1. Moving Towards ICD-10What you dont know will hurt you!

2. Cortnie R. Simmons, MHA, RHIA, CCSDirector of ICD-10 ProgramKforce HealthcareCortnie R. Simmons, MHA, RHIA, CCS is the Director if ICD-10 for Kforce Healthcarewhere she is responsible for implementing ICD-10 CM/PCS related technology andservice offerings for healthcare payers and providers and oversees the rollout ofICD-10 CM/PCS training and education to more than 500 Kforce Consultants.Ms. Simmons has 11 years of HIM consulting and coding experience in healthcare.Ms. Simmons is a graduate of Florida A&M Universitys Health Information Management program. Shecompleted her Masters in Health Administration at University of Maryland University College and also hasher certificate in Healthcare Informatics from St. Petersburg College.She has held various roles in HIM and coding with both hospital systems and healthcare vendors. She beganher career as a coding consultant in a large consultant firm where she perfected her skills in ICD-9 CM andCPT coding as a coding auditor and CDI specialist. Ms. Simmons has also spent several years working forHospital Corporation of America where she was responsible for coding and HIM support for severalfacilities, which included training and education, auditing, risk reduction, and results reporting. Ms.Simmons currently serves as the Florida Health Information Management Association Chair for ICD-10 aswell as a member of the AHIMA Clinical Terminology and Classification Practice Council. She also is anadjunct instructor for a Coding and Healthcare Informatics program.Ms. Simmons has experience conducting educational presentations on ICD-9, CPT and ICD-10 to variousorganizations and healthcare facilities across the country including speaking engagements at AHIMA,NCHIMA, FHIMA, and other State Association meetings, workshops, and/or roundtables. In 2010, Ms.Simmons became an AHIMA Certified Train the Trainer for ICD-10 CM and ICD-10 PCS. She hasauthored several coding and compliance-related articles for AHIMA, HCPro and other publications onICD-10 and other coding topics. 3. Agenda Brief baseline overview of ICD-10 Why is it important? What is it? Comprehensive Preparedness Assessments and why they are important Documentation Challenges in ICD-10 CM/PCS Preparing for Challenges 4. ICD-10 BASELINE OVERVIEW 3 5. CMS Goals for ICD-10 CM/PCS Measure quality, safety and efficacy of care Reduce need for attachments to explain patients condition Design payment systems and process claims for reimbursement Conduct research, epidemiological studies and clinical trials Set health policy Operational and strategic planning Design health care delivery systems Monitor report utilization Improve clinical, financial and administrative performance Prevent and detect health care fraud and abuse Track public health and health risks4 6. Myths vs. FactsMYTH FACTMYTHFACT Unnecessarily As with ICD-9- The The greaterdetailed CM, ICD-10- increased number ofmedical record CM/PCS codesnumber of codes in ICD-documentationshould be based codes in ICD- 10-CM/PCSwill beon medical10-CM/PCS make it easierrequired whenrecordwill make the to find theICD-10-documentation.new codingright code.CM/PCS issystemimplemented. impossible to use.5 7. Why is Preparing for ICD-10 Important? ICD-10 is the biggest change to healthcare providers since the creation of Medicare in 1965 Implementing ICD-10 will impact every IT system, process and transaction that contains or uses a diagnosis or procedure code The devotion of time and resources will be greater than that required for Y2K or MS-DRG readiness 8. What Entities are Impacted? Payers Reimbursement systems Contracts Claim systems Providers Hospitals Physicians HHAs, Rehabs, SNFs, LTACs Clearinghouses, Vendors, EmployersSource: American Hospital Association 9. Who Needs to be Trained? StakeholdersL M H Coders inpatient and outpatient Physicians and Mid Levels Clinical documentation specialists Case management / UR Decision support IT professionals Patient