ICD-10-CM. Objectives

Full text

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ICD-10-CM

What is it? Why? Now What?

Debbie Johnson, RHIT, CHP

American Health Care Association Webinar September 12, 2013

Objectives

Learn

what ICD-10-CM is

what the main differences in ICD-9 and ICD-10

are

Why the change is necessary

What steps are needed to

prepare for ICD-10 implementation

What resources are available

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What is it?

In order to understand 10, let’s look at 9…..

ICD-9-CM: International Classification of Diseases, 9

th

Revision, Clinical Modification

– Was developed 30 years ago

– Developed by the Word Health Organization (WHO)

– Classifies morbidity and mortality information for statistical purposes

– Required for billing for Medicare, Medicaid and other services

– 2000 HIPAA Transaction & Code Set rule requires for electronic transactions

What is it?

ICD-10-CM: International Classification of

Diseases, 10

th

Revision, Clinical Modification

Is the international standard

Federally mandated to begin October 1, 2014

Will be used by all providers in every health care

setting

Single implementation date for all users

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What is it?

Know the difference

ICD-10-CM

(diagnoses)

• All health care settings

ICD-10-PCS

(procedures)

• Inpatient hospitals only

Important Tip: In the Post-Acute setting:

training is not needed for ICD-10 PCS

Why the Change?

ICD-9-CM is running out of codes

Code system is 30 years old

ICD-10 better captures advances in medicine

and technology

Statistical improvement

Billing improvement

ICD-10 is more specific

Allowing better data capture for quality, safety

and efficacy of care

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Differences - Structural

ICD-9

3-5 characters

Alpha-numeric

Characters 2-5 are

numeric

Always least 3

characters

14,000 codes

ICD-10

3-7 characters

1

st

character is alpha (all

letters except U are

used)

Alpha characters are

not case sensitive

Uses dummy

placeholders – “X”

68,000 codes

Differences – New Characteristics

Laterality

More combination codes

Combining conditions and symptoms

More specificity

Codes to indicate episode of care

No more aftercare codes for fractures

No more therapy codes

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Examples

ICD-9

V58.49

Aftercare following a healing traumatic fracture of

hip

ICD-10

S72.141D

Displaced intertrochanteric fracture of the right

femur, subsequent encounter for closed fracture

with routine healing

Examples

ICD-9

– 438.21

– Hemiplegia following CVA affecting dominant side

ICD-10

– I69.051

– Hemiplegia and hemiparesis following nontraumatic subarachnoid hemorrhage affecting right dominant side OR

– I69.052

– Hemiplegia and hemiparesis following nontraumatic subarachnoid hemorrhage affecting left dominant side

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Now What?

Impact Analysis

Training Plans

Implementation Plans

Budget Considerations

Impact Analysis

Identify all areas of diagnosis code use

Software

• What are vendor plans and delivery timeframes?

• Is the upgrade included in your contract?

• What costs will be involved?

• Will the vendor be able to provide dual coding systems at once?

• Will your software be able to maintain historical data?

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Impact Analysis

Billing

• What are your payers’ plans for conversion?

• Are there business associates involved with billing that need to transition?

• Are there separate applications used for billing and financial reporting?

Forms and Reports

• Identify all forms/documents that need to be revised

• Identify all reports that need to be revise – manual and electronic

Impact Analysis

Documentation

• Audit current documentation to assess documentation quality, i.e. laterality, episodes of care, stages of healing, etc.

• Findings may be used later to identify training needs

Other Systems to Consider

• Case Mix

• Quality Management

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Training Plans

Assess varying levels of training needs

Awareness Training

• General knowledge of the code system and the differences in the systems

• Operations

• Senior management

• Department management

• Key medical staff

Training Plans

Assess varying levels of training needs

Data User Training

• Knowledge of the basic structural differences in the systems, implementation plans, data use, areas of impact

• Business Office

• Physicians

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Training Plans

Assess varying levels of training needs

Coders

• Intensive ICD-10-CM training needed

–Coding Guidelines and Principles

–Specialty-specific coding

–Transitional changes

• Evaluate knowledge level of coders

–Anatomy and physiology

–Medical terminology

• Should be done 4-6 months prior to implementation

Training Plans

Assess types of training methods

One-to-one training

Classroom training

Online courses

Audio or web-based programs

Self-directed learning

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Training Plans

Training Sources

Professional Associations

Commercial Vendors

Independent Consultants

Colleges and Universities

Self-Study Courses

REMEMBER: PCS Training is not needed for Post

Acute Care

Implementation Plans

Develop a time line for your implementation

plan

Include impact analysis tasks

Training

Budgeting

Awareness – Planning – Testing – Training –

Go Live

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Implementation Plan

Sample 4

th

Quarter 2013

– Present ICD-10 Facility Requirements to Leadership

Create Steering Committee and begin quarterly meetings (e.g., Quality, Compliance, Risk Management, Billing, IT, Rehab, etc.)

– Poll Facility - Who codes?

– Steering Committee completes Impact Assessment Analysis, including forms analysis

– Consider options for Coder knowledge base - Anatomy & Physiology, terminology, etc.

– Overview/Awareness to all-staff (what to expect, budgetary impact, training, knowledge base, etc.)

– Begin exploring options for how ICD-10 training will be accomplished,

i.e., consultant, seminars, etc.

Implementation Plan

Sample 1

st

Quarter 2014

– Financial Awareness Training for relevant staff

– Review readiness with vendor software; verify when they plan to have their ICD-10 available in the clinical and financial software (e.g., State Medicaid agencies, MAC, Managed Care organizations, etc.

– Facilities order ICD-10 Manuals so they are available for training

– Determine whether physicians will need any training related to long term care and if they are getting any training at their hospitals, etc.

– Begin weekly ICD-10 Fact Sheets via e-mail to appropriate staff

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Implementation Plan

Sample 2

nd

Quarter 2014

– Coder training for relevant staff

– If available, case mix analysis to determine how, if at all, the new codes change the case mix outcome

– Determine how long the facility has to support dual systems in the software

– Steering Committee begins monthly meetings

– Documentation Review and assess sampling of documentation. Determine if the documentation is supportive of new level of specificity

– Determine strategy for documentation improvement as necessary

Implementation Plan

Sample 3

rd

Quarter 2014

– Assess facility and payer readiness early in quarter

– Distribute weekly proficiency e-mails for coders

– Refresher awareness training for the financial staff; they won’t need to know how to code but need to be apprised of the status of the implementation

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Implementation Plan

Sample 4

th

Quarter 2014

– Go live 10/1/2014

– Weekly meetings or calls with relevant staff for questions and support

– Steering Committee monitors claims/denials

– On-going training for new coders and rehab staff

Budget Considerations

Try to identify all areas that the transition will

affect

Identify how various department budgets will

be impacted

Consider budgets for training, software, new

forms

Lost productivity, increased coding

time

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Budget Considerations

Consider how receivables may be affected by

transition

Remember 5010

Staffing

Consultant Fees

Resources

www.ahima.org/ICD10

CMS Implementation Widget and Timelines

https://www.cms.gov/ICD10/03_ICD-10andVersion5010ImplementationTimelines.asp#

TopOfPage

CMS ICD-10 E-Mail Updates

https://www.cms.gov/ICD10/02d_CMS_ICD-10_Industry_Email_Updates.asp#TopOfPage

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Resources

HIMSS ICD-10 Playbook

http://www.himss.org/library/icd-10/playbook

Wedi.org

ICD-10-CM books available from all current

ICD-9 –CM vendors

Free online at website: National Center for

Health Statistics

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