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Kyle Miller, Todd Couts CMS ICD-10 PMO February, 2011

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Presentation on theme: "Kyle Miller, Todd Couts CMS ICD-10 PMO February, 2011"— Presentation transcript:

1 Kyle Miller, Todd Couts CMS ICD-10 PMO February, 2011
Introduction to ICD-10 Kyle Miller, Todd Couts CMS ICD-10 PMO February, 2011

2 Agenda Overview of ICD-10 CMS’ ICD-10 Program and Activities to Date Impact on ESRD at CMS Additional Resources

3 The ICD-10 Regulation Adopts ICD-10 code sets under HIPAA Diagnosis
ICD-10 Clinical Modification (CM) ICD-10 Procedure Coding System (PCS) Diagnosis ICD-10 CM replaces ICD-9 CM diagnosis codes in all settings Procedures ICD-10 PCS replaces ICD-9 CM procedure codes for hospital inpatient procedures HCPCS and CPT-4 codes remain the official procedural coding systems for outpatient reporting Applies to all HIPAA Covered Entities and electronic interactions between those entities

4 Diagnosis and Procedure Codes
All Settings Inpatient Single implementation date of October 1, 2013 for all users Date of service for ambulatory and physician reporting Ambulatory services provided on or after will use ICD-10-CM diagnosis codes Date of discharge for inpatient settings Inpatient discharges occurring on or after will use ICD-10-CM and ICD-10-PCS codes No delays No grace period ICD-9 Volumes 1 and 2 Diagnosis Codes ICD-9 Volume 3 Procedure codes ICD-10 Clinical Modification (CM) – DIAGNOSIS CODES ICD-10 Procedure Coding System (PCS) – INPATIENT PROCEDURE CODES

5 Why ICD-10 Now? ICD-9-CM code set is outdated
30 years old ICD-9-CM codes cannot reflect current medical technologies Many code chapters are full, resulting in code placement in non-related chapters Current codes are often not descriptive enough The rest of the world is already on ICD-10 ICD-10-CM and ICD-10-PCS provides these improvements More codes, greater specificity Greater flexibility to add new codes Reflects current use of medical technology

6 ICD-10 Advantages for Physicians
Ability to report (inpatient) procedures exactly as performed (OP still CPT) Ability to describe complex and atypical patients Less staff time (less expensive) claims coding due to decreased ambiguity and better organization Better ability of payer to match payment to work involved

7 ICD-10 is Different than Other HIPAA Implementations
Original HIPAA Implementation Code set standards were already de facto standards – ICD-9, CPT, HCPCS Significant front-end translation to insulate systems from changes Heavy IT focus ICD-10 Implementation Much more expansive than maintenance updates to ICD-9 codes First mandated industry wide implementation of a new medical code set Reach extends into policies, business processes, and systems Requires broad business and systems focus

8 ICD-10 is No Worse Than Other HIPAA Implementations for Most Providers
Software must be updated and Staff must be trained but Physicians only use a small section of codes regularly and Diagnoses and procedures are all the same, just with clearer distinctions

9 Changes in ICD-10 Structural Changes Clinical Content Differences
Expanded field lengths (diagnosis and procedure codes) Different field formats (procedure codes) Clinical Content Differences New taxonomy for documenting Diseases, injuries, impairments, cause of injury (diagnosis codes) Specific procedures done to a patient (procedure codes) ICD-10 provides greater detail in describing diagnoses and procedures There are many more ICD-10 codes than ICD-9-CM codes

10 Diagnosis Code Changes

11 Diagnosis Code Example
ICD-10 Codes Provide Greater Specificity in Some Cases ICD-9 code - Striking against or struck accidentally in sports without subsequent fall (E917.0) 24 ICD-10-CM Detail Codes

12 Nephrology Diagnosis Codes: Consistent Organization
(N00-N08) Glomerular diseases (N00) Acute nephritic syndrome (N01) Rapidly progressive nephritic syndrome (N02) Recurrent and persistent hematuria (N03) Chronic nephritic syndrome (N04) Nephrotic syndrome Lipoid nephrosis (N05) Unspecified nephritic syndrome (N06) Isolated proteinuria with specified morphological lesion (N07) Hereditary nephropathy, not elsewhere classified (N08) Glomerular disorders in diseases classified elsewhere Suffixes: .0 Minor glomerular abnormality .1 Focal and segmental glomerular lesions .2 Diffuse membranous glomerulonephritis .3 Diffuse mesangial proliferative glomerulonephritis .4 Diffuse endocapillary proliferative glomerulonephritis .5 Diffuse mesangiocapillary glomerulonephritis .6 Dense deposit disease .7 Diffuse crescentic glomerulonephritis .8 Other .9 Unspecified

