Medtronic Cardiac Rhythm and Heart Failure ICD-10 Coding for Hospitals
May 19, 2015 Disclaimer
This presentation is intended for educational use. Any duplication is prohibited without written consent of Medtronic’s Economics and Health Policy department. This information does not replace seeking coding advice from the payer and/or your coding staff. The ultimate responsibility for correct coding lies with the provider of services. Please contact your local payer for their interpretation of the appropriate codes to use for specific procedures.
Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other third party payers as to the correct form of billing or the amount that will be paid to providers of service.
2 Topics
Background and Framework ICD-10-CM Diagnosis Codes ICD-10-PCS Procedure Codes DRG Impact Appendix : Key Resources Questions
Attachment : Diagnosis Code Crosswalks
3 Background and Framework
4 Effective Date
ICD-10 goes into effect October 1, 2015.
Use of ICD-10 in the United States was formally proposed in August 2008 and finalized in January 2009.
Implementation of ICD-10 was initially scheduled for October 2013 and has been postponed twice since then.
ICD-10 is effective by date of discharge, not by date of admission.
ICD-10-CM for diagnosis codes and ICD-10-PCS for procedure codes go into effect together on the same date.
5 Who Uses What
Hospitals, physicians and all other providers must use ICD-10 diagnosis codes.
Hospitals must also use ICD-10-PCS procedure codes for inpatient cases. Implementation of ICD-10 does not affect use of CPT®.
Provider Setting Diagnoses Procedures
Hospitals Inpatient ICD-10-CM ICD-10-PCS
Hospitals Outpatient ICD-10-CM CPT
Physicians Facility/Office ICD-10-CM CPT
ASCs Outpatient ICD-10-CM CPT
6 ICD-10 Coding Guidelines
Guidelines for use of ICD-10 are available from multiple credible sources.
Instructions within the ICD-10 codebook itself The ICD-10 Official Guidelines for Coding and Reporting Coding Clinic and AHA Coding Clinic Advisor AHA ICD-10-CM and ICD-10-PCS Coding Handbook Minutes from meetings of the ICD-10 Coordination and Maintenance Committee
ICD-10-PCS Reference Manual AHIMA ICD-10-PCS: An Applied Approach
7 General Equivalence Mappings
General Equivalence Mappings (GEMs) are a useful tool for going back-and-forth between ICD-9 and ICD-10 codes, for both diagnoses and procedures.
Forward GEMs go from ICD-9 to ICD-10; Backward GEMs go from ICD-10 to ICD-9. The GEMs can be found at: http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2105 http://www.cms.gov/Medicare/Coding/ICD10/ 2015-ICD-10-CM-and-GEMs.html
The GEMs can be a good starting place. But NCHS and CMS strongly recommend coding directly from the ICD-10 codebooks, as studies have consistently indicated that this is most accurate.
8 ICD-10-CM Diagnosis Codes
9 Diagnosis Code Structure
Codes are organized by chapter, mostly by body system. The chapters are virtually identical to those in ICD-9-CM.
Codes are alpha-numeric and can be 3 to 7 digits long.
CategoryDecimal Details Extension T82.120A T 8 2 1 2 0 A Displacement of cardiac electrode, initial encounter alpha number alpha or number
R55 R 5 5 Syncope
I50.23 I 5 0 2 3 Acute on chronic systolic heart failure
10 Volume of Diagnosis Codes
ICD-10-CM has far more diagnosis codes ICD-9-CM than ICD-9-CM and provides a greater 14,567 codes level of specificity. ICD-10-CM Example: Atrial fibrillation and atrial flutter 69,823 codes
ICD-9-CM ICD-10-CM I48.0 Paroxysmal atrial fibrillation I48.1 Persistent atrial fibrillation 427.31 Atrial fibrillation I48.2 Chronic atrial fibrillation I48.91 Unspecified atrial fibrillation I48.3 Typical atrial flutter (type I) 427.32 Atrial flutter I48.4 Atypical atrial flutter (type II) I48.92 Unspecified atrial flutter
But some unnecessary distinctions have been removed. Example: Second degree atrioventricular block
ICD-9-CM ICD-10-CM 426.12 AV block, Mobitz II I44.1 Atrioventricular block, second degree 426.13 AV block, other second degree
11 Heart Failure
Heart failure works the same way in ICD-10-CM as it does in ICD-9-CM.