access and PFS personnel Researchers (if applicable) Administration 8 10. Educational Tiers/Levels Staff that require familiarity &Tier 1-awareness of impact of the changes between the two code sets (e.g., Low physicians) Staff that require a moderate Tier 2- understanding to interpret & use ICD10 CM/PCS ( e.g., quality Mediummanagement, UR, compliance) Staffthat require a detailed or expertTier 3-understanding to apply & interpret ICD10 CM/PCS (e.g., coders, coding Highauditors, clinical documentation specialists) 11. Education & TrainingExtensive Stakeholder Training will be required throughout the organization700 5,434 HoursTotal Hours: 15,5546009,224 Hours Total Count: 1,084500Number of Staff400300200100896 Hours0Tier 1/ Low (457) Tier 2/Medium (608)Tier 3/High (19) 12. Systems Requiring Assessment for ICD-10 Compliance Accounting Systems Medical necessity software Clinical systems Test-ordering systems Physician practice management Clearinghouse EDI systemssystems Medical record abstracting Aggregate data reporting Utilization management Decision-support systems Clinical protocols Provider profiling systems Payer claims adjudication systems Billing systems All Custom Reporting systems, Disease management systems Interface Engine coding, Quality management Data Extracts & Custom Data Bases Case management Clinical reminder systems Encoding software Performance-measurement systems Registration and scheduling All systems sending and receivingsystems clinical information to/from external Case-mix systemsresources11 13. What Could Happen? Failure to successfully implement could causecash flow reductions and /or delays through: Coding and billing backlogs (i.e. DNFB) Increased claims downgrades and rejections Payer contacts at risk due to poor quality ratings Permanent loss in coder productivity (20 50%)increasing costs (Also consider coder costpremium near go live) Substantial cost to remediate / replace ITsystems 14. Organizational Cost Projected Organizational Cost by Bed SizeBed SizeProjected Organizational Cost400+$1,000,000 5,000,000100 400 $500,000 1,500,00014,000 unique codes Characters >68,000 unique codesICD-10-PCS(Procedure) ICD-9-CM (Procedure) 7 Alphanumeric5 Digits Characters>4000 unique codes>72,000 unique codes15 17. ICD-9 CM vs. ICD-10 CMSimilaritiesDifferences Index Abbreviations 3 to 7 characters Punctuations First character alpha Coding Conventions Excludes 1 and Exclude Include Notes/Inclusion 2 Notes 21 Chapters All Categories are 3 Combination codes characters Laterality Guidelines (coding, Episode of Care chapter specific) Expanded codes Trimester codes Changes in timeframe 18. ICD-9 CM vs. ICD-10 PCS Similarities Differences Used for reporting Codes are arrangedinpatient services into tablesand procedures Codes contain 7 characters Codes are alphanumeric Root operations Each character has a specific meaning17 19. One ICD-9 Code.. Multiple ICD-10 Codes OSRB07Z OSRB0KZ OSRB0J7 OSRB0J881 5 1 OSRB0J6 OSRB0J5 Total Hip Replacement OSRB0JZ OSR907Z OSR90KZ OSR90J7 OSR90J8 OSR90J6 OSR90J5 OSR90JZ 20. One ICD-9 Code.. Multiple ICD-10 CodesICD-10-PCS 0H96X0Z Drainage of BackSkin with DrainageDevice, External Approach 0H96XZZ Drainage of BackSkin, External Approach Plus 264 other codes860 4specifying location (e.g. Left upper extremity, elbow, abd omen, genitalia, etc.),Other incision withdepth (e.g. skin or subcutaneous tissue) drainage of skin andapproach (e.g. external, open subcutaneous tissue , percutaneous, percu taneous endoscopic), and drainage device 21. 