ICD-10-CMAN INTRODUCTION

June Monthly In-serviceJune 1, 2011

9:00 a.m. & 2:00 p.m.

Venita Jones, RHIT, PresenterDeVry Community Hospital and Health Services

Presentation HighlightsIntroduction to the ICD-10 (10th Revision)HIPAA Rules and Designations in CodingReasons for Replacing the ICD-9-CMThe Benefits of Converting to the ICD-10-CMComparison between the ICD-9-CM and the

ICD-10-CMStructure and Format of the ICD-10-CM

Presentation Highlights cont.Users of the ICDImplementation ConsiderationsConclusionQ & A/ ResourcesWebsite references

Introduction to the ICD-10Statistically ThinkingHistory of the ICD

World Health Organization (WHO)Classification systems

Mortality Morbidity

Creation of the ICD-10Reason for changeEmerging technology

HIPAA Rules and DesignationsICD-9-CM incompatibility with HIPAACooperating Parties

American Hospital Association (AHA)American Health Information Management

Association (AHIMA)Centers for Medicare and Medicaid Services

(CMS)National Center for Health Statistics (NCHS)

Adoption and Implementation of the ICD-10-CM

Implementation Date: October 1, 2013 !!!!

Reason for Replacing ICD-9-CMOutdated in the 21st

centuryMortality recordingWhy upgrade

Tracking and Responding

Maintenance of clinical data

Lack specificityRunning out of

capacity

ObsoleteCurrent knowledge

Disease processes Contemporary

medical terminology Modern practice of

medicine Hampers ability to

compare costs and outcomes

Incompatibility Health data exchange

The Benefits of Converting to ICD-10-CM

•Quality measurement and medical error reduction (patient safety•Outcomes measurement•Clinical research•Clinical, financial, and administrative performance measurement•Health policy planning•Operational and strategic planning and health care delivery systems design•Payment systems design and claims processing•Reporting on use and effects of new medical terminology•Provider profiling•Refinements to current reimbursement systems, such as severity-adjusted DRG systems•Pay-for-performance programs•Public health and bioterrorism monitoring•Managing care and disease processes•Educating consumers on consumer costs and outcomes treatment options (Bowman 2008b)

Benefits continued

•Increased use of automated tools to facilitate the coding process•Decreased claims submission or claims adjudication costs•Fewer rejected and improper reimbursement claims•Greater interoperability•Decreased need for manual review of health records to meet the information of payers, researchers, and other data mining purposes•Decreased need for large research organizations to maintain dual classification systems (one for reimbursement and one for research•Reduced number of coding errors•Reduced labor costs and increased productivity•Increased ability to prevent and detect healthcare fraud and abuse (Bowman 2006b)•RAND Corporation Study• More accurate payment for new procedures• Fewer rejected claims• Fewer fraudulent claims• Better understanding of new procedures• Improved disease management (RAND Corporation 2004)

Types of Code ChangesGrouping of codesMore complete

descriptionsFifth and sixth

charactersLateralityIncreased specificityUse of seventh

character

Combination codesTerminology usedPostprocedural

conditionsTrimester specificityNew codes

Comparing ICD-9-CM & ICD-10-CMICD-10-CM differs from ICD-9-CM in its organization and structure, code composition, and level of detail.

ICD-9-CM ICD-10-CM Consists of three to five characters First digit is numeric or alpha (E or V) Second, third, fourth, and fifth digits are numeric Always at least three digits Decimal placed after the first three characters

Consists of three to seven characters First digit is alpha All letters are used except for U Second and third digits are numeric Fourth, fifth, sixth, and seventh digit can be alpha or

numeric Decimal placed after the first three characters

Code Structure of the ICD-10-CM versus ICD-9-CMICD-10-CM codes may consist of up to seven digits, with the seventh digit extensions representing visit encounter or sequelae for injuries and external causes.

ICD-9-CM Format ICD-10-CM FormatX X X . X X

First three digits represents the category Fourth and fifth digit represents etiology,

anatomic site, manifestation

X X X . X X X X First three digits represents the category Fourth, fifth, and sixth digit represents etiology,

anatomic site, severity Seventh digit represents the extension

Structure of the ICD-10-CMSimilar to the ICD-9-CMVolume 3 of the ICD-9-CM will be replaced to

ICD-10-PCS (Procedural Coding System)Three Volumes

Volume 1 – The Tabular ListVolume 2 – The Instructional ManualVolume 3 – The Alphabetical Index

ICD-10-CM cont.In the ICD-10 the information about diseases

and conditions and their causes are grouped as followed:Communicable diseasesGeneral diseases that affect the whole bodyLocal diseases arranged by siteDevelopmental diseasesInjuries External causes

Volume 1-The Tabular ListAlphanumeric listing

All alphabetic letters are used except for UV and E codes are incorporatedThree-digit character codes

Disease groups and health-related problemsContains inclusions and exclusion notes and

some coding rulesThere are 22 chapters in the Tabular list and

over 11400 four-character codes

ICD-10 Volume 2-The Instructional ManualContains an introduction to the classification

and instructions regarding how to use the classification to code death certificates, hospital medical records and other forms of health information.

Specifically contains:Guidelines for certifications and rules for

mortality coding (i.e. causes of death)Guidelines for recording and coding for

morbidity data (i.e. hospital statistics)

Volume 3-The Alphabetic IndexAlphabetic listing of diseases and conditionsMore entries in the index than in Tabular listAlso contains:

Guidance on selecting the appropriate codes for many conditions not displayed in the Tabular List

A Table of NeoplasmsAn Index of External Causes of DiseasesA Table of Drugs and Chemicals

Golden Coding Rule Number 1

Volumes 1 and 3 must be used together to correctly find codes for each case such as cause of death or diagnosis.

Rules to follow:

First, check the Index (Volume 3) for a code representing your diseases

Then, confirm your choice in the Tabular List (Volume 1)

Volumes 1 and 3 are Inseparable!

ICD-10 Volume 1 Chapters22 Chapters (19 Chapters in ICD-9)Most associated with particular body systemsSpecial disease chaptersChapter XX – External Causes of Morbidity

and MortalityChapter XXI – Factors Influencing Health

StatusChapter XVII – Coding Symptoms, Signs and

Abnormal Clinical and Laboratory Findings, Not elsewhere classified

Golden Coding Rule

Number 2

The special diseases categories take priority over the body systems categories.

Example: Neoplasm of the lung

Volume 1 Chapters FormatCHAPTER II_________________________________Neoplasms(C00-D48)

Malignant neoplasms of lip, oral cavity and pharynx(C00—C14) C00 Malignant neoplasm of lip

Excludes: skin of lip (C43.0, C44.0)

C00.0 External upper lipUpper lip:

• NOS• Lipstick area• Vermillion border

Chapter

Block Category

Code

Users of the ICDCertifiersCodersUsers of coded data

Last but not leastImplementation considerationsConclusion/Questions and AnswersSources

Basic ICD-9-CM Coding, Lou Ann Schraffenberger, MBA, RHIA, CCS, CCS-P, FAHIMA. (2010) pp. 355-385

ICD-10 Interactive Self Learning Tool (highly recommended. http://apps.who.int/classifications/apps/icd/icd10training/

AHIMA website – www.ahima.org