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ICD-10 is ComingReady or Not
Dr. Thomas AyoubNorwalk Hospital
10/1/2013
2
Punishment…of doctors…by the government…for purposes of lowering
reimbursements
This is not part of “Obama-care”.
ICD-10 is NOT
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• Derives from the World Health Organization.– CMS is acting on behalf of the US government
• Links to quality of care– Primary purpose is epidemiologic
tracking of illness and injury; worldwide outcomes data is important
• Long overdue – ICD-9 has been in use since 1979 and
medicine has changed
ICD-10
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UK 1995Nordic Countries 1994-7France 1997Australia 1998Belgium 1999Germany 2000Canada 2001United States Oct 1st, 2013
ICD-10 adoption by other Countries
Another delay will not occur
2014
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U.S. will be the only country to use ICD-10 for reimbursement.
ICD-10
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For a typical practice the total cost depends on the size:•Small $83,290•Medium $285,195•Large $2.7 million
The Cost
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Much worse than Y2K; effects include:•Clinical documentation/EHR systems•Encounter forms/Superbills•Practice management systems•Contracts•Public health and quality reporting protocols
IT Issues
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8Other Office Issues
Staffing: ½ of billers are expected to retire or change jobs
Productivity: may drop as much as 50%
Dual systems: required from several months prior to several months after…maybe longer
Delayed Payments: the industry is expecting significant delays
Cash Flow: CMS & Insurers will not accept bills after Oct 1, 2014 in ICD-9 format
• An opportunity to bring physicians together
• I'll be more than happy to assist you in finding the help you need to tackle this project.
What Lies Ahead 9
10/1/2013
• You can use our new website www.norwalkhospital/icd-10 with links to resources (try our QR logo on your invitation)
• You can contact Susan Herson, MD at [email protected]
Resources 10
10/1/2013
How Can Physicians PrepareSusan Herson, MD
HospitalistDocumentation Improvement
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You’ve heard there will be a vast expansion in the number of codes but…
•60% of the new code volume pertains to musculoskeletal system
•New coding system is logical
ICD-10
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13Coding Classifications
The new coding is logical because it relates to treatment decisions.
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14Most Common ICD-9
CMS recommends that offices start by listing their most commonly used ICD-9 codes and becoming familiar with corresponding ICD-10 codes
The best resource is www.CMS.gov/icd10“Understanding the Basics”
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Start with highest volume codes
The vast majority of practices use very few codes…
5% of codes account for 70% of the volume
Majority Rules
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16Example: GI Most Common Codes
ICD-9 Code & Description
# of Encntrs
% of Activity
ICD-10 Code & Description
V76.51 Screen malig neop-colon
4695 41% Z12.11 Encounter for screening for malignant neoplasm of colon
V12.72 Prsnl hst colonic polyps
1214 11% Z86.010 Personal history of colonic polyps
530.81 Esophageal Reflux 670 6% K21.9 Gastro-esophageal reflux disease without esophagitis
569.3 Rectal & Anal Hemorrhage
451 4% K62.5 Hemorrhage of anus and rectum
787.91 Diarrhea 396 3% K52.2 Allergic and dietetic gastroenteritis and colitisK52.89 Other specified non-infective gastroenteritis and colitisR19.7 Diarrhea, unspecified
Top 5 ICD-9 codes cover 64% of the Encounters
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Principal Diagnosis
ICD-9
Screen Malig Neop-Colon V76.51
Prsnl Hst Colonic Polyps V12.72
Esophageal Reflux 530.81
Rectal & Anal Hemorrhage 569.3
Diarrhea 787.91
Top GI Diagnosis in ICD-9
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Use free internet sites like http://www.icd10data.com
or download free apps
Translate ICD-9 to ICD-10
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Start typing the ICD-9 text here
A broad search occurs; all yellow highlights are possible matches.
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Or choose “Convert” to use the code instead of the text
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As you start typing the code here, a list of options appear below
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Principal Diagnosis ICD-10Encounter for Screening for Malignant Neoplasm of the Colon Z12.11
Personal history of Colonic Polyps Z86.010Gastro-Esophageal Reflux Disease without Esophagitis K21.9
Hemorrhage of Anus and Rectum K62.5Allergic and dietetic gastroenteritis and colitis K52.2Other specified non-infective gastroenteritis and colitis K52.89
Diarrhea R19.7
Top GI Diagnosis now in ICD-10
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23What we learned from the conversion process
3 out of 5 codes were direct conversions / perfect matches2 out of 5 codes required more documentation•GERD requires with or without esophagitis
The default will likely be “without”•Diarrhea requires etiology
- due to infectious or non-infectious process- due to diet- due to allergy
We learned not only which diagnoses require more documentation but exactly what type of documentation is required.
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Not all ICD 9 unspecified codes exist in ICD 10e.g. CAD, unspecified the provider must choose native & graft
vessel
Unspecified codes cause shifts in reimbursement
Unspecified codes may not capture relevant data reporting and improved patient care.
Unspecified Codes still exist. However…
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• Document Initial or Follow-up encounter for every visit
• Use adjectives like acute, chronic, or acute on chronic, and mild, moderate, or severe, early onset, diffuse
• Link cause and effect with words like "due to"• Specify anatomic site particularly left, right,
bilateral• Use exact dates of injury or disease onset
General Documentation Improvement Tips
ICD-10 is like learning a new languageit is not intuitive but it is logical
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Specialty Societies for guidance & billing forms
Internet tools and appswww.CMS.gov/icd10
http://www.icd10data.com
Norwalk Hospital: • 3M videos in 18 subspecialties• 1-hour training sessions in April with HC-Pro• Quarterly ICD-10 meetings
Resources
