ICD-10 5th Edition Implementation Preparing for implementation Clinical Classifications Service

ICD-10 5th Edition ImplementationPreparing for implementation

Clinical Classifications Service

ICD-10 5th Edition checklist

• Here’s a checklist to help you plan and manage the ICD-10 5th Edition implementation– You may not need everything included here– But, it will help you identify what needs to happen

• Take what is useful for you and your organisation ……..

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Topics covered

• Overview of ICD-10 5th Edition– What is ICD-10– Impact and number of changes– Products delivered centrally

• Implementation planning and strategies– Organisation, systems and coding readiness– Go live preparation– Post implementation

• Links to central resources

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Overview of ICD-10 5th Edition

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• World Health Organisation International Statistical Classification of Diseases and Related Health Problems – Tenth Revision, 5th Edition

• Commonly referred to as ICD-10 5th Edition

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What is ICD-10?•NHS Information standard •Used to classify hospital diagnoses for secondary uses such as statistical purposes and reimbursement•Comprises a list of alphanumeric codes, organised into chapters, categories and subcategories

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Under the Health and Social Care Act 2012 the following bodies must have regard to this information standard:•the Secretary of State•NHS England•Monitor•public bodies exercising functions in connection with health services or adult social care•anyone providing publicly funded health services or adult social care commissioned by or on behalf of a public body•in addition, this information standard applies to NHS IT system and software suppliers who provide software to support NHS business functions and interoperability, according to new and existing contractual arrangements.

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Scope of ICD-10 5th Edition mandate:•All “in-patient” episodes and day cases that contain diagnoses must be recoded using the mandated version of ICD-10

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ICD-10 data uses include:•National data collections including Admitted Patient Care Commissioning Data Sets (CDS)•Hospital operational and strategic planning to support business processes including reimbursement

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ICD-10 update cycle:

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ICD-10 version: NHS implementation on:

ICD-9 -

ICD-10 1 April 1995

ICD-10 Reprinted (with corrections and updates) 2000

1 April 2004

ICD-10 4th Edition 1 April 2012

ICD-10 5th Edition 1 April 2016


ICD-10 5th Edition compliance•1 April 2016

– Compliance date for NHS implementation of ICD-10 5th Edition

•Inpatient episodes and day cases ending on or after 1 April 2016 must be coded using ICD-10 5th Edition

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No change to architecture of ICD-10 •Changes made in both the Tabular List and Alphabetical Index•New entries fall within existing chapters•Addition, retirement and modifications to existing code descriptions and notes

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NHS and system supplier formal notification•Standardisation Committee for Care Information (SCCI) oversees the development, assurance and approval of information standards, data collections, and data extractions•Advanced Notification (AN) – gives warning of update and implementation requirement published by SCCI on 1 April 2015: http://www.hscic.gov.uk/isce/publication/SCCI0021•Information Standards Notice (ISN) – for publication in September 2015, mandates the implementation of ICD-10 5th Edition on 1 April 2016 subject to acceptance of the standard by SCCI: http://www.hscic.gov.uk/isce/publication/SCCI0021

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http://www.hscic.gov.uk/isce/publication/SCCI0021

http://www.hscic.gov.uk/isce/publication/SCCI0021


Number of changes•Tabular List

•Approximately 900 changes to individual index entries •Removal of morphology codes not included in figures

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Changes Number

Additions 215

Deletions 70

Modifications 169

TOTAL 455


Changes to ICD-10•ICD-10 5th Edition contains updates released by the World Health Organisation (with implementation dates up to 2016)•Draft summary of changes available at: http://systems.hscic.gov.uk/data/clinicalcoding/codingstandards/icd10/icd10updates•Public consultation on proposed changes and implementation support held 29-Mar-2014 to 25-Apr-2014 and 20-May-2015 to 19-Jun-2015•Final summary of changes will be available in September 2015 at: http://systems.hscic.gov.uk/data/clinicalcoding/codingstandards/icd10/icd10updates

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http://systems.hscic.gov.uk/data/clinicalcoding/codingstandards/icd10/icd10updates





