Preparing for ICD-10: Stay the Course · 2017-10-07 · Preparing for ICD-10: Stay the Course November 9, 2012 . Is this your transition strategy for ... Type 2 Diabetes w/severe

Preparing for ICD-10: Stay the Course

November 9, 2012

Is this your transition strategy for ICD -10?

Or maybe you’ve been a little busy!

EOT’s

Learn key advantages to ICD-10 over ICD-9

Understand the basic differences in format and structure between ICD-9 CM and ICD-10 CM

Develop strategies to transition to ICD 10 in facilities

Objectives

CMS delayed implementation

by 1 year

to October 1, 2014

AMA Strongly opposed 2013 date

AHIMA Strongly encouraged 2013 date

Current Status

International Classification of Diseases

Diagnosis and procedure code sets

Morbidity classification for diagnoses and reason for visits in all health care settings

Mortality classifications for death certificates

ICD-10 is…

Who is involved?

All health care providers who conduct

electronic transactions

Vendors and business associates (not

under HIPAA) who use ICD-9 codes

Worker’s Comp programs

Life insurance companies

Anyone covered by HIPAA

Replacement of ICD-9-CM is long overdue.

ICD-9-CM developed in the 1970s and no longer represents 21st century medical knowledge and practice.

Continued use of the outdated and broken ICD-9-CM system will have impact on the value of healthcare data including the accuracy of decisions based on faulty or imprecise data.

Continued use only hinders US efforts to gather clinically relevant and internationally comparable data

AHIMA Position of ICD-10

Clear and complete descriptions of diseases that reflect

modern-day medical knowledge

Precise descriptions of procedures performed in hospitals

Greater detail and specificity to prevent coding errors,

improve patient safety, and decrease opportunities to

commit fraud

Descriptive detail to support and enable electronic quality

measurement of healthcare

AHIMA believes that a transition to ICD-10 will bring

significant benefits to U.S. healthcare providers and

their patients through:

Permits the international exchange of data for disease

prevention and advanced healthcare research;

Enhances the benefits of implementing EHRs and allows

health data analysis to assist providers and consumers to make

crucial healthcare decisions through data aggregations and

analysis; and

Increases value of current clinical terminologies and

permits greater use of health information technology to

improve our health knowledge and decision support while

lowering the cost of healthcare

ICD-10 Classification System & HIT

U.S. is lagging behind other countries already using ICD-10 codes

ICD-10 issued in 1998 by the World Health

Organization and is the standard for > 150

industrialized countries

It is now the standard for: – Mortality and morbidity reporting

– Reimbursement systems

– Automated decision support

Structure and Format

ICD 9 vs.10

Two Segments of ICD- 10

#1

ICD-10 CM (Clinical modifications)

• Replaces ICD-9 CM

• Updated medical terminology and classification

of diseases

• Newly organized-more detail, increased clinical accuracy

#2 ICD-10 PCS

(Inpatient procedure coding for hospital setting)

Understand Basic Differences

ICD-9 CM

3-5 digits

First digit is alpha or numeric

Digits 2-5 are numeric

Decimal after third character

ICD-10 CM

3-7 Digits

First digit is alpha

2nd and 3rd digits are numeric

Digits 4-7 alpha or

numeric (non case sensitive)

Decimal after third character

Understand Basic Differences

ICD-10 CM

ICD 9 versus ICD 10 Understand Basic Differences

ICD-9 Versus ICD-10

ICD-9

• 496- Chronic airway obstruction, NEC

• 511.9 – Unspecified pleural effusion

• V02.61 Hepatitis B carrier

ICD-10

• J44.9 Chronic obstructive pulmonary disease

• J91.8 Pleural effusion in other conditions classified elsewhere

• Z22.51 Carrier of viral hepatitis B

Alphabetic Index - Alphabetical list of terms

and their corresponding code

Index of Diseases and Injury

Index of External Causes of Injury

Table of Neoplasms

Table of Drugs and Chemicals

Tabular List - Chronological list of codes divided into

chapters based on body system or condition

Categories – Subcategories - Codes

ICD-10 Format

New Features

Laterality (Left, right, bilateral)