5010 / ICD-10 Timeline Jan 1, 2009Jan 1, 2010Jan 1, 2011 Jan 1, 2012Jan 1, 2013 Phase 1Phase 2Phase 3Phase 4 Phase 1Phase 2Phase 3 Phase 4 Organize steering Conduct IS inventory Outline specific tasks/monitor Evaluate software committee Assess vendor readinesstimeline for completion upgrades Select leader Conduct staff Review budget requirements Review quality of Develop meetingawareness sessions Develop metrics and coded data schedule Assess/plan for staffmonitoring progress Conduct additional Identify requiredtraining needs Routine reporting of progress staff training tasks/develop Identify necessary tools towards completion Reinforce physician timelines Identify areas requiring Implement changes to system documentation Assign tasks/operational/policy design/developmenttraining responsibilities changes Test/validate of system changes Assess case mix Evaluate health plan Conduct staff trainingimpactcontract implications Conduct physician training/ Budget planningaddress documentation gaps Identify gaps in healthrecord documentation 5010 testingSource: American Hospital Association, HIPAA Code Set Rule: 20ICD-10 Implementation, Executive Briefing Copyright 2011 byAmerican Hospital Association. 22. HOW TO PREPARE 21 23. Why are Many Providers not Prepared? Management on overload. Focusing on more immediatepriorities e.g. meaningful use, HIE, cost reduction, etc.Easy for management to think there is plenty of time toaddress ICD-10, 10/1/13 right? Most industry surveys find less than 10% of providershave started Hospital management is too narrowly focused on codertraining as the issue and not the training needs of othersas well as the significant process and IT system changesthat are required and financial planning matters 24. Thoughts on Preparedness Get organized Form a Multi-disciplinarySteering Committee (consider a PMO) Develop a comprehensive approach thatincludes Operations, IT and Finance Develop a Roadmap of key projects andproject owners that covers now through 2013 Think past October 2013 as there will be muchto do after go live 25. ICD-10 Program Roles ExecutiveManagement SponsorOperations SteeringCommittee ProgramManagementOffice Team TeamTeamTeam ExternalLeader LeaderLeaderLeader Consultants 26. Operations Steering Committee MembersVP ComplianceCIOLead CoderHIS Director Case Management IT Director DirectorCDI Team Leader ControllerProcess ImprovementMulti-Disciplinary Team for 280 Bed Hospital 27. 280 Bed Hospital Work Streams and Projects Work Streams Individual ProjectsOperations18Information Technology27Finance5Total 50Does not include 16 additional modules related to Meditech 6.0 Upgrade 28. Implementation Hours by Quarter9,0008,0007,0006,0005,0004,000PMO/PM Hrs3,000Total Hours2,0001,000 35,357 Total Hrs -Q4Q1 Q2 Q3Q4 Q1Q2Q3Q411 121212 1213 13 13 13* Does not include Meditech 6.0 implementation 29. Implementation Cost/Hours by Work StreamExternal Cost Parkview HoursWorkIncremental CostConsulting (Consulting/Vendor (Hours SalariedStream (Parkview) HoursStaff))Finance $0$0063Operation 1,040** $210,600 $588,810**16,634s +Fixed Cost IT $0 $431,300 2,7248,140 PMO$0 $372,000 2,1204,636Totals $210,6001,392,110 5,884 Hrs29,473 Hrs$1,603,00035,357 Hrs 30. Budget by Quarter$350,000$300,000$1.603 Million$250,000$200,000$150,000$100,000 $50,000 $0Q4 Q1 Q2Q3Q4Q1Q2Q3Q4111212 12 12 13 13 13 13 * Does not include Meditech 6.0 implementation 31. Other Considerations Parallel Coding When? What % of accounts and which accounts? CDI Program More Staff? Internally Staff Augmentation 32. WHATS SO HARD ABOUT ICD-10? 31 33. ICD-10 CM Code Structure ICD-9-CMICD-10-CM 3-4 characters 3-7 characters All characters are 1st character is alpha numeric (except E and V Codes) 2nd character is numeric All codes have at least All letters used except U 3 characters (digits) Decimal after 1st 3 characters32 32 34. The Entire Code Structure Changes! Diagnosis Code: ICD-9-CM (3 5 numbers) 821.01 = Closed Fracture of shaft of femur ICD-10-CM (3 7 alpha/numeric characters) S72.344 = Displaced spiral fracture of shaft of right femur33 35. ICD-10 PCS Code Structure ICD-9 CMICD-10 PCS ICD-9-CM has 3-4 ICD-10-PCS has 7 characterscharacters All characters are Each can be either alpha numeric or numeric All codes have at least Numbers 0-9; letters A- 3 charactersH, J-N, P-Z Alpha characters are not case-sensitive Each code must have 7 characters3434 36. The Entire Code Structure Changes Procedure Code: ICD-9-CM (3 -4 numbers) 47.01 Laparoscopic