New codes include:•Multiple system atrophy, cerebellar type [MSA-C] (G23.3)•Locked in syndrome (G83.5)•Specified types of atrial fibrillation (I48.-)•Aneurysm and dissection of vertebral artery (I72.6)•5th characters for type I, II and unspecified respiratory failure (J96.-) •Caries with pulp exposure (K02.5)•Incisional, parastomal and ventral hernias (K43.-)•Haemorrhoids by degree and perianal venous thrombosis (K64.-)•Excessive and redundant skin and subcutaneous tissue (L98.7) •Acquired hydrocephalus of newborn (P91.7)•Personal history of female genital mutilation (Z91.7) •Dependence on artificial heart (Z99.4)•Emergency use of codes (U06 and U07)•Resistance to antimicrobial and antineoplastic drugs (U82-U85).

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Morphology codes•Removal of ICD-O morphology codes in the ICD-10 5th Edition Volumes 1-3•Morphology codes in 4th Edition not compliant with current version of ICD-O•WHO advise full ICD-O is used for morphology coding•Removal does not affect data files•ICD-O used by cancer registries•Morphologies can still be recorded locally and policy owners/Information managers will need to review local requirements and advise their Clinical Coders accordingly.•Codes in chapter II Neoplasms (C00-D48) must be used to code neoplasms (topography/site)•For more information see: http://systems.hscic.gov.uk/data/clinicalcoding/codingstandards/icd10/icd10updates

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Products delivered centrally•Draft Summary of Changes (April 2015)•Final Summary of Changes (Sept 2015)•ICD-10 5th Edition Volume 1-3 via The Stationary Office (Oct 2015)•ICD-10 5th Edition data files and technical specifications (2 Nov 2015)•National Clinical Coding Standards reference book, Key Learning Points and ICD-10 5th Edition Update Powerpoint presentation (Jan 2016)•Updates to Clinical Coding Standards Course and Clinical Coding Standards Refresher course materials released to approved clinical coding trainers (Jan 2016)•ICD-10 5th Edition eVersion (Feb 2016)•Terminology to ICD-10 5th Edition cross-maps (SNOMED CT, CTV3 and V2) (March 2016)

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National Tariff•The HSCIC National Casemix Office is responsible for the mapping of ICD-10 codes to Healthcare Resource Groups (HRG) for use in associated groupers. The ICD-10 updates will be incorporated into the HRGs to ensure the codes are accepted in the grouper(s) to be used from April 2016 onwards. See www.hscic.gov.uk/casemix for details about HRGs.

•2016-17 National Tariff will include updates in ICD-10 5th Edition

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http://www.hscic.gov.uk/casemix

Implementation planning and strategies

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Consequences of poor preparation•Compliance issues•Coding backlogs•Decisions based on inaccurate data•Incorrect reimbursement

Problems can be mitigated with proper advance preparation

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Don’t delay getting started•Early initiation of the planning process, thorough preparation, adequate education and proper testing will result in smoother implementation and earlier realisation of benefits

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Who is leading within your organisation to prepare a plan for implementation?

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Suggested phases•Phase 1 – organisation readiness•Phase 2 – systems readiness•Phase 3 – coding readiness•Phase 4 – go live preparation•Phase 5 – post implementation

Phases may vary, depending on the type, size and complexity of your organisation, phases may overlap

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Phase 1 - Organisation readiness

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Implementation planning and strategies – Phase 1

Phase 1 - Organisation readiness:•Project team established•Assess organisational readiness•Conduct survey of all business areas to determine extent of the impact•Analyse impact on all business processes•Develop communications plan•Document all risks and issues relating to implementationDelay to impact assessment will jeopardise ability to implement ICD-10 5th Edition by compliance date

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Phase 2 - Systems readiness

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Phase 2 – systems’ readiness:•Perform systems’ audit•Identify new or upgraded hardware or software requirements (if necessary)•Consider impact on electronic tools (e.g. encoders)•Ensure access to legacy data•Build flexibility of IT systems under development to ensure compatibility with ICD-10 5th Edition

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Systems/applications potentially impacted include:•Electronic Patient Record systems•Clinical systems•Patient Administration systems•Encoding software•Medical record abstracting systems•Decision support systems•Resource Utilisation•Quality management•Casemix systems•Case management•Financial•Compliance software

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Determine your business readiness•Determine vendor readiness and timelines for software upgrades•Information Standards Notices are included in NHS Contracts but check:

– Which systems upgrades or replacements are needed, if any, to accommodate ICD-10 5th Edition?

