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On April 2, 2014, the US Senate voted in favor of H.R. 4302, known as Protecting Access to Medicare Act of 2014, soon signed by President Barack Obama. This bill is primarily meant to forestall cuts in Medicare payment rates for physicians, and also contained provisions that called for delaying ICD-10 implementation until 2015 at the earliest. This panel discussion will thresh out the advantages and disadvantages of the delay, and provide insights on how the Healthcare Information Management (HIM) sector in the Philippines should position itself in the midst of the extended implementation. To learn more about the current state of the HIM sector in the Philippines, visit http://www.teeledevelopment.com.ph.
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ICD-10 DELAY:ICD-10 DELAY:Relief or Grief?Relief or Grief?
PETER EDU MD, CPC, CPC-I, CCSHealthcare Sr. Training ManagerTeleDevelopment Services, Inc.
1. Background
2. What’s new with ICD-10?
3. Impact of ICD-10-CM implementation on
different sectors
4. Causes for ICD-10-CM implementation delay
ICD-10 DELAY: Relief or Grief?
OUTLINE
ICD-10 DELAY: Relief or Grief?
5. Updates on ICD-10-CM implementation
6. Effects of ICD-10-implementation delay
7. Conclusions and next steps
OUTLINE
BACKGROUNDWhat is ICD-10?•Classification system for diseases and health problems, created and published by the WHO•Basis for the compilation of national mortality and morbidity statistics by WHO member states•Also used for reimbursement and resource allocation by some countries
ICD-10 DELAY: Relief or Grief?
BACKGROUNDInternational versions•Different countries have their own clinical modifications for their specific purposes•Australia, Canada, France, Germany, Korea, Netherlands, South Africa, Sweden, Thailand, United States, UAE, etc•Philippine modification created in 2008
ICD-10 DELAY: Relief or Grief?
BACKGROUND
Historical aspects
•WHO members first used ICD-10 in 1994
•New version (ICD-11) is already being
developed, with target completion in 2017
ICD-10 DELAY: Relief or Grief?
BACKGROUND
American version
•Used by the Philippine BPO industry
•ICD-9-CM (current), composed of 3 volumes
•Volumes 1 and 2 = diagnosis codes
•Volume 3 = hospital procedure codesICD-10 DELAY: Relief or Grief?
BACKGROUND
American version
•ICD-10-CM and ICD-10-PCS (new, upcoming)
•ICD-10-CM = diagnosis codes
•ICD-10-PCS = hospital procedure codes
ICD-10 DELAY: Relief or Grief?
BACKGROUND
American version: History
•1978: ICD-9 published by WHO, adopted by US as ICD-9-CM same year
•1990: WHO published ICD-10
•1994: US began development of ICD-10-CM
•1998: ICD-10-CM first version releaseICD-10 DELAY: Relief or Grief?
BACKGROUNDICD-9-CM ChaptersChapter 1 Infectious and Parasitic Diseases
Chapter 2 Neoplasms
Chapter 3 Endocrine, Nutritional and Metabolic Diseases, and Immunity Disorders
Chapter 4 Diseases of Blood and Blood-Forming Organs
Chapter 5 Mental, Behavioral and Neurodevelopmental Disorders
Chapter 6 Diseases of Nervous System and Sense Organs
Chapter 7 Diseases of Circulatory System
Chapter 8 Diseases of Respiratory System
ICD-10 DELAY: Relief or Grief?
Chapter 9 Diseases of Digestive System
Chapter 10 Diseases of GenitourinarySystem
Chapter 11 Complications of Pregnancy, Childbirth, and the Puerperium
Chapter 12 Diseases of Skin and Subcutaneous Tissue
Chapter 13 Diseases of MusculoskeletalSystem and Connective Tissue
Ch 14,15 Congenital Anomalies; Certain Conditions Originating in Perinatal Period
Chapter 16 Symptoms, Signs, and Ill-Defined Conditions
Chapter 17 Injury and Poisoning and E Codes
BACKGROUND
ICD-10 DELAY: Relief or Grief?
