ICD-10 & DSM-5

Enhancements for TIER Shelly Casale

ICD-10 Mandate

• Effective October 1, 2014 – Industry is moving to

ICD-10 for diagnosis and inpatient procedures • All claims for services rendered prior to October 1, 2014 MUST be

submitted with ICD-9

• All claims for services rendered on or after October 1, 2014 MUST be submitted with ICD-10

• ICD-10-PCS does NOT replace CPT for outpatient or inpatient physician charges – only inpatient procedures impacted

• Applies to any HIPAA covered entity

DSM-5 Facts

• Published in May 2013 – ICD-10 Changes released in Q4 2013 will incorporate changes for DSM-5

• Provides mapping to ICD-9 and ICD-10

– Maps DSM-5 terms to ICD-9 or ICD-10

– Contains no DSM-5 specific codes

• Removes multiaxial diagnosis

– Combines Axis I, II and III and moves to a diagnosis list format

– Environmental factors (Axis IV) documented using ICD-10 Z Codes

– GAF (Axis V) no longer documented with diagnosis • Recommend using WHODAS 2.0 for disability and functioning levels

• Copyrighted material

– Per user/per year cost for access via EHR

TERMS ICD-10

– ICD-10 is the 10th version of the International Statistical Classification of Diseases and

related Health Problems (ICD-10). It is a medical classification list created by the World

Health Organization (WHO). More than 25 countries utilize ICD-10 for coding and

reimbursement. ICD-10 was published in 1992 and the mandate for the United States to

adopt ICD-10 is set for October 1, 2014.

ICD-9

– ICD-9 is the 9th version of the International Statistical Classification of Diseases and was

designed to promote international comparability. ICD-9 will no longer be utilized after

September 30, 2014 and the ICD-10 will be utilized from October 1, 2014 forward.

DSM-IV

– DSM–IV is psychiatric diagnoses categorized by the Diagnostic and Statistical Manual of

Mental Disorders, 4th Edition. The manual is published by the Psychiatric Association. The

DSM uses a muliaxial approach to diagnosing

DSM-5

– The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) was

published on May 10, 2013. DSM-5 is the 2013 update to the American Psychiatric

Association’s (APA) classification and diagnostic tool.

SNOMED

– SNOMED (Systematized Nomenclature of Medicine) is a comprehensive clinical terminology

distributed by the International Health Terminology Standards Development Organisation

(IHTSDO). SNOMED is one of the designated standards for use in U.S. Federal Government

systems for the electronic exchange of clinical health information and is also a required

standard in interoperability specifications of the U.S. Healthcare Information Technology

Standards Panel.

Planned Solution

• Netsmart diagnosis service that is leveraged by

most Netsmart solutions including TIER

– Will access copyrighted vocabulary content hosted by

Netsmart

– Include cross-mapping between ICD-9, ICD-10, DSM-

IV, DSM-5 and SNOMED

– 3rd party to provide content • Provides clinician friendly terms for searching

• Maps to multiple vocabularies: ICD-9, ICD-10, DSM-IV, DSM-5 and SNOMED

• Mappings updated 10x a year

• Priced not to exceed 4% of existing software maintenance

Planned Solution (continued)

• TIER will be updated to include:

