Provider Education

Cathy Munn MPH RHIA CPHQSr. Consultant

Basic ICD-10 Overview

• Status of ICD-10 Transition– Who, What, Where, When & Why– Industry Update

• Impact of the Change– Providers– Payers– Translation Examples

• Arkansas DMS Remediation Update• Next Steps & Resources

Agenda

• ICD-10-CM (diagnoses) will be used by all providers in every health care setting

• ICD-10-PCS (procedures) will be used only for hospital claims for inpatient hospital procedures

• No impact on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes

• CPT and HCPCS will continue to be used for physician and ambulatory services including physician inpatient hospital visits

Who: The Healthcare Industry

• ICD-9-CM: International Classification of Diseases, 9th revision, Clinical Modification

– US transitioned from ICD-8 to ICD-9 in 1979– Annual updates

• ICD-10: Developed by the World Health Organization as the nomenclature for all countries

– ICD-10-CM: International Classification of Diseases, 10th revision, Clinical Modification – US only

– ICD-10-PCS: International Classification of Diseases, 10th revision, Procedure Classification System – US only

What: ICD-10 CM/PCS

• Final Rule Originally Published by HHS on January 16, 2009 requiring the adoption of ICD-10 on October 1, 2013

– Dates of Service (outpatient) After 10/1/2013– Dates of Discharge (Inpatient) After 10/1/2013

• House Bill 4302 passed on March 31, 2014 delays the implementation of ICD-10 until “no earlier than October 2015”

• This is a Federal Mandate

When: October 1, 20XX

• Systems will have to utilize both ICD-9-CM and ICD-10-CM for overlap e.g. claims backlog, Arkansas Medicaid allows providers 365 days to submit a claim.

• Inpatient discharges occurring on or after 10-1-20XX will use ICD-10-CM and ICD-10-PCS codes regardless of date of admission.

• Outpatient dates of service occurring on or after 10-1-20XX will use ICD-10-CM codes

• There will be period of time when payers will be processing claims in both ICD-9 and ICD-10

Where: Inpatient vs Outpatient

• Better data will be available for:– Measuring the quality, safety and efficacy of care– Designing payment systems and processing claims for

reimbursement– Conducting research, epidemiological studies and clinical

trials– Setting health policy– Operational and strategic planning and designing healthcare

delivery systems– Monitoring resource utilization– Improving clinical, financial and administrative performance – Preventing and detecting healthcare fraud and abuse– Tracking public health and risk

Why: Data Benefits of ICD-10

ICD-10: Key to the success of

each initiative

ACOs/ Patient Centered Medical

Home

EHR/ Meaningful

Use

Value Based Purchasing

Reimbursement changes

Public Reporting & Quality Measures

Health Insurance Exchanges

Other Competing Priorities

Alpha Character Narrative Description

A and B Certain infectious and parasitic diseases.

C00 to D48 Neoplasms.

D50 to D89 Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism.

E Endocrine, nutritional and metabolic diseases.

F Mental and behavioral disorders.

G Diseases of the nervous system.

H00 to H59 Diseases of the eye and adnexa.

H60 to H95 Diseases of the ear and mastoid process.

ICD-10 Chapter Headings

ICD-9 Diagnosis Codes – 13,000 ICD-10 Diagnosis Codes – 69,000

3-5 Characters 3-7 Characters

First character is numeric or alpha (E or V)

First character is alpha

Use of decimal after 3rd character Use of decimal after 3rd character

Characters 2-7 are alpha or numeric – letter U is not used

Use of dummy placeholder “X” for future code expansion

ICD-9 vs. ICD-10 Diagnosis Codes

ICD-9 - E codes reference External Causes of Injury & PoisoningICD-10 - E references the Endocrine System

ICD- 9 - V codes reference Health Status & Contact with Health ServicesICD-10 - V – Y codes reference External Causes of Morbidity

Diagnosis ICD-9 Codes ICD-10 Codes

Fractures 747 17,099

Obstetrics 1,104 2,155

Poisoning 244 4,662

Diabetes 69 239

Migraine Headache 40 44

Impact of ICD-10

ICD-9 Procedure Codes – 4,000 ICD-10 Procedure Codes – 72,000

3-4 Digits 7 Digits

All digits are numeric Alpha or numeric composition• Numbers 0 - 9 • Letters O & I are omitted

Example: Artery suture has 1 code in ICD-9

Example: Artery suture has 195 coding options in ICD-10

Example: Fractured femur has 16 codes in ICD-9

Example: Fractured femur has 1530 coding options in ICD-10

ICD-9 Procedure vs. ICD-10-PCS

The increase in the number of procedure codes is driven by the increased specificity, granularity & laterality contained within the ICD-10 codes. There are also 7th digit designations (A or D) which identify initial or subsequent encounter for care.

• Asthma

Code Translations

ICD-9 Code Description ICD-10 Code Description

493.00Extrinsic asthma, unspecified J45.20

Mild intermittent asthma, uncomplicated

493.00Extrinsic asthma, unspecified J45.30

Mild persistent asthma, uncomplicated

493.00Extrinsic asthma, unspecified J45.40

Moderate persistent asthma, uncomplicated

493.00Extrinsic asthma, unspecified J45.50

Severe persistent asthma, uncomplicated

493.01Extrinsic asthma with status asthmaticus J45.22

Mild intermittent asthma with status asthmaticus

493.01Extrinsic asthma with status asthmaticus J45.32

Mild persistent asthma with status asthmaticus

493.01Extrinsic asthma with status asthmaticus J45.42

Moderate persistent asthma with status asthmaticus

493.01Extrinsic asthma with status asthmaticus J45.52

Severe persistent asthma with status asthmaticus

• Otitis Media

Code Translations

ICD-9 Code Description ICD-10 Code Description

382.00

Acute suppurative otitis media without spontaneous rupture of eardrum H66.001

Acute suppurative otitis media without spontaneous rupture of ear drum, right ear

