ICD‐10: Implications for Content Conversion in
Vendor Products
Ardith Campbell, CPC, CPC‐H, CCP
Manager, Charge and Revenue Integrity Services
MedAssets
ICD‐10: Implications for Content Conversion in Vendor
Products
OVERVIEW
Implementation of ICD‐10 requires attention to both internal and external
systems. Begin preparing your external content for ICD‐10 implementation
now. Learn what steps you can take to make your conversion easier.
LEARNING OBJECTIVES
• Participants will learn to recognize the major differences between ICD‐
9 and ICD‐10 coding systems.
• Participants will learn to recognize how this change is going to affect
software and other systems within a given facility and how it will
impact workflow processes. Participants will recognize a need for an
effective action plan.
• Participants will identify key steps to make the transition easier and
identify key areas of focus.
FACULTY
Ardith Campbell, CPC, CPC‐H, CCP
Manager, Charge and Revenue Integrity Services
MedAssets
Ardith Campbell is Manager of Charge & Revenue Integrity Services for MedAssets.
Beginning her healthcare career in 1987, she has also worked for Central
Washington Comprehensive Mental Health and Yakima Valley Radiology where her
jobs have included working with coding, reimbursement and utilization review. In
her current role, Ardith works with the internal controls of three MedAssets
products to ensure compliance with federal regulations and established coding
conventions. She has also written articles for several industry publications, and has
spoken at several industry‐related events throughout the country. She is certified
as a CPC and CPC‐H through the American Academy of Professional Coders and as a
CCP through the Professional Healthcare Institute of America.
INTENDED AUDIENCE
INSTRUCTIONS FOR OBTAINING CONTINUING EDUCATION CREDIT
To be eligible for CE NASBA credit:
• Attendees must be badge scanned for attendance and submit a completed
evaluation form for this session
• Attendees should contact Dayna Baskerville (
[email protected]
)
to obtain their Certificate of Completion.
ICD‐10: Implications For Content
Conversion In Vendor Products
CONFIDENTIAL – PROPERTY OF MEDASSETS. MedAssets® is a registered trademark of MedAssets, Inc. Copyright MedAssets, 2010. All rights reserved.
Ardith Campbell, CPC, CPC‐H, CCP
Manager, Charge and Revenue Integrity Services
MedAssets
Objective
To understand the implications
p
of the October 2013 deadline for
implementation of the International
Classification of Diseases (ICD)
Classification of Diseases (ICD),
Goals
•
To recognize the difference between ICD‐9 and ICD‐10
•
To understand how this will affect my software
•
Identify steps I can take to make the transition easier
3Agenda
•
Introduction to the ICD‐10
•
Internal versus external content
•
Why focus on external content?
•
What should you be doing now?
4History of ICD‐10
Diagnosis and Procedure
History of ICD‐10
•
ICD‐9 developed by World Health Organization (WHO)
for use worldwide
for use worldwide.
•
United States (US) developed clinical modification
(ICD‐9CM).
– Implemented in 1979 in US – Expanded diagnosis codes • Volumes I & II • Volumes I & II – Developed procedure coding system • Volume IIIHistory of ICD‐10
(cont’d)
•
Health Insurance Portability & Accountability Act
(HIPAA) designated as a standardized code set
(HIPAA) designated as a standardized code set
– Volumes I & II (diagnosis codes) for professional & facilities – Volume III (procedures) for inpatient claims only – Currently around 14,000 ICD‐9 diagnosis • ICD‐10 expands to almost 68,000 – Approximately 4,000 procedure codes • ICD‐10PCS expands to approximately 87,000 – Current Procedural Terminology (CPT®) for professional & outpatient claims 7History of ICD‐10
(cont’d)
•
Why is a new coding system needed?
ICD 9 is 30 years old
– ICD‐9 is 30 years old – Running out of room – Technology has changed – Not descriptive enough – Lack of specificity requires supporting documentation submission prior to claim adjudication – Data/quality tracking limited 8
History of ICD‐10
(cont’d)
•
ICD‐9 Diagnosis has three digits
Chapters 1 17 begin with numbers
– Chapters 1 – 17 begin with numbers – Supplemental Chapters V & E begin with letters – Used by all providers – Examples: • 311 Depression, not otherwise specified • 250.32 Diabetes with other coma, type II or unspecified type, t ll d uncontrolled • E916 Struck accidentally by falling object 9
History of ICD‐10
(cont’d)
•
ICD‐10 Diagnosis codes three to seven digits
•
First digit is alpha
•
Second digit is alpha or numeric
•
Third digit is alpha or numeric
•
Fourth through seventh digits may be alpha or numeric
•
Case insensitive alpha characters
•
Beginning alpha expands classification from 12 to 26
History of ICD‐10
(cont’d)
•
Examples:
J32 0 Chronic maxillary sinusitis
– J32.0 Chronic maxillary sinusitis – L89.131 Pressure ulcer of right lower back, stage I – S52.131a Displaced fracture of neck of right radius, initial encounter for closed fracture – Code 996.1 Mechanical complication of other vascular device, implant, and graft E d t 156 diff t d • Expands to 156 different codes • T82.322 Displacement of femoral arterial graft (bypass) 11
History of ICD‐10
(cont’d)
•
ICD‐10 Procedural Coding System (PCS) affects
inpatient claims only
inpatient claims only
•
Expanding to seven digits
– Can be either alpha or numeric character
– Letters I and O not used
• Avoids confusion with numbers 1 or 0
– Identifies body part approach and device(s) usedIdentifies body part, approach, and device(s) used
History of ICD‐10
(cont’d)
•
Example
3 Administration – 3 Administration – 0 Circulatory – 2 Transfusion; putting in blood or blood products – 3 Peripheral vein – 3 Percutaneous – N Red blood cells – 1 Nonautologous 13History of ICD‐10
(cont’d)
•
Code 39.50 Angioplasty is one ICD‐9 code
•
For ICD‐10, expands to 1170 codes
– 047K04Z Dilation of right femoral artery with drug‐eluting intraluminal device, open approach – 047K0DZ Dilation of right femoral artery with intraluminal device, open approach•
Will ICD‐9 become a dead language?
