ICD-10-CM 1 7 MONTHS TO GO
ICD-10-CM BASICS PRE-IMPLEMENTATION: PHASE I PLAN DEVELOPMENT WORKFLOW ASSESSMENT PREP EXERCISES PREP EXAMPLES PRE-IMPLEMENTATION: PHASE II CURRENT STATUS ISSUES TO RESOLVE RESOURCES 2
IMPLEMENTATION DATE 3 OCTOBER 1, 2012 OCTOBER 1,2013 OCTOBER 1, 2014 PER CMS NO MORE DELAYS
WHY IS ICD-10 SO CONTROVERSIAL? COMPLEXITY TECHNICAL ISSUES SHORT-TERM REVENUE IMPLICATIONS INDUSTRY CLIMATE DEPENDENCIES VARY FROM PRACTICE TO PRACTICE 4
IMPLEMENTATION GOAL 5 MOVE TO ICD-10-CM WITH AS SMOOTH A TRANSITION AS POSSIBLE MINIMIZE PRODUCTIVITY LOSS/PAYMENT DELAY ACCOMPLISH THE TRANSITION WITHOUT BLOODSHED
ICD-10-CM 6 BASICS
INCREASE DIAGNOSIS CODING OPTIONS FROM 14,000 CODES TO 68,000 CODES ALL CODES CHANGE: FROM PRIMARILY NUMERIC TO ALL ALPHA NUMERIC INCREASE FROM 5 TH DIGIT CAPACITY TO 7 TH DIGIT CAPACITY GREATER SPECIFICITY FOR SOME CODING CATEGORIES, FEWER COMBINATION CODES ARE REQUIRED FOR SOME CODING CATEGORIES, DEFINITIONS HAVE CHANGED 7
LATERALITY LOCATIONS STATUS TIMING GREATER SPECIFICITY 8
ALL CODES ARE ALPHA-NUMERIC DESCRIPTION: GENERALIZED ANXIETY DISORDER 9 ICD-9-CM: 300.02 ICD-10-CM: F41.1
CODES VALID FROM 3-7 DIGITS 10 I10 BENIGN ESSENTIAL HYPERTENSION E11.8 TYPE 2 DIABETES W/O COMPLICATIONS R62.51 FAILURE TO THRIVE (CHILD) M24.431 RECURRENT DISLOCATION, RIGHT ELBOW S70.211A T41.0X51 ABRASION, RIGHT HIP, INITIAL ENCOUNTER ADVERSE EFFECT OF INHALED ANESTHETICS, FIRST ENCOUNTER
ICD-10-CM PROPERTIES 11 S90. 032 A CATEGORY ETIOLOGY, ANATOMIC SITE, SEVERITY EXTENSION
ICD-10-CM: SPECIFICITY EXAMPLES # DESCRIPTION CODE 12 CONDITION CATEGORY SUBCATEGORIES: (ETIOLOGY, ANATOMIC SITE, SEVERITY) EXTENSION (FINAL CODE) 1 OPEN WOUND, ANKLE S90 (OPEN WOUND: ANKLE, FOOT, TOES) ANKLE S90.1 PUNCTURE WOUND W/O FOREIGN BODY S91.03 LEFT S91.032 SUBSEQUENT ENCOUNTER S91.032D
DEFINITION CHANGES 13 ICD-9-CM 250.00 + 362.03 V58.67 DIABETES W/O COMPLICATIONS, TYPE II NOT STATED AS UNCONTROLLED NONPROLIFERATIVE DIABETIC RETINOPATHY LONG TERM CURRENT INSULIN USE ICD-10- CM E11.321 E11.329 E11.331 E11.339 E11.341 E11.349 TYPE II DM W/MILD NONPROLIF DIAB RETINOPATHY W/ME TYPE II DM W/MILD NONPROLIF DIAB RETINOPATHY W/O ME TYPE II DM W/MOD NONPROLIF DIAB RETINOPATHY W/ME TYPE II DM W/MOD NONPROLIF DIAB RETINOPATHY W/O ME TYPE II DM W/SEVERE NONPROLIF DIAB RETINOPATHY W/ME TYPE II DM W/SEVERE NONPROLIF DIAB RETINOPATHY W/O ME USE ADD L CODE Z79.4 TO IDENTIFY ANY INSULIN USE Don t need additional code in ICD-10-CM to identify type of ophthalmologic manifestation May need more information about the manifestation in order to identify correct code
CODE EXTENSIONS ALPHA A = INITIAL ENCOUNTER D = SUBSEQUENT ENCOUNTER S = SEQUELA (LATE EFFECTS) 14 NUMERIC 1 = RIGHT 2 = LEFT 3 = BILATERAL 9 = UNSPECIFIED (AS TO RIGHT, LEFT, OR BILATERAL) EXAMPLE: S52.131A DISPLACED FRACTURE OF NECK OF RIGHT RADIUS, INITIAL ENCOUNTER FOR CLOSED FRACTURE EXAMPLE: H83.01 LABYRINTHITIS, RIGHT EAR
