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Introduction to ICD-10 Kyle Miller, Todd Couts CMS ICD-10 PMO February, 2011

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Introduction to ICD-10 Kyle Miller, Todd Couts CMS ICD-10 PMO February, 2011 Slide 2 2 Agenda Overview of ICD-10 CMS ICD-10 Program and Activities to Date Impact on ESRD at CMS Additional Resources Slide 3 The ICD-10 Regulation Adopts ICD-10 code sets under HIPAA ICD-10 Clinical Modification (CM) ICD-10 Procedure Coding System (PCS) Diagnosis ICD-10 CM replaces ICD-9 CM diagnosis codes in all settings Procedures ICD-10 PCS replaces ICD-9 CM procedure codes for hospital inpatient procedures HCPCS and CPT-4 codes remain the official procedural coding systems for outpatient reporting Applies to all HIPAA Covered Entities and electronic interactions between those entities 3 Slide 4 Diagnosis and Procedure Codes Single implementation date of October 1, 2013 for all users Date of service for ambulatory and physician reporting Ambulatory services provided on or after 10-1-2013 will use ICD-10-CM diagnosis codes Date of discharge for inpatient settings Inpatient discharges occurring on or after 10-1-2013 will use ICD-10-CM and ICD-10-PCS codes No delays No grace period 4 ICD-9 Volumes 1 and 2 Diagnosis Codes ICD-9 Volume 3 Procedure codes ICD-10 Clinical Modification (CM) DIAGNOSIS CODES ICD-10 Procedure Coding System (PCS) INPATIENT PROCEDURE CODES All Settings Inpatient Slide 5 Why ICD-10 Now? ICD-9-CM code set is outdated 30 years old ICD-9-CM codes cannot reflect current medical technologies Many code chapters are full, resulting in code placement in non- related chapters Current codes are often not descriptive enough The rest of the world is already on ICD-10 ICD-10-CM and ICD-10-PCS provides these improvements More codes, greater specificity Greater flexibility to add new codes Reflects current use of medical technology 5 Slide 6 ICD-10 Advantages for Physicians Ability to report (inpatient) procedures exactly as performed (OP still CPT) Ability to describe complex and atypical patients Less staff time (less expensive) claims coding due to decreased ambiguity and better organization Better ability of payer to match payment to work involved 6 Slide 7 ICD-10 is Different than Other HIPAA Implementations Original HIPAA Implementation Code set standards were already de facto standards ICD-9, CPT, HCPCS Significant front-end translation to insulate systems from changes Heavy IT focus ICD-10 Implementation Much more expansive than maintenance updates to ICD-9 codes First mandated industry wide implementation of a new medical code set Reach extends into policies, business processes, and systems Requires broad business and systems focus 7 Slide 8 ICD-10 is No Worse Than Other HIPAA Implementations for Most Providers Software must be updated and Staff must be trained but Physicians only use a small section of codes regularly and Diagnoses and procedures are all the same, just with clearer distinctions 8 Slide 9 Changes in ICD-10 Structural Changes Expanded field lengths (diagnosis and procedure codes) Different field formats (procedure codes) Clinical Content Differences New taxonomy for documenting Diseases, injuries, impairments, cause of injury (diagnosis codes) Specific procedures done to a patient (procedure codes) ICD-10 provides greater detail in describing diagnoses and procedures There are many more ICD-10 codes than ICD-9-CM codes 9 Slide 10 Diagnosis Code Changes 10 Slide 11 Diagnosis Code Example ICD-10 Codes Provide Greater Specificity in Some Cases ICD-9 code - Striking against or struck accidentally in sports without subsequent fall (E917.0) 24 ICD-10-CM Detail Codes 11 Slide 12 Nephrology Diagnosis Codes: Consistent Organization (N00-N08) Glomerular diseases (N00) Acute nephritic syndrome (N01) Rapidly progressive nephritic syndrome (N02) Recurrent and persistent hematuria (N03) Chronic nephritic syndrome (N04) Nephrotic syndrome Lipoid nephrosis (N05) Unspecified nephritic syndrome (N06) Isolated proteinuria with specified morphological lesion (N07) Hereditary nephropathy, not elsewhere classified (N08) Glomerular disorders in diseases classified elsewhere Suffixes:.0 Minor glomerular abnormality.1 Focal and segmental glomerular lesions.2 Diffuse membranous glomerulonephritis.3 Diffuse mesangial proliferative glomerulonephritis.4 Diffuse endocapillary proliferative glomerulonephritis.5 Diffuse mesangiocapillary glomerulonephritis.6 Dense deposit disease.7 