appendectomy ICD-10-PCS (7 alphanumeric characters) ODTJ4ZZ Laparoscopic appendectomy35 37. ICD-10 PCS Coding Example Posterior spinal fusion of the posteriorcolumn at L2-L4 levels with BAKcage, interbody fusion device, open 38. ICD-10 PCS Coding Example (cont.) 0: MEDICAL AND SURGICAL S: LOWER JOINTS G: FUSION: Joining together portions of an articular body part rendering the articular body part immobileBody PartApproachDevice QualifierCharacter 4Character 5 Character 6Character 70 Lunbar Vertebral Joint 0 Open3 Interbody Internal 0 Anterior Approach, Anterior1 Lumbar Vertebral Joints, 2 3 PercutaneousFixation DeviceColumnor more4 Percutaneous4 Internal Fixation Device 1 Posterior Approach, Posterior3 Lumbosacral JointEndoscopic7 Autologous TissueColumn Substitute J Posterior Approach, Anterior H Interbody SyntheticColumn Substitute K Lateral Transverse Process J Synthetic Substitute Approach, Posterior Column K Nonautologous Tissue Substitute N Interbody Nonautologous Tissue Substitute Z No Device5 Sacrococcygeal Joint 0 Open4 Internal Fixation Device Z No Qualifier6 Coccygeal Joint3 Percutaneous7 Autologous Tissue7 Sacroiliac Joint, Right4 PercutaneousSubstitute8 Sacroiliac Joint, Left EndoscopicJ Synthetic Substitute K Nonautologous Tissue Substitute Z No Device9 Hip Joint, Right 0 Open4 Internal Fixation Device Z No QualifierB Hip Joint, Left3 Percutaneous5 External Fixation DeviceC Knee Joint, Right4 Percutaneous7 Autologous TissueD Knee Joint, Left EndoscopicSubstituteF Ankle Joint, Right J Synthetic SubstituteG Ankle Joint, LeftK Nonautologous Tissue Subsitute Z No DeviceH Tarsal Joint, RightJ Tarsal Joint, LeftK Metatarsal-Tarsal Joint,RightL Metatarsal-Tarsal Joint,LeftM Metatarsal-PhalangealJoint, RightN Metatarsal-PhalangealJoint, LeftP Toe Phalangeal Joint, RightQ Toe Phalangeal Joint, Left 39. ICD-10 PCS Example Answer 0 S G 1 0 31Section:Body RootBody Approach:Device:Qualifier:Med/Surg System: Operation: Part: OpenInterbody PosteriorLower FusionLumbar Internal Approach,JointsVertebralFixation Posterior Joints Device Column38 40. Polling QuestionHave you or your facility participated in anycoding or documentation assessments toprepare you for ICD-10? Yes No No but they arein the plans 41. Assessments Are they Important? Coding Assessments Assess current knowledge Anatomy, Physiology, Pathophysiology, and Terminology Determine areas that need additional focus Clinical Documentation Assessments Determine the full extent of documentation reviews that will be performed during the course of the ICD10 transition. Operational Assessments Determine who is affected by ICD-10 and what education is needed IT Technology Assessments Determine what software/hardware upgrades will be necessary 42. Coding Assessment Results Results by Category76.00%73.76%74.00%72.00%70.00%69.64%68.00%67.27%66.00%64.00% 65.81%62.00%60.00% A&PTerminology Pathophysiology Overall 43. Coding Assessment Results Results by Credential72.00%70.55%70.00%69.38%68.00%66.00%64.00%62.00% 60.92%60.00%58.00%56.00%CCS/CCS-P RHIA/RHITCPC/CPC-H 44. Documentation Assessments Quality clinical documentation is a key factor in reportingaccuracy & ICD-10-CM/PCS code assignment.Documentation assessments will provide insight into howICD-9-CM codes will map to ICD-10-CM/PCS & howchanges will affect your current high-volume/dollar cases. Assess the current level of specificity & quality of physicianclinical documentation practices Review top diagnosis codes, procedure codes &/or MS-DRGs. 45. Documentation Assessments Determine how frequently unspecified &/or non-descriptivecodes were used in the current ICD-9 system. Determine if the documentation required to appropriatelyassign diagnosis & procedure codes in ICD-10-CM/PCS ispresent in the medical records reviewed. Findings provide recommendations for documentationimprovement and assist in designing the physicianeducation program for your facility &/or organization. 