ICD-10-CM/PCS Impact AssessmentICD-10-CM/PCS Impact Assessment AHIMA 2009 HIM Webinar Series 3 Notes/Comments/Questions ICD-10 CM/PCS Final Rule Issues Implementation date October

© Copyright 2009 American Health Information Management Association. All rights reserved.

ICD-10-CM/PCS Impact Assessment

Webinar May 5, 2009

Practical Tools for Seminar Learning

Disclaimer

AHIMA 2009 HIM Webinar Series i

The American Health Information Management Association makes no representation or guarantee with respect to the contents herein and specifically disclaims any implied guarantee of suitability for any specific purpose. AHIMA has no liability or responsibility to any person or entity with respect to any loss or damage caused by the use of this audio seminar, including but not limited to any loss of revenue, interruption of service, loss of business, or indirect damages resulting from the use of this program. AHIMA makes no guarantee that the use of this program will prevent differences of opinion or disputes with Medicare or other third party payers as to the amount that will be paid to providers of service.

CPT® five digit codes, nomenclature, and other data are copyright 2009 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT®. The AMA assumes no liability for the data contained herein.

As a provider of continuing education the American Health Information Management Association (AHIMA) must assure balance, independence, objectivity and scientific rigor in all of its endeavors. AHIMA is solely responsible for control of program objectives and content and the selection of presenters. All speakers and planning committee members are expected to disclose to the audience: (1) any significant financial interest or other relationships with the manufacturer(s) or provider(s) of any commercial product(s) or services(s) discussed in an educational presentation; (2) any significant financial interest or other relationship with any companies providing commercial support for the activity; and (3) if the presentation will include discussion of investigational or unlabeled uses of a product. The intent of this requirement is not to prevent a speaker with commercial affiliations from presenting, but rather to provide the participants with information from which they may make their own judgments.

The faculty has reported no vested interests or disclosures regarding this presentation.

Faculty

AHIMA 2009 HIM Webinar Series ii

Caroline Piselli, RN, MBA, FACHE

Caroline Piselli, RN, MBA, FACHE, is pay for performance and ICD-10 program manager for 3M Health Information Systems in Wallingford, CT. Prior to joining 3M, Ms. Piselli served in management positions in several healthcare organizations. She is also a certified Six Sigma Black Belt, a Fellow with the American College of Healthcare Executives, and is on the board of directors of its Connecticut state chapter.

Allison Viola, MBA, RHIA

Allison Viola, MBA, RHIA, is director of federal relations for AHIMA’s Washington, DC office, where she educates and works with federal officers and staff on HIM-related issues in order to further AHIMA’s public policy positions, mission, and goals. Prior to joining AHIMA, Ms. Viola served as an associate with a consulting firm, leading health IT projects for clients such as the Veterans Health Affairs and the Department of Defense Military Health System.

Table of Contents

AHIMA 2009 HIM Webinar Series

Disclaimer ..................................................................................................................... i Faculty ......................................................................................................................... ii Polling Question #1 ........................................................................................................ 1 Global Use of ICD-10 (WHO version) ............................................................................... 1 What If We Were Mandated to Speak Greek on One Day? ................................................. 2 Agenda ........................................................................................................................ 2 ICD-10-CM/PCS Final Rule Issues .................................................................................... 3 The Transition from ICD-9 to ICD-10 ............................................................................... 3 ICD-10-CM Diagnoses – Structure Overview ..................................................................... 4 Specificity Looks Like This in ICD-10-CM .......................................................................... 4 ICD-10-PCS – Structure Overview .................................................................................... 5 Each Code Tells a Story .................................................................................................. 5 Start Now! ..................................................................................................................... 6 ICD-10-CM/PCS Implementation: Critical Success Factors .................................................. 6 Polling Question #2 ........................................................................................................ 7 ICD-10-CM/PCS Provider Integrated Implementation Team ................................................ 7 Key 1st Step: Risk/Opportunity Assessment ....................................................................... 8 AHIMA Team Summary: ICD-10-CM/PCS Organizational Transition Planning ....................... 8 Snapshot of Transition Planning Framework ..................................................................... 9 Risk/Opportunity Tool ..................................................................................................... 9 People ....................................................................................................................... 10 Process ....................................................................................................................... 10 Technology ................................................................................................................... 11 Key Words of Wisdom ................................................................................................... 11 Risk/Opportunity Assessment ‘Simulation’ Guidelines (For Your Implementation) ................ 12 Health Care: Provider/Payer Enterprise ........................................................................... 12 Strategic Plans: Provider/Payer ...................................................................................... 13 ICD-10 Implementation Strategic Decision Tree (Example) ............................................... 13 Risk Opportunity Assessment Process ........................................................................ 14-17 Polling Question #3 ....................................................................................................... 17 Next Steps – Get Started and Realize Results .................................................................. 18 ICD-10 Implementation Summary ................................................................................... 18 Discussion and Recommendations .................................................................................. 19 Audience Questions ....................................................................................................... 19 Audio Seminar Discussion .............................................................................................. 20 Become an AHIMA Member Today ! ................................................................................ 20 Audio Seminar Information Online .................................................................................. 21 Upcoming Audio Seminars ............................................................................................ 21 AHIMA Distance Education online courses ....................................................................... 22 Thank You/Evaluation Form and CE Certificate (Web Address) .......................................... 22

