ICD-10-CM. Objectives

(1)

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

(2)

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

(3)

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

(4)

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

(5)

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

(6)

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?

(7)

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

(8)

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

(9)

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

(10)

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

(11)

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

(12)

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