ICD-9-CM ICD-10-CM 428.0 Congestive heart failure, unspecified I50.9 Heart failure, unspecified 428.1 Left heart failure I50.1 Left ventricular failure 428.20 Systolic heart failure, unspecified I50.20 Unspecified systolic (congestive) heart failure 428.21 Acute systolic heart failure I50.21 Acute systolic (congestive) heart failure 428.22 Chronic systolic heart failure I50.22 Chronic systolic (congestive) heart failure 428.23 Acute on chronic systolic heart failure I50.23 Acute on chronic systolic (congestive) heart failure 428.30 Unspecified diastolic heart failure I50.30 Unspecified diastolic (congestive) heart failure 428.31 Acute diastolic heart failure I50.31 Acute diastolic (congestive) heart failure 428.32 Chronic diastolic heart failure I50.32 Chronic diastolic (congestive) heart failure 428.33 Acute on chronic diastolic heart failure I50.33 Acute on chronic diastolic (congestive) heart failure Unspecified combined systolic and diastolic Unspecified combined systolic (congestive) and diastolic 428.40 I50.40 heart failure (congestive) heart failure Acute combined systolic and diastolic heart Acute combined systolic (congestive) and diastolic 428.41 I50.41 failure (congestive) heart failure Chronic combined systolic and diastolic heart Chronic combined systolic (congestive) and diastolic 428.42 I50.42 failure (congestive) heart failure Acute on chronic combined systolic and Acute on chronic combined systolic (congestive) and 428.43 I50.43 diastolic heart failure diastolic (congestive) heart failure 428.9 Unspecified heart failure I50.9 Heart failure, unspecified “Congestive” heart failure does not have its own code. A code from I50 is assigned separately to identify the type of heart failure with hypertensive heart disease with heart failure.
12 Acute Myocardial Infarction
ICD-10-CM handles acute myocardial infarction differently from ICD-9-CM.
AMI: ICD-9-CM
ICD-9-CM 410.0x Acute myocardial infarction, of anterolateral wall 410.1x Acute myocardial infarction, of other anterior wall 5th digit 410.2x Acute myocardial infarction, of inferolateral wall 0 – unspecified 410.3x Acute myocardial infarction, of inferoposterior wall episode of care 410.4x Acute myocardial infarction, of other inferior wall 1 – initial episode of 410.5x Acute myocardial infarction, of other lateral wall care 410.6x Acute myocardial infarction, true posterior wall 410.7x Acute myocardial infarction, subendocardial (NSTEMI) 2 – subsequent episode of care 410.8x Acute myocardial infarction, of other specified sites 410.9x Acute myocardial infarction, unspecified site
AMI: ICD-10-CM
Episode of care is not identified per se. AMI is differentiated between initial AMI (I21) and subsequent AMI (I22) The AMI site identifies the specific coronary artery involved (“culprit lesion”).
13 Acute Myocardial Infarction
Initial AMI (I21)
ICD-10-CM I21.01 ST elevation (STEMI) myocardial infarction involving left main coronary artery I21.02 ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery I21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall I21.11 ST elevation (STEMI) myocardial infarction involving right coronary artery I21.19 ST elevation (STEMI) myocardial infarction involving other coronary artery I21.21 ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery I21.29 ST elevation (STEMI) myocardial infarction involving other sites I21.3 ST elevation (STEMI) myocardial infarction of unspecified site I21.4 Non-ST elevation (NSTEMI) myocardial infarction
Initial AMI codes I21 continue to be assigned to encounters for continued care, including transfer to another hospital or post-acute setting, while the AMI is within 28 days of onset.1
If the AMI is documented as NSTEMI (subendocardial, non-transmural) and a site is provided, it is still coded as NSTEMI.2
1. ICD-10-PCS Official Guidelines for Coding and Reporting (Diagnosis), FY 2015, Section I, C9.e(1 ) 2. ICD-10-PCS Official Guidelines for Coding and Reporting (Diagnosis), FY 2015, Section I, C9.e(3 )
14 Crosswalk: Acute Myocardial Infarction
Subsequent AMI (I22)
ICD-10-CM I22.0 Subsequent ST elevation (STEMI) myocardial infarction of anterior wall I22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wall I22.2 Subsequent non-ST elevation (NSTEMI) myocardial infarction I22.8 Subsequent ST elevation (STEMI) myocardial infarction of other sites I22.9 Subsequent ST elevation (STEMI) myocardial infarction of unspecified site
A subsequent AMI is a new AMI that occurs within 28 days of a previous AMI, regardless of site.3
Codes from I22 cannot be assigned alone. They must always be assigned with a code from I21. Sequencing of the codes depends on the circumstances of the encounter.3 Old MI
ICD-9-CM ICD-10-CM 412 Old myocardial infarction I25.2 Old myocardial infarction
3. ICD-10-PCS Official Guidelines for Coding and Reporting (Diagnosis), FY 2015, Section I, C9.e(4 )
15 Bradycardia and Tachycardia Tachycardia
ICD-9-CM ICD-10-CM I47.1 Supraventricular tachycardia (includes AVNRT) 427.0 Paroxysmal supraventricular tachycardia I49.2 Junctional premature depolarization I47.0 Re-entry ventricular arrhythmia 427.1 Paroxysmal ventricular tachycardia I47.2 Ventricular tachycardia 427.2 Paroxysmal tachycardia, unspecified I47.9 Paroxysmal tachycardia, unspecified 785.0 Tachycardia, unspecified R00.0 Tachycardia, unspecified “Paroxysmal” does not need to be documented for SVT and VT. But tachycardia that’s unspecified is assigned to symptom code R00.0.