(CONTINUED)

Table of Contents

AHIMA 2009 HIM Webinar Series

Appendix .................................................................................................................. 23 Resource/Reference List ....................................................................................... 24 CE Certificate Instructions


AHIMA 2009 HIM Webinar Series 1

Notes/Comments/Questions

Polling Question #1

What functional area do you represent?a) Health Information Management b) Clinicalc) Clinical Qualityd) Financee) Information Systemsf) Strategyg) Operationsh) C-suitei) Other

1

Poland

Global Use of ICD-10 (WHO version)

Thailand

United States

Iceland

Denmark

Brazil

New Zealand

Argentina

Austria

Norway

Australia

Finland

Singapore

Canada

Sweden

China

Japan

Venezuela

Germany

SwitzerlandItaly

SpainPortugal

Colombia

Belgium

UKIreland

Czech RepublicThe Netherlands

France

Costa Rica

2013

2




What If We Were Mandated to Speak Greek on One Day?

How might you apply a dictionary or mapped document for every spoken word?• Conversations, Documents, Email, Complete

tasks

How does this concept apply to ICD-10?

I-9

I-10

I-10

I-10

I-10

I-10

3

Agenda

ICD Situational AnalysisKey Critical Success FactorsRisk/Opportunity AssessmentTool SimulationDiscussion and Recommendations

4




ICD-10 CM/PCS Final Rule Issues

Implementation date October 1, 2013• Single date for all users

• Date of service for ambulatory & physician reporting

• Date of discharge for inpatient settings• ICD-9-CM codes will not be accepted for

services provided on or after October 1, 2013

• ICD-9-CM claims for services prior to implementation date will continue to flow through systems for a period of time

Source: CMS Final Rule and 3M HIS ICD-10 Awareness Hour- March 2009 5

The Transition from ICD-9 to ICD-10

ICD-10 is the language of healthcare• ICD-10-CM: Diagnosis coding- Used for in and outpatient• ICD-10-PCS: Procedure coding- Used for inpatient only

• CPT codes will continue to be used for Outpatient Procedure Coding

All healthcare providers will transition from ICD-9 to ICD-10 on October 1, 2013

ICD-9 to ICD-10 Code Transition

13,0004,000

68,000

87,000

0

20,000

40,000

60,000

80,000

100,000

Diagnosis Codes Procedure Codes

Comparison of ICD-9 and ICD-10 Codes

# Co

des

ICD-9(thru 9/30/13)

ICD-10(after 10/1/13)

Characters from 3-5 Alphanumeric to 3-7

Characters from 3-4 Numeric to 7 Alphanumeric

Note:

• With ICD-10’s increased detail and alphanumeric characters the width of the codes have increased

•In contrast- Y2K simply impacted 1 character

6




ICD-10-CM Diagnoses –Structure Overview

ICD-10-CM has 3 – 7 digitsDigit 1 is alpha (A – Z, not case sensitive)Digit 2 is numericDigits 3 – 7 are alpha (not case sensitive) or numeric• A66 Yaws• A69.20 Lyme disease, unspecified• O9 .311 Physical abuse complicating pregnancy,

first trimester• S42.001A Fracture of unspecified part of right

clavicle, initial encounter for closed fractureX– ask about filler digit

7

Specificity Looks Like This in ICD-10-CM…

ICD-10-CMK35.0 Acute appendicitis with generalized peritonitisK35.1 Acute appendicitis with peritoneal abscessK35.9 Acute appendicitis, unspecified