PLACEHOLDERS 15 CERTAIN ICD-10-CM CATEGORIES HAVE APPLICABLE 7 TH CHARACTERS. THE APPLICABLE CHARACTER IS REQUIRED FOR ALL CODE WITHIN THE CATEGORY. THE 7 TH CHARACTER MUST ALWAYS BE THE 7 TH CHARACTER IN THE DATA FIELD. IF A CODE THAT REQUIRES A 7 TH CHARACTER IS NOT 6 CHARACTERS, A PLACEHOLDER X MUST BE USED TO FILL THE EMPTY CHARACTERS: EXAMPLE: T37.5X1 POISONING BY ANTIVIRAL DRUGS, ACCIDENTAL
CHANGES PER SECTION (volume) 16 Description ICD-9-CM ICD-10-CM Infectious/Parasitic Disease 001-139 (25) AǾǾ-B99 (17) Neoplasms 140-239 (22) CǾǾ-D49 (29) Endocrine/Nutritional/ Metabolic/Immunity Blood/Blood Forming Organs Mental/Behavioral Disorders 240-279 (10) EǾǾ-E89 (15) 280-289 ((7) D5Ǿ-D89 (6) 290-319 (13) FǾǾ1-F99 (14) Nervous System 320-389 (35) GǾǾ-G99 (14) Eye/Adenexa HǾǾ-H59 (30) Ear/Mastoid Process H6Ǿ-H95 (9)
CHANGES PER SECTION (volume) 17 DESCRIPTION ICD-9-CM ICD-10-CM CIRCULATORY SYSTEM 390-459 (20) IǾǾ-I99 (32) RESPIRATORY SYSTEM 460-519 (9) JǾǾ-J99 (9) DIGESTIVE SYSTEM 520-579 (21) KǾǾ-K94 (16) GU SYSTEM 580-629 (16) NǾǾ-N99 (13) PREGNANCY/CHILDBIRTH/ PUERPERIUM SKIN/SUBCUTANEOUS SYSTEM MUSCULOSKELETAL SYSTEM 630-679 (12) OǾǾ-O9A (28) 680-709 (9) LǾǾ-L99 (16) 710-739 (15) MǾǾ-M99 (77)
CHANGES PER SECTION (VOLUME) 18 DESCRIPTION ICD-9-CM ICD-10-CM CONGENITAL MALFORMATION /DEFORMATION/CHROMOSOMAL ABNORMALITIES CONDITIONS ORIGINATING IN PERINATAL PERIOD SYMPTOMS/SIGNS/ABNORMAL CLINICAL/LAB FINDINGS 740-759 (15) QǾǾ-Q99 (14) 760-779 (7) PǾǾ-P96 (8) 780-799 (13) RǾǾ-R99 (13) INJURY/POISONING/ETC 800-999 (43) SǾǾ-T88 (185) EXTERNAL CAUSES OF MORBIDITY VǾ1-Y99 ((67) FACTORS INFLUENCING HEALTH STATUS EXTERNAL CAUSES OF INJURY/POISONING V01-V91 ((25) ZǾǾ-Z99 (21) E000-E999 (32)
EXTERNAL CAUSES OF MORBIDITY CONTACT WITH DOLPHIN BITTEN BY DOLPHIN STRUCK BY DOLPHIN OTHER CONTACT WITH A DOLPHIN 19 WHILE IN A HURRICANE TORNADO TIDAL WAVE FLOOD EXTENSION FIRST ENCOUNTER SUBSEQUENT ENCOUNTER SEQUELA
ICD-10-CM 20 PRE-IMPLEMENTATION PHASE I
PHASE I ACTION ITEMS 21 CONDUCT IMPACT ANALYSIS COMMUNICATE WITH VENDORS & CARRIERS/VALIDATE READINESS ASSIGN INTERNAL PROJECT TEAM, ACCOUNTABILITY AND AUTHORITY DEVELOP BUDGET DEVELOP INTERNAL TIME LINE CONDUCT WORKFLOW ANALYSIS/RE-DESIGN IF NECESSARY DEVELOP PLAN TO ASSESS DOCUMENTATION DEVELOP TRAINING PLAN June 2013
QUESTIONS TO CONSIDER 22 WHAT CODES DO WE USE MOST AND WHAT IS THE AVERAGE CROSSWALK RATIO? WHO ASSIGNS ACTUAL CODES NOW AND WHEN WE TRANSITION TO ICD-10? HOW LONG WILL IT TAKE TO ASSIGN CODES? WORKFLOW CHANGES NEEDED? DOES DOCUMENTATION SUPPORT THE SPECIFICITY REQUIREMENTS? HOW WILL WE MIGRATE THE PATIENT PROBLEM LISTS? WHAT POSITIONS REQUIRE THE GREATEST AMOUNT OF CODING SUPPORT?
