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Preparing for ICD-10: Stay the Course
November 9, 2012
Is this your transition strategy for ICD -10?
Or maybe you’ve been a little busy!
EOT’s
Learn key advantages to ICD-10 over ICD-9
Understand the basic differences in format and structure between ICD-9 CM and ICD-10 CM
Develop strategies to transition to ICD 10 in facilities
Objectives
CMS delayed implementation
by 1 year
to October 1, 2014
AMA Strongly opposed 2013 date
AHIMA Strongly encouraged 2013 date
Current Status
International Classification of Diseases
Diagnosis and procedure code sets
Morbidity classification for diagnoses and reason for visits in all health care settings
Mortality classifications for death certificates
ICD-10 is…
Who is involved?
All health care providers who conduct
electronic transactions
Vendors and business associates (not
under HIPAA) who use ICD-9 codes
Worker’s Comp programs
Life insurance companies
Anyone covered by HIPAA
Replacement of ICD-9-CM is long overdue.
ICD-9-CM developed in the 1970s and no longer represents 21st century medical knowledge and practice.
Continued use of the outdated and broken ICD-9-CM system will have impact on the value of healthcare data including the accuracy of decisions based on faulty or imprecise data.
Continued use only hinders US efforts to gather clinically relevant and internationally comparable data
AHIMA Position of ICD-10
Clear and complete descriptions of diseases that reflect
modern-day medical knowledge
Precise descriptions of procedures performed in hospitals
Greater detail and specificity to prevent coding errors,
improve patient safety, and decrease opportunities to
commit fraud
Descriptive detail to support and enable electronic quality
measurement of healthcare
AHIMA believes that a transition to ICD-10 will bring
significant benefits to U.S. healthcare providers and
their patients through:
Permits the international exchange of data for disease
prevention and advanced healthcare research;
Enhances the benefits of implementing EHRs and allows
health data analysis to assist providers and consumers to make
crucial healthcare decisions through data aggregations and
analysis; and
Increases value of current clinical terminologies and
permits greater use of health information technology to
improve our health knowledge and decision support while
lowering the cost of healthcare
ICD-10 Classification System & HIT
U.S. is lagging behind other countries already using ICD-10 codes
ICD-10 issued in 1998 by the World Health
Organization and is the standard for > 150
industrialized countries
It is now the standard for: – Mortality and morbidity reporting
– Reimbursement systems
– Automated decision support
Structure and Format
ICD 9 vs.10
Two Segments of ICD- 10
#1
ICD-10 CM (Clinical modifications)
• Replaces ICD-9 CM
• Updated medical terminology and classification
of diseases
• Newly organized-more detail, increased clinical accuracy
#2 ICD-10 PCS
(Inpatient procedure coding for hospital setting)
Understand Basic Differences
ICD-9 CM
3-5 digits
First digit is alpha or numeric
Digits 2-5 are numeric
Decimal after third character
ICD-10 CM
3-7 Digits
First digit is alpha
2nd and 3rd digits are numeric
Digits 4-7 alpha or
numeric (non case sensitive)
Decimal after third character
Understand Basic Differences
ICD-10 CM
ICD 9 versus ICD 10 Understand Basic Differences
ICD-9 Versus ICD-10
ICD-9
• 496- Chronic airway obstruction, NEC
• 511.9 – Unspecified pleural effusion
• V02.61 Hepatitis B carrier
ICD-10
• J44.9 Chronic obstructive pulmonary disease
• J91.8 Pleural effusion in other conditions classified elsewhere
• Z22.51 Carrier of viral hepatitis B
Alphabetic Index - Alphabetical list of terms
and their corresponding code
Index of Diseases and Injury
Index of External Causes of Injury
Table of Neoplasms
Table of Drugs and Chemicals
Tabular List - Chronological list of codes divided into
chapters based on body system or condition
Categories – Subcategories - Codes
ICD-10 Format
New Features
Laterality (Left, right, bilateral)
Character “x” – 5th digit placeholder for
future expansion
Combination codes for certain conditions
and common associated symptoms
– E11.341 – Type 2 Diabetes w/severe
proliferative diabetic retinopathy with macular
edema
Injuries are grouped by anatomical site
rather than by type of injury
Category restructuring and code
reorganization have occurred in a
number of ICD-10-CM chapters
The codes corresponding to ICD-9-CM
V and E codes are now incorporated into
main classification
New Features
Important!
Diagnosis codes are to be used
and reported at their highest
number of characters available.
How is ICD-10
related to 5010?
New standards for electronic health care
transactions
Replaces Version 4010/4010A1
Accommodates ICD-10 Code Sets
5010 must be in place prior to ICD 10 transition
Consequences
January 1, 2012 90-day grace period +
another 90-day grace
period = July 1, 2012
If providers do not conduct
electronic health transactions
using Version 5010 delays in
claim reimbursement may result.
Official Implementation Date
ICD-10 codes must be used on all HIPAA
transactions, including outpatient claims
with dates of service, and inpatient claims
with dates of discharge on and after
October 1, 2013 2014
Mapping Examples
ICD 9 ICD 10
Chronic Gout due to renal impairment, left shoulder, without tophus
One to One Mapping
GEMS
Consistency in Coding
Tool to assist with code conversion
Annual updates along with code updates
National Version
General Equivalency Mapping (GEMS)
Where do we start?
Project Management
Suggested Implementation Preparation Checklist
• Phase 1 – Impact assessment/ Self Evaluation
• Phase 2 – Preparing for implementation
• Phase 3 – Go live preparation
• Phase 4 - Post-implementation
AHIMA 2009
Facility Self Evaluation Phase 1
Who touches ICD coding in our facility?
What changes are needed in business operations and workflows? Pre-admission process? Documentation requirements?
What is the skill level of the medical records staff?
Facility Self Evaluation Phase 1
What other staff members need training? What type?
Have you completed 5010 testing?
What manuals/forms need reprinting?
Budgeting for new resources, training in place?
Important!
• Facility processes that use the ICD-9 currently
will NOT change with the transition to ICD 10.
Only the coding changes.
• Continued adherence to the official coding
guidelines in all healthcare settings is required
under the Health Insurance Portability and
Accountability Act.
Your
Strategy
Develop written action plan/ longitudinal timeline ( i.e Gantt Chart)
Schedule Educational Programs- timing of training
Contact all software vendors- vendor readiness
Strategies for Implementation Phase 2
Meet with medical director and physician groups
Meet with local hospital medical records dept, discharge planners
Strategies for Implementation Phase 2
Final run through of action plan
Assess readiness of each department
Practice, practice, practice
TEST, TEST, TEST
Strategies for Implementation Phase 3
Self audits
Evaluate the plan- Lessons learned
Ongoing evaluation
Strategies for Implementation Phase 4
Celebrate Team Success!
Take a much needed vacation!
CMS ICD-10 site
http://www.cms.gov/Medicare/Coding/ICD10/index.htm
l?redirect=/ICD10/
Center for Disease Control
http://www.cdc.gov/nchs/icd/icd10cm.htm
Professional Associations
http://www.aapc.com/icd-10/codes/
http://www.ahima.org/icd10/
http://www.himss.org/ASP/topics_icd10playbook.asp
AHIMA Primer
http://library.ahima.org/xpedio/groups/public/docu
ments/ahima/bok1_038084.hcsp?dDocName=bo
k1_038084
Misc.
http://www.contexomedia.com/icd-10/
http://www.medilexicon.com/
CDC Website
Questions?
Maria Arellano MS, RN