M84.362A Stress fracture, left tibia, initial encounter for fracture

M84.362D Stress fracture, left tibia, subsequent encounter for fracture with routine healing

M84.362G Stress fracture, left tibia, subsequent encounter for fracture with delayed healing

8




ICD-10-PCS – Structure Overview

A character is a stable, standardized code component• Holds a fixed place in the code• Retains its meaning across a range of codes

A value is an individual unit defined for each character

Section Body Root Body Approach Device QualifierSystem Operation Part

9

0 D B 6 8 Z X

Med/Surg

Gastrointestinal

Excision

Stomach

TransorificeIntraluminalEndoscopic

None

Diagnostic

Each Code Tells a Story

SectionBody

SystemRoot

OperationBodyPart Approach Device Qualifier

10




Start Now!

Will you be ready?• Payer, Provider, Vendor?

“Take advantage of lead time!”Canadian and Australian Colleagues

“I wish I had taken the transition more seriously. In retrospect, I could have positively impacted

my organization if we had paid attention to ICD-10 opportunities rather than be consumed with

day-to-day operations.”Coding Services Manager

Canadian hospital

Source: 3M HIS ICD-10 Voice of Customer Research 11

ICD-10-CM/PCS Implementation: Critical Success Factors

Be ready by October 1, 2013• Strategic imperatives continue to be met

• e.g. Financials, Quality, Access

• ALL systems/ functions that currently have ICD-9 codes ready for ICD-10• Native or mapped

• Provider, Physician, Payer, Vendor integration across systems

• Contracting in place

12




Polling Question #2

Has Your Organization initiated ICD-10 Planning?

a) Yesb) Noc) Not Sure

13

ICD-10-CM/PCS Provider Integrated Implementation Team

InformationTechnology

Clinical Services Patients/Families Executives

HIM/CodersPatient FinancialServices/Finance

PayerIntegration

VendorIntegration

Source: 3M HIS ICD-10 Awareness Hour- March 2009 14




Key 1st Step: Risk/Opportunity Assessment

Defensive: Compliant Position• Perform Impact/ Gap Analysis• Implement minimum necessities

Offensive: Strategic - Optimize Position• Integrate opportunities across enterprise• Embrace the strategic advantage across the

spectrum• Quality Improvement – Accuracy and data

integrity• Provider/Payer integration/contracting -

Detailed information15

AHIMA Team Summary: ICD-10-CM/PCS Organizational Transition Planning

Initiated focus workgroup: “Think Tank” to hear from industry in early 2009• HIT vendors, developer, hospital HIM, physician

informaticist, help desk

What can AHIMA do to assist with the transition?What kind of tools are needed to jump start the process?Developed “Transition Planning Framework”

Think Tank Team Members: Racheal D’Andrea, Gina Sanvik, Karen Hope, Shelley Harward McDonald, Mary Bessinger, Gaylene Gladden, Amy Wang, Kathryn

Perron, Caroline Piselli, Eric Rose, June Bronnert, Rita Scichilone, Allison Viola 16




Snapshot of Transition Planning Framework

Transition planning components• Conduct impact assessment• Conduct risk assessment• Define dependencies• Define stakeholders

PrioritizationAdditional Considerations• Governance management• Communication strategy• Contingency planning• Dual system management

17

Risk/Opportunity Tool

PeopleProcessesTechnology• Tool Objectives• Instructions

18




People

Interdisciplinary Steering Committee• Charge:

• Develop and implement organization-wide cross functional implementation plan

• Critical Success Factors• Executive Leadership (may be appointed)• Stakeholder Champions• Linkage to Strategic Plan

• Perquisite Enablers of Success• Pre-committee- “stakeholder buy in

sessions”19

Process

Initial Process Focus-• Your organization

Evolved Process Focus• Expand to integration across functional areas

related to patient care, quality, operations and revenue

20




Technology

Apply toolset to:• Link strategic objectives to ICD-10 Plan • Provide ability to prioritize according to

key organizational objectives• Focus on priorities and expand to

additional key implementation milestones• Project Plans• Resource Needs/ROI• Tracking• Cross- organization planning