13 Procedure Code Changes

14 Procedure Code Example - 2 ICD-9-CM Codes Replaced by 112 ICD-10-PCS Codes

15 Nephrology Procedure Codes: Better Organization
Example: Percutaneous Pyelostomy Current Ambiguity 55.03 Percutaneous Nephrostomy OR 55.12 (Unspecified) Pyelostomy 1 2 4 3 New 0T9330Z 5 6 Better ability of payer to match payment to work involved

16 ICD-10 and 5010 5010 is short for Version 5010 of the ACS (Accredited Standards Committee) X12 standards for electronic transactions (e.g. claim submission) 5010 is a prerequisite for ICD-10 as 4010/4010A1 transactions cannot carry ICD-10 codes 5010 also enhances diagnosis reporting Separates principal diagnosis, admitting diagnosis, external cause of injury and reason for visit Increases number of ICD occurrences on 837 transactions (electronic claims)

17 Tools and Implementation Strategies
Tools/Files General Equivalence Mappings (GEMs) Reference mappings to help navigate between code sets. Bi-directional translation dictionaries (9 > 10 and 10 > 9) All codes in one set that could be used to replace a code in the other Reimbursement Mapping (9 > 10 and 10 > 9) To provide non CMS payers a temporary mechanism for mapping records containing ICD-10 codes to “reimbursement equivalent” ICD-9 codes One code that most closely replaces the resources/costs of the other Implementation Strategies Upgrade Update the impacted systems to accept, use, and send ICD-10 codes natively Crosswalk Shield the impacted systems from accepting, using, or sending ICD-10 codes natively

18 Fundamental Payer ICD-10 Strategy Choices

19 Fundamental Provider ICD-10 Strategy Choices
Upgrade Crosswalk Physician Codes in ICD-10 Physician Codes in ICD-9 ICD-10 Diagnosis Codes ICD-10 Procedure ICD-10 Diagnosis Codes ICD-10 Procedure Staff Translates ICD-9 to 10 ICD-10 Diagnosis Codes ICD-10 Procedure Office Submits in ICD-10 Office Submits in ICD-10 ICD-10 Diagnosis Codes ICD-10 Procedure ICD-10 Diagnosis Codes ICD-10 Procedure Use GEMS to find new versions of your most commonly used codes. Adds extra work, increases errors and loses the benefits of ICD-10. All claims MUST be submitted in ICD-10 For DOS after October 1, 2013

20 CMS ICD-10 Program and Activities to Date

21 ICD-10 Program History and Current State

22 ICD-10 Program Organization
ICD-10 Implementation Projects

23 Project Structure

24 High Level Implementation Timeline

25 Key CMS Activities Created GEMS and Reimbursement Mapping Tools
MS-DRG Update and Associated White Paper October 2009 FFS JAD Session Analysis CR Detailed planning conference calls with MACs/Fis/Carriers and Shared System Maintainers Educational materials and calls

26 Impact on ESRD at CMS

27 Milestones for ESRD QE-0: Preliminary Analysis
QE-1: Policy Decision on How Facilities Will Report Assessment Data for Patients Whose Stay Spans the ICD-10 Implementation Date QE-2: Mapping/Crosswalk Implementation Strategy Approach Defined QE-3: End-to-End Testing Strategies Defined QE-4: CMS Staff and Quality Contractors Educated and Trained QE-5.1: Form 2728 Updated QE-5.2: VISION Updated QE-5.3: REMIS Updated QE-6.1: ESRD Activities End-to-End Testing Level 1 QE-6.2: ESRD Activities End-to-End Testing Level 2 QE-7: Transition and Implement ESRD Activities Systems QE-8: Providers, Contractor Provider Contact Centers, and QIOs Educated on the Increased Granularity and Use of ICD-10 Code Set QE-9: Education and Outreach Provided to External Vendors on ICD-9 to ICD- 10 Translations QE-10: CROWNWeb Updated

28 Additional Resources

29 CMS Resources ICD-10 General Information
MS-DRG Conversion Report Central Version 5010 and D.0 web page on the CMS website The CMS ICD-10 website provides the latest ICD-10 information and links to resources for providers to prepare for ICD-10 implementation in a 5010 environment. CMS Sponsored Calls web page provides current information on CMS national provider conference calls focused on the implementation of ICD-10 You will find copies of call materials (presentations, written and audio transcripts, etc.). 

30 Additional Resources The following organizations offer providers and others ICD-10 resources WEDI (Workgroup for Electronic Data Interchange) HIMSS (Health Information and Management Systems Society)

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