Bradycardia
ICD-9-CM ICD-10-CM 427.81 Sinoatrial node dysfunction (SSS) I49.5 Sick sinus syndrome (tachy-brady syndrome) — R00.1 Bradycardia, unspecified
Bradycardia that’s unspecified or documented only as “sinoatrial” or “sinus” bradycardia is assigned to symptom code R00.1.
16 Device Complications
Mechanical complication is defined the same way in ICD-10-CM as it is in ICD-9-CM. For mechanical complication, ICD-10-CM differentiates the type of complication and the component but not the device.
ICD-9-CM ICD-10-CM Mechanical T82.110A Breakdown (mechanical) of cardiac electrode, initial encounter complication T82.111A Breakdown (mechanical) of cardiac pulse generator, initial encounter 996.01 due to cardiac T82.118A Breakdown (mechanical) of other cardiac electronic device, initial encounter pacemaker T82.120A Displacement of cardiac electrode, initial encounter Mechanical T82.121A Displacement of cardiac pulse generator, initial encounter T82.128A Displacement of other cardiac electronic device, initial encounter 996.04 complication due to T82.190A Other mechanical complication of cardiac electrode, initial encounter implantable T82.191A Other mechanical complication of cardiac pulse generator, initial encounter defibrillator T82.198A Other mechanical complication of other cardiac electronic device, initial encounter For other (non-mechanical) complications, ICD-10-CM also differentiates the type of complication but not the type of device. Proposals have already been made to ICD-10 C&M Committee to create new codes to provide more detail on the specific device.
17 ICD-10-PCS Procedure Codes
18 ICD-10-PCS Format and Structure
Codes are alpha-numeric and are always 7 digits long. There is no decimal point. There are virtually no unspecified or default codes. Each position in an ICD-10-PCS procedure code represents a distinct element. 1234567
section root operation approach qualifier body system body part device
In ICD-10-PCS, codes are not assigned per se. They are constructed, character by character, from code tables. ICD-10-PCS contains no instructional notes. Standardized terms and definitions are used throughout.
19 Volume of Procedure Codes
ICD-10-PCS has far more procedure ICD-9-CM codes than ICD-9-CM and provides much 3,882 codes greater specificity. ICD-10-PCS Full system ICD-9-CM 1 code 71,962 codes CRT-D ICD-10-PCS 4 codes
Use of ICD-10-PCS requires in-depth clinical and technical coding knowledge: Relevant clinical anatomy Procedural components Exact nature of devices used Standard terms, particularly Root Operation Procedure coding guidelines and precedents
20 Root Operations for Devices
Six root operations always involve implanted devices where the sole objective is do something with the device. Three of the six root operations are relevant for cardiac rhythm and heart failure devices.
Root Operation Objective4 Example H-Insertion Putting in a non-biological device Implanting a pulse generator P-Removal Taking out a device Removing a lead W-Revision Correcting a malfunctioning or displaced device Repositioning a lead R-Replacement Putting in a device that replaces a body part Replacing a hip or heart valve Putting in a device that reinforces or augments a U-Supplement Laying mesh in a hernia repair body part 2-Change Exchanging a device without cutting or puncture Exchanging a tracheostomy tube
There are two scenarios for replacing a device:5 H-Insertion of the new device and P-Removal of the old device R-Replacement of the body part with a new device and P-Removal of the old device
4. ICD-10-PCS Reference Manual 2015, p.67 5. ICD-10-PCS Reference Manual 2015, p.69; see also AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p.416, 418, 302
21 Cardiac Rhythm and HF Procedures
PPM, ICD, CRT-P, CRT-D Antibacterial Envelope Implanted Loop Recorder (Cardiac Event Monitor)
Ablation for Arrhythmia Diagnostic Electrophysiologic Studies (EPS) Electrophysiologic (EP) Mapping
Device Evaluation Cardioversion
22 PPM, ICD, CRT-P, CRT-D
Typical Indications Conventional pacemakers are placed for bradycardia and heart block.