46. Operational Assessments for Education &Training Stakeholder Training Count HoursUnemployed Physician Office Staff 399 4,389 Other Staff320 6,655(Admissions, Registration, Nursing, etc.)Unemployed Physicians 266 2,926 Employed Physicians38 418 IT 2472 Hospitalists 18 198 Coders 16 800Clinical Documentation Improvement 396Total 1,084 15,554 47. Technology Assessments IT Assessment Identified gaps in overall ICD-10 product/system readiness. 27products/systems impacted by ICD-10 with significant implementation overlap requiring careful critical path & resource management Product Readiness represents the state of IT readinessto implement. Out of 100 IT products used atProduct Readiness Parkview, 27 products identified as ICD-10 impacted Assessed / Analyzed vendor readiness based uponVendor Readinessproducts impacted Two major clusters observed cluster/dependenciesRoadmap & Budgetwithin groups of products & clusters around MeditechPlanningupgrade 48. Polling Question What do you believe the hardest transitionto ICD-10 will be? Supporting documentation Understanding the ICD-10 codes ICD-10 code and guideline changes 49. DOCUMENTATION CHALLENGES48 50. A Few Documentation Challenges Diabetes Mellitus AMI Pregnancy Cerebral Infarctions Injuries Fractures Respiratory/Vents Drug Underdosing ICD-10 PCS 51. New Documentation Requirements for ICD-10Changes inCombinationLateralityTimeframesCodes Inclusion of GreaterEpisode oftrimesters inSpecificity CareOB Codes50 52. There are More Codes and More DetailUnstable AnginaICD-9-CM 1 CODE ICD-10-CM - 9 CODES 411.1 Intermediate Coronary I20.0 Unstable AnginaSyndrome, including I25.700 Atherosclerosis of coronaryUnstable Angina artery bypass graft(s), unspecifiedwith unstable angina pectoris I25.710 Atherosclerosis ofautologous vein coronary arterybypass graft(s) with unstable anginapectoris I25.720 Atherosclerosis ofautologous artery coronary bypassgraft(s) with unstable anginapectoris I25.730 Atherosclerosis ofnonautologous biological coronaryartery bypass graft(s) with unstableangina pectoris 51 53. There are More Codes and More Detail Acute BronchitisICD-9-CM 1 CODE ICD-10-CM - 9 CODES 466.0 Acute Bronchitis J20.0 Acute bronchitis due to Mycoplasmapneumoniae J20.1 Acute bronchitis due to streptococcus J20.3 Acute bronchitis due tocoxsackievirus J20.4 Acute bronchitis due to parainfluenzavirus J20.5 Acute bronchitis due to respiratorysyncytial virus J20.6 Acute bronchitis due to rhinovirus J20.7 Acute bronchitis due to echovirus J20.8 Acute bronchitis due to otherspecified organisms J20.9 Acute bronchitis, unspecified 52 54. Diabetes MellitusICD-9 CMICD-10 CMCategories 249-250 (59 Codes)Categories E08-E13 (200+ Codes)4th and 5th digit identify Combination codes used to identifymanifestation, complication, or type manifestation and complicationAdditional code for manifestationType of diabetes is separated by categories in ICD-10 (E10 Type 1, E11 Type 2)Additional code for insulinZ79.4 used for long term insulin usedependency V58.67 Drug induced goes to Drug Code/DRG Inadequately controlled, poorly controlled, out of control are assigned to diabetes by type with hyperglycemia 55. Myocardial InfarctionICD-9 CMICD-10 CMCategories 410, 414, and 412Categories I21 and I224th and 5th digit identify location and I21- is used for NSTEMI and STEMIepisode of careAcute is defined as symptoms lastingI22- was created for subsequent MIless than 8 weeks (occurring within 4 weeks of initial)Acute period changed to 4 weeks orlessI22 has to be used with I21;sequencing depends on reason foradmission In the event of an untreated or unaddressed MI prior to admission, physicians willneed to determine and document when this occurred. This is particularly important when addressing reinfarctions or complication of AMI.54 56. Pregnancy ICD-9 CM ICD-10 CMCategories 630-679Categories O00-O9ACode identifies trimesterCode identifies the number offetusesPlaceholders are often used in thischapter55 57. Pregnancy, Childbirth and Puerperium On pregnancy, childbirth and puerperium chartsthe episode of care (delivered, antepartum,postpartum) are no longer the axis of classificationin assigning diagnosis codes. The trimester in which the condition occurred isnow the driving factor. 