Icd 10
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ICD-10 Wednesday, December 18, 2013 INSIGHTS Disclaimer: Nothing that we are sharing is intended as legally binding or prescriptive advice. This presentation is a synthesis of publically available information and best practices.
Transcript of Icd 10
ICD-10 Wednesday, December 18, 2013
INSIGHTS
Disclaimer: Nothing that we are sharing is intended as legally binding or prescriptive advice. This presentation is a synthesis of publically available information and best practices.
Agenda
• Introductions • ICD-10 • IMO • What’s next? • Q&A
Quick Overview
• October 1, 2014 hard cut-off • Affects all entities covered by HIPAA • 14,000 ICD-9 codes grow to 68,000 ICD-10 codes • No impact on CPT codes • Version 5010 standards • Significant changes to clinical and revenue cycle
systems • Complex conversion to updated codes • System upgrades to expand data fields for longer codes • Staff retraining on new versions and codes
ICD-10 Historical Retrospective
ICD-10 Regulatory Mandates
Federal Mandate Department of Health and Human Services Final Rule CMS-0013-F Published January 2009
HIPAA 5010
Transaction formats for payors and providers
January 1, 2012
ICD-10
Diagnosis and procedure codes for clinical transactions
October 1, 2014
What are ICD-10 Codes?
• Granular code set developed by WHO for: – Increased clinical accuracy – Improved disease tracking – Disease trending
• More ICD-10 codes compared to ICD-9
ICD-9 14,000 diagnosis codes 4,000 procedure codes 5 digit numeric codes
ICD-10 68,000 diagnosis codes 87,000 procedure codes
7 digit alphanumeric codes
Anatomy of ICD-10 Diagnosis Codes
• 3–7 digits • Digit 1 is alpha, including O and I but no U • Digit 2 is numeric • Digits 3–7 are alpha (not case sensitive) or numeric • Decimal is after third digit • Examples:
– A78 – Q fever – A69.21 – Meningitis due to Lyme disease; and – S52.131a – Displaced fracture of neck of right radius, initial
encounter for closed fracture
Anatomy of ICD-10-CM
Anatomy of ICD-10 Procedure Codes
• 7 digits • Alpha (not case sensitive) or numeric digits
– O and I not used to avoid confusion with 0 and 1 • No decimal • Examples:
– 0FB03ZX – Excision of liver percutaneous approach, diagnostic; and
– 0DQ10ZZ – Repair upper esophagus, open approach
Anatomy of ICD-10-PCS
• “Procedure” – Complete specification of 7 characters
PCS Section
• Medical and surgical
Body System
• Heart and great vessels
Root Operation
• Dilation
Body Part
• Coronary artery, one site
Approach
• Percutaneous
Device
• Intraluminal device
Qualifier
• Bifurcation
Most Impacted Specialties • Easy transition
– Hematology – Oncology
• Hard – Musculoskeletal – Injury – Poisoning
• Most challenging – Obstetrics – Psychiatry – Emergency medicine (poisoning)
• 42% of infectious disease code mappings convoluted, which will impact most specialties
What is SNOMED?
• Acronym for Systematized Nomenclature of Medicine – Clinical Terminology
• International standard for comprehensive clinical terminology
• Available at no cost through the National Library of Medicine
• Enables providers and EHRs to communicate in common language – Increased quality of patient care across specialties – Improved accuracy of patient data analysis
What is SNOMED? Continued
• Structured into 19 “hierarchies” which define the clinical concept
• Broken down into increasing granularity • Very specific clinical concepts to define patient
condition • More complex than ICD-10 hierarchy
Why is it important?
• MU2 criteria expands upon MU1 requirements to improve and utilize HIT and EHRs – Provide consistent, collaborative care – Interoperability between EHRs and need for
understanding each other • Use of common language • Problem list
The ICD-10-SNOMED Relationship • SNOMED CT has better clinical coverage than ICD • Number of codes:
– SNOMED CT (Clinical finding): 100,000 – ICD-9-CM: 14,000 – ICD-10-CM: 68,000
• ICD focus is statistical – Less common diseases subsumed under general categories – After-the-fact codes
• SNOMED CT is clinically-oriented – Used during care – Clinical relevance and user-friendliness
• Clinically coded data generates ICD-10 code for billing
Optimal Project Plan
• Developing a plan for 2014 is imperative
Effective Implementation Strategy
Impact Analysis •Identify current systems and work processes that use ICD-9 codes •Talk with payers about effect of ICD-10 implementation on provider contracts
Needs Assessment •Workflow and business process changes •Staff training •Practice management vendor accommodations
Project Plan •Implementation plan with clearing houses, billing services, and payers •Inventory systems and workflows •Contingency plan for failed go-live
Budget •Time and costs related to implementation •Training •IT/IS upgrade •Assistance from outside vendor/consultant •Potential productivity loss
Conversion •Transaction testing using ICD-10 codes •Historic data conversion •Review coded data for claims reimbursement consistent with ICD-9 rates
Project Considerations
External testing
Internal testing
Provider training
Document customization
Template customization
Core team training
Training • AHIMA recommendation: begin no more than six months
before compliance deadline • Approximately 16 hours for ambulatory coders and 50
hours for hospital coders – Physician practice coders need to learn ICD-10 diagnosis coding
only – Hospital coders need to learn both ICD-10 diagnosis and ICD-10
inpatient procedure coding • Specialty-specific ICD-10 training • ICD-10 coding training integrated into credential
maintaining CEUs • ICD-10 resources and training materials available through
CMS, professional associations and societies
Resources • http://www.navicure.com/icd10analyzer • http://www.nextgen.com/pdf/ICD-10_Expanded_Timeline.pdf • http://www.himss.org/library/icd-10/playbook • http://www.aapc.com/ICD-10/training.aspx • http://www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/ICD10 • http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-
your-practice/coding-billing-insurance/hipaahealth-insurance-portability-accountability-act/transaction-code-set-standards/icd10-code-set.page
• http://www.cdc.gov/nchs/icd/icd10.htm • http://www.ahima.org/icd10/ • http://apps.who.int/classifications/apps/icd/ICD10Training/ • http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-
Topics/Data-and-Systems/ICD-Coding/ICD-10-Final-Regulation-and-Training.html
Poll
• Do you use IMO? – Yes – No
What’s Next?
January 8, 2014 –
Meaningful Use 1
January 15, 2014 –
Meaningful Use 2
January 22, 2014 – Patient-
Centered Medical Home
(PCMH)
January 29, 2014 –
Accountable Care
Organizations (ACOs)