Diffuse crescentic glomerulonephritis.8 Other.9 Unspecified 12 Slide 13 Procedure Code Changes 13 Slide 14 Procedure Code Example - 2 ICD-9-CM Codes Replaced by 112 ICD-10-PCS Codes 14 Slide 15 Nephrology Procedure Codes: Better Organization 15 Example: Percutaneous Pyelostomy New 0T9330Z Current Ambiguity 55.03 Percutaneous Nephrostomy OR 55.12 (Unspecified) Pyelostomy 12 3 4 56 Better ability of payer to match payment to work involved Slide 16 ICD-10 and 5010 5010 is short for Version 5010 of the ACS (Accredited Standards Committee) X12 standards for electronic transactions (e.g. claim submission) 5010 is a prerequisite for ICD-10 as 4010/4010A1 transactions cannot carry ICD-10 codes 5010 also enhances diagnosis reporting Separates principal diagnosis, admitting diagnosis, external cause of injury and reason for visit Increases number of ICD occurrences on 837 transactions (electronic claims) 16 Slide 17 Tools and Implementation Strategies Tools/Files General Equivalence Mappings (GEMs) Reference mappings to help navigate between code sets. Bi- directional translation dictionaries (9 > 10 and 10 > 9) All codes in one set that could be used to replace a code in the other Reimbursement Mapping (9 > 10 and 10 > 9) To provide non CMS payers a temporary mechanism for mapping records containing ICD-10 codes to reimbursement equivalent ICD- 9 codes One code that most closely replaces the resources/costs of the other Implementation Strategies Upgrade Update the impacted systems to accept, use, and send ICD-10 codes natively Crosswalk Shield the impacted systems from accepting, using, or sending ICD- 10 codes natively 17 Slide 18 Fundamental Payer ICD-10 Strategy Choices 18 Slide 19 Fundamental Provider ICD-10 Strategy Choices 19 Physician Codes in ICD-9Physician Codes in ICD-10 Office Submits in ICD-10 Staff Translates ICD-9 to 10 ICD-10 Diagnosis Codes ICD-10 Procedure Codes ICD-10 Diagnosis Codes ICD-10 Procedure Codes ICD-10 Diagnosis Codes ICD-10 Procedure Codes ICD-10 Diagnosis Codes ICD-10 Procedure Codes ICD-10 Diagnosis Codes ICD-10 Procedure Codes Use GEMS to find new versions of your most commonly used codes. Adds extra work, increases errors and loses the benefits of ICD-10. All claims MUST be submitted in ICD-10 For DOS after October 1, 2013 UpgradeCrosswalk Slide 20 20 CMS ICD-10 Program and Activities to Date Slide 21 ICD-10 Program History and Current State 21 Slide 22 ICD-10 Program Organization 22 ICD-10 Implementation Projects Slide 23 Project Structure 23 Slide 24 High Level Implementation Timeline 24 Slide 25 Key CMS Activities Created GEMS and Reimbursement Mapping Tools MS-DRG Update and Associated White Paper October 2009 FFS JAD Session Analysis CR Detailed planning conference calls with MACs/Fis/Carriers and Shared System Maintainers Educational materials and calls 25 Slide 26 26 Impact on ESRD at CMS Slide 27 Milestones for ESRD QE-0: Preliminary Analysis QE-1: Policy Decision on How Facilities Will Report Assessment Data for Patients Whose Stay Spans the ICD-10 Implementation Date QE-2: Mapping/Crosswalk Implementation Strategy Approach Defined QE-3: End-to-End Testing Strategies Defined QE-4: CMS Staff and Quality Contractors Educated and Trained QE-5.1: Form 2728 Updated QE-5.2: VISION Updated QE-5.3: REMIS Updated QE-6.1: ESRD Activities End-to-End Testing Level 1 QE-6.2: ESRD Activities End-to-End Testing Level 2 QE-7: Transition and Implement ESRD Activities Systems QE-8: Providers, Contractor Provider Contact Centers, and QIOs Educated on the Increased Granularity and Use of ICD-10 Code Set QE-9: Education and Outreach Provided to External Vendors on ICD-9 to ICD- 10 Translations QE-10: CROWNWeb Updated 27 Slide 28 28 Additional Resources Slide 29 CMS Resources ICD-10 General Information MS-DRG Conversion Report Central Version 5010 and D.0 web page on the CMS website The CMS ICD-10 website provides the latest ICD-10 information and links to resources for providers to prepare for ICD-10 implementation in a 5010 environment. CMS Sponsored Calls web page provides current information on CMS national provider conference calls focused on the implementation of ICD-10 You will find copies of call materials (presentations, written and audio transcripts, etc.). 29 Slide 30 Additional Resources The following organizations offer providers and others ICD-10 resources WEDI (Workgroup for Electronic Data Interchange) HIMSS (Health Information and Management Systems Society) 30

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