Conventional defibrillators are placed for ventricular tachycardia or ventricular fibrillation, or for primary prevention indications such as cardiomyopathy. CRT-P (biventricular pacemakers) are placed for heart failure, with or without bradycardia or heart block.
CRT-D (biventricular defibrillators) are placed for heart failure with either ventricular tachycardia or primary prevention indications.
23 PPM, ICD, CRT-P, CRT-D
Device Values and Models
The model name may be insufficient to assign the device value.
4-Pacemaker, Single Chamber 7-Cardiac Resynchronization 5-Pacemaker, Single Chamber RR Pacemaker Pulse Generator 6-Pacemaker, Dual Chamber Adapta Sensia Advisa Versa Viva Consulta Syncra
8-Defibrillator Generator 9-Cardiac Resynchronization Defibrillator Pulse Generator Evera Secura Protecta DR/VR Viva Quad, XT, S Protecta
The model numbers differentiate and can be found at: http://www.medtronic.com/wcm/groups/mdtcom_sg/@mdt/@crdm/ documents/documents/medicare-c-code-list-color.pdf (see p. 6-7)
24 Generator Placement
Root Operation Body System H–Insertion J – Subcutaneous Tissue and Fascia Coding Guidelines Creation of the pocket is not coded separately6 Examples of Generator Insertion
0JH608Z Insertion of defibrillator generator into chest subcutaneous tissue and fascia, open approach 0JH609Z Insertion of cardiac resynchronization defibrillator pulse generator into chest subcutaneous tissue and fascia, open approach
6. AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p.419
25 Generator Removal
Root Operation Device Value P–Removal P – Cardiac Rhythm Related Device
Coding Guideline For P-Removal, the same device value and same code are used regardless of whether the generator is a PPM, ICD, CRT-P, or CRT-D.7 Example of Generator Removal
0JPT0PZ Removal of cardiac rhythm related device from trunk subcutaneous tissue and fascia, open approach
7. AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p.418
26 Generator Revision
Root Operation Device Value W – Revision P – Cardiac Rhythm Related Device Coding Guideline For W-Revision, the same device value and same code are used regardless of whether the generator is a PPM, ICD, CRT-P, or CRT-D. Example of Generator Revision This can be used for revising or relocating the device pocket8, or re-opening the pocket to correct a flipped generator.
0JWT0PZ Revision of cardiac rhythm related device from trunk subcutaneous tissue and fascia, open approach
8. AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p.416, 417 27 Lead Placement
Root Operation Body System H–Insertion 2 – Heart and Great Vessels Coding Guidelines Placement of each lead is coded separately. Body Parts 6 and 7 for Atrium, Right and Left and K and L for Ventricle, Right and Left are apparently assigned for transcatheter placement of a lead into the chamber. Transcatheter placement of a “left ventricular” lead via the coronary vein is apparently assigned to Body Part 4-Coronary Vein.
Body Part N-Pericardium is apparently assigned for placement of an epicardial lead (patch).
28 Lead Placement
Examples of Lead Insertion
Transvenous placement of CRT-D leads into right atrium and right ventricle with transvenous left ventricular lead via coronary sinus 02H63KZ Insertion of defibrillator lead into right atrium, percutaneous approach 02HK3KZ Insertion of defibrillator lead into right ventricle, perc approach 02H43KZ Insertion of defibrillator lead into coronary vein, perc approach Epicardial placement of CRT-D left ventricular lead by thoracotomy 02HN0KZ Insertion of defibrillator lead into pericardium, open approach
29 Lead Removal
Root Operation Device Value P–Removal M – Cardiac Lead Coding Guideline For P-Removal, the same device value and same code are used regardless of whether the lead is for a PPM, ICD, CRT-P, or CRT-D.
