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Documenting Health Care Interventions

1. ICD-9-CM (International Classification of Diseases). – Volumes 1 and 2 of this code set deal with diagnoses. – Volume 3 covers procedures with a focus on inpatient

procedures.

2. CPT® (Current Procedure Terminology) describes outpatient procedures and inpatient services reported directly by physicians.

– The CPT is owned by the American Medical Association.

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History

The International Classification of Diseases (ICD) is a common framework and language to report, compile, use and compare health information: •In 1893, the first edition was adopted, known as the International Cause of Death; •In 1948, the World Health Organization (WHO) took responsibility for ICD with the sixth revision; •WHO updates the ICD periodically to reflect current epidemiology and medical understanding of disease (i.e., ICD-7 through 10).

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Why change?• The current revision of ICD used in the United States is

obsolete. ICD-9 no longer supports advances in medicine and new procedures. It does not have the capacity to expand and incorporate new codes.

• The detail in the codes is expected to streamline claims for payers to clearly understand the purpose of the patient visit.

• The United States is the last developed country to implement ICD-10 which restricted our ability to track and respond to disease patterns (e.g. H1N1) and epidemics on a worldwide basis.

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Users of ICD-10

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Timelines

In the late 1970s, the United States developed a clinical modification of this code set (ICD-9-CM) and mandated its use for all diagnoses (Volumes 1 and 2 of ICD-9-CM). A third volume of ICD-9-CM was developed for procedures.

In 1993, ICD-10 was issued and it, too, was clinically modified to produce ICD-10-CM. A new standard, ICD-10-PCS (ICD-10, Procedure Classification System), was developed at the same time to succeed ICD-9-CM, Volume 3.

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– January 1, 2014: After 30 years of providing ICD-9-CM coding advice, the AHA Central Office will shift its attention to ICD-10-CM/PCS and will no longer accept nor respond to requests for ICD-9-CM coding advice.

– First Quarter 2014: Last issue of Coding Clinic for ICD-9-CM will be published. First issue of Coding Clinic for ICD-10-CM and ICD-10-PCS will be published.

– October 1, 2014: Compliance date for implementation of ICD-10-CM and ICD-10-PCS. ICD-9-CM codes will not be accepted for services provided on or after October 1, 2014.

<http://www.ahacentraloffice.org/codes/ICD10.shtml>

Timelines

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Comparing the versions

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Comparative Anatomy

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ICD-10 Conversion and Mapping

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ICD-10 Conversion and Mapping

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ICD-10 Conversion and Mapping

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ICD-10 Conversion and Mapping

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There’s a code for that?

V95.43XA - Spacecraft Collision Injuring Occupant. Initial encounter.

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There’s a code for that?

W56.42XA – Struck by a shark. Initial encounter.

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There’s a code for that!

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5 Benefits of ICD-10 for Physicians

1.Grow compensation and reimbursement. ICD-9 codes were not originally developed with reimbursement in mind. ICD-10, however, offers a more decisive system to determine payments by offering greater detail on the quality of the care provided. In turn, government payers, insurers, hospitals, health systems, medical groups and others will use ICD-10’s granular data to determine accurate and fair physician compensation and reimbursement for goods and services.

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5 Benefits of ICD-10 for Physicians

2. Determine Severity and Prove Medical Necessity. As a general rule, sicker patients are more expensive to treat because they utilize more resources, have a higher rate of complications, and predictably, have worse outcomes. ICD-10 codes will support documented Severity of Illness data capture and reporting, because ICD-10 codes carry much more descriptive information than ICD-9 codes.

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5 Benefits of ICD-10 for Physicians

3. Ensure Your Strong Reputation. With the advent of healthcare industry changes brought on by Value-Based Purchasing, documentation becomes akin to a physician’s social media page. “Everybody” sees it. Once the care has been provided, documentation becomes the basis for the ICD-10 codes, which will more accurately reflect the quality of care provided by a physician.

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5 Benefits of ICD-10 for Physicians

4. Reduce the hassle of audits. ICD-10 codes will allow the physician’s documentation to be translated into a more accurate clinical picture, thereby reducing the chances of misinterpretation by third parties, auditors, payers and attorneys. Insufficient documentation, on the other hand, may lead to scrutiny and potentially a take-back by CMS or other payer.

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5 Benefits of ICD-10 for Physicians

5. Gain access to better clinical information. ICD-10 will trigger a deeper level of clinical detail in the medical record. This information can be used to reduce errors, impact multidisciplinary care, and provide improved assurance of appropriate reimbursement. It also offers significant data mining and research opportunities

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It’s actually simple…it’s just documentation.

There are only four new clinical concepts that drive that entire change:

1. laterality,

2. joint involvement,

3. encounter and

4. healing

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It’s actually simple…it’s just documentation

If we don't start documenting these new concepts, three things will happen:

(1) A claim will be coded lower than it should have and will be reimbursed less than it should have;

(2) the claim can be submitted and billed but eventually will be denied; or

(3) we don't end up billing it and query the physicians, which is fine, but it slows down the process significantly.

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