21

Key Words of Wisdom

Focus on Initial Scope:• Develop and Prioritize Plan• Do not Boil the Ocean

Create “idea” list for future attentionGain additional stakeholder support with a well-done prioritized project…then move forward

22




Risk/Opportunity Assessment ‘Simulation’ Guidelines (For Your Implementation)

Let the Simulation Begin:Participant Roles Assigned• Example: Providers, Physicians, Payers, Vendors

• Financial, Clinical, HIM, IT, PFAS, Regulatory, Compliance, Quality

Tool Overview and InstructionTool ApplicationDiscussion• How did it go?

• Positive• Improvement Recommendations

• How might you apply this in your organizationAwards

23

Health CareProvider Enterprise

Strategy, Budget, Planning and Reporting

Health CarePayer Enterprise

Strategy, Budget, Planning and Reporting

I-9/I-10 Translation

IT Integration

Vendor Integration

Critical Success Factors

I-9/I-10 Translation

Critical Success Factors24




Strategic Plans: Provider/PayerICD-10 Opportunities?

Strategic Plans emerge regardless of ICD-10

ICD-10 Strategy ChoicesDefensive ICD-10 Plan-• Compliant transitioning

from I-9 scenarioOffensive- Optimize ICD-10 Plan-• Opportunistic

transitioning to I-10 granularity to enhance strategic goals

How might payers/providers/ vendors integrate/coordinate?

Provider Strategic Plan Payer Strategic Plan

Strategic Goals Strategic Goals

Maximize Revenue Maximize Revenue/ Market Share

Comply w/ Regulatory mandates and P4P Requirements

Effectively and Effectively Manage Claims

Maximize Market Share Regulatory Compliance/ Litigation Prevention

Improve Clinical Quality Outcomes

Maintain Good Provider Relationships

Deliver most efficient/ effective services/ operations across the continuum of care

Monitor Clinical Quality

25

ICD-10 Implementation Strategic Decision Tree (Example)

26




Importance Weight

Strategic Category

ICD-

10-C

M/PC

S Co

mplia

nce

5010

Com

plian

ce

Integ

ratio

n with

othe

r reg

ulator

y co

mplia

nce p

rogr

ams (

RACs

, HAC

s, MA

Cs)

Regu

lator

y Sco

re

Drop

bill a

nd no

chan

ge in

A/R

days

Portf

olio m

anag

emen

t

Paye

r/Pro

vider

integ

ratio

n (Co

ntrac

ts)

Reve

nue C

ycle

Scor

e

IT S

ystem

Integ

ratio

n

Clini

cal in

tegra

tion

Func

tiona

l integ

ratio

n

Paye

r/Pro

vider

integ

ratio

n

Oper

atio

nal S

core

Accu

racy

Quali

ty re

portin

g pro

gram

s

Perfo

rman

ce M

anag

emen

t

Over

all IC

D-10

Prio

rity S

core

Strategy Component: HIM Coding and ReimbursementEncoding software 5 5 4 140 5 3 3 5 5 5 5 5 5 469Case mix systems 3 5 3 4 3 3 4 4 4 4 4 4 384DRG grouper 5 5 3 5 3 3 3 3 3 4 5 5 403Compliance checking systems 5 5 2 4 1 2 2 2 1 1 4 2 273Strategy Component: Revenue Cycle ManagementBilling Systems 5 5 5 4 2 5 2 3 3 4 4 4 401Claim submission systems 2 3 2 2 3 5 3 2 1 3 4 3 281Registration and scheduling systems 1 2 1 3 2 1 3 1 1 3 3 2 193Strategy Component: Clinical SystemsTest ordering systems 4 3 2 4 3 2 5 4 3 1 4 2 317Pharmacy systems 3 4 2 3 4 5 3 5 5 5 5 5 412Registries 2 2 1 4 5 4 1 3 4 5 3 2 306Patient assessment data sets (PAI, OASIS) 1 1 1 1 1 1 1 1 1 1 1 1 103

10 9

Regulatory Revenue CycleOperational Efficiency

Performance Management

8 7ICD-10-CM/PCS - Readiness Assessment and Prioritization

Risk/Opportunity Assessment ProcessNote: Sample Tool – Customize for Your Organization