Character “x” – 5th digit placeholder for

future expansion

Combination codes for certain conditions

and common associated symptoms

– E11.341 – Type 2 Diabetes w/severe

proliferative diabetic retinopathy with macular

edema

Injuries are grouped by anatomical site

rather than by type of injury

Category restructuring and code

reorganization have occurred in a

number of ICD-10-CM chapters

The codes corresponding to ICD-9-CM

V and E codes are now incorporated into

main classification

New Features

Important!

Diagnosis codes are to be used

and reported at their highest

number of characters available.

How is ICD-10

related to 5010?

New standards for electronic health care

transactions

Replaces Version 4010/4010A1

Accommodates ICD-10 Code Sets

5010 must be in place prior to ICD 10 transition

Consequences

January 1, 2012 90-day grace period +

another 90-day grace

period = July 1, 2012

If providers do not conduct

electronic health transactions

using Version 5010 delays in

claim reimbursement may result.

Official Implementation Date

ICD-10 codes must be used on all HIPAA

transactions, including outpatient claims

with dates of service, and inpatient claims

with dates of discharge on and after

October 1, 2013 2014

Mapping Examples

ICD 9 ICD 10

Chronic Gout due to renal impairment, left shoulder, without tophus

One to One Mapping

GEMS

Consistency in Coding

Tool to assist with code conversion

Annual updates along with code updates

National Version

General Equivalency Mapping (GEMS)

Where do we start?

Project Management

Suggested Implementation Preparation Checklist

• Phase 1 – Impact assessment/ Self Evaluation

• Phase 2 – Preparing for implementation

• Phase 3 – Go live preparation

• Phase 4 - Post-implementation

AHIMA 2009

Facility Self Evaluation Phase 1

Who touches ICD coding in our facility?

What changes are needed in business operations and workflows? Pre-admission process? Documentation requirements?

What is the skill level of the medical records staff?

Facility Self Evaluation Phase 1

What other staff members need training? What type?

Have you completed 5010 testing?

What manuals/forms need reprinting?

Budgeting for new resources, training in place?

Important!

• Facility processes that use the ICD-9 currently

will NOT change with the transition to ICD 10.

Only the coding changes.

• Continued adherence to the official coding

guidelines in all healthcare settings is required

under the Health Insurance Portability and

Accountability Act.

Your

Strategy

Develop written action plan/ longitudinal timeline ( i.e Gantt Chart)

Schedule Educational Programs- timing of training

Contact all software vendors- vendor readiness

Strategies for Implementation Phase 2

Meet with medical director and physician groups

Meet with local hospital medical records dept, discharge planners

Strategies for Implementation Phase 2

Final run through of action plan

Assess readiness of each department

Practice, practice, practice

TEST, TEST, TEST

Strategies for Implementation Phase 3

Self audits

Evaluate the plan- Lessons learned

Ongoing evaluation

Strategies for Implementation Phase 4

Celebrate Team Success!

Take a much needed vacation!

CMS ICD-10 site

http://www.cms.gov/Medicare/Coding/ICD10/index.htm

l?redirect=/ICD10/

Center for Disease Control

http://www.cdc.gov/nchs/icd/icd10cm.htm

Professional Associations

http://www.aapc.com/icd-10/codes/

http://www.ahima.org/icd10/

http://www.himss.org/ASP/topics_icd10playbook.asp

AHIMA Primer

http://library.ahima.org/xpedio/groups/public/docu

ments/ahima/bok1_038084.hcsp?dDocName=bo

k1_038084

Misc.

http://www.contexomedia.com/icd-10/

http://www.medilexicon.com/

CDC Website

Questions?

Maria Arellano MS, RN

[email protected]