instructional Notations

Secondary Only Diagnosis Edits

Z Codes and Their Importance in Worker’s Compensation and Personal Injury

A Basic Seven-Step Process for Diagnostic Coding

A Basic Seven-Step Process Case Example

4 Chapter Four

Overview of Six-Category System for Injury Coding

Six-Category System: Step-by-Step Process

Category 1: Find the Correct Z Code

Category 2: Find the Correct Health Condition Code(s)

Category 3: Find the Correct External Cause Code(s)

Category 4: Find the Correct Place of Occurrence Code

Category 5: Find the Correct Activity Code

Category 6: Find the Correct Status Code

5 Chapter Five

Combination Codes

Cardiovascular System

One ICD-10 Code Representing Two ICD-9 Codes

One ICD-9 Code Translating into Three ICD-10 Codes

Dermatology/Family Practice and Others

Emergency Medicine/Hospitalist

Endocrinology/Gastroenterologist

Geriatrics

Internal Medicine/General Practice

Oncology

Ophthalmology

Orthopedics

Pain Management Specialist

Pediatrics

Podiatry

Primary Care

Gout

Lumbago and Sciatica

Obstetrics and Gynecology

Diabetes in Pregnancy

Complications Specific to Multiple Gestation (O31-)

Maternal Care for Malpresentation of Fetus (O32-)

Psychiatry and Psychology

Pulmonology

Radiology

Rheumatology and Related

Urology

ENT (Otolaryngology)

Surgery: General

Toxicology/Internal Medicine and General Medicine

Nephrology and Cardiology

There Are Many Possible Combination Codes

Other Provider Requirements for ICD-10

Seventh-Character Codes

Greater Level of Detail Required

External Cause of Morbidity Codes (Transport and Other)

Other External Causes of Morbidity Code Examples

6 Chapter Six

ICD-10 Coding Guidelines for General and Family Practice (Specific Coding for Differential Diagnoses)

Head/Neck

Sore Throat

Headache

Eye (Vision) Problems

Upper Extremity

Shoulder Pain

Elbow Pain

Chest

Chest Pain

Common Respiratory Problems

Abdomen

Abdominal Pain

Irritable Bowel Syndrome (IBS)

Dialysis Status

Spine

Back Pain

Subluxation

Neck Pain

Pelvis

Rectal Pain and Bleeding

Urinary Tract Infection, Site Not Specified N39.0

Prostatitis

Testicular Pain

Lower Extremity

Knee Pain

Generalized

Cardiovascular System

Neurology

Neuro/Psychiatry

General Pain

Diabetes

Obesity

Malnutrition

Hyperlipidemia

Dermatitis and Skin Related

Oncology

Women’s Health

Other Conditions

7 Chapter Seven

Worker’s Compensation, Personal Injury, and Drug or Chemical Induced Diabetes

Diabetes Mellitus Discussion

Diabetes Mellitus in Pregnancy, Childbirth, and the Puerperium

Use of Flowcharts

Diabetes Flowcharts

ICD-10-CM Draft Release Expert Edition: Diabetes Mellitus Section

8 Chapter Eight

Worker’s Compensation and Personal Injury Billing Guide

Code Extensions for External Cause Code

Coding Injuries

Coding of Traumatic Fractures

Injury Coding Can Be a Big Challenge

Place of Occurrence and Activity Codes

Encounter Codes

Using the Crosswalk

Personal Injury Example Case 1

Worker’s Compensation Example Case 2

Worker’s Compensation Example Case 3

Seventh-Character Codes for Fracture

Billing for Physical Therapy

Procedure

Billing for Injections

Arthrocentesis

Billing for X-Rays

Billing for Minor Surgical Procedures

Worker’s Compensation and Personal Injury Patients

Commonly Used Diagnosis Codes

Abdominal Pain: ICD-10 Category R10

Carpal Tunnel Syndrome in Worker’s Compensation and Personal Injury

Psychological Discussion

9 Chapter Nine

Cumulative Trauma

Compensable Consequences versus Cumulative Trauma

10 Chapter Ten

Causation and Apportionment in Worker’s

Causation

Apportionment

11 Chapter Eleven

Dilemma of the Independent Medical Evaluator (The Law of Unintended Consequences)

Overview for Independent Medical Evaluators

12 Chapter Twelve

Multi-Specialty Discussions

Whiplash Injury Case

How a Provider Might Use ICD-10

Depression: The Leading Cause of Disability Worldwide

How a Provider Might Use ICD-10

ICD-10 and Pain Coding

How a Provider Might Use ICD-10

Pain Management Case

How a Provider Might Use ICD-10

Diagnosis Coding

Adverse Effects of Medication

Codes

How a Provider Might Use ICD-10

Final Coding

Orthopedic Examination with Emphasis on Apportionment and How ICD-10 Helps

Coding

How a Provider Might Use ICD-10

Medical-Legal Sleep Disorder Evaluation

How a Provider Might Use ICD-10

Discussion

ICD-10: Waiting for the Other Shoe to Drop

Orthopedic Independent Medical Evaluation: Complicated by Staph Infection following Surgery

How a Provider Might Use ICD-10

Orthopedic Independent Medical Evaluation Involving Surgical Coding

How a Provider Might Use ICD-10

Appendix

Index

Preface

The implementation of ICD-10 is the biggest change that Eugene Fukumoto has seen in over 30 years of billing and coding. It will be a continuing challenge to make this transition. It is very important that providers understand that their documentation is key and that they have to know that their documentation must support claims submitted.

The changes in ICD-10 are especially daunting for Worker’s Compensation and Personal Injury because of the specific knowledge of injury codes required, as well as the medical-legal complications.

There are conflicting statements in ICD-10. On the one hand, there is a statement that there is no national mandatory ICD-10 External Cause reporting, unless it is required per state-based reporting mandate. On the other hand, many of the ICD-10 codes, such as sprains, are S codes, which by definition are External Cause codes.

We don’t know how claims will be processed,...

Table of contents

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• Halftitle
• Title
• Copyright
• Table of Contents