Example of Lead Removal
02PA3MZ Removal of cardiac lead from heart, percutaneous approach
30 Lead Revision
Root Operation Device Value W – Revision M – Cardiac Lead Coding Guideline For W-Revision, the same device value and same code are used regardless of whether the lead is for a PPM, ICD, CRT-P, or CRT-D. Example of Lead Revision This can be used for repositioning a displaced lead.9
02WA3MZ Revision of cardiac lead in heart, percutaneous approach
9. AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p.419, see also ICD-10-PCS Reference Manual 2015, p.74-75
31 Subcutaneous Defibrillator Lead
The lead is tunneled subcutaneously and positioned in the left chest to achieve reliable defibrillation. The electrical impulse generated travels through the tissues to the heart. Body System J – Subcutaneous Tissue and Fascia Device Value P – Cardiac Rhythm Related Device10
0JH60PZ Insertion of cardiac rhythm related device into chest subcutaneous tissue and fascia, open approach
10. Coding Clinic, 4th Q 2012 32 Antimicrobial Envelope
Antimicrobial envelopes are coated with antibiotics. They hold PPM, ICD, CRT-P or CRT-P generators and are implanted with the generator. The intent is to reduce infection and also stabilize the devices. Device: AIGISRx envelope (also called TYRX) Example of Envelope Placement There’s a separate code for placement of an antimicrobial envelope; it is assigned in addition to the generator insertion code.
3E0102A Introduction of anti-infective envelope into subcutaneous tissue, open approach 33 Implanted Loop Recorder
ILRs (implanted cardiac event recorders, implanted cardiac monitors) are placed in subcutaneous tissue for long-term recording and monitoring of heart rhythms. Devices 2 – Monitoring Device : Reveal XT, Reveal LINQ Approach 0 – Open 3 – Percutaneous placement of Reveal XT placement of Reveal LINQ
34 Loop Recorder
Example of Loop Recorder Placement
0JH632Z Insertion of monitoring device into chest subcutaneous tissue and fascia, percutaneous approach Example of Loop Recorder Removal
0JPT32Z Removal of monitoring device from trunk subcutaneous tissue and fascia, percutaneous approach 35 Ablation for Arrhythmia
Transvenous ablation is performed to disrupt aberrant electrical conduction pathways within the heart and restore normal rhythm. Root Operation Body Part 5 – Destruction 8 – Conduction Mechanism11 Example of Ablation for Arrhythmia A single code is apparently used for all ablations of all arrhythmias because the target is always the aberrant conduction pathway.11
02583ZZ Destruction of conduction mechanism, percutaneous approach
11. Coding Clinic, 4th Q 2014 36 Diagnostic Electrophysiologic Studies
In a diagnostic EP study, catheters are threaded through the vena cava and into the heart, usually at the high right atrium, bundle of HIS, and right ventricle. For diagnosis, the catheters are used to perform pacing and recording as well as induction of arrhythmia. The patients may go on to receive an therapeutic ablation. Example of EP Study There’s just one code for a diagnostic EP study12
4A023FZ Measurement of cardiac rhythm, percutaneous approach
12. AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p.415 37 Electrophysiologic Mapping
Mapping is often performed together with diagnostic EP studies and also with therapeutic ablations. Special mapping catheters within the heart precisely identify the arrhythmia origin or path, and create 3D maps to guide the physician. Example of Cardiac EP Mapping This is a separate step and is coded separately from the EP study or ablation.
02K83ZZ Map conduction mechanism, percutaneous approach
38 Device Evaluation: Interrogation
Pacemakers and defibrillators, both conventional and biventricular, need to be checked periodically. This can be done by interrogation or by non-invasive programmed stimulation (NIPS). Both evaluations are non-invasive. The difference is that for an interrogation, an arrhythmia is not induced but for NIPs, it is.
Example of Interrogation13 The approach is X-External by its nature.
4B02XSZ Measurement of cardiac pacemaker, external approach 4B02XTZ Measurement of cardiac defibrillator, external approach
13. AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p.416
39 Device Evaluation: NIPS
NIPS tests the device to ensure it can deliver the appropriate shock as needed. This requires inducing a potentially lethal arrhythmia. Coding Guidelines Do not code NIPS for device testing at the time of defibrillator implantation. This is considered integral and is not coded at all.14 Do not code a diagnosis of ventricular fibrillation when NIPS is performed. Inducing this arrhythmia is the point.14 Example of NIPS The approach is X-External by its nature.
4A02X4Z Measurement of cardiac electrical activity, external approach 14. AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p.415
40 Cardioversion
Cardioversion applies electrical shock to convert an arrhythmia to normal rhythm. Coding Guidelines15 This code is used only for external cardioversion. The code is still assigned regardless of whether cardioversion was successful in converting the rhythm. Example of Cardioversion There’s just one code for external cardioversion.
