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Basic Basic Introduction Introduction to to ICD-10 CM/PCS ICD-10 CM/PCS

Basic Introduction to ICD-10 CM/PCS. ICD-10 Implementation October 1, 2015 – Compliance date for implementation of ICD-10-CM (diagnoses) and ICD-10-PCS

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  • Basic Introduction toICD-10 CM/PCS

  • ICD-10 ImplementationOctober 1, 2015 Compliance date for implementation of ICD-10-CM (diagnoses) and ICD-10-PCS (procedures)

    ICD-10-CM (diagnoses) will be used by all providers in every health care setting

    ICD-10-PCS (procedures) will be used only for hospital claims for inpatient hospital procedures ICD-10-PCS will not be used on physician claims, even those for inpatient visits

  • CPT and HCPCs CodesNo impact on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes

    CPT and HCPCS will continue to be used for physician and ambulatory services including physician visits to inpatients

  • ICD-10 ImplementationSingle implementation date of October 1, 2015 for all users

    Ambulatory and physician services provided on or after October 1, 2015 will use ICD-10-CM diagnosis codes

    Inpatient discharges occurring on or after October 1, 2015 will use ICD-10-CM and ICD-10-PCS codes

  • Why ICD-10Current ICD-9 Code Set is:Outdated: 30 years oldCurrent code structure limits amount of new codes that can be createdHas obsolete groupings of disease familiesLacks specificity and detail to support:Accurate anatomical positionsDifferentiation of risk & severityKey parameters to differentiate disease manifestations

  • Diagnosis Code Structure Comparison

    ICD-9-CM (Volume 1 & 2)ICD-10-CM3-5 characters in length3-7 characters in lengthApproximately 14,000 codesApproximately 68,000 codesFirst digit may be alpha (E or V) or numeric; digits 2-5 are numericDigit 1 is alpha (to indicate the category);Digit 2 is numeric (in the future, alpha characters may be used if code expansion is needed); Digits 3-7 can be alpha or numericLimited space for adding new codesFlexible for adding new codesLacks detailVery specificLacks lateralityIncludes laterality (i.e., codes identifying right vs. left)

  • ICD-10-CM (diagnosis) Code FormatS32010AAlpha (except U)2nd Always Numeric3rd-7th Alpha or NumericAdditional CharactersCategoryEtiology, Anatomic Site, Severity Added code extensions (7th Character) for obstetrics, injuries and external causes of injuries3-7 Characters

  • Comparison: ICD-9 to ICD-10With specificity and laterality, one ICD-9 code translates into 14 possible ICD-10 codes

    434.11Cerebral embolism with infarction

    Code represents embolism of cerebral arteries with infarction

    I63.40 Cerebral infarction dew to embolism of unspecified cerebral artery I63.49 Of other cerebral artery I63.411Of right middle cerebral artery I63.412Of left middle cerebral artery I63.419Of unspecified middle cerebral artery I63.421Of right anterior cerebral artery I63.422Of left anterior cerebral artery I63.429Of unspecified anterior cerebral artery I63.431Of left posterior cerebral artery I63.432Of right posterior cerebral artery I63.439Of unspecified posterior cerebral artery I63.441Of right cerebellar arteryI63.442Of left cerebellar artery I63.449Of unspecified cerebellar artery

  • Procedure Code Structure Comparison

    ICD-9-CM (Volume 3)ICD-10-PCS3-4 numbers in length 7 alpha-numeric characters in length Approximately 3,000 codes Approximately 87,000 available codes Based on outdated technologyReflects current usage of medical terminology and devices Limited space for adding new codes Flexible for adding new codes Lacks detail Very specific Lacks laterality Has laterality Generic terms for body parts Detailed descriptions for body parts Lacks descriptions of methodology and approach for procedures Provides detailed descriptions of methodology and approach for procedures Lacks precision to adequately define procedures Precisely defines procedures with detail regarding body part, approach, any device used, and qualifying information

  • ICD-10-PCS Code FormatS32010ASectionBody SystemRoot OperationBody PartApproachDeviceQualifier

  • Comparison: ICD-9 to ICD-10

    ICD-9 Procedure Code 39.50 Angioplasty 39.31 Suture of artery 47.01 Laparoscopic appendectomy

    ICD-10 Procedure Code 0DN90ZZ Release of duodenum, open approach 0FB03ZX Excision of liver, percutaneous approach, diagnostic 02PS0CZ Removal, extraluminal device from pulmonary vein, right, open

  • ICD-10 Provider ImpactsClinical documentation is the foundation of successful ICD-10 ImplementationGolden Rule of DocumentationIf it isnt documented by the physician, it didnt happenIf it didnt happen, it cant be billedThe purpose in documentation is to tell the story of what was performed and what is diagnosed accurately and thoroughly reflecting the condition of the patient what services were rendered and what is the severity of the illnessThe key word is SPECIFICITYGranularityLateralityComplete and concise documentation allows for accurate coding which leads to maximized reimbursement

  • ICD-10 Changes Everything!ICD-10 is a Business Function Change, not just another code set change.

    ICD-10 Implementation will impact everyone:Registration, Nurses, Managers, Lab, Clinical Area, Billing, Physicians, and Coding.

    Know your role How is ICD-10 going to change what you do?

  • ICD-10 Next StepsAssess & track vendor compatibility

    UHS Master Education PlanIdentify all employees and medical staff who need training by April 15, 2015.Assign all Precyse Courses in Healthstream by April 30, 2015.Be mindful of assigned staff training hours

    Dual coding / practicing with ICD-10-CM/PCS

  • ICD-10 Facility ResourcesCost centers have been established specifically for the resources needed to implement ICD-10 successfully. This covers both the training of employees and any necessary back-fill of staff during training.ICD -10 Training: coded to account #xxx-86100-687923 Two ICD-10 translation tools:Code Translation Tool (CTT)Translates ICD-9 to ICD-10 utilizing description, specific code, code ranges or list of codes.Training and Roll-out of the CTT tool has been completed and end users are actively using the tool for Code translation needs.Financial Impact Tool (FIT) Analyzes historical DRG data to predict the financial impact of ICD-10, both positive and negative. Variance reports can be utilized toidentify avoidable DRG shifts in order to reduce financial risk through physician documentation education.Training and Roll-out of the FIT tool is in progress.

  • ICD-10 Resources

    CMS Resources MS-DRG Conversion Report http://www.cms.hhs.gov/ICD10/Downloads/MsdrgConversion.pdf ICD-10 General Informationhttp://www.cms.hhs.gov/ICD10

    The following organizations offer providers and others ICD-10 resources AHIMA (American Health Information Management Association) http://www.ahima.org/icd10/default.aspxWEDI (Workgroup for Electronic Data Interchange) http://www.wedi.org HIMSS (Health Information and Management Systems Society) http://www.himss.org/icd10

  • OCTOBER 1, 2015!!