– Will upgrades will be covered by existing contracts, what other costs are involved?

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Determine system supplier readiness•When will upgrades be available for testing and implementation?•What customer support and training will they provide if required?•How will their products and services accommodate ICD-10 4th Edition and ICD-10 5th Edition?•How long will their products accommodate both code sets?

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Project plan is in place•Project lead to ensure all the activities and tasks required for local Trust implementation are included in the project schedule tracking tool and estimates for these tasks are regularly reviewed for accuracy

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Phase 3 - Coding readiness

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Phase 3 – Coding readiness•Review final Summary of changes available in September 2015 at: http://systems.hscic.gov.uk/data/clinicalcoding/codingstandards/icd10/icd10updates•Consider local impact of proposed changes and plan accordingly

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Assess quality of medical record documentation•Evaluate samples of various types of medical records to determine whether documentation supports level of detail found in ICD-10 5th Edition•Implement documentation improvement strategies where needed

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Coding and documentation - always work toward better documentation•Avoids misinterpretation•Provides a more accurate clinical picture of the quality of care provided•Supports current and future initiatives aimed at improving quality and improved patient care•Issues related to poor documentation must be resolved by the provider •Develop closer links between clinicians and coders to effect improvement

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Gap analysis•Conduct gap analysis of coding professionals’ knowledge and skills•Assess coding professionals’ knowledge•Refresh coding staff’s knowledge as needed on basis of assessment results

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Education and training•Minor update, changes represent improvements to reflect latest clinical knowledge, better indexing of conditions and aid coding of diagnostic information.

•Code format and coding process will not change, so conversion training not required

•Coders to review the Key Learning Points and the table of changes and full coding standard in the updated National Clinical Coding Standards ICD-10 reference book, available in January 2016.

•Trainers, managers and coders can use the ICD-10 5th Edition Update Powerpoint presentation alongside the KLP’s and updated reference book to learn about the changes being made in ICD-10 and the main changes to National Standards, available in January 2016.

•Trusts to assess and decide level of update awareness training required to suit local needs.

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Consider update awareness needs for:•Clinical coders•Information personnel•Clinicians•Senior management•Information technology•Finance•Auditors•Commissioners•Clinical department managers•Data analysts•Researchers•Epidemiologists

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Data uses•Performance improvements•Corporate compliance•Data quality management•Data security•Clinical documentation•Reimbursement

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Identify all implementation expenses and estimate associated costs including:•Education / training•Hardware / software upgrades if applicable•Staff time / temporary or contract staff•Systems’ testing related costs•Data conversion•Maintenance of dual code set•Purchase of ICD-10 5th Edition books

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Additional implementation preparation steps•Refine project plan, timeline and budget as needed•Assess potential reimbursement impact•Develop strategies to minimise problems and maximise opportunities•Assess impact of

– Decreased coding productivity– Decreased coding accuracy

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Register now ….•Agree the authorised person within the organisation to accept licence agreements on TRUD •Pre-register on TRUD for the ICD-10 data files sub-packs in readiness to download the files when released. Requestor will be notified when files become available.

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Phase 4 – Go live preparation

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Phase 4 – Go live preparation•Follow-up on readiness of systems suppliers•Develop business continuity plan in case critical systems are adversely affected when the ICD-10 5th Edition implementation goes live•Completion of communication plan•Provide senior executives and stakeholders with updates

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Information Standards Notice (ISN)•Review ISN and Standard Specification and ensure system suppliers have read and are taking appropriate actions to meet planned deliverables (ISN published September 2015 subject to SCCI approval of standard)•http://www.hscic.gov.uk/isce/publication/SCCI0021

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ICD-10 5th Edition data files•Download data files released via Technology Reference Update data Distribution (TRUD) in November 2015:

– ICD-10 5th Edition codes and title and metadata– ICD-10 5th Edition table of coding equivalences– Technical specification documents