WORKFLOW OPTION #1: PROVIDER ASSIGNS CODE 23 PROVIDER SEES PATIENT PROVIDER ASSIGNS CODE CLAIM FILED EHR LIBRARY CODE USING EHR PATIENT PROBLEM LIST OTHER CODING REFERENCE TOOLS
WORKFLOW OPTION#2: STAFF ASSIGNS CODES BASED ON DOCUMENTATION 24 PROVIDER SEES PATIENT PROVIDER COMPLETES DOCUMENTATION STAFF ASSIGN CODE BASED ON DOCUMENTATION EHR REFERENCE LIBRARY CODE USING PATIENT PROBLEM LIST OTHER CODING REFERENCE TOOLS
EXAMPLE: PREPARATION EXERCISES 25 Run a report to determine the most frequently reported ICD-9-CM codes reported by your practice; crosswalk these to ICD-10-CM Conduct a random audit looking at current documentation to determine if it will support the specificity requirements of ICD-10-CM Evaluate by observation how many encounters are usually coded per hour by coders. Then give the coder the same number of encounters and code to ICD-10-CM. Measure the difference to estimate training value and potential internal production loss (This exercise should be repeated consistently as the organization moves closer to implementation)
ICD-10-CM 26 PRE-IMPLEMENTATION PHASE II
WHAT S HAPPENING NOW 27 VENDORS: CARRIERS: MEDICARE TEST WEEK 3/3-3/7 PHYSICIAN PRACTICE: PHYSICIANS: CODERS:
MAJOR IDENTIFIED ISSUES DOCUMENTATION INSUFFICIENCY UNSPECIFIED CODES PATIENT PROBLEMS LIST 28
WORKFLOW OPTION: PROBLEM LIST MIGRATION 29 EXISTING PROBLEM LIST CONVERSION TO ICD-10-CM USING STAFF MANUAL REVIEW EHR GENERATED PHYSICIAN MANUAL REVIEW
TASKS LEFT TO ACCOMPLISH ADDRESS TESTING RESULTS TRAINING CUSTOMIZED SUPPORT TOOLS 30
ICD-10-CM 31 RESOURCES
ICD-10 RESOURCES: BOOKS ICD-10-CM Draft Code Set 32 ICD-10-CM Mappings Preparing for ICD-10-CM by Deborah Grider Comprehensive Anatomy & Physiology for ICD-10-CM Coding (OptumInsight) Detailed Instruction for Appropriate ICD-10-CM Coding (OptumInsight) ICD-10: A Comprehensive Guide by Carline Dalgleish (available for Kindle)
ICD-10 RESOURCES: BOOKS 33 Understanding ICD-10-CM & ICD-10-PCS: A Worktext by Mary Jo Bowie & Regina Schaffer (available for Kindle) Coding from the Operative Report for ICD-10 (OptumInsight) ICD-10-CM Coding Workbook for Cardiology (OptumInsight) ICD-10-CM Coding Workbook for Orthopaedics (OptumInsight) ICD-10-CM Coding Workbook for OB/GYN (OptumInsight) ICD-10-CM Documentation: How to Guide Coders, Physicians & Healthcare Facilities (AMA)
ICD-10 RESOURCES: ARTICLES Planning Organization Transition to ICD-10-CM/PCS 34 http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_ 044964.hcsp?dDocName=bok1_044964 Transitioning ICD-10-CM/PCS Data Management Processes http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_ 044963.hcsp?dDocName=bok1_044963 Step-by-Step Strategic Planning for ICD-10 by PrimeWest Health http://www.primewest.org/providers/5010_icd10/countdown/stepbyst epplanning.aspx
ICD-10 RESOURCES: ON-LINE CMS: www.cms.hhs.gov/icd10 35 GEMS Fact Sheet: www.cms.gov/mlnproducts/downloads/icd-10_gem_factsheet.pdf AAPC: http://www.aapc/com/icd-10/ AHIMA: http://www.ahima.org/icd10/ MGMA: http://www.mgma.com AMA: http://www.ama-assn.org/ama/home/index.shtml Codapedia Codapedia.com
ICD-10 RESOURCES: ON-LINE 36 WHO: http://www.who.int/classifications/icd/en/ AHA: http://www.ahacentraloffice.com/ahacentraloffice_app/icd-10/icd-10.jsp CDC: http://www.cdc.gov/nchs/icd.htm Rand Report: http://www.rand.org/pubs/technical_reports/2004/rand_tr132.pdf Nolan Report: http://www.renolan.com/healthcare/icd10study_1003.pdf Nachimson Report: http://www.nachimsonadvisors.com/documents/icd- 10%20Impacts%20on%20Providers.pdf
ICD-10 RESOURCES: SOFTWARE Complete Practice Resources ICD-10 Transition Software http://www.cpticdpros.com/gems/index.html 37
ICD-10-CM 38 QUESTIONS?
HealthCare Management Consultants Providing consulting services and support to the medical community since 1992 Carol Wintermute, ACS-EM 7070 SW 169 th Ave Beaverton OR 97007 Phone: 503-591-7264 Fax: 503-591-7264 Email: wintermutemc@comcast.net 39