1. Identify Organizational Strategic Priority Categories

27

Importance Weight

Strategic Category

ICD-

10-C

M/PC

S Co

mplia

nce

5010

Com

plian

ce

Integ

ratio

n with

othe

r reg

ulator

y co

mplia

nce p

rogr

ams (

RACs

, HAC

s, MA

Cs)

Regu

lator

y Sco

re

Drop

bill a

nd no

chan

ge in

A/R

days

Portf

olio m

anag

emen

t

Paye

r/Pro

vider

integ

ratio

n (Co

ntrac

ts)

Reve

nue C

ycle

Scor

e

IT S

ystem

Integ

ratio

n

Clini

cal in

tegra

tion

Func

tiona

l integ

ratio

n

Paye

r/Pro

vider

integ

ratio

n

Oper

atio

nal S

core

Accu

racy

Quali

ty re

portin

g pro

gram

s

Perfo

rman

ce M

anag

emen

t

Over

all IC

D-10

Prio

rity S

core


10 9





2. Identify importance weight of each strategic category Weight Range = 1-10 Do not duplicate

weight number

28




Importance Weight

Strategic Category

ICD-

10-C

M/PC

S Co

mplia

nce

5010

Com

plian

ce

Integ

ratio

n with

othe

r reg

ulator

y co

mplia

nce p

rogr

ams (

RACs

, HAC

s, MA

Cs)

Regu

lator

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re

Drop

bill a

nd no

chan

ge in

A/R

days

Portf

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anag

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t

Paye

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integ

ratio

n (Co

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ts)

Reve

nue C

ycle

Scor

e

IT S

ystem

Integ

ratio

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Clini

cal in

tegra

tion

Func

tiona

l integ

ratio

n

Paye

r/Pro

vider

integ

ratio

n

Oper

atio

nal S

core

Accu

racy

Quali

ty re

portin

g pro

gram

s

Perfo

rman

ce M

anag

emen

t

Over

all IC

D-10

Prio

rity S

core


10 9





3. Identify critical success objectives of each category

29

Importance Weight

Strategic Category

ICD-

10-C

M/PC

S Co

mplia

nce

5010

Com

plian

ce

Integ

ratio

n with

othe

r reg

ulator

y co

mplia

nce p

rogr

ams (

RACs

, HAC

s, MA

Cs)

Regu

lator

y Sco

re

Drop

bill a

nd no

chan

ge in

A/R

days

Portf

olio m

anag

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t

Paye

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ratio

n (Co

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ts)

Reve

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ycle

Scor

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IT S

ystem

Integ

ratio

n

Clini

cal in

tegra

tion

Func

tiona

l integ

ratio

n

Paye

r/Pro

vider

integ

ratio

n

Oper

atio

nal S

core

Accu

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Quali

ty re

portin

g pro

gram

s

Perfo

rman

ce M

anag

emen

t

Over

all IC

D-10

Prio

rity S

core


10 9





4. Populate with ICD-10 Action Plan Milestones

30




Importance Weight

Strategic Category

ICD-

10-C

M/PC

S Co

mplia

nce

5010

Com

plian

ce

Integ

ratio

n with

othe

r reg

ulator

y co

mplia

nce p

rogr

ams (

RACs

, HAC

s, MA

Cs)

Regu

lator

y Sco

re

Drop

bill a

nd no

chan

ge in

A/R

days

Portf

olio m

anag

emen

t

Paye

r/Pro

vider

integ

ratio

n (Co

ntrac

ts)

Reve

nue C

ycle

Scor

e

IT S

ystem

Integ

ratio

n

Clini

cal in

tegra

tion

Func

tiona

l integ

ratio

n

Paye

r/Pro

vider

integ

ratio

n

Oper

atio

nal S

core

Accu

racy

Quali

ty re

portin

g pro

gram

s

Perfo

rman

ce M

anag

emen

t

Over

all IC

D-10

Prio

rity S

core


10 9





5. Prioritize Milestones according to strategic

priorities

Key Relation to Strategic Category

5‐ Highest Priority Direct

4‐ High Priority Indirect

3‐ Medium Priority Somewhat

2‐ Medium Priority Minimally1‐ Low Priority Not

31

Importance Weight

Strategic Category

ICD-

10-C

M/PC

S Co

mplia

nce

5010

Com

plian

ce

Integ

ratio

n with

othe

r reg

ulator

y co

mplia

nce p

rogr

ams (

RACs

, HAC

s, MA

Cs)

