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 nowmandated 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.
- The first book in the US on ICD-10 as it relates to Worker’s Compensation and Personal Injury.
- Provides a step-by-stepprocessforphysicians to makesurethey are givingtherightcodeforthe diagnosis givenforthepatientforanyinsurancetype.
- Provides a sixcategoryprocess to handleeverythingneededforallinjury cases.
- Includesexpertguidanceneededfortheinjurycoding as theindustryevolves to createthecorrectcodingalongtheway as thisallevolves.
- Includesworksheets and case studies to illustratetheprocess.
1: Introduction to Worker’s Compensation and Personal Injury in ICD-10
2: Structure Overview of the "2015 ICD-10-CM"
- Using ICD-10 Overview
3: Components of ICD-10 and Their Usage
- ‘Z’ codes and theirimportance in Worker’sCompensation/Personal Injury
- A basic 7-Step processforDiagnosticcoding
- A basic 7-step process case example
- 6-category processforinjurycoding
4: Provider Requirements
- 7th charactercodes
- Greaterlevel of detailrequired
- External cause codes
- External causes of morbidity (transport and other)
5: Worker’s Compensation, Personal Injury and Drug or Chemically Induced Diabetes
- Diabetes Mellitus discussion
- Use of flow charts for diabetes
- Diabetes flow charts
- 2015 ICD-10-CM draftreleaseexpertedition – diabetes mellitus section
6: Worker’s Compensation and Personal Injury Billing Guide
- Personal injuryexample – case #1
- Worker’scompensationexample – case #2
- Worker’scompensationexample – case #3
- Billingfor x-rays
7: Commonly Used Diagnosis Codes
- Abdominal pain – ICD-10 category R10
- CarpalTunnelSyndrome in Worker’sCompensation and Personal Injury
8: Complex Examples and Worksheet section
- Example of whiplash case
- Exampleoncarpaltunnelsyndromewithmultipleother injuries
- ExampleonAgreed Medical re-evaluationfromanInternal Medical or Cardiovascular standpoint
- Exampleon medical sleepdisorderevaluation
- ExampleonOrthopaedicAgreed Medical evaluation – complicatedbyStraphInfectionfollowingsurgery
- ExampleonPsychiatricAgreed Medical re-examination
9: Causation and Apportionment in Worker’s Compensation and Personal Injury
10: Dilemma of the Independent Medical Evaluator
- TheLaw of UnintendedConsequences
- OverviewforIndependent Medical Evaluators
Appendix 1: Medicare coverage, diagnosis requirements and coding edits
- CorrectCodingInitiative (CCI) Edits
- ICD-9 Diagnosis Codes are used in CurrentLCD’s
Appendix 2: Worker’s Compensation and Medicare Set asides
Appendix 3: Implementation Guide for ICD-10
Appendix 4: Discussion of ICD-10 Crosswalks
Appendix 5: Crosswalk from ICD-9 to ICD-10 of common diagnosis codes used in Worker’s Compensation and Personal Injury with notes on potential problem areas
Appendix 6: Glossary
Appendix 7: General Sample Fee Slip
Appendix 8: New California Worker’s Compensation Forms
Appendix 9: Web Links for additional information
Eugene Fukumoto is President and General Manager of Health Claims Services, Inc., a consulting firm that manages the billing and collection for sole proprietors and medical groups including provider disputes with Insurance Companies. He is an authorized billingvendor for the Regents of the University of California, and has contracted with the USC School of Medicine and UCLA. He previously was General Manager for Health Computer Systems, a referenced Hewlett-Packard software vendor of medical billing systems whichdeveloped the first electronic billing software for medical practices. He is the author of numerous publications including Conquering ICD-10 for Chiropractors and Conquering ICD-10 for Family Physicians and General Practice.