Post on 23-Feb-2016
description
Crossroads Conference
Susan H. Fenton, PhD, RHIAAsst. Dean for Academic Affairs
UT School of Biomedical Informatics @ Houston
ICD-10 Industry Update
Policy•The delay• ICD-11•SNOMED
Practical impacts•Clinical documentation•Coding productivity•Quality Measures
Agenda
• H.R. 4302• SEC. 212. DELAY IN TRANSITION FROM ICD–9 TO ICD–10
CODE SETS. The Secretary of Health and Human Services
may not, prior to October 1, 2015, adopt ICD–10 code sets as
the standard for code sets under section 1173(c) of the Social
Security Act (42 U.S.C. 1320d–2(c)) and section 162.1002 of
title 45, Code of Federal Regulations.
• $1 billion to $6.6 billion additional – CMS
The Delay
“On April 1, 2014, the Protecting Access to Medicare Act of 2014
(PAMA) (Pub. L. No. 113-93) was enacted, which said that the
Secretary may not adopt ICD-10 prior to October 1, 2015.
Accordingly, the U.S. Department of Health and Human Services
expects to release an interim final rule in the near future that will
include a new compliance date that would require the use of ICD-
10 beginning October 1, 2015. The rule will also require HIPAA
covered entities to continue to use ICD-9-CM through September
30, 2015.”
Latest Update
Part B News, 73% of providers plan to stick with their original ICD-
10 implementation plans, despite the delay, EHR Intelligence
reports (Bresnick, EHR Intelligence, 4/24).
How providers feel about the delay. Specifically:
• 34% of organizations ready but appreciate additional time;
• 31% of organizations disappointed with the delay;
• 20%+ of organizations frustrated because physicians now might want to
delay training; and
• 13.5% of organizations happy with the delay because they would not have
been ready otherwise (Marbury, Medical Economics, 4/23).
Provider Responses
Conducted in March 2014•2,600 participating organizations; 50% were clearinghouses
•127,000 claims submitted with ICD-10-CM/PCS codes
•89% of claims were accepted• Some claims included intentional errors to ensure the system would reject appropriately
Contact local MAC for acknowledgment testing detailsMore end-to-end testing in 2015
CMS ICD-10 Claims Submission Testing
Release delayed to 2017 – WHO
Derived from SNOMED
Compatible with EHRs
Participate @ http://www.who.int/classifications/icd/revision/icd11faq/en/
ICD-11
Focused on clinical information
Compatible with EHRs
311,000 active concepts
33% agreement on core concept choice•Andrews, J.E., Richesson, R.L., and Krischer, J. (2007) SNOMED CT Coding of Clinical Research Concepts, Journal of AMIA, 14(4), 497-506.
SNOMED
• Public health
• Quality patient care
• Research
• Reimbursement
So, why move at all?
• Laterality: No longer accept injuries to limbs or bilateral organ conditions without laterality.
• Paralytic syndromes require right/left and dominant/nondominant
• Infectious organisms. How can we help clinicians include these in their documented diagnoses?
Clinical Documentation Improvement
• A for Initial Encounter – active initial treatment
in ER, surgery or new clinician
• D for Subsequent – healing or recovery such
as cast change or aftercare
• S for Sequela – complications or conditions as
a direct result of the injury. Examples include
scars or frozen joint
Injuries
• Open, including Type vs. Closed
• Routine vs. Delayed healing
• Nonunion vs. Malunion
• Displaced vs. Nondisplaced
• Many types, transverse, comminuted, or spiral
to name just a few
Fractures
Track use of unspecified codes by clinician
•Appropriate or not?
Random coding of records in ICD-10-CM/PCS to
determine adequacy of documentation
•Feedback
•Evaluation criteria
Clinician-specific Efforts
• 54 records
• 6 coders
• ICD-9-CM Avg Coding Time – 25.51
• ICD-10-CM/PCS Avg Coding Time – 43.23
• Overall on average it took 17.72 minutes or
69% longer to code a record in
ICD-10-CM/PCS
Inpatient Coding Productivity
• ICD-9-CM Diagnostic = .68
• ICD-9-CM Procedural = .61
• ICD-10-CM = .49
• ICD-10-PCS = .42
Coding Quality or Inter-rater Reliability
• Spearman’s Correlation
•Correlation Coefficient = -.424
•P-value = .027
• As the time spent per record increases, the
coding quality decreases
Quality vs. Minutes/Record
• 382 inpatient records
• 65% decrease in productivity
• 12.5 minute decrease without procedures
• 20 minute decrease with procedures
• Non-OR procedures accounted for longest
Veterans Health Administration Inpatient Coding Productivity
• 1,024 ambulatory care records
• 6.7% decrease in productivity
• Longest time to code ER and Therapy
• Productivity recovered within 2 months
Veterans Health Administration Ambulatory Coding Productivity
• Comparability, aka bridge-coding, for longitudinal
data comparison
• Performed for ICD-9 to ICD-10 for Cause of Death
•http://www.cdc.gov/nchs/data/nvsr/nvsr49/nvsr49_02.pdf
• Must dual code same set of records
Comparability Factors or Ratios
• Frequencies run for ICD-9-CM and ICD-10-CM
diagnostic codes
• Used the 2013 General Equivalence Maps
• Used the July 2, 2013 National Hospital Inpatient
Quality Measures, Appendix A (ICD-9) and Appendix
P (ICD-10)
Calculating the Comparability Factors
Joint Commission Core Measure Comparison (ongoing analysis)
Missing ICD-9-CM Cases for AMI
I21.02 – STEMI involving diagonal coronary artery
I21.4 – Acute subendocardial MI
410.72 – Subendocardial infarction 6410.12 – AMI of other anterior wall 1
Extra ICD-9 Cases for Respiratory Failure
J96.01 – Acute hypoxemic respiratory failure
J96.02 – Acute hypercapnic respiratory failure
518.81 – Acute Respiratory
Failure 27 4
• Implementation now slated for 10/1/2015
• Review insurance and vendor contracts
• More time for system upgrades
• Continue documentation improvement
• Maybe consider Computer-assisted Coding
• Identify potential longitudinal data concerns
In the Final Analysis
Thank you to Texas Tech and the West Texas AHEC.
Questions
• Susan H. Fenton, PhD, RHIA, FAHIMA
• Assistant Dean, UT SBMI
• susan.h.fenton@uth.tmc.edu
Contact Information