ICD-10

READY OR NOT!

Terrance Govender, MD, MBBCh, C-CDI, CHBC

OBJECTIVES

• History of ICD• Benefits and Goals• Impacts on the Industry• How to prepare•What next?

HISTORY• Core of the healthcare payment system in the

United States.• Current set: ICD-9, been in use since 1980!• Advancement in medicine, but not the code set.• Rely heavily on the codes: Medical record words

never leave the hospital. Only the codes do.• ICD 10 is essentially a new language with which

we are expected to describe and report healthcare encounters.

HISTORY• ICD-10 copyrighted by the WHO (World Health

Organization) They own and publish the classification.

• Global standard for reporting and categorizing diseases, health related conditions and external causes of diseases and injury.

• ICD-10 code set has been modified by many countries to suit their own medical systems.

BACK IN TIME• 1893: The first International list of causes of

death. Bertillon Classification• 1900-1929: France convened the first

international conference for the revision of the Bertillon of International list of causes of death in 1900.

• 1938: First international conference for the revision of the International list of causes of death.

• 1948: International conference for the 6th Revision of the International lists of diseases and causes of death in Paris.

BACK IN TIME• 1955-1983: 3 successive decennial revision

conferences in 55, 65, 75, recognized the increasing use of ICD for the indexing of hospital medical records.

• 1977: ICD 9 was published.• 1980: ICD-9 implemented in the US.• 1983: DRG (Diagnosis Related Groups

implemented in the US)• 1996-2006: ICD-10 implementation begins

outside the US.• 1999: US starts to use ICD-10 for mortality stats.

BACK IN TIME• 2007: IIPS- Changed to a Medicare Severity

DRG system (MS-DRG)

• 2014: ICD-10 will be implemented in the USA.

IMPLEMENTATION OF ICD-10 AROUND THE WORLD

GOALS OF ICD-10 IMPLEMENTATION

• ICD-10 will provide greater detail and a more accurate depiction of patient severity.

• This will enhance the ability to measure quality more information will be provided/captured about the relationship between a providers performance and the patient’s condition.

GOALS OF ICD-10 IMPLEMENTATION

• Provide greater specificity of clinical data.• Obtain relevant robust clinical data that can be

used to make intelligent data driven decisions.• Allow for more accurate payments for new

procedures.• Provide better data for fraud and abuse

monitoring.• Reduce the number of miscoded, rejected and

improper reimbursement claims.

GOALS OF ICD-10 IMPLEMENTATION

• Offer a better understanding of the value of new medical procedures.

• Improve the understanding of healthcare outcomes.

• Provide more ICD codes to address Global Disease Emergencies.

ICD-10 STRUCTURE AND FORMATICD-9- CM Diagnosis Codes

• 3-5 Characters in length.• Approximately 13,500

codes.• Limited space for adding

new codes.• Lacks detail• Lacks laterality • Difficult to analyze data due

to non specific codes. • Does not support

interoperability because not used by other countries.

ICD-10-CM Diagnosis Codes

• 3-7 Characters in length.• Approximately 69,000

codes.• Flexible for adding new

codes.• Very Specific • Has Laterality • Specificity improves coding

accuracy and data analysis. • Supports interoperability

and the exchange of health data between US and others

ICD 10 Overview

Diagnosis Codes Procedure Codes0

10000

20000

30000

40000

50000

60000

70000

80000

90000

ICD 9ICD 10

IMPACT ON THE INDUSTRY

• From hospitals to physician offices, health plans to patients Everyone will be affected.

• Expect changes in documentation, reimbursement, coverage, insurance plans structure, quality measures, audits, etc.

PAYMENTS

• Most info regarding payments will not be released until very close to the implementation.

• Financial Impact really cannot be predicted.• Expect delays in payments, teething phase.• Expect denials and rejections.• Unless there is a drastic culture change in your

providers, revenue will drop significantly.

PROVIDER DOCUMENTATION• SPECIFICITY-SPECIFICITY-SPECIFICITY!!• Not as daunting as it sounds.• Get away with a lot in ICD-9. ICD-10 world:

Poor documentation = rejection of claim.• Not otherwise specified, unless absolutely

correct, will not cut it come 2014.• More queries from coders, increase in

documentation times.• Clinicians need to be onboard early.

IMPLEMENTING ICD-10

• CMS suggests the ffg. Milestones and tasks for the implementation of ICD-10:

1. Planning2. Communication and awareness3. Assessment4. Operational Implementation5. Testing Phase6. Transition

BREAKDOWN• Important: Must get

stakeholders/admin/medical staff involved from the get go!

1. CREATE AWARENESS:» Start today» Designate 1 person to initiate interest in ICD-10» Use CMS, AMA and WHO as valuable resources for

information.» Accountability is important» Frequent meetings and updates

IMPLEMENTATION

2. PLANNING COMMUNICATION:

– Different parts of your organization affected– Make sure ALL are on the same page– Identify critical staff members involved eg. Physician

Champions, CIO etc.– What’s the best means of communication for your

organization or specific groups of individuals

IMPLEMENTATION3. CONDUCT AN IMPACT ANALYSIS:

» Take a look at your systems and how they will be impacted by the transition

» Includes things like work flow, operational systems and business processes.

» Eg. Revenue cycle alone:• Charge Capture• Coding and Documentation• Utilization Management• Managed Care Contracts• Billing• Collections

IMPLEMENTATION

4. DOCUMENTATION:

» 3M suggests that this will be the largest impact area of the implementation.

» Assess current documentation» Does it meet current ICD-9 requirements?» Perform an audit- can be done in house.» Start training with clinicians early.» Instill good habits.

IMPLEMENTATION

5. CHECK YOUR VENDORS:

» Does your current system accommodate changes to ICD-10

» Modifications to 4010 transition to 5010 billing form.» What changes and updates will need to be made and how

much will this cost me?» Have one individual in charge of dealing with vendors and

request frequent updates.» Do this with ALL vendors, document and file the

response.

IMPLEMENTATION

• 6. FINANCIAL EFFECTS:» Creating a steering committee possible incentives

necessary for certain key members.» Upgrade to systems» Implementation of new systems» Awareness and training of staff» Anticipated delays in claims processing.» Possible rejections/denials of claims.» Decrease in coder productivity.» Reimbursement implication.» How long can you survive if claims are delayed for a

prolonged period of time (physician practices)

WHAT NEXT?

• START NOW!• Establish awareness among your

administration and clinical leadership.• Identify those key players: 1 coordination

player.• Budget accordingly• Good luck!

QUESTIONS