BACKGROUND
Rationale for ICD-10-CM implementation
•Compatibility with global classification standards (WHO ICD-10)
•Obsolete basis of classification in ICD-9-CM
•Lack of space for new diseases / pathophysiologic mechanisms in ICD-9-CM
ICD-10 DELAY: Relief or Grief?
WHAT’S NEW WITH ICD-10?ICD-9-CM ICD-10-CM
Structure(max # of digits) 5 7
Structure(characters used) Numbers only Alphanumeric
Specificity ↓ ↑
Number of codes ↓ ↑
ICD-10 DELAY: Relief or Grief?
WHAT’S NEW WITH ICD-10?
ICD-9-CM vs ICD-10-CM comparison
•More relevant ambulatory care and encounter codes
•More specific injury coding
•More combination codes (eg, disease + symptom description in one code)
ICD-10 DELAY: Relief or Grief?
IMPACT OF ICD-10-CM
On healthcare providers
•More conscientious documentation
•Retraining/reorientation of staff
•Investment on software upgrades/updates
•Migration to digital records (EMR)
ICD-10 DELAY: Relief or Grief?
IMPACT OF ICD-10-CM
On insurance companies
•Update of entire CMS
•Retraining/reorientation of staff
•Greater need for auditing claims from providers
•Obamacare is a confounding factor!
ICD-10 DELAY: Relief or Grief?
IMPACT OF ICD-10-CM
On HIM service providers
•Retrain certified coders and ensure compliance to new standards
•Updating of software and/or hardware
•Supply of knowledgeable manpower to cover for learning curve of existing coders’ retraining
ICD-10 DELAY: Relief or Grief?
CAUSES OF I-10 IMPLEMENTATION DELAY
• 12-year gap between I9 and I10 release (WHO)
• Rapid growth of health records and HIM technology
• Economic factors
• Logistical nightmare for everyoneICD-10 DELAY: Relief or Grief?
UPDATES ON I-10 IMPLEMENTATION
• Centers for Medicare and Medicaid Services (CMS) initially announced an October 2014 date, but this was delayed
• Latest FINAL implementation date has been set to October 1, 2015
ICD-10 DELAY: Relief or Grief?
RESULTS OF I-10 DELAY
On healthcare providers
•More time for staff to learn new system
•Preserve status quo for doctors
•Those that already invested will wait another year to implement new system
•Readiness to adapt to I10 by 10/1/15ICD-10 DELAY: Relief or Grief?
RESULTS OF I-10 DELAYOn payers•More time to learn new system and grow I10 compliant staff•Those that already invested will wait another year to implement new system•Readiness for dual coding and new rules by 10/1/15
ICD-10 DELAY: Relief or Grief?
RESULTS OF I-10 DELAYOn HIM service providers•More time to learn new system and grow I10 compliant staff•Those that already invested will wait another year to implement new system•Readiness for dual coding and new rules by 10/1/15•Can better service clients come 10/1/15
ICD-10 DELAY: Relief or Grief?
CONCLUSIONSRelief or grief?
ICD-10 DELAY: Relief or Grief?
RELIEF GRIEF
• More time to hire and train staff• More time to setup, test and
implement new system• HIM service providers can better
serve clients for dual coding and ICD-10-CM requirements in 2015
• Wasted (?) early investment on ICD-10-CM compliant systems
• Early training of staff may require refreshers prior to implementation date
NEXT STEPSBuilding a knowledgeable workforce from local healthcare pool•50-60,000 new RNs every year•Availability of US-licensed medical coding instructors locally•New AAPC inpatient coding credential in Oct 2014•Very good outcome of local coder training programs•High cost of acquiring existing coders in the market
ICD-10 DELAY: Relief or Grief?
NEXT STEPS
Achieving ICD-10-CM compliance among currently
certified coders
•Online AAPC and AHIMA exams available for I10
compliance demonstration
•ICD-10-CM and PCS training available from licensed
coding instructors
ICD-10 DELAY: Relief or Grief?
ICD-10 DELAY: Relief or Grief?
