Update to ICD 10 CM Diagnostic Code Set

Agenda

• Why ICD 10 CM?• Highlights of ICD 10 CM & ICD 10 PCS• Is it a big change?• Timeline• Make your Plans• We want your Feed back.

ICD 10• For Mortality

coding• 14,000 to 16,000

codes

What are the Diagnostic Code Sets?

ICD 9 CMFor Mortality &

Morbidity coding13,000 codes

ICD 10 CMFor Morbidity &

Mortality coding68,000 codes

ICD 10 AMFor Morbidity &

Mortality coding15,000 codes

• Because Abu Dhabi continues to use version ICD-9, it has difficulty comparing its health service utilization to other countries.

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ICD-9-CM Limitations

• Space limitations– Codes have already been assigned to

inappropriate sections – Leads to challenges for coders

• Workarounds– Use of ‘overflow’ chapters compromise the

structure of ICD-9-CM• Emerging technology– Not expandable nor detailed enough to capture

future healthcare information

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Why ICD-10-CM??

• Significant improvement in coding primary care encounters, external causes of injury, mental disorders, neoplasms, and preventative health

• Recognition of advances in medicine and technology• More detail• Addition of laterality (where the procedure or

disease is located)• Expanded distinctions for ambulatory and managed

care encounters

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Highlights

In the US as of 2014 ICD-10-CM (Diagnosis)

Will affect inpatient and outpatient

ICD-10-PCS ( Procedures) Will only affect

inpatient in the U.S. NOT UAE -We have

CPT for outpatient reimbursement

ICD-10-CM/PCS:• Incorporates much greater

specificity and clinical information, which results in:

Improved ability to measure health care services;• Increased sensitivity when refining

grouping and reimbursement methodologies;

• Enhanced ability to conduct public health surveillance; and

• Decreased need to include supporting documentation with claims;

• Includes updated medical terminology and classification of diseases;

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Highlights

In the US as of 2014 All software will be ICD

10 based All certified coders will

be ICD 10 based All RVU’s will be ICD 10

based ICD 9 CM will no longer

be updated after 2012

ICD-10-CM/PCS:• Provides codes to allow

comparison of mortality and morbidity data; and• Provides better data for:• Measuring care furnished to

patients;• Designing payment systems;• Processing claims;• Providers making clinical

decisions;• Tracking public health;• Identifying fraud and abuse; and• Conducting research.

• A revised classification system that: – permits international exchange of data for disease

prevention & advanced healthcare research; – 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.

– gives more specificity to Payers to reduce denials due to lack of information

Why Upgrade to ICD 10 CM?

Upgrade to ICD 10 CMDSP 184CCSC 092

Amend decision to: Implement ICD 10 CM one year after Implementation in the USA

Implement ICD 10 CM as the Code Set for Diagnostic coding one year after implementation the USA (which presently means as of Encounter.Start >=1 Oct 2015), contingent on availability of DRG grouper for pricing minimum 12 months prior to the implementation date. Request DRG panel to confirm the timeframe.

Daman: to establish and negotiate prices Payers and Providers will need at least on year after the DRG grouper is available for pricing (not for testing)

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Is it a big change?Comparison

ICD-9-CMMechanical complication of

other vascular device,implant and graft1 code (996.1)

ICD-10-CMMechanical complication of other vascular grafts156 codes, includingT82.310 – Breakdown (mechanical) of aortic(bifurcation) graft (replacement)T82.311 – Breakdown (mechanical) of carotid arterialgraft (bypass)T82.312 – Breakdown (mechanical) of femoral arterialgraft (bypass)T82.318 – Breakdown (mechanical) of other vascular graftsT82.319 – Breakdown (mechanical) of unspecifiedvascular graftsT82.320 – Displacement of aortic (bifurcation) graft(replacement)T82.321 – Displacement of carotid arterial graft (bypass)T82.322 – Displacement of femoral arterial graft(bypass)T82.328 – Displacement of other vascular grafts

X X X XX X XX X XX X

category etiology,anatomic site,manifestation

category etiology,anatomic site,

severity

extension

ICD-9 Code Format ICD-10 Code Format

ICD-9-CM

14,025

ICD-10-CM

68,069Diagnosis Codes

Comparisons

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Comparisons

• Extensions• A = initial encounter• D = subsequent encounter• S = sequela (late effect)

• Patient is discharged with principal diagnosis of nontraumatic subarachnoid hemorrhage, commonly known as a stroke.

Patient Case Scenario 1: Subarachnoid Hemorrhage

In ICD-9-CM there is one code: 430 Subarachnoid hemorrhage

In ICD-10-CM - twenty possible codes requiring detail of which artery the hemorrhage came from for accurate code assignment.

right and left carotid siphon and bifurcation; right and left middle cerebral; right and left anterior communicating;right and left posterior communicating; basilar; right and left vertebral; and other or unspecified intracranial arteries.

• A patient is treated for fracture of the patella to assign an accurate code, sixth and seventh characters are needed in ICD-10-CM.

Patient Case Scenario 2: Fracture of the Patella

ICD-9-CM 822.0 - Fracture of patella, closed

ICD-10-CM S82.021D - Fracture of patella, displaced longitudinal, right patella - subsequent encounter for closed fracture with routine healing

Tentative Timeline

Make Your Plan to ICD 10 CM

• Phase 1: Implementation plan development and potential impact assessments– Establish interdisciplinary steering committee to develop ICD‐

10 implementation strategy– Development of potential impact assessments

• Phase 2: Implementation preparation– Training/awareness on Codes and Code uses (data etc) – Education on the available GEM and how to use

• Phase 3: “Go live” preparation – Contracts

• Impact assessment. The purpose of this assessment is to anticipate who or what will be affected by the transition to ICD-10-CM while determining the degree of impact.

• An implementation budget must be created to address the costs associated with upgrading technology and training as well as the potential loss of productivity, which can delay remittance.

• A systems inventory is necessary to identify systems requiring modifications – All processes and systems that pertain to ICD codes need to

be analyzed and modified to accommodate the expanded alpha-numeric code structure of ICD-10.

Make Your Plan to ICD 10 CM

• Training: More intense training regarding the specifics of the code set will be required for those who use coded data for the purpose of reimbursement, statistics, and/or research. – Ahima estimates the training time for experienced

codes to be 16 hours with 10 hours practice) – And we mustn’t forget the Documentation Training

required for doctors.

Make Your Plan to ICD 10 CM

• GEMs and the multiple uses of these GEMs – • Maps are created for many purposes, (exchange of

data for patient care purposes, access to longitudinal data, reimbursement, public health data reporting, and KEH.

• Correct mapping requires a complete understanding of how data will be used. – Even though standardized mappings will facilitate the process

of translating between the old and new code sets, there will still be challenges connecting data coded under

Make Your Plan to ICD 10 CM• ICD-9-CM to data coded under ICD-10-CM due to the d

ifferences in the code sets. This will impact reports that compile statistical data for trend analysis.

Download GEM from CMS website

http://www.cms.gov/Medicare/Coding/ICD10/2014-ICD-10-CM-and-GEMs.html

We want your feedback:• HealthSystemFinance@haad.ae• http://www.shafafiya.org/dictionary/portal/• ccsc@haad.ae