Will ICD 9 become a dead language?
– Example later
Internal vs. External Content
Internal vs. External Content
•
Internal
‘Within your facility’
– ‘Within your facility’ – Your staff • Discussed later – How will your facility handle the transition? • Identify affected departments • Create committees to explore possibilities • Consider/budget training & development costs • Inventory existing systems • Contact vendors • Consider doing a general system upgrade 16
Internal vs. External Content
•
External
‘Outside the facility’
– ‘Outside the facility’ – Are the vendors ready? – Can they support both ICD‐9 and ICD‐10? – For how long will they support both? 17
Focus On External Content
Why?
Focus on External
•
Why?
We are a vendor – We are a vendor•
Identify vendor relationships
– Center for Medicare & Medicaid Services (CMS) vendor – Medicaid – Insurance carriers– Vendor products used internally
– Vendor products used internally 19
Focus on External
(cont’d)
•
May impact many information systems
Where to look – Where to look • Billing • Case management • Pharmacy • Reporting 20Focus on External
(cont’d)
•
Evaluate work flow processes
Medical necessity tools
– Medical necessity tools – Point of service collection tools – Pre‐certification processes – Claim scrubbers – Claim clearing houses – Any other vendors 21
Focus on External
(cont’d)
•
Inpatient versus outpatient
ICD 10 diagnosis affects all provider types
– ICD‐10 diagnosis affects all provider types – Outpatient will continue to use CPT for procedures – ICD‐10PCS affects inpatient only • Will vendor transition to ICD‐10PCS or map back to ICD‐9? – Your use of ICD‐10PCS vs ICD‐9 procedures • Statistics • Map ICD‐9 to ICD‐10 or convert?
Focus on External
(cont’d)
•
CMS has developed General Equivalence Mappings
(GEMS)
(GEMS)
– Works bi‐directionally – Not a 1:1 mapping system – ICD‐9 to ICD‐10 results may be different than ICD‐10 to ICD‐9 lookup – GEMS to be updated only three years post‐conversion 23Focus on External
(cont’d)
•
Data requirements
Can be two way
– Can be two‐way • What do you require from vendor? • What does vendor require from you? • If mapping to GEMS, what happens after 3‐year period? –Dead language example 24
Focus on External
(cont’d)
•
Discussion with providers
Inpatient procedures different than outpatient
– Inpatient procedures different than outpatient – Will this affect order entry? – What about lab requisitions? – Your charge description master (CDM)? – Will conversion be done on the back end? 25
What Should I Be Doing?
Major Steps for ICD‐10 Readiness
•
Organize the Team
•
Conduct a Business Process Analysis
•
Develop a Communication Strategy
•
Perform Technology Assessment
•
Training, Training, Training
•
Create a Deployment Strategy
27Organize the Team
•
Cross functional team with key areas of focus
Define the project and the scope of the project
– Define the project and the scope of the project
– Budget planning
– Assess impact to vendor operations
– Review impact on operations
Conduct a Business Process Analysis
•
How will ICD‐10 impact your business practices
•
Review Health Plan Contracts
•
Patient Care and Service Impact
PROJECT TEAM Patient Health Plan Contracts 29 ICD‐10 Impact Patient Care ServiceDevelop a Communication Strategy
•
Develop a Leveled Communication Strategy
Knowledge – Knowledge – Application – Expert•
Stress benefits of ICD‐10
•
Share timeline
•
Conduct periodic briefings
Perform a Technology Assessment
•
Complete assessment of each electronic process
ELECTRONIC MEDICAL RECORD (EMR)
– ELECTRONIC MEDICAL RECORD (EMR) – HEALTH INFORMATION MANAGEMENT (HIM) – SCHEDULING SYSTEMS – BILLING AND COLLECTIONS – ORDER ENTRY – PHARMACY – UTILIZATION MANAGEMENT – PURCHASING – AUDITING 31
