ICD-10-CM: Changes Ahead For the Clinical Work Process

KMIT 7/17/2013 Shamsi Daneshvari, PhD [email protected] ICD-10-CM: Changes Ahead

For the Clinical Work Process

This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 United States License.

Objectives

• History of ICD-9 and ICD-10 • Structure of ICD-9 and ICD-10

• Benefits and Drawbacks of ICD-10

History of ICD-9-CM

• World Health Organization (WHO) developed ICD-9 for use worldwide

• U.S. developed clinical modification (ICD-9-CM) Implemented in 1979 in U.S.

– Expanded number of diagnosis codes – Developed procedure coding system

ICD-9-CM Currently

• 30 years old

• Many categories full

– About 14,000 codes

• Ability to add codes limited • Not as descriptive as ICD-10

Benefits of ICD-10-CM Adoption

• Incorporates much greater specificity and clinical information, which results in:

– Improved ability to measure health care services – Increased sensitivity when refining grouping and

reimbursement methodologies

– Enhanced ability to conduct public health surveillance – Decreased need to include supporting documentation

with claims

Structural Differences –ICD-9-CM

Diagnoses

• ICD-9-CM has 3 –5 digits

– Digit 1 is numeric or alpha – Digit 2-5 is numeric

• Examples:

– 496 Chronic airway obstruction not elsewhere classified (NEC)

– 511.9 Unspecified pleural effusion – V02.61 Hepatitis B carrier

Structural Differences ICD-10-CM

Diagnoses

• ICD-10-CM has 3 –7 digits

– Digit 1 is alpha – Digit 2 is numeric

– Digit 3 is alpha or numeric

– Digits 4 –7 are alpha or numeric

• Examples:

– A69.20 Lyme disease, unspecified

– O9A.311 Physical abuse complicating pregnancy, first trimester

– S42.001A Fracture of unspecified part of right clavicle, initial encounter for closed fracture

Drawbacks of ICD-10-CM Adoption

• 65,000 codes (ICD-9-CM: 14,000) • Very specific

• Physicians cannot use previous process for documenting

• Requires significant planning, training, software/system upgrades/replacements

Example 1

• A pedestrian is walking down the street and is hit by a motorcycle

• What are the diagnoses codes using ICD-9 and ICD-10?

ICD-9-CM

• E814 Motor vehicle traffic accident involving collision with pedestrian

– collision between motor vehicle, any kind, and

pedestrian

ICD-10-CM

• Pedestrian injured in transport accident V00-V09

– V00 Pedestrian conveyance accident

– V01 Pedestrian injured in collision with pedal cycle

– V02 Pedestrian injured in collision with two- or three-wheeled motor vehicle

– V03 Pedestrian injured in collision with car, pick-up truck or van – V04 Pedestrian injured in collision with heavy transport vehicle or

bus

– V05 Pedestrian injured in collision with railway train or railway vehicle

– V06 Pedestrian injured in collision with other non-motor vehicle – V09 Pedestrian injured in other and unspecified transport accidents

V02Pedestrian injured in collision

with 2 or 3 wheeled motor vehicle

• V02.0 Pedestrian injured in collision with two- or three-wheeled motor vehicle in nontraffic accident

– V02.00Pedestrian on foot injured in collision

– V02.01Pedestrian on roller-skates injured in collision – V02.02Pedestrian on skateboard injured in collision

– V02.09Pedestrian with other conveyance injured in collision

• V02.1 Pedestrian injured in collision with two- or three-wheeled motor vehicle in traffic accident

• V02.9 Pedestrian injured in collision with two- or three-wheeled motor vehicle, unspecified whether traffic or nontraffic accident

• V02.99XA…… initial encounter

• V02.99XD…… subsequent encounter • V02.99XS…… sequela

Example 2

• An individual fractures left hand. A

month later, she/he fractures their right

hand.

– Patient fractures left hand

ICD-9-CM

• initial, subsequent, or sequela • Left, right

• Nonunion, malunion, delayed or routing healing • Open, closed initial fracture

ICD-10-CM

• ICD-10-CM describes:

– Left versus right

– Initial versus subsequent

• S62.51Fracture of proximal phalanx of thumb

– S62.511Displaced fracture of proximal phalanx of right thumb

• S62.511A…… initial encounter for closed fracture

• S62.511B…… initial encounter for open fracture

• S62.511D…… subsequent encounter for fracture with routine healing

• S62.511G…… subsequent encounter for fracture with delayed healing

• S62.511K…… subsequent encounter for fracture with nonunion

• S62.511P…… subsequent encounter for fracture with malunion

Example 3

Example –combination defibrillator pacemaker device

• Codes for this device are not in the

cardiovascular chapter of ICD-9-CM with other defibrillator and pacemaker devices

• Coders and researchers have trouble finding these codes with this type of erratic code

assignment

• ICD-10 provides distinct codes for all these types of devices, in an orderly manner that is easy to find

ICD-9 and the Current Workflow

• Each clinic has:

– ICD-9 code form of top 100 codes used

– Physician choose diagnoses and turn into billing • Assumed that all documentation is present for

diagnosis

ICD-10 and the Workflow

• Changes include:

– Cannot use code form of top codes used • ICD-10 too granular

– Computer chooses diagnoses from patient notes • All documentation must be present for diagnosis

How do we implement ICD-10?

• Fairly significant process and workflow

changes for all medical providers in all parts of the health system

• Focus on improving clinical documentation quality

• Require retraining on how to document in the new system

ICD-10 Implementation at UNM

• Clinical Document Improvement (CDI) Project

– Goals:

• Appropriate description of the patient problem list and care plan

• Appropriate description of the care and care plan for billing purposes

• Appropriate documentation on disease specificity, complexity and acuity

CDI Project

• Implementation procedure in process

• Designate Department/Division Champions • Training, training and more training

• On-going feedback to improve process

The tsunami of change is coming!

• ICD-10 implementation: October 2014 • Costs of implementation large

• Cost of non-compliance lethal to organizations • Predict that:

– Money collected will drop

– Time to complete notes in clinic will increase

Countries using ICD-10-CM

• United Kingdom (1995)

• Nordic countries (Denmark, Finland, Iceland, Norway, Sweden) (1994 –1997) • France (1997) • Australia (1998) • Belgium (1999) • Germany (2000) • Canada (2001) http://www.cms.gov/Medicare/Coding/ICD10/downloads/ICD-10OverviewPowerPoint.pdf

ICD-11-CM??

• Due by 2015

• Rumored to be a more sophisticated coding system

• Built upon a robust ontological framework,

with linkages to underlying terminologies such as SNOMED CT

KMIT 7/17/2013 Shamsi Daneshvari, PhD [email protected] ICD-10-CM: Changes Ahead

For the Clinical Work Process

This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 United States License.