Medtronic Structural Heart ICD-10 Coding for Hospitals

[Pages:52]Medtronic Structural Heart ICD-10 Coding for Hospitals

Linda Holtzman RHIA, CCS, CCS-P, CPC,COC Clarity Coding January 2016

Disclaimer

Reimbursement information provided by Medtronic is for illustrative purposes only and does not constitute legal advice.

Information provided is gathered from third party sources and is subject to change without notice due to frequently changing laws, rules and regulations. 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.

The provider of service has the responsibility to determine medical necessity and to submit appropriate codes and charges for care provided. Please contact your local payers, reimbursement specialists and/or legal counsel for interpretation of coding, coverage, and payment policies.

Medtronic does not promote the use of its products outside FDA-approved labeling.

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Topics

Background and Framework ICD-10-CM Diagnosis Codes ICD-10-PCS Procedure Codes DRG Impact Appendix : Key Resources Questions

Attachment : Diagnosis Code Crosswalks

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Background and Framework

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Effective Date

ICD-10 went 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.

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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 Hospitals

Setting Inpatient

Diagnoses ICD-10-CM

Procedures ICD-10-PCS

Hospitals Outpatient ICD-10-CM CPT

Physicians Facility/Office ICD-10-CM CPT

ASCs

Outpatient ICD-10-CM CPT

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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

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General Equivalence Mappings

General Equivalence Mappings (GEMs) are useful tools 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:

2015-ICD-10-CM-and-GEMs.html

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.

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