– Effective date concept for pulling ICD-10 vs. ICD-9

after cutover

– UI and architecture changes to support new DSM-5

diagnosis format

– Reports to identify open episodes with no ICD-10

code for manual updates

TIER ICD-10 Strategy

Updating Diagnosis Table

• New table structure for recording all diagnosis

– Removes dependency on DSM Axes

– Includes ability to capture recording practitioner for

each diagnosis

– Captures multiple codes: ICD-9, ICD-10, DSM-IV,

DSM-5 (Term) and SNOMED

Hosted Diagnosis Content

• Hosted content managed by Netsmart

– Requires internet connection at desktop

• Provides 1:1 cross-mapping between search results and ICD-9,

ICD-10, DSM-IV, DSM-5 Terms and SNOMED

– Cross-mappings AHIMA reviewed for coding accuracy

• Updated 10x a year

• Users search the terms they’re familiar with and best describes the

client’s condition

• Additional charge – priced not to exceed 4% of annual software

maintenance

• Includes access to DSM copyrighted terms and code mappings

Diagnosis

Diagnosis Entry

Additional forms being updated

• Updates to all electronic claims to

support transition from ICD-9 to

ICD-10

– 837 Institutional

– 837 Professional

• Updates to paper claims to

support transition from ICD-9 to

ICD-10

– UB-04

– HCFA-1500

• Updates to procedure input to

support transition from ICD-9 to

ICD-10

– Does not replace CPT codes -

only applies to inpatient procedure

billing

• Allows clients to input cross

mapped content for simultaneous

capture of both ICD-9 and ICD-10

procedure codes

• Reports

– Reports will be updated to

reference new diagnosis table, no

specific changes outlined for

DSM-5

• Progress Notes

– Reference new diagnosis table

– Include ability to specify diagnosis

Managing ICD-10 Cutover

• Effective Dates

– Setting for Agency or by Payor

– New Form captures both ICD-9 and ICD-10 so the

new diagnosis form can be used before effective date

and will be encouraged to do so – so that diagnosis

data can be updated to new format during normal

client update and review of diagnosis.

Claim Updates

• All electronic claims will be updated to pull

appropriate code based on cutover date

– Outpatient claims – date of service

– Inpatient claims – THROUGH date or Discharge Date

– Also updated to pull ICD-9 or ICD-10 indicator

– If multiple dx codes – will be listed in order of Billing

Order

• Paper Claims will be updated to pull appropriate

diagnosis and indicator

Progress Notes

• Progress Notes

– The standard progress notes will allow configuration

to enable selecting diagnosis on the progress note.

– Allow the End User to set Primary, secondary, tertiary

for specific note and ability to add diagnosis to client

from note

Working Diagnosis Impact

• Allows clients to indicate that diagnosis is

working vs. active

– Working diagnosis will pull into claims as appropriate

• Also allows clients to indicate that diagnosis has

been ruled out

– Will not pull into claims

TIER features for ICD-10

• Diagnosis Configuration

– What terms are displayed by agency or program

• ICD-10, ICD-9, DSM IV, DSM5 or SNOMED

• Diagnosis by Agency /Client or Program /Client

• Diagnosis captured at point of time – Copy

feature and Copy/Edit feature

• Ability to set/add diagnosis on progress note and

modify ranking

• Ability to add Diagnosis to Problem List

ICD-10 and DSM-5 Delivery Timelines for TIER

• The TIER team is preparing for the implementation of ICD-10. The product

team is estimating that the release of the ICD-10 package will be available

March 14th 2014.

• The package will only be available to the clients who have engaged with

Netsmart Consulting to assist with their ICD-10 conversion through the first

half of 2014. This will allow us to ensure that we have the appropriate

support resources available during the early releases of the software.

• The ultimate plan is have this implemented early enough so that end users

can begin using the new structure on the next review of the client’s

diagnosis in order to collect the ICD- 10 code. The new structure will

capture both ICD-9 and ICD-10 so it can be used immediately after

implementation in preparation for the cutover date.

ICD-10 Package

• ICD-10 will be implemented into existing clients

as a package. This involves scripts, forms and

procedures being applied to the client’s

database

• The client will have to upgrade to the new 8.0

EXE.

Getting Started

• Contact your Client Alignment Executive!

Getting Educated

• AHIMA Website (www.ahima.org)

• HIMSS ICD-10 playbook (www.himss.org)

• CMS has many free resources on their website,

including the 2013 draft coding guidelines, code

sets, and general equivalency mapping tables.

(www.cms.gov/Medicare/Coding/ICD10/index.ht

ml?redirect=/icd10)

• The APA page dedicated to DSM-5

(http://www.psychiatry.org/dsm5)