1st trimester less than 14 weeks 2nd trimester 14 weeks to less than 28 weeks 3rd trimester 28 weeks to delivery 56 58. Ulcers Ulcers (non pressure) documentation shouldstate the deepest tissue layer exposed (i.e.fat layer, necrosis, necrosis of muscle or skinbreakdown only) For pressure ulcers the site, laterality andseverity are specified in a single code in ICD-10 More specific codes for bilateral pressureulcers of the same site Added new codes for head, sacral, andcontiguous sites57 59. Pressure Ulcers What a Difference!ICD-9 CMICD-10 CM 9 location codes, 125 possible codessecond code showing more specificshows stages, location as well asdepth15 codes totalExample: Pressure ulcer of right lower back, stage III58 60. Cerebral InfarctionsGreater Specificity Required Specific artery involvement Vertebral artery Carotid artery Cerebellar artery tPA (rtPA) given in a different facility within 24 hours Glasgow Coma Scale Laterality59 61. Trauma Documentation Requirements Assigned separately for each Require laterality and specificinjurylocation Have a 7th character Cord injuries of the neckextension to identify the require specific type and theencounter type, with A as specific level of the cervicalinitial encounter and D for vertebra involvedsubsequent encounterInternal Organ Lacerations/ Lacerations reported as withContusionsand without foreign body Minor length and depth less than 1 cm spleen Puncture wounds arereported separately with and Moderate length and depthwithout foreign body-1 to 3 cm spleen Infected lacerations are Major length and depth reported as both a laceration greater than 3 cmand a wound infection60 62. FracturesICD-9 CMICD-10 CMCategories 800-829Default is displaced fractureFracture not indicated as open or Fracture not indicated as open orclosed should be classified asclosed should be classified asclosedclosedCodes are organized by type ofGustilo-Anderson classification forinjury and then by site assigning the 7th characterextension for open fracturesCodes are organized by site andthen by typeCategory M80 non-traumaticfractures61 63. Hip and Knee Replacements Type of implant for hip replacements needto be documented (i.e. ceramic onceramic, ceramic on polyethylene, metalon metal, metal on polyethylene)62 64. Mechanical Ventilation In ICD-10 mechanical ventilation is categorized by: less than 24 hrs, 24 to 96 hrs and greater than 96 hrs. Length of stay assigned will more than likely besequenced by number of hours on vent.63 65. Underdosing New to ICD-10 Combination codes exist that can identify asituation where a patient has taken less of amedication than prescribed, as well as thespecific drug. The medical condition is sequenced first with theunderdosing code listed as a secondarydiagnosis. Intentional vs. unintentionalUnderdosing of insulin due to an insulin pump failure 66. Incision and Drainage Document the following: Site of drainage Type of approach (i.e. open, percutaneous,external) Note if a drainage device was left 65 67. PREPARING FOR CHALLENGES 66 68. Current Challenges Physician Documentation Education & Training Productivity Payer Readiness System Upgrades 69. Preparing for ICD-10 CM/PCS Establish Documentation Assessment Methodology Determine the full extent of documentation reviews that will be performed during the course of the ICD10 transition. Establish types of assessments/reviews Establish timelines for the performance of the documentation assessments Transitional documentation needs: Use of queries that use both ICD9CM terminology and ICD10 terminology (MI time frames and capture of OB/pregnancy trimester information) Template queries that contain multiple choice selections should be cleansed to assure terminology that is obsolete in ICD10 (such as urosepsis) is removed. Crosscoding of records in both ICD9CM and ICD10CM to allow coders and CDS staff to determine