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Complete tasks identified in Phase 1 - during impact assessment•Implement system changes•Provide education to users where needed•Implement and monitor documentation improvement strategies•Re-engineer processes and workflows identified in Phase 1 if necessary•Complete internal testing•Begin external testing once system suppliers are ready

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ICD-10 5th Edition volume sets•Purchase ICD-10 5th Edition Volumes sets from The Stationary Office from August 2015, see http://systems.hscic.gov.uk/data/clinicalcoding/codingstandards/icd10/icd10updates •Clinical coders should not attempt to manually add the ICD-10 5th Edition changes into their ICD-10 4th Edition books because of the number of changes and of the risk of introducing errors which will impact data collection and statistical outputs.

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Training and education•Deliver training requirements where needed•Download key learning points and National Clinical Coding Standards ICD-10 reference book from TRUD in January 2016•Download ICD-10 5th Edition Update Powerpoint presentation from TRUD in January 2016.•Ensure protected time for clinical coders to review:

– Changes to the classification– Key Learning Points and the table of changes and full

coding standard in the updated National Clinical Coding Standards ICD-10 reference book.

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ICD-10 5th Edition eVersion•Download from TRUD from February 2016•Clinical Coders

– Advise Trust IT department that the ICD-10 eVersion will be available for download in February 2016

– Request Trust IT department to download and install the eVersion on computer if necessary permission have not been granted

•IT Manager/ IT department– may need to white list ICD-10 5th Edition eVersion TRUD download

website at https://isd.hscic.gov.uk/trud3 to ensure access – Ensure users have correct rights to run executable file required to

install and use the application – Assist Clinical Coders to install the application, as necessary

•Read detailed installation instructions and user guide, included with the eVersion application, before installation

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SNOMED CT users:•Download data via Technology Reference Update data Distribution (TRUD) website in March 2016:

– SNOMED CT to ICD-10 5th Edition Cross-maps– Cross-maps Change Report– Cross-maps Tables Technical Specification

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Legacy terminologies•Download released data via Technology Reference Update data Distribution (TRUD) website in March 2016:

– Read Version 2 (V2) to ICD-10 5th Edition cross-maps– Clinical Terms Version 3 (CTV3) to ICD-10 5th Edition cross-

maps•V2 and CTV3 are both deprecated terminologies scheduled for withdrawal in April 2020 •Consequently the V2 and CTV3 cross-maps to ICD-10 5th Edition and OPCS-4.7 will cease to be maintained following the April 2016 Terminology release •Static legacy cross-maps files will continue to be available from HSCIC, on request.

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Data analysis•Determine impact on longitudinal data analysis

– Will legacy data be converted? If so, how will it be converted?

– Determine which data will be linked by using mapping applications and which data will be maintained separately according to the source code set

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Equivalences•Equivalences are mappings to assist users in navigating the complexity of translating meaning from the content of one code set to another code set•They should not be used for coding medical records

– The ICD-10 5th Edition Tables of Coding Equivalences are part of the data files available for download from TRUD from 2 November 2015.

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Continue to assess and improve coding documentation•Continue to assess quality of medical record documentation, implementation documentation and strategies as needed, and monitor impact of documentation improvement strategies•Coders should continue to gain familiarity with ICD-10 5th Edition codes and coding standards and improve skills in areas identified in gap analysis

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Phase 5 – Post implementation

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Phase 5 – Post implementation•Lessons learned and post implementation review

– What can you learn for next time?– What went well?– What didn’t go well?– Did you implement the 5th Edition on time?– Did you implement the required changes that were

identified in each phase of your implementation plan?

•Informs future updates

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Did this help you?

• Let us know if this implementation support helped, and how we can improve for future releases ………..

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Links to central resources

Technology Reference Update data Distribution (TRUD)•https://isd.hscic.gov.uk/trud3/user/guest/group/0/home

Health and Social Care Information Centre – Clinical Classifications Service•http://systems.hscic.gov.uk/data/clinicalcoding/codingstandards/icd10

New interactive environment that provides information about emerging and changing standards•http://www.infostandards.org

Information standards helpdesk•[email protected]

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Connect with us

[email protected]/hscic

Documents

ICD-10 5th Edition Implementation Preparing for implementation Clinical Classifications Service