382.00

Acute suppurative otitis media without spontaneous rupture of eardrum H66.002

Acute suppurative otitis media without spontaneous rupture of ear drum, left ear

382.00

Acute suppurative otitis media without spontaneous rupture of eardrum H66.003

Acute suppurative otitis media without spontaneous rupture of ear drum, bilateral

382.00

Acute suppurative otitis media without spontaneous rupture of eardrum H66.004

Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, right ear

382.00

Acute suppurative otitis media without spontaneous rupture of eardrum H66.005

Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, left ear

382.00

Acute suppurative otitis media without spontaneous rupture of eardrum H66.006

Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, bilateral

382.00

Acute suppurative otitis media without spontaneous rupture of eardrum H66.007

Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, unspecified ear

• Congestive Heart Failure

Code Translations

ICD-9 Code Description ICD-10 Code Description

428.0Congestive heart failure, unspecified I50.20

Unspecified systolic (congestive) heart failure

428.0Congestive heart failure, unspecified I50.21

Acute systolic (congestive) heart failure

428.0Congestive heart failure, unspecified I50.22

Chronic systolic (congestive) heart failure

428.0Congestive heart failure, unspecified I50.23

Acute on chronic systolic (congestive) heart failure

428.0Congestive heart failure, unspecified I50.30

Unspecified diastolic (congestive) heart failure

428.0Congestive heart failure, unspecified I50.31

Acute diastolic (congestive) heart failure

428.0Congestive heart failure, unspecified I50.32

Chronic diastolic (congestive) heart failure

428.0Congestive heart failure, unspecified I50.33

Acute on chronic diastolic (congestive) heart failure

Systems•EHR, Practice Management & Billing Systems•System upgrades/testing/cost•Vendor readiness/testing

Operations•Systems, workflows & operating metrics•Encounter forms/Superbills•Payer readiness/testing

Documentation•Coding audit for documentation of specificity•Identify common codes within the practice•Consider dual coding to gauge accuracy & productivity

Impact on Provider Operations

• AHIMA Online Education Physician Series– Clinical Documentation for ICD-10: Principles &

Practice• Short, self-paced training modules• Case-based, real life examples

– Provides more than 200 bite-sized, on-demand, specialty-specific training modules that can be accessed anytime or anywhere with a mobile device – computer, tablet or smartphone

– Delivers 3-5 minutes modules that cover physician’s 10 – 20 most commonly billed diagnoses & conditions making learning targeted and relevant to their practice specialty.

– www.ahima.org\physicianICD10

Clinical Documentation Resources

• There are a wide variety of training opportunities and materials available through a variety of resources:

– Professional Coding Associations – AAPC, AHIMA

– Online Courses – ICD10 Monitor, Contexo University, Precyse, Nuance

– Webinars – ICD10 Monitor, HCPro

– Onsite Training – Train-the-Trainer approach, Coding Boot Camp

– Arkansas Hospital Association – monthly coding classes

– Non-Traditional - Partner with the HIM Department at a nearby hospital

Training Resources

• Arkansas Medicaid has been working on ICD-10 for over two years

– Completed• Operational assessment • Remediation of Medical Policy, Edits and Audits complete• Provider Manual Updates – HP coordinating revisions• Data Requirements – HP/MMIS, Xerox/ACS, integrated & stand alone systems

– Ongoing• Remediation of Pharmacy Policy & Edits • Remediation of DHS reports, forms, and brochures • Provider Outreach

o Meetings/Webcastso Provider Bulletinso Newsletterso ICD-10 Website www.humanservices.Arkansas.gov/ICD10

• Internal & external testing to begin mid-year

Akansas DHS Current Stated

Leadership & Strategic Direction

Communication & Planning

Systems

Vendors

Training

Documentation

Testing

The Starting Point

• Create a checklist of all systems & work flow processes that currently use ICD-9

• Create a list of vendor contact information• Identify all staff who work with ICD-9• Identify all possible work flow changes that will need to

switch to ICD-10• Identify the practice billing service (if applicable)• Identify the practice clearinghouse • Identify a contact for each of the practice’s payers

AMA ICD-10 Checklist

• Contact vendors to determine their ICD-10 implementation plans

• Contact the practice’s billing service, if applicable, to identify their ICD-10 implementation plans

• Contact payers to determine their ICD-10 implementation plans

• Identify any internal work flow processes that will need to be change for ICD-10

http://www.ama-assn.org/resources/doc/washington/icd10-checklist.pdf

AMA ICD-10 Checklist

• www.CMS.gov/ICD10• www.CMS.gov/NPC• http://www.roadto10.org/• www.AHIMA.org• www.AAPC.com• http://www.cms.gov/Medicare/Coding/ICD-10/Download

s/ICD10SmallandMediumPractices508.pdf

• http://www.himss.org/ASP/topics_icd10playbook.asp• www.WEDI.org• www.humanservices.Arkansas.gov/ICD10

Industry Website Resources

CMS Resources

CMS Resources

CMS Road to I-10

• White Papers (including but not limited to)– ICD-10 A Primer– ICD-10 Clinical Documentation– ICD-10 Physician Impact– ICD-10 Advantages– ICD-10 Specified or Unspecifiedhttp://healthdataconsulting.com/

• Checklists published by CMS for providers (small, medium and large) at:

– http://www.cms.gov/Medicare/Coding/ICD10/ICD-10ImplementationTimelines.html

– http://www.roadto10.org/

Additional ICD-10 Resources

Websites to Watch