if documentation is sufficient and to allow appropriate training in coding 70. Preparing for ICD-10 CM/PCS Where will the results be disseminated? Senior leadership Service line meetings Senior Committee Meetings CDS and coding staffs meetings Utilize the assessment results Physician education materials and Pocket cards Educational presentations What will be the effect on current physician orders,protocols, etc? 71. What can you do to prepare?Begin studying Begin learningPCSabout GEMsdefinitionsLearn about Refresh the Structure, knowledge of Organization, biomedical and Features sciencesUnderstandthe ICD-10 NextLearn the fundamentals of ICD-10 CM Final Rule Stepsand PCS system 72. Tips for Coders/CDI Specialists Explore available resources like the MLN (Medicare LearningNetwork) and CMS (Centers for Medicare and Medicaid Services) forlinks, tips, and frequently asked questions. Familiarize yourself with the new code set. The ICD-10 codes willallow for greater clinical details in describing conditions and a greattest for any practice is to take some of your most common codes andusing these tools determine the difference ICD-10 will make with thatparticular code. Become a coach for your providers and see if they are codingspecific enough to allow for accuracy with the new set. Be knowledgeable in coding, anatomy, and physiology. Keep reminding everyone of these changes and help out where youcan. 73. General Equivalence MapsGEMs General Equivalence Maps exist to translate data fromICD-9 to ICD-10 or vice versa Bi-directional Good for Databases used for multiple year analyses Trending Research studies Focusing on potential issues between 9 and 10 A single ICD-9 code disease or procedure may now be represented by multiple ICD-10 codes Cannot arbitrarily pick an ICD-10 code Might pick a code that does not represent complexity of service you are providing or patients that you are seeing (e.g. an unspecified ICD-10 code) could result in underpayments Might pick a code that overstates patient complexity or services provided 74. General Equivalence MappingsUse the GEMs When You are translating lists of codes, code tables, or othercoded data You are converting a system or application containing ICD-9-CM codes You are creating a one-to-one applied mapping (akacrosswalk) between code sets that will be used in anongoing way to translate records or other coded data You want to study the differences in meaning between theICD-9-CM classification systems and the ICD-10-CM/PCSclassification systems by looking at the GEMs entries for agiven code or area of classification 75. AHA Coding Clinics Will they be published for ICD-10? Will ICD-9 be converted to ICD-10? 76. Maintaining Certification through AHIMAs Begin earning ICD-10-CM/PCS specific CEUs during theperiod of 01/01/11 12/31/13CHPS 1CEUCHDA 6 CEUsRHIT 6 CEUsRHIA 6 CEUsCCS-P 12 CEUsCCS 18 CEUsCCA 18 CEUs****Note: Multiple credential-holders educate to thehighest CEU requirement 77. Maintaining Certification through AAPC Testing 10/01/12 09/30/13 Must pass proficiency to maintain AAPCcertification (AHIMA has similar program) Online, timed test 75 questions, open book May utilize any resources available $60 exam fee (take exam twice) 78. Training ConsiderationsTraining Considerationso WHO? Final Regulation states: coders 16 hours ICD-10-CM billing/compliance(diagnosis) physicians 24 hours ICD-10-PCS data users(procedures) o WHAT? 10 hours additional diagnosis codingpractice procedure coding Total training = o WHEN? 50 hours (Inpatient start now Coders) o HOW? 26 hours (Outpatient in-house programs Coders) AHIMA certified trainers 79. References and resources http://www.cms.hhs.gov/ICD10 http://www.ahima.org/ICD10/ www.contexomedia.com www.hcpro.com http://www.cdc.gov/nchs/icd/icd10cm.htm http://www.who.int/classifications/icd/en/ Final Rule (CMS-0013)http://edocket.access.gpo.gov/2009/pdf/E9-743.pdf 80. For More Information Contact:CSimmons2@Kforce.com 81. 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