Introduction to ICD-10Introduction to ICD-10
Kyle Miller, Todd Couts
CMS ICD-10 PMO
February, 2011
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Agenda
Overview of ICD-10
CMS’ ICD-10 Program and Activities to Date
Impact on ESRD at CMS
Additional Resources
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
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Diagnosis and Procedure Codes
Single implementation date of October 1, 2013 for all users Date of service for ambulatory and
physician reportingAmbulatory 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
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ICD-9 Volumes 1 and 2 Diagnosis CodesICD-9 Volumes 1 and 2 Diagnosis Codes
ICD-9 Volume 3 Procedure codesICD-9 Volume 3 Procedure codes
ICD-10 Clinical Modification (CM) – DIAGNOSIS CODES
ICD-10 Clinical Modification (CM) – DIAGNOSIS CODES
ICD-10 Procedure Coding System (PCS) – INPATIENT PROCEDURE CODES
ICD-10 Procedure Coding System (PCS) – INPATIENT PROCEDURE CODES
All Settings Inpatient
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ICD-9-CM code set is outdated 30 years old ICD-9-CM codes cannot reflect current medical technologies Many code chapters are full, resulting in code placement in non-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
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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 organizationBetter ability of payer to match payment to work involved
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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
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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
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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
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Diagnosis Code Changes
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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
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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
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Procedure Code Changes
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Procedure Code Example - 2 ICD-9-CM Codes Replaced by 112 ICD-10-PCS Codes
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Nephrology Procedure Codes:Better Organization
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Example: Percutaneous Pyelostomy
New0T9330Z
Current Ambiguity55.03 Percutaneous NephrostomyOR 55.12 (Unspecified) Pyelostomy
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Better ability of payer to match payment to work involved
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)
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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
CrosswalkShield the impacted systems from accepting, using, or sending ICD-10 codes natively
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Fundamental Payer ICD-10 Strategy Choices
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Fundamental Provider ICD-10 Strategy Choices
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Physician Codes in ICD-9Physician Codes in ICD-10
Office Submits in ICD-10Office Submits in ICD-10
Staff Translates ICD-9 to 10
ICD-10 DiagnosisCodes
ICD-10 ProcedureCodes
ICD-10 DiagnosisCodes
ICD-10 ProcedureCodes
ICD-10 DiagnosisCodes
ICD-10 ProcedureCodes
ICD-10 DiagnosisCodes
ICD-10 ProcedureCodes
ICD-10 DiagnosisCodes
ICD-10 ProcedureCodes
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-10For DOS after October 1, 2013
Upgrade Crosswalk
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CMS ICD-10 Program and Activities to Date
ICD-10 Program History and Current State
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ICD-10 Program Organization
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ICD-10 Implementation Projects
Project Structure
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High Level Implementation Timeline
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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
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Impact on ESRD at CMS
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
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Additional Resources
CMS Resources
ICD-10 General Information
http://www.cms.gov/ICD10
MS-DRG Conversion Report http://www.cms.gov/ICD10/Downloads/MsdrgConversion.pdf
Central Version 5010 and D.0 web page on the CMS website http://www.cms.gov/Versions5010andD0/
The CMS ICD-10 website http://www.cms.gov/icd10/ 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 http://www.cms.gov/ICD10/02c_CMS_Sponsored_Calls.asp#TopOfPage. You will find copies of call materials (presentations, written and audio transcripts, etc.).
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Additional Resources
The following organizations offer providers and others ICD-10 resources WEDI (Workgroup for Electronic Data
Interchange)
http://www.wedi.org
HIMSS (Health Information and Management Systems Society)
http://www.himss.org/icd10
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