Regu

lator

y Sco

re

Drop

bill a

nd no

chan

ge in

A/R

days

Portf

olio m

anag

emen

t

Paye

r/Pro

vider

integ

ratio

n (Co

ntrac

ts)

Reve

nue C

ycle

Scor

e

IT S

ystem

Integ

ratio

n

Clini

cal in

tegra

tion

Func

tiona

l integ

ratio

n

Paye

r/Pro

vider

integ

ratio

n

Oper

atio

nal S

core

Accu

racy

Quali

ty re

portin

g pro

gram

s

Perfo

rman

ce M

anag

emen

t

Over

all IC

D-10

Prio

rity S

core

Strategy Component: HIM Coding and ReimbursementEncoding software 5 5 4 140 5 3 3 99 5 5 5 5 120 5 5 70 469Case mix systems 3 5 3 110 4 3 3 90 4 4 4 4 96 4 4 56 384DRG grouper 5 5 3 130 5 3 3 99 3 3 3 4 80 5 5 70 403Compliance checking systems 5 5 2 120 4 1 2 63 2 2 1 1 32 4 2 42 273Strategy Component: Revenue Cycle ManagementBilling Systems 5 5 5 150 4 2 5 99 2 3 3 4 80 4 4 56 401Claim submission systems 2 3 2 70 2 3 5 90 3 2 1 3 48 4 3 49 281Registration and scheduling systems 1 2 1 40 3 2 1 54 3 1 1 3 40 3 2 35 193Strategy Component: Clinical SystemsTest ordering systems 4 3 2 90 4 3 2 81 5 4 3 1 64 4 2 42 317Pharmacy systems 3 4 2 90 3 4 5 108 3 5 5 5 120 5 5 70 412Registries 2 2 1 50 4 5 4 117 1 3 4 5 96 3 2 35 306Patient assessment data sets (PAI, OASIS) 1 1 1 30 1 1 1 27 1 1 1 1 24 1 1 14 103

10 9





6. Review/ discuss priorities and

communicate to organization executives

32





Create a One Page Dashboard for Key Stakeholder:• Examples:

• All Executives- Overall Summary with Sub-summaries by key areas

• Revenue Cycle- Sort by this key category to enable specific discussions

33

Polling Question #3

Do you think a tool like this could assist in prioritizing your organization’s ICD-10 Planning when the timing is right?

a) Yesb) Noc) Not Sure

34




Next Steps –Getting Started…and Realize Results

Communicate opportunity to key executives and stakeholdersProvide knowledge transfer re: opportunityObtain executive decision re: organizational priorities/strategic objectivesPrioritize data/functional translations accordingly with interdisciplinary teamInitiate processImplement PlanRealize Results!

35

ICD-10 Implementation Summary

Goal Timing1. Provide Organization Education/Awareness NOW!2. Appoint Interdisciplinary Steering Committee

3. Develop ICD-10 Strategy and Plan

4. Determine Functional Area Opportunities and Gap

5. Initiate Interdisciplinary Project Management

6. Partner with Vendors and stakeholders

7. Ensure Payer Implementation Plan in Place

8. Provide Detailed Training According to Program Plan

9. Simulate and Manage Change

10. Successful Implementation!36




Discussion & Recommendations

Debrief• Positive• Recommendations

How might you use this approach in your organization?References:• AHIMA http://www.ahima.org/ICD10/• 3M HIS ICD-10

http://solutions.3m.com/wps/portal/3M/en_US/3M_Health_Information_Systems/HIS/Resources/ICD-10/

• CMS Educational resources http://www.cms.hhs.gov/ICD10/05_Educational_Resources.asp#TopOfPage

37

Audience Questions




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Appendix


Resource/Reference List ....................................................................................... 24 CE Certificate Instructions

Appendix


Resource/Reference List http://www.ahima.org/ICD10/

http://solutions.3m.com/wps/portal/3M/en_US/3M_Health_Information_Systems/HIS/Resources/ICD-10/

http://www.cms.hhs.gov/ICD10/05_Educational_Resources.asp#TopOfPage

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