5A2204Z Restoration of cardiac rhythm, single
15. AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p.112
41 DRG Impact
42 ICD-10 DRG Conversion
The conversion of the DRG Grouper is about coding, not about grouping.
CMS has repeatedly stated its goal in the DRG conversion: The same DRG will be assigned regardless of whether the case is coded in ICD-9 or ICD-10. The conversion process has involved only replacing the ICD-9-CM codes with the equivalent ICD-10 codes. DRG titles and underlying DRG logic has not changed, but some minor DRG variations are unavoidable. In a study of 10 million FY 2013 MedPAR records, CMS found a DRG shift of 1.07%, with reimbursement change of -0.04%15 If the same DRG is not assigned, recheck the codes
15. Estimating the Impact of the Transition to ICD-10 on Medicare Inpatient Hospital Payments http://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/Downloads/2015-03-18-Impact-ICD10-Transition.pdf 43 Sample CCs
Code Description Code Description E44.0-E46 other malnutrition venous thrombosis and I82.409-I82.891 E87.0 hypernatremia embolism E87.1 hyponatremia J44.1 acute exacerbation of COPD I31.4 cardiac tamponade acute respiratory distress J80 cardiomyopathy (non-ischemic) syndrome (adult, child) I42.0, I42.5, (dilated, congestive, constrictive, pleural effusion, hemothorax, I42.8-I42.9 J90, J94.2, J94.8 restrictive) hydrothorax (non-traumatic) I44.2 AV block, complete J95.811-J95.812 iatrogenic pneumothorax, air leak I45.2 bifascicular block J96.10-J96.12 respiratory failure, chronic I45.3 trifascicular block J98.11-J98.19 atelectasis, pulmonary collapse I45.89 other conduction disorder K56.0, bowel obstruction, ileus I47.2 ventricular tachycardia K56.60-K56.7 I50.1 left ventricular failure acute renal failure, other and N17.8-N17.9 I50.20 systolic heart failure, unspecified unspecified I50.22 systolic heart failure, chronic N18.4 CKD, stage IV I50.30 diastolic heart failure, unspecified N18.5 CKD, stage V I50.32 diastolic heart failure, chronic N39.0 urinary tract infection combined diastolic/systolic heart I50.40 R65.10 SIRS failure, unspecified R78.81 bacteremia combined diastolic/systolic heart I50.42 Z68.1 BMI less than 19, adult failure, chronic Z68.41-Z68.45 BMI 40 and over, adult
44 Sample MCCs
Code Description A40.0-A40.9, septicemia, sepsis A41.01-A41.9 E41-E43 severe malnutrition I21.01-I21.4, acute myocardial infarction I22.0-I22.9 I26.01-I26.99 pulmonary embolism I50.21 systolic heart failure, acute I50.23 systolic heart failure, acute on chronic I50.31 diastolic heart failure, acute I50.33 diastolic heart failure, acute on chronic I50.41 combined diastolic/systolic heart failure, acute I50.43 combined diastolic/systolic heart failure, acute on chronic J12.0-J18.9 pneumonia J69.0 aspiration pneumonia J81.0 acute pulmonary edema J96.00-J96.02 respiratory failure, acute J96.20-J96.22 respiratory failure, acute on chronic N17.0-N17.2 acute renal failure, specified lesion N18.6 ESRD R65.20-R65.21 severe sepsis
45 Appendix: Key Resources
46 Key Websites
NCHS and CMS have a wealth of ICD-10 resources and educational materials available on-line. NCHS http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2105 • ICD-10-CM Tabular and Index • Diagnosis code GEMS • Official ICD-10-CM guidelines (diagnoses) CMS http://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-CM- and-GEMs.html • ICD-10-PCS Code Tables and Index • Procedure code GEMs • Official ICD-10-CM guidelines (procedures) ICD-10 Coordination and Maintenance Committee Diagnoses: http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm Procedures: http://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/ ICD-9-CM-C-and-M-Meeting-Materials.html • Code proposals, presentation slides, videos, summaries 47 Medtronic Contacts
Medtronic is available to assist with your ICD-10 questions and issues.
Hotline: 1-866-877-4102 We’re here to Email us: help make [email protected] this transition Visit the CRHF reimbursement website at: smoother www.medtronic.com/crdmreimbursement for you
48 Questions