Medtronic Cardiac Rhythm and 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 and 69,823 codes

ICD-9-CM ICD-10-CM I48.0 Paroxysmal 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

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 427.1 Paroxysmal 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 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 , 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 , Right and